Written Answers Nos. 1424-1441
1424. Deputy David Cullinane asked the Minister for Health the number of times that the HSE has been in breach of the European Working Time Directive from 2020 until the end of May 2022; and if he will make a statement on the matter. [29068/22]
Amharc ar fhreagraAs this is a service matter, I have asked the HSE to reply directly to the Deputy with the data sought.
1425. Deputy David Cullinane asked the Minister for Health his plans to carry out a root-and-branch reform of the dental treatment service scheme; his plans to put in place a new contract; and if he will make a statement on the matter. [29070/22]
Amharc ar fhreagraI have given a commitment to substantial reform of oral health provision in accordance with the National Oral Health Policy, Smile agus Sláinte, which was published in 2019. Improving and enabling easy access for the public to oral healthcare services is a key component of that Policy.
Under the Policy, it is proposed that oral healthcare packages will be provided for medical card holders over 16 years. The packages will be provided in a local primary care setting by oral healthcare practitioners contracted by the HSE. HSE community oral healthcare services will provide additional high-support care as required.
Work on the substantive review has already commenced and I have asked my officials and the HSE to undertake further engagement with all dental stakeholders in implementing necessary reforms.
The outcome of the review will be reflected in a new contract for oral health care.
1426. Deputy David Cullinane asked the Minister for Health his plans to put in place a new public-only consultant contract; and if he will make a statement on the matter. [29071/22]
Amharc ar fhreagraThe Government, as provided for in the Programme for Government, is committed to introducing the Sláintecare 2022 public-only consultant contract in a timely manner. A new consultant contract is a key step in the move towards universal, single-tier healthcare, with public hospitals exclusively used for the treatment of public patients.
Last July terms of reference for the negotiations process were agreed with the representative bodies under an Independent Chair. My Department, in conjunction with the HSE, commenced engagement with the representative bodies, the IMO and the IHCA, on the new contract last autumn and talks continued up to Christmas.
I am committed to the negotiations recommencing as soon as possible under a new Chair. I recently met with the IHCA and the IMO concerning this. Following on from this meeting, officials of my Department and the representative bodies are in discussions on recommencing the process.
When the date of implementation of the new contract is set, this contract will apply to all consultant appointment offers from that date.
1427. Deputy David Cullinane asked the Minister for Health his plans to put in place a new contract for general practitioners; and if he will make a statement on the matter. [29072/22]
Amharc ar fhreagraThe vision of Sláintecare, the report of the Oireachtas Committee on the Future of Healthcare, is to deliver safe, quality health and social care services that meet the needs of the growing population.
General practice policies central to the implementation of Sláintecare are the reform of the GMS GP contract and the roll out of a Chronic Disease Management (CDM) programme for GMS patients, and the move towards universal access to GP services without charges on a phased basis.
The 2019 GP Agreement helps to modernise and reform the GMS scheme, expanding services for patients and making general practice a more attractive career option for doctors.
The Agreement includes a commitment to undertake a strategic review of GP services within the lifetime of the Agreement, to examine how best to ensure the provision of GP services in Ireland for the future. The review will examine the broad range of issues affecting general practice and will set out measures necessary to deliver a sustainable service into the future. The outcome of this review will inform future contractual changes, with preparatory work for the review having begun this year.
1428. Deputy David Cullinane asked the Minister for Health his plans to provide funding for training and education of general practice nurses; and if he will make a statement on the matter. [29073/22]
Amharc ar fhreagra1429. Deputy David Cullinane asked the Minister for Health to provide an outline of the career pathway of general practice nurses and the ways in which they are supported to progress in their careers; and if he will make a statement on the matter. [29074/22]
Amharc ar fhreagraI propose to take Questions Nos. 1428 and 1429 together.
Practice nurses are not employees of the HSE but are privately employed by general practitioners.
GPs contracted under the GMS scheme with a panel size of 100 patients or more receive a contribution towards the cost of employing a practice nurse.
Practice nurses must be registered on the live general register of the Nursing and Midwifery Board of Ireland (NMBI). They are responsible for their own scope of practice which is guided by the NMBI. There is no mandatory education or training to become a practice nurse. Ideally, practice nurses should have at least 2 years post-registration general nursing experience. However, 4 to 5 years post-graduate experience is more desirable. This enables nurses to develop their competencies in a broader clinical background.
Practice nurses may undertake further education. For example, education on:
- respiratory management
- diabetes management
- cardiovascular disease management
- women's health
- cancer screening
- immunisation
The HSE employs professional development coordinators for practice nursing (PDCPN) These coordinators:
- have responsibility for the strategic development of practice nursing
- provide guidance and direction for practice nursing
- work as the link between the HSE and practice nurses
- facilitate education and continuing professional and role development
- collaborate with relevant healthcare professionals, educational bodies and other stakeholders.
