Thursday, 12 Dec 2019

Written Answers Nos. 249-269

Hospital Waiting Lists

Ceisteanna (249)

Michael Fitzmaurice

Ceist:

249. Deputy Michael Fitzmaurice asked the Minister for Health when resources will be made available for surgery for a person (details supplied); and if he will make a statement on the matter. [52358/19]

Freagraí scríofa

Minister for Health

Under the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.

The National Waiting List Management Policy, a standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, since January 2014, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the HSE, sets out the processes that hospitals are to implement to manage waiting lists.

In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.

Medical Aids and Appliances Provision

Ceisteanna (250)

Aengus Ó Snodaigh

Ceist:

250. Deputy Aengus Ó Snodaigh asked the Minister for Health if a person (details supplied) will be issued with a wheelchair that is appropriate to the person's needs. [52361/19]

Freagraí scríofa

Minister for Health

As this is a service matter it has been referred to the HSE for direct reply to the Deputy.

Services for People with Disabilities

Ceisteanna (251, 252)

Aengus Ó Snodaigh

Ceist:

251. Deputy Aengus Ó Snodaigh asked the Minister for Health if a person (details supplied) will be assigned a social worker as a matter of urgency. [52362/19]

Aengus Ó Snodaigh

Ceist:

252. Deputy Aengus Ó Snodaigh asked the Minister for Health the supports available for a person (details supplied). [52363/19]

Freagraí scríofa

Minister of State at the Department of Health

I propose to take Questions Nos. 251 and 252 together.

The Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.

As the Deputy's questions relate to service matters, I have arranged for the questions to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.

Services for People with Disabilities

Ceisteanna (253)

Niall Collins

Ceist:

253. Deputy Niall Collins asked the Minister for Health if a psychiatric nurse can work with persons with disabilities; and if he will make a statement on the matter. [52373/19]

Freagraí scríofa

Minister of State at the Department of Health

As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Assisted Decision Making

Ceisteanna (254)

Michael Fitzmaurice

Ceist:

254. Deputy Michael Fitzmaurice asked the Minister for Health the status of the consultation process on the recommendations of the multidisciplinary working group submitted to the director of the decision support services on 21 December 2018; the timeline for the completion of the consultation process and the publication of the final code of practice as prescribed by Part 8 of the Assisted Decision-Making (Capacity) Act 2015; and if he will make a statement on the matter. [52379/19]

Freagraí scríofa

Minister for Health

Part 8 of the Assisted Decision-Making (Capacity) Act 2015 provides a legislative framework for advance healthcare directives (AHDs). An AHD is a statement made by a person with capacity setting out his or her will and preferences regarding treatment decisions that may arise in the future when he or she no longer has capacity. On 17 October 2016 the Minister for Health established a multidisciplinary working group to prepare a detailed series of recommendations for the Director of the Decision Support Service (DSS), in relation to the code of practice under section 91(2) of the Act. In anticipation of the completion of that process, the Minister for Health commenced the remainder of section 91 on 17 December 2018 [S.I. No. 527 of 2018]. This enabled the Director of the DSS to progress the preparation of the code of practice on the AHD provisions, based on the working group’s recommendations, and in accordance with the specific process outlined in the Act. The multidisciplinary working group submitted its recommendations on the code of practice to the Director of the DSS on 21 December 2018.

The Director of the DSS will go out to consultation on the recommendations and once completed the final code of practice can be published by the Director with the Minister's consent. It is not possible to give a timeline for implementation of Part 8 of the Act at this time but work is ongoing to address the various requirement of this Part before commencement.

Hospitals Data

Ceisteanna (255)

Stephen Donnelly

Ceist:

255. Deputy Stephen Donnelly asked the Minister for Health the type of procedures that were cancelled or postponed in regard to the recent cancellations of elective procedures at the children’s hospitals; and if he will make a statement on the matter. [52381/19]

Freagraí scríofa

Minister for Health

Maintaining scheduled care access for all patients is a key priority for hospitals. I fully acknowledge the distress and inconvenience for patients and their families when elective procedures are cancelled, particularly for clinically urgent procedures.

While every effort is made to avoid cancellation or postponement of planned procedures, the HSE advise that planned procedures and operations can be postponed or cancelled for a variety of reasons including capacity issues due to increased scheduled and unscheduled care demand, medical reasons, and patient choice.

In relation to the specific question raised by the Deputy, as this is a service matter, I have asked the HSE to reply to the Deputy directly.

