Written Answers Nos. 223-242
223. Deputy Niamh Smyth asked the Minister for Health the estimated full-year cost to adopt a national endometriosis strategy centred around education, diagnosis, and treatment including wrap-around supports and pain management and including access to specific diagnostics for general practitioners to avoid diagnosis delay. [25126/22]
Amharc ar fhreagraThe information requested by the Deputy is being collated by Department officials and a deferred reply will be submitted within ten working days.
224. Deputy Niamh Smyth asked the Minister for Health the estimated full-year cost to provide dedicated ringfenced funding for the eradication of period poverty administered by the Department of Health, and for each Department to disburse as relevant and for-free products to be made available in all public buildings. [25127/22]
Amharc ar fhreagraThe information requested by the Deputy is being collated by Department officials and a deferred reply will be submitted within ten working days.
225. Deputy Niamh Smyth asked the Minister for Health the estimated full-year cost to ensure paediatric gynaecology services are available on a regional basis to support early intervention. [25128/22]
Amharc ar fhreagraThe information requested by the Deputy is being collated by Department officials and a deferred reply will be submitted within ten working days.
226. Deputy Niamh Smyth asked the Minister for Health the estimated full-year cost to review medical card thresholds to reflect on-going cost-of-living increases. [25129/22]
Amharc ar fhreagraEligibility for a Medical Card is primarily based on a financial assessment which is conducted by the HSE in accordance with the Health Act 1970 (as amended). The HSE assesses each medical card application on a qualifying financial threshold. This is the amount of money that an individual can earn a week and still qualify for a card. It is specific to the individual’s own financial circumstances. Persons aged 69 and under are assessed under the general means tested medical card thresholds which are based on an applicant’s household income after tax and the deduction of PRSI and the Universal Social Charge. Certain expenses are also taken into account, i.e. mortgage payments, which help to increase the amount a person can earn and still qualify for a medical card. Persons aged 70 or older are assessed under the over 70s medical card income thresholds which are based on gross income. It should be noted that in November 2020, the weekly gross medical card income thresholds for those aged 70 and over were increased to €550 per week for a single person and €1,050 for a couple. This increase ensures that a greater proportion of those aged 70 and over now qualify for a medical card. With regard to the estimated cost of the deputy's proposal, the data required to model this is not readily available and it is therefore not possible to provide an estimate of the associated cost.
However, I wish to assure the Deputy that, to ensure the medical card system is responsive and sensitive to people's needs, my Department keeps medical card issues, including the current medical card income thresholds under review and any changes are considered in the context of Government policy, the annual budgetary estimates process and other issues which may be relevant.
227. Deputy Niamh Smyth asked the Minister for Health the estimated full-year cost to develop a dedicated centre of excellence for complex gynaecological cases with a multi-disciplinary team on-site with referral pathways from regional clinics. [25130/22]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
228. Deputy Niamh Smyth asked the Minister for Health the estimated full-year cost to adequately resource the National Sexual Health Strategy; and to involve women across the lifecourse in its periodic review. [25131/22]
Amharc ar fhreagraThe National Sexual Health Strategy, 2015-2020, (NSHS) was launched in October 2015. It takes a life course approach, acknowledging the importance of developing a healthy attitude to sexuality in young people and of building on that foundation for positive sexual health and wellbeing into adulthood and older age.
Current priority deliverables under the Strategy are HIV prevention, including the continued expansion of a Pre-Exposure Prophylaxis (PrEP) programme, which commenced in late 2019, and the HIV Fast Track Cities programme, involving Dublin, Cork, Limerick and Galway.
Other key areas of work include expanding access to contraception, free of charge; expanding sexually transmitted infection (STI) services, progressing a population survey on sexual health and improving sexual health education, training and resources, including in schools, higher and further education.
A review of the Strategy began in 2021, having been postponed as a result of the onset of the Covid-19 pandemic. Focus group meetings were held with key stakeholders, including clinical and public health staff, the HSE Sexual Health and Crisis Pregnancy Programme (SHCPP) team, those working in STI clinics, the education sector, the Department of Health and Women’s Health Taskforce, the research and academic sector and organisations representing the LGBTI+ community.