The 2019 GP Agreement includes a commitment to undertake a strategic review of GP services within the lifetime of the Agreement, to examine how best to ensure the provision of GP services in Ireland for the future. The Government is open to considering other options of support for general practice as part of the strategic review. The outcome of this review will inform future contractual changes, with preparatory work for the review having begun this year.
The Minister published the Expert Review Body on Nursing and Midwifery 2022 which is a pathway for developing and strengthening the roles of the nurse and the midwife. It contains 47 recommendations that will support nurses and midwives to continue to learn and develop in professional roles, enabling significant reform and ensuring that critical Sláintecare priorities are realised. One of the recommendations will require the identification and development of clinical nurse/midwifery specialist and advanced nursing/midwifery practice career pathways to meet service demands in community and primary care settings. The Chief Nursing Office in my Department is currently exploring options in relation to the provision of education programmes for practice nurses.
1430. Deputy David Cullinane asked the Minister for Health his plans to put in place a new contract for pharmacists; and if he will make a statement on the matter. [29075/22]
Amharc ar fhreagraI value the important role community pharmacists play in our Health Service in the delivery of holistic patient care. I also fully acknowledge that community pharmacists have played a vital role in responding to the health needs of the public during the COVID-19 pandemic.
Community pharmacists have ensured the continued availability of a professional, accessible service for the public and have successfully managed to alleviate concerns around continuity of medicine supply. They have also played a central role in the national vaccination rollout – the largest ever undertaken by the state.
During the COVID-19 pandemic the HSE established a Community Pharmacy Contingency Planning working group with relevant stakeholders, including the Irish Pharmaceutical Union and the Pharmaceutical Society of Ireland, to support the implementation of all COVID-19 support measures. This group – now called the Community Pharmacy Planning Forum – had examined the operational and clinical challenges confronting community pharmacists during the COVID-19 emergency and played a key role in resolving them to the benefit of the people of Ireland.
The work of the Forum has now transitioned to discussing the strategic direction of the community pharmacy profession. These discussions will bring clarity to the role to be played by community pharmacy in the context of Sláintecare. The central objective of Sláintecare is providing the right care, in the right place, at the right time. This means providing more care to patients in the communities in which they live. Community pharmacists will play a vital and increasing role in delivering this care.
The ongoing work of the Community Pharmacy Planning Forum will also prove invaluable in the context of future contractual reform. Of course, any publicly funded pharmacy service expansion should address unmet public healthcare needs, improve access to existing public health services, and provide better value for money.
I believe there is a real opportunity to work collaboratively, and with other healthcare providers, to make a significant difference to patient outcomes. I welcome the ongoing work of the Community Pharmacy Planning Forum in that regard.
1431. Deputy David Cullinane asked the Minister for Health his plans to put in place a new contract for optometrists; and if he will make a statement on the matter. [29076/22]
Amharc ar fhreagraI value the important role community optometrists play in our Health Service in the delivery of holistic patient care. In particular, I fully acknowledge that community optometrists have played a key role in responding to the health needs of the public during the COVID-19 pandemic. During the pandemic optometrists have been responsive to the challenges presented and have developed guidelines and procedures to safely deliver patient care. I also recognise that optometrists have also played an important role in the delivery of the COVID-19 vaccination campaign. Optometrists have the potential to play a greater role, and my officials are working with their counterparts in the HSE with a view to contracting more services from acute and community settings out to community optometrists.The current contract with Optometrists dates back to 1999 and it is accepted that it is has not kept pace with developments that have taken place over the course of recent years, including the recommendations from the 2017 Primary Care Eye Services Review Group Report, interdisciplinary collaboration. I am fully committed to the development of community services which can facilitate expanded and more integrated provision of eye care in local communities. In this context, a contractual relationship between optometrists and the HSE which is modernised to emphasise a strengthened primary care system will be required.Any publicly funded service expansion should address unmet public healthcare needs, improve access to existing public health services or provide better value for money or patient outcomes.Subject to available resources, the 2022 priorities for the HSE are to support the Primary Care Eye Teams in CHOs 6, 7 and 9 in rolling out a team model and to advance the transfer of care for children aged 8+ years to local optometrists.
1432. Deputy David Cullinane asked the Minister for Health if he intends to hire salaried general practitioners to work within the HSE; and if he will make a statement on the matter. [29077/22]
Amharc ar fhreagraGPs are private practitioners who hold contracts with the HSE to provide services under various public health schemes; there are no plans at present to directly employ GPs. Any proposed model involving salaried GP positions would require careful consideration to ensure the required level of service could be provided for medical card and GP visit card holders.