Cancer Services Provision

Ceisteanna (256)

Stephen Donnelly

Ceist:

256. Deputy Stephen Donnelly asked the Minister for Health if chemotherapy sessions for children are being delayed; if so, the details of the delays; the causes of same; the number of children affected; the length of delay; and if he will make a statement on the matter. [52382/19]

Freagraí scríofa

Minister for Health

Children's Health Ireland (CHI) at Crumlin is the national referral centre for children & teenagers requiring Haematological/Oncological and HSCT (bone marrow /stem cell) treatments and care.

The capacity to admit patients is governed by the number of patients at any one time, and the availability of beds needed to treat these patients. On occasion it is necessary to defer a patient’s admission.

CHI at Crumlin is very aware of the impact on patients and their families that a change in admission for chemotherapy has, and takes every care to avoid a patient’s deferral. When such a decision is made, the priority at all times is to ensure a safe environment, and safe delivery of care to all patients.

Every effort to stay in direct contact with families whose child’s admission has been postponed and to reschedule as soon as possible.

Cancer Services Provision

Ceisteanna (257)

Stephen Donnelly

Ceist:

257. Deputy Stephen Donnelly asked the Minister for Health the number of acute beds for paediatric oncology; the number that will be available when the national children’s hospital is open; and if he will make a statement on the matter. [52383/19]

Freagraí scríofa

Minister for Health

As this is a service matter, I have asked the Children's Health Ireland to respond to you directly, as soon as possible.

Commencement of Legislation

Ceisteanna (258)

Dara Calleary

Ceist:

258. Deputy Dara Calleary asked the Minister for Health the reason the minimum unit pricing provisions of the Public Health (Alcohol) Act 2018 have not been commenced; when they will be commenced; and if he will make a statement on the matter. [52387/19]

Freagraí scríofa

Minister for Health

The 2013 Government Decision which approved a minimum pricing regime envisaged its introduction in Northern Ireland and in this jurisdiction simultaneously. It is my intention to seek a revised Government Decision so that minimum unit pricing can be implemented as soon as possible in order to address the very significant health harms and financial costs of the way alcohol is currently consumed here.

Occupational Therapy Provision

Ceisteanna (259)

Brian Stanley

Ceist:

259. Deputy Brian Stanley asked the Minister for Health when a child (details supplied) will be seen for occupational therapy services. [52393/19]

Freagraí scríofa

Minister for Health

As this question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply.

Departmental Expenditure

Ceisteanna (260)

Niall Collins

Ceist:

260. Deputy Niall Collins asked the Minister for Health the number of credit cards issued to Ministers and officials working in his Department; the amount spent on credit cards in each year since 2016; the bank interest paid on credit cards in each year since 2016; the controls in place to monitor the issuing of and the expenditure on the cards; the controls in place in each agency to monitor expenditure on personally held credit card bills that are subsequently used to recoup work-related expenses; and if he will make a statement on the matter. [52404/19]

Freagraí scríofa

Minister for Health

Please see below details of both the controls and amounts involved in Department of Health credit card transactions from 01 January 2016 to 30 November 2019.

Credit Cards 2016 – 2019 (30 Nov)

From 2016 until October 2019, the Department had two credit cards, one assigned to the Private Secretary of the Minister for Health and the other assigned to the Assistant Principal in the Accounting Unit. Currently, the Department just has one credit card, held by the Accounting Unit.

All requests for new credit cards have to be approved by the Secretary General. None are issued to the Department without his approval.

When a staff member wishes to use the credit card, they must contact the Accounting Unit for the credit card details. The staff member is then instructed to send the supporting documentation verifying this transaction to the Accounting Unit to reconcile with the monthly statement when it is received.

Since September 2019, the Department are now able to see credit card transactions going through on-line which enables reconciliations to be done on a weekly basis. All credit card transactions relating to business not relating to the Minister’s Office are processed on the credit card held in the Accounting Unit.

Credit Card	Year	Amount €	Interest €	Total €	Overall Total €
Accounting Unit	2016	21,693.76	187.66	21,881.42
Minister’s Private Secretary	2016	167.36	0.00	167.36	22,048.78
Accounting Unit	2017	19,671.47	225.52	19,896.99
Minister’s Private Secretary	2017	571.39	15.39	586.78	20,483.77
Accounting Unit	2018	26,440.13	422.19	26,862.32
Minister’s Private Secretary	2018	0.00	0.00	0.00	26,862.32
Accounting Unit	2019 to 30 Nov	42,780.02	617.08	43,397.10
Minister’s Private Secretary	2019 to 30 Nov	0.00	0.00	0.00	43,397.10
Total 2016 - 2019					112,791.97

Disability Services Data

Ceisteanna (261)

Margaret Murphy O'Mahony

Ceist:

261. Deputy Margaret Murphy O'Mahony asked the Minister for Health the number of children’s disability network teams now established; and the CHO breakdown of same. [52410/19]

Freagraí scríofa

Minister of State at the Department of Health

The Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.