The detailed feedback from these meetings has been collated and will inform the future direction of the next iteration of the strategy. Commissioning an external review of the Strategy has been approved and is currently progressing through standard procurement processes. It is envisaged that the procurement process will conclude by July, with the Review to take 3-4 months once commenced. When complete, the Report will be published on the Healthy Ireland website. Results will, in turn, inform future policy direction and the Women's Health Taskforce will continue to provide input as the policy is implemented.
Funding to support implementation of NSHS is provided to the HSE SHCPP as part of the annual Budget process. An additional €3.3m was allocated in Budget 2022 for the expansion of online STI testing and for continuation of two other Sláintecare Integration Fund projects. supporting sexual health services in Athlone Institute of Technology and north inner-city Dublin. Of further relevance to sexual and reproductive healthcare and services, €9m was also provided for the rollout of free contraception for women aged 17-25, as per the Programme for Government Commitment. This is scheduled to commence in August, 2022
Funding for the next iteration of the NSHS will be considered as part of the annual Budgetary process and will be contingent on, firstly, the recommendations of the forthcoming external review, secondly, monitoring and evaluation of existing and new 2022 initiatives and finally, public health considerations relating to STI prevention and treatment.
229. Deputy Niamh Smyth asked the Minister for Health the estimated full-year cost to ensure safe access zones around facilities providing abortion services. [25132/22]
Amharc ar fhreagraI am committed to ensuring safe access to termination of pregnancy services, and the area remains an ongoing priority for me, this Government and my Department, including progressing legislation this year.
Officials in my Department are actively engaging with stakeholders to work through the challenges, refine the policy position, and develop the necessary legislative approach. Stakeholders include other Government Departments and state bodies such as An Garda Síochána, the HSE, and the Department of Justice.
Subject to Government approval, I plan to progress legislation on safe access as part of the Government's legislative programme for 2022. As part of the legislative process, a Regulatory Impact Analysis (RIA) will be completed which will consider impacts, including costs, if any, associated with implementing the proposed legislation.
230. Deputy Niamh Smyth asked the Minister for Health the estimated full-year cost to ensure equality-of-access to abortion services for women by ensuring national coverage. [25133/22]
Amharc ar fhreagraAs the Deputy’s question relates to a service area, I have referred this question to the HSE for direct response.
231. Deputy Niamh Smyth asked the Minister for Health the estimated full-year cost to develop a clear pathway of care from general practitioners for those with fertility concerns, including general practitioner--access to diagnostics where appropriate. [25134/22]
Amharc ar fhreagra233. Deputy Niamh Smyth asked the Minister for Health the estimated full-year cost to commit to four publicly-funded IVF cycles, including medication and mental health supports. [25136/22]
Amharc ar fhreagra236. Deputy Niamh Smyth asked the Minister for Health the estimated full-year cost to establish a publicly-funded one-stop-shop for surrogacy medical testing, including mental health supports. [25139/22]
Amharc ar fhreagraI propose to take Questions Nos. 231, 233 and 236 together.
As the Deputy will be aware, a commitment to “introduce a publicly funded model of care for fertility treatment” is included in the Programme for Government.
The model of care for infertility was developed by the Department of Health in conjunction with the HSE’s National Women & Infants Health Programme (NWIHP) in order to ensure that infertility issues are addressed through the public health system at the lowest level of clinical intervention necessary.This model of care comprises three stages, starting in primary care (i.e. GPs) and extending into secondary care (i.e. Regional Fertility Hubs) and then, where necessary, tertiary care (i.e. IVF, and other advanced assisted human reproduction (AHR) treatments), with patients being referred onwards through structured pathways.
Phase One of the roll-out of the model of care has involved the establishment, at secondary care level, of Regional Fertility Hubs within maternity networks, in order to facilitate the management of a significant proportion of patients presenting with infertility issues at this level of intervention. The completion of Phase One of the roll-out, envisaged before the end of this year, will result in fully operational Regional Fertility Hubs in each of the six Hospital Groups across the country.