The 2019 GP Agreement on Contractual Reform and Service Development includes a commitment to undertake a strategic review of GP services within the lifetime of the Agreement, to examine how best to ensure the provision of GP services in Ireland for the future. Work on the review is to commence this year. The review will examine the broad range of issues affecting general practice, and will set out measures necessary to deliver a sustainable service into the future.
1433. Deputy David Cullinane asked the Minister for Health the number of dentists working for the HSE; and if he will make a statement on the matter. [29078/22]
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.
1434. Deputy David Cullinane asked the Minister for Health his plans to hire more dentists to work for the HSE; and if he will make a statement on the matter. [29079/22]
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.
1435. Deputy David Cullinane asked the Minister for Health the timeframe for fully removing private healthcare from public hospitals; and if he will make a statement on the matter. [29080/22]
Amharc ar fhreagraA Public Only Consultant Contract is a key step in the move towards universal, single-tier healthcare, with public hospitals exclusively used for the treatment of public patients, including private patients opting to go public, as envisaged in the Sláintecare Report.
As recommended by the Independent Review Group established to examine the removal of private healthcare from the public system, this will be achieved through the appointment of all future consultant doctors in the public health service to a contract that allows only public activity in public sites. Over time, as existing consultants with rights to private practice retire and are replaced with a public-only consultant, private activity rates will reduce and be replaced with increased public activity.
The Government is committed to introducing the public-only consultant contract in a timely manner. It is intended that the Contract will be introduced following engagement with the representative bodies, the IMO and the IHCA. When the date of implementation of the new Contract is set, the new consultant contract will apply to all consultant appointment offers from that date.
1436. Deputy David Cullinane asked the Minister for Health his plans to reduce the cost of healthcare; and if he will make a statement on the matter. [29081/22]
Amharc ar fhreagraThe Irish Public Health System provides for two categories of eligibility for persons ordinarily resident in the country, i.e., full eligibility (medical cards) and limited eligibility.
Eligibility for a Medical Card is primarily based on a financial assessment which is conducted by the Health Service Executive (HSE) in accordance with the Health Act 1970 (as amended).
Individuals with full eligibility can access a range of services including General Practitioner services, prescribed drugs and medicines, all in-patient public hospital services in public wards, including consultant services, all out-patient public hospital services including consultant services, dental, ophthalmic, and aural services, aids and appliances, and maternity and infant care services.
A General Practitioner (GP) visit card provides for eligible individuals to visit a participating GP service without fees and also covers visits to GP out-of-hours service.
The Government is committed to making healthcare more accessible and affordable and has introduced several reductions in the cost of healthcare.
On 1 November 2020, prescription charges under the General Medical Services (GMS) scheme were reduced as follows:
- For persons over 70, the charges were reduced to €1 per item with a maximum monthly charge of €10 per person or family per month.
- For persons under 70, the charges were reduced to €1.50 per item with a maximum monthly charge of €15 per person or family.
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.
In certain circumstances, the HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income guidelines, where he or she faces difficult financial circumstances, such as extra costs arising from illness.
In circumstances where an applicant is still over the income limit for a medical card, they are then assessed for a GP visit card. Since 2015, every individual aged 70 and over has automatic eligibility for a GP visit card.
It is my intention that the next stage of the phased expansion of GP care without fees to all children aged 12 years and under, namely, the provision of GP care without fees to all children aged 6 and 7, will be commenced this year. Consultations with the IMO, representing GPs, are ongoing in this regard.
The Drug Payment Scheme (DPS) provides for the refund of the amount by which expenditure on approved prescribed medicines or medical and surgical appliances exceeds a named threshold in any calendar month. The DPS is not means tested and is available to anyone normally resident in Ireland.
On 1 January 2022, the DPS threshold was reduced to €100 per month. On 1 March 2022, the DPS threshold was further reduced the DPS threshold to €80. The DPS significantly reduces the cost burden for families and individuals with ongoing expenditure on medicines. The combined effect of those two reductions in the DPS threshold will be an annual minimum saving of €408, or 30%, for any individual or household that regularly exceeded the 2021 threshold of €114. In addition, there have been almost 37,000 additional claimants under the DPS since these reductions were introduced.
The Long Term Illness (LTI) scheme was established under Section 59(3) of the Health Act 1970 (as amended). Regulations prescribed 16 illnesses covered by the scheme. Under the LTI Scheme, patients receive drugs, medicines, and medical and surgical appliances directly related to the treatment of their illness, free of charge. Prescription charges do not apply to persons who qualify for the LTI scheme.
A review of the current eligibility framework, including the basis for existing hospital and medication charges, is to be carried out under commitments given in the Sláintecare Implementation Strategy. The current priority has been on access to GP services and a review of hospital charges.