As the Deputy's question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.

Respite Care Services Data

Ceisteanna (262, 263)

Margaret Murphy O'Mahony

Ceist:

262. Deputy Margaret Murphy O'Mahony asked the Minister for Health the number of new persons with a disability who commenced respite services (details supplied) to date in 2019. [52411/19]

Margaret Murphy O'Mahony

Ceist:

263. Deputy Margaret Murphy O'Mahony asked the Minister for Health the number of persons with a disability formally discharged from respite services (details supplied) to date in 2019. [52412/19]

Freagraí scríofa

Minister of State at the Department of Health

I propose to take Questions Nos. 262 and 263 together.

The Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.

The Programme for Partnership Government states that the Government wishes to provide more accessible respite care to facilitate full support for people with a disability.

As the Deputy's questions relate to service matters, I have arranged for the questions to be referred to the Health Service Executive (HSE) for direct reply to the Deputy

Medicinal Products Availability

Ceisteanna (264)

Frank O'Rourke

Ceist:

264. Deputy Frank O'Rourke asked the Minister for Health the reason persons with multiple sclerosis here face significant delays in accessing new medicines and treatments in comparison with other European countries; if there will be engagement with the pharmaceutical industry in order to remedy the situation and to improve market access; and if he will make a statement on the matter. [52416/19]

Freagraí scríofa

Minister for Health

The HSE has statutory responsibility for medicine pricing and reimbursement decisions, under the Health (Pricing and Supply of Medical Goods) Act 2013. The Act specifies criteria for decisions on the reimbursement of medicines.

HSE decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds, on the advice of the National Centre for Pharmacoeconomics (NCPE). The NCPE conducts health technology assessments (HTAs) for the HSE and makes recommendations on reimbursement to assist HSE decisions. The NCPE uses a decision framework to systematically assess a drug's clinical and cost effectiveness as a health intervention.

As a country, we invest heavily in medicines, to the tune of almost €2 billion annually. In 2019 to date, the HSE has approved 31 new medicines and 5 new indications for existing medicines for reimbursement in the public healthcare system. The approvals to date represent an additional investment by the HSE over five years of approximately €220m in providing access to new and innovative treatment for Irish patients. It is expected that over 3,000 patients will benefit from access to these new medicines over the next 5 years.

Notwithstanding the significant progress on drug costs achieved from price reductions under the pricing framework agreed with industry and commercial negotiations conducted by the HSE, the Health Service is still facing very significant challenges in relation to the affordability of medicines. The industry continues to develop very expensive products, particularly in the high-tech medicines area and the costs involved are a challenge for health systems even in countries with much greater resources than Ireland.

The HSE has received 2 applications for pricing and reimbursement of ocrelizumab (Ocrevus). Application 1 is for use of Ocrelizumab for the treatment of adult patients with relapsing forms of Multiple Sclerosis (RMS) with active disease defined by clinical or imaging features. Following a number of rounds of commercial negotiations, an agreement was reached in relation to the commercial terms which will apply to this indication. The HSE intends to progress ocrelizumab for the RMS indication, which has been approved for funding from October 2019, on a patient-specific basis for this indication.

Application 2 is for the use of ocrelizumab for the treatment of adult patients with early primary progressive multiple sclerosis (PPMS) in terms of disease duration and level of disability, and with imaging features characteristic of inflammatory activity. On 4 October 2018 the NCPE completed its assessment for this indication. They did not recommend that ocrelizumab be reimbursed for this indication.

The HSE and the manufacturer have had a number of rounds of commercial negotiations in relation to this indication. Commercial discussions have concluded and the medicine has been reviewed by the HSE Drugs Group. The HSE Senior Leadership Team have received the Drugs Group recommendation. The HSE's final decision on reimbursement will take into consideration the criteria contained in the 2013 Health Act.

The HSE has also received an application for reimbursement of Delta-9-tetrahydrocannabinol/Cannabidiol, THC/CBD (Sativex) which is indicated as treatment for symptom improvement in adult patients with moderate to severe spasticity due to multiple sclerosis who have not responded adequately to other anti-spasticity medication and who demonstrate clinically significant improvement in spasticity related symptoms during an initial trial of therapy.