Initial funding of €2m was assigned in order to commence Phase One of the roll-out of the model of care in 2020 and additional funding of approximately €1m was made available for 2021. These allocations were utilised to enable the setting-up of the Regional Fertility Hubs. According to figures updated by NWIHP in 2021, the total full-year cost of fully operating the six Hubs is estimated to be in the region of €2.87m.
Phase Two of the roll-out of the model of care will see the introduction of tertiary infertility services, including IVF, in the public health system. Substantial planning, development and policy work is required to establish the scope, design and requirements for this component of the model of care. At this juncture, the design and scope of this aspect of the model of care have not been finalised as detailed consideration of a range of issues including service and treatment design, eligibility and access criteria, and associated resource implications is required. This work will also need to be informed by the final Health (Assisted Human Reproduction) Act, the progress of this Bill – which has recently passed Second Stage in the Dáil – and associated regulations that will be developed following the enactment of this legislation. My officials are continuing engagement with the HSE in relation to the necessary programmes of work required to further advance consideration of the issues arising for commencing Phase Two of the roll-out of the model of care.
Finally, in respect of surrogacy services, Part 7 of the Health (Assisted Human Reproduction) Bill 2022 outlines the proposed circumstances under which domestic surrogacy will be permitted in Ireland. The proposed specific conditions include a requirement for all surrogacy agreements to be altruistic and authorised by the new Assisted Human Reproduction Regulatory Authority prior to the provision of AHR treatment. The surrogate mother and the intending parent(s) must have provided fully-informed consent to the surrogacy agreement, have received appropriate counselling specific to surrogacy, and the surrogate mother must have been assessed as being both physically and psychologically suitable to act as a surrogate mother. The scope of surrogacy related-services, if any, that may be incorporated into the model of care for infertility will be considered as part of the above-mentioned programmes of work.
232. Deputy Niamh Smyth asked the Minister for Health the estimated full-year cost to expand publicly-funded regional fertility hubs for each province. [25135/22]
Amharc ar fhreagraMy Department is working with the HSE’s National Women & Infants Health Programme to implement a Model of Care for Infertility to ensure that infertility issues are addressed through the public health system at the lowest level of clinical intervention necessary.
This model of care comprises three stages, starting in primary care (i.e., GPs), extending into secondary care (i.e., Regional Fertility Hubs) and then, where necessary, tertiary care (i.e., IVF and other advanced assisted human reproduction (AHR) treatments), with patients being referred onwards through structured pathways.
Phase One of the roll-out of the Model of Care for Infertility has involved the establishment of Regional Fertility Hubs one within each of the six maternity networks across the country. These Hubs aim to maximise the outcome for women and their partners by offering an assessment and management service on-site that will streamline the process and minimise delays in access to fertility services.
These Hubs offer a tailored, multi-disciplinary approach. Patients are referred, if they meet the relevant criteria, by their GPs to their local Hub, which is being resourced so that it has available specific expertise in this area from a medical perspective, a nursing perspective and a laboratory perspective.
Following the provision of funding in 2020 and again in 2021, six Regional Fertility Hubs have been established and are now operational in the National Maternity Hospital, the Rotunda, the Coombe, Cork University Maternity Hospital, University Hospital Galway and at Nenagh General Hospital (under the governance of University Maternity Hospital Limerick).
234. Deputy Niamh Smyth asked the Minister for Health the estimated full-year cost to introduce regulation of IVF clinic services. [25137/22]
Amharc ar fhreagra235. Deputy Niamh Smyth asked the Minister for Health the estimated full-year cost to enact the Assisted Human Reproduction (AHR) Bill 2022. [25138/22]
Amharc ar fhreagraI propose to take Questions Nos. 234 and 235 together.
As the Deputy will be aware, the Health (Assisted Human Reproduction) Bill 2022 (AHR Bill) passed Second Stage in the Dáil on March 23rd 2022 and has been referred to the Select Committee on Health for Third Stage.
The AHR Bill proposes to introduce, for the first time in this country, a regulatory framework for assisted human reproduction (AHR), which is a complex, innovative and fast-moving area of medicine.
Ireland is currently very much an outlier internationally. The State is not funding advanced AHR treatment at present and we do not have a specific regulatory framework in place in respect of this area of health care. This means that individuals are currently availing of complex and sometimes risky procedures without the benefit of a regulatory framework.