Funding was provided in Budget 2022 for measures to alleviate the financial burden of statutory hospital charges incurred for children accessing care in a public hospital. This allocation of funding follows on from the commitment given in the Programme for Government to abolish statutory acute public in-patient charges for children over the lifetime of the Government. It is my intention to bring the necessary legislation before the Oireachtas this year.
Finally, individuals may also be entitled to claim tax relief on the cost of their medical expenses. This includes medicines prescribed by a doctor, dentist, or consultant. Relief is at the standard tax rate of 20%.
1437. Deputy David Cullinane asked the Minister for Health the timeframe to deliver full universal and free general practitioner-care to all citizens; and if he will make a statement on the matter. [29082/22]
Amharc ar fhreagraAs per the Programme for Government, the Government is committed to increasing access to GP care without charges for more children, an important healthcare measure that will remove a potentially prohibitive cost barrier to accessing GP care and will help to improve children’s health as they develop.
My officials and the HSE are engaged in preparatory work for the commencement of the initial stage of the phased expansion of GP care without fees to all children aged 12 years and under, the provision of GP care without fees to all children aged 6 and 7. Consultations with the IMO, representing GPs, are currently underway with the intention of introducing this service this year.
The Sláintecare vision for universal access to healthcare at low or no cost recognises the need for careful planning, as expanding eligibility could generate significant increases in demand for GP and other primary care services. Eligibility is to be expanded on a phased basis in line with GP capacity so as not limit the ability of general practice to meet the needs of all patients in the community. As such there is currently no timeline for universal GP care without charges.
Measures taken by the Government to increase GP capacity and the number of GPs in the State are already having an impact. There has been a significant increase in the number of GPs entering training in recent years, up from 120 in 2009 to 233 in 2021, with large increases made in recent years. The transfer of responsibility for training to the ICGP, completed last year, will result in further increases in the coming years. 258 GP training places are planned for 2022.
1438. Deputy David Cullinane asked the Minister for Health his plans to increase the number of patients on the general practitioner visit-only card; and if he will make a statement on the matter. [29083/22]
Amharc ar fhreagraAt the 1st May, 530,425 people hold a GP visit card and, when those holding medical cards are taken into account, nearly 2.1m people (over 41% of the population) have access to GP care without charges.
In accordance with the Programme for Government, the Government is committed to increasing access to GP care without charges for children. At present, my officials and the HSE are engaged in preparatory work for the commencement of the initial stage of the phased expansion of GP care without fees to all children aged 12 years and under, the provision of GP care without fees to all children aged 6 and 7. Consultations with the IMO, representing GPs, are underway with the intention of introducing this service this year. It is estimated approximately 80,000 additional children aged 6 and 7 will be eligible for a GP visit card under the expansion.
1439. Deputy David Cullinane asked the Minister for Health his timeframe to deliver full universal and free primary healthcare to all citizens; and if he will make a statement on the matter. [29084/22]
Amharc ar fhreagraThe Sláintecare Report outlines the steps required for reformed health system where the vast majority of all aspects of healthcare are provided for in the community through population health, primary or social care.
The Programme for Government commits to the full implementation of Sláintecare as part of a mission to introduce universal single tier health and social care system where everyone has equitable access to services based on need, and not ability to pay and to deliver safe, quality health and social care services that meet the needs of our growing population, and attracts and retains the very best healthcare clinicians, managers, and staff.
That Government’s ongoing full commitment is made clear in the Sláintecare Implementation Strategy & Action Plan 2021-2023 was approved by Government in May 2021, the mid-year and end of year progress reports and the publication last week of the 2022 Action Plan detailing the plans for Sláintecare Implementation.
As the Deputy will be aware, the report recommends a phased expansion of entitlement to GP services. Currently 2.1 million people in Ireland have access to free GP care through the Medical Card and GP Visit Card schemes. The Programme for Government sets out the Government’s commitment to the expansion of universal care in a fair and affordable manner, including the expansion of GP Visit Cards to children. Talks are currently underway on the implementation of free GP care for children aged 6 and 7, which will have a meaningful impact on the cost of living for impacted households. In line with Sláintecare and Programme for Government commitments to the expansion of universal care, the Department of Health is currently exploring options for further expanding eligibility to GP services in a fair and affordable manner.
1440. Deputy Pádraig Mac Lochlainn asked the Minister for Health when a person (details supplied) in County Donegal can expect a date for surgery in Letterkenny University Hospital; and if he will make a statement on the matter. [29112/22]
Amharc ar fhreagraUnder 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.
In relation to the particular query raised, as this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1441. Deputy Maurice Quinlivan asked the Minister for Health the status of the case of a child (details supplied) whose parents have been advised that they will be waiting in excess of three years for an ADHD assessment by the child and adolescent mental health service; and if he will make a statement on the matter. [29116/22]
Amharc ar fhreagraAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