The HSE commissioned a full HTA with respect to this indication in April 2018. On 12 August 2019, the NCPE received the applicant's submission and the HTA is currently underway.

The Government wants new and innovative medicines to be available to our citizens as quickly as possible but this can only be achieved if medicines are priced by the pharmaceutical industry in a viable and sustainable manner.

In an effort to identify workable solutions to the challenges which we face, I proposed a dialogue with Industry to explore ways in which new medicines might be more easily introduced in Ireland. This invitation was built on the premise that any innovative approaches that may be tabled must be compatible with the statutory provisions which are in place and must also recognise the context of finite Exchequer resources. It was in this context that an Open Policy Forum took place in 2018 between the Department of Health, the Department of Finance, Public Expenditure and Reform and the Irish Healthcare Pharmaceutical Association (IPHA) in 2018 and an Open Dialogue meeting took place in 2019 between the Department of Health, the HSE and IPHA in relation to new medicines.

Hospital Discharges

Ceisteanna (265)

Louise O'Reilly

Ceist:

265. Deputy Louise O'Reilly asked the Minister for Health further to Parliamentary Question No. 318 of 26 November 2019, the national total of delayed discharges by month to date 2019. [52419/19]

Freagraí scríofa

Minister for Health

Delayed transfers of care (previously referred to as delayed discharges) occur when patients have been deemed clinically fit for discharge from an acute bed but their discharge is delayed because they are waiting for some form of ongoing support or care following their discharge. There are many reasons for this, such as a patient undertaking the application process for NHSS, awaiting assessment for a home support package, homelessness, ward of court application, and the availability of resources.

When possible, the HSE will use transitional care to accommodate the patient during the period between discharge and the finalisation of new care arrangements, but there can often be a delay, especially in cases where the patient and family are coming to terms with the new circumstances.

This year, services are being stretched more than ever, with demand consistently outstripping supply, and we have seen an increase the number of delayed transfers of care. While the HSE maximises the use of resources, prioritising those requiring discharge from acute hospitals, there is a growing demand for egress support. In response, and in the context of planning and preparing for the challenges of the winter period, the Department and the HSE have been considering a comprehensive approach to the current high-level of DTOCs. However, recognising the urgency of the situation, approval was provided to the HSE to begin actions immediately to the value of €5m in 2019. As part of these measures the HSE released a significant number of funding approvals within NHSS in September, and provided additional home care and transitional care beds.

In addition, the HSE Winter Plan was launched on Thursday 14 November. The aim of the Winter Plan is to ensure that service providers are prepared for the additional external pressures associated with the winter period, including the prolonged holiday period, severe winter weather, seasonal influenza, and the spread of norovirus and other healthcare associated infections.

Nine Winter Action Teams, each aligned to a Community Healthcare Organisation and associated acute hospitals and Hospital Groups, have prepared Integrated Winter Plans. These plans focus on demand management and reduction, staffing availability, timely access to the most appropriate care pathway for patients, and appropriate timely discharge from acute hospitals.

The HSE Winter Plan is supported by an additional €26m in winter funding nationally. This winter funding will support access to the Fair Deal scheme, and will provide additional home support and transitional care to facilitate timely hospital discharge and reduce congestion in EDs over the winter period.

With regard to the Deputy's specific question, I have asked the HSE to respond to the Deputy directly with the requested information.

Hospital Charges

Ceisteanna (266)

Stephen Donnelly

Ceist:

266. Deputy Stephen Donnelly asked the Minister for Health the date on which the cut to the minor injury unit fee will come into effect; if the fee cut is temporary or permanent; if temporary, the date on which the cut will expire; the estimated cost of the measure; and the estimated full-year cost of implementing such a measure by year. [52430/19]

Freagraí scríofa

Minister for Health

The Health (Out-Patient Charges) Regulations 2017 (S.I. No. 248 of 2017) provides the legislative basis for the €100 charge currently levied by the HSE for out-patient services provided at a number of facilities, including an emergency department and a minor injury unit. Revised regulations are currently being drafted, in conjunction with the Office of the Attorney General, to provide the legislative basis necessary to underpin the introduction of a lower charge for out-patient services provided at minor injury units and will be finalised as soon as possible.