The new rules, regulations and provisions that will be provided through this legislation will help bring guidance, clarity and peace of mind.
Post-commencement of the Act, the main ensuing budgetary requirements will relate to the establishment and running costs of the Assisted Human Reproduction Regulatory Authority (AHRRA for short).
A Regulatory Impact Analysis in respect of the AHRRA was undertaken in 2017 and it estimated the combined set-up and operational costs for one year as being between €1.6m and €2.5m, dependent primarily on the level of functions or services the new body may share with another public body or other public bodies. The budgetary requirements for the AHHRA will be kept under ongoing consideration as more detailed planning for the establishment of the Authority progresses and, having regard to amendments, if any, to the proposed legislation that may impact on the AHRRA as the Bill progresses through the Houses of the Oireachtas.
237. Deputy Niamh Smyth asked the Minister for Health the estimated full-year cost to expand free STI testing and screening services, including self-sampling where appropriate. [25140/22]
Amharc ar fhreagraSTI testing and treatments are available through the national network of STI clinics; more details of service provision, including details of how to access STI testing, are available through www.sexualwellbeing.ie.
For asymptomatic individuals, online HSE home STI/HIV testing is currently available in 22 counties. Online STI testing (involving self-sampling), was originally provided via a pilot funded in Dublin, Cork and Kerry by the Sláintecare Integration Fund in 2021. In response to high initial demand, rising STI rates and a public health declared syphilis outbreak, the service has been expanded, with full national roll-out to commence shortly, following the conclusion of a tendering process €3.3m was allocated in Budget 2022 for online STI testing and for continuation of two other Sláintecare Integration Fund projects. supporting sexual health services in Athlone Institute of Technology and north inner-city Dublin.
STI services are therefore currently undergoing expansion. This process will be subject to monitoring and evaluation, in order to assess the extent of increased capacity and any remaining unmet need. Any consideration of further service needs will await the outcomes of the monitoring and evaluation process.
With regard to projected full year costs, as this is a service matter I have asked the Health Service Executive to respond to the Deputy as soon as possible.
238. Deputy Niamh Smyth asked the Minister for Health the estimated full-year cost to commit to fully funding the National Maternity Strategy and its successor. [25141/22]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
239. Deputy Niamh Smyth asked the Minister for Health the estimated full-year cost to deliver the new National Maternity Hospital without delay. [25142/22]
Amharc ar fhreagraThe business case to support the capital project to relocate the National Maternity Hospital (NMH) to the St Vincent’s University Hospital (SVUH) Campus is progressing. Site preparatory and enabling works were required to support the relocation but, with the exception of these enabling works, no further contractual commitments have been entered into with respect to works on the project. All capital development proposals must progress through a number of approval stages, in line with the Public Spending Code, before a firm timeline or funding requirement can be established. A Final business case has been submitted to the Department by the NMH Project Board and is now subject to technical review by the Department of Health, including the External Assurance Process for major capital projects recently introduced by the Department of Public Expenditure and Reform. Pending favourable review under the Spending Code, a Memorandum for Government will then be brought forward to progress the programme for the NMH. If approval in principle is granted, the project can move to preparation of tender documents in line with EU law and deployment of a tendering strategy. The planned allocation for 2022 to support this business case progression is €10.9m. The final decision to proceed with the construction and therefore to estimate the final cost for the new NMH cannot be made until the tender process has been completed and the costings reviewed to ensure that the proposal delivers value for money and remains affordable.
240. Deputy Niamh Smyth asked the Minister for Health the estimated full-year cost to ensure that every woman has full choice-of-care and delivery options when pregnant, to include midwife-led care. [25143/22]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
241. Deputy Niamh Smyth asked the Minister for Health the estimated full-year cost to develop further education for healthcare workers, including general practitioner and practice nurses in the area of breastfeeding. [25144/22]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
242. Deputy Niamh Smyth asked the Minister for Health the estimated full-year cost to ensure that every woman has immediate access to a lactation consultant before being discharged from hospital or within 48 hours following a home-birth. [25145/22]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