General Practitioner Data

Ceisteanna (267)

Stephen Donnelly

Ceist:

267. Deputy Stephen Donnelly asked the Minister for Health the additional funding being provided to out-of-hours general practitioner services in winter 2020; and the local breakdown of the allocation in tabular form. [52431/19]

Freagraí scríofa

Minister for Health

General practitioners contracted under the GMS scheme must make suitable arrangements to enable contact to be made with them, or a locum/deputy, for emergencies outside normal practice hours. As part of their regular obligations, GPs are contracted to provide all-hours access for GMS patients. Most GPs do this through regional GP cooperatives. GP cooperatives are private companies that provide out-of-hours services (i.e. weeknights, weekends, and public holidays).

The HSE supports the provision of these services in terms of infrastructure, call handling, and recruiting nursing staff. Currently, over 90% of the population has access to an out-of-hours GP services.

The provision of GP Out of Hours services forms an important part of service user needs in the Winter period. Each CHO area has established a Winter Action Team in conjunction with acute hospital colleagues, and each team prioritises the allocation of dedicated additional Winter funding based on local service needs and priorities.

The table below sets out the additional funding to be allocated to GP Out of Hours services in 2020 and where relevant in the 2019 Winter Period. CHO Midwest have advised that €60,000 has been allocated from their Winter funding allocation for the enhancement of GP Out of Hours services as provided by Shannondoc.

GP out of hours Service/s	Geographic Coverage of GP out of hours Service	Additional Funding	Winter Action Funding 2019
Both Caredoc and NoWDOC cover GP out of hours services within the Community Healthcare Organisation.	The Caredoc GP out of hours service covers the geographical areas of Sligo, North Leitrim and West Cavan	€250,000
Shannondoc & Limerick Doc cover GP out of hours services within the Community Healthcare	Limerick, Clare and North Tipperary. Engagement is ongoing with a GP in the Mid West who is not a member of either of co-op.		€60,000 to Shannon Doc
The South West Doctors on Call Ltd. (SouthDoc) cover GP out of hours services within the Community Healthcare	Counties of Cork and Kerry	€450,000
Carlow Emergency Doctors on Call (Caredoc CLG) cover GP out of hours services within the Community Healthcare	Carlow, Kilkenny, South Tipperary, Wexford, Waterford	€238,000
KDOC cover GP out of hours services within the Community Healthcare	Kildare & West Wicklow	€340,000
Midoc and NEDOC cover GP out of hours services within the Community Healthcare	Cavan, Monaghan, Meath & Louth (excluding Dundalk and Cooley Peninsula) and Longford / Westmeath and Laois / Offaly	€342,188
DDOC cover GP out of hours services within the Community Healthcare	Any GP who is not registered with the Northdoc Coop is not covered by this service or if they live in DNCC and their GP is in a different Coop they are not covered by this service	€179,812
Total		€1.8 m	€0.06m

National Maternity Hospital Status

Ceisteanna (268, 269)

Róisín Shortall

Ceist:

268. Deputy Róisín Shortall asked the Minister for Health the status of the plan to relocate the National Maternity Hospital to the grounds of St. Vincent’s University Hospital, Elm Park, Dublin; the timescale for a response from the Vatican for the divesting of the site; if the site and hospital building will be publicly owned; and if he will make a statement on the matter. [52434/19]

Róisín Shortall

Ceist:

269. Deputy Róisín Shortall asked the Minister for Health the proposed governance structure that will apply in the new national maternity hospital in view of his commitment that it will be a public hospital; and if he will make a statement on the matter. [52435/19]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 268 and 269 together.

The Government is fully committed to the development of the new National Maternity Hospital (NMH) on the campus of St Vincent’s University Hospital at Elm Park. As such, this project is encompassed within Project Ireland 2040, as well as the HSE Capital Plan 2019-2021.

My Department continues to engage with the NMH and St Vincent's Healthcare Group (SVHG) to develop a legal framework to protect the State’s significant investment in the new hospital. SVHG has agreed to provide the State with a 99-year lease of the land upon which the new maternity hospital will be built, and this will allow the State to retain ownership of the new facility.

The governance arrangements for the new NMH will be based on the provisions of the Mulvey Agreement. That Agreement provides for the establishment of a new company - National Maternity Hospital at Elm Park DAC - which will have clinical and operational, as well as financial and budgetary independence in the provision of maternity, gynaecology and neonatal services. The Agreement ensures that a full range of health services will be available at the new hospital without religious, ethnic or other distinction.

My Department has not had any engagement with the Religious Sisters of Charity or the Vatican in this matter; however, at a recent meeting, the Chair of SVHG advised the Department that the Sisters have requested the Vatican to approve their decision to transfer their shareholding and they are confident that such approval will be forthcoming