Written Answers Nos. 511-526
511. Deputy David Cullinane asked the Minister for Health if he will address the matter raised in correspondence (details supplied) in relation to the drugs payment scheme card; and if he will make a statement on the matter. [46982/22]
Amharc ar fhreagraThe Government is committed to making healthcare more accessible and affordable and has introduced several reductions in the cost of healthcare.
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.
The DPS threshold was reduced twice in 2022; to €100 per month as of 1 January 2022, and to €80 per month as of 1 March 2022. The DPS significantly reduces the cost burden for families and individuals with ongoing expenditure on medicines.
People who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be eligible for a medical card under the General Medical Services (GMS) scheme. In accordance with the provisions of the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE. 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.
On 1 November 2020, prescription charges under the 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 addition to this change, 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.
It is also important to note that the DPS is deliberately designed as a simple universal non-means tested scheme which is in place to protect those who do not qualify for a medical card from excessive medical costs. There is a process around means testing for medical cards which requires the HSE to consider hardship and inability to pay for required health care when making determinations around eligibility. The introduction of a two-tiered DPS threshold would introduce an element of complexity in that scheme – including legislative, IT and verification changes – that is not warranted when there is already a system in place for the HSE to issue discretionary medical cards on hardship grounds.
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%.
512. Deputy David Cullinane asked the Minister for Health the reason that a child (details supplied) who was assessed by an agency over the summer and whose parents were verbally informed that they meet the criteria for an autism diagnosis have not yet received the written report despite repeated requests by them and the children's disability network team; and if he will take steps to ensure that they receive a diagnosis without further delay given that same is required this September in order to make applications for a suitable place in secondary school. [46987/22]
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.
513. Deputy Colm Burke asked the Minister for Health if he will urgently establish a high-level working group on future general practice, to help find innovative solutions, and work collectively to address shortages in the general practitioner-sector; and if he will make a statement on the matter. [46991/22]
Amharc ar fhreagra514. Deputy Colm Burke asked the Minister for Health if general-practitioner training in business planning and management will be made available, particularly, GP training in setting-up and building group practices at community level, and where group practice is not viable or feasible; if the HSE will facilitate the ongoing support of such practices, enhancing practice collaboration and networking; and if he will make a statement on the matter. [46992/22]
Amharc ar fhreagra515. Deputy Colm Burke asked the Minister for Health if his Department will set up an initiative whereby it would work with the European Investment Bank to set-up a fund to provide low interest loans to groups of general practitioners to set-up primary care centres run by those GPs; and if he will make a statement on the matter. [46993/22]
Amharc ar fhreagra521. Deputy Colm Burke asked the Minister for Health if he will consider the establishment of an academic general practitioner-career pathway to recruit, support and retain sufficient academic GPs to meet Ireland’s expanding primary care teaching, healthcare policy and research requirements, and to deliver high-quality evidence-based GP care to patients; and if he will make a statement on the matter. [46999/22]
Amharc ar fhreagraI propose to take Questions Nos. 513 to 515, inclusive, and 521 together.
In accordance with the 2019 Agreement with GPs, the Department of Health and the HSE have commenced preparatory work on a strategic review of GP services 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 the measures necessary to improve the delivery of the GP services nationwide. It is anticipated that key stakeholder groups will provide an important contribution to the review and in determining the measures to be undertaken.
516. Deputy Colm Burke asked the Minister for Health the plans that are in place and being considered to resource rural general practice to attract general practitioners; the measures that will be put in place to achieve this; and if he will make a statement on the matter. [46994/22]
Amharc ar fhreagraGPs are self-employed practitioners and therefore may establish practices at a place of their own choosing. There is no prescribed ratio of GPs to patients and the State does not regulate the number of GPs that can set up in a town or community.
The Government is aware of the workforce issues currently facing general practice, including the limited access to GP services in certain rural areas, and has implemented a number of measures to improve recruitment and retention in general practice.
Under the 2019 GP Agreement between the Department of Health, the HSE and IMO, over €210 million in annual funding has been committed to provide for a more sustainable general practice.
In addition to increased service payments to GPs and the allocation of resources to implement the Chronic Disease Management Programme, the Agreement provided for a 10 percent increase in payments under the pre-existing Rural Practice Support Framework and a 28 percent increase to dispensing doctor fees. Practices in receipt of rural practice supports attract the maximum allowable rates for practice staff support subsidies and locum contributions for leave taking.
The Agreement also provides for support for GPs working in disadvantaged urban areas, and for improved family friendly arrangements, with an increases in the locum rate for maternity and paternity cover, and an increase in the paternity leave allowance from 3 days to 2 weeks.
The number of doctors entering GP training has increased approximately ten percent year on year from 2019, rising from 193 in 2019 to 258 in 2022. Following the transfer of responsibility for GP training from the HSE to the Irish College of General Practitioners (ICGP), the ICGP aims to have 350 training places available for new entrants per year by 2026.
Preparatory work has commenced on a strategic review of GP services 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 in general and in rural areas specifically, and will set out the measures necessary to deliver a better general practice.
Overall, these measures will see an increase in the number of GPs working in the State, improving access to GP services for patients throughout the country.
517. Deputy Colm Burke asked the Minister for Health his plans to improve ICT systems in general practice; if he will consider the implementation of such measures as summary care records, facilitated with a unique patient identifier, to enable an efficient, integrated healthcare system; his plans for investment in e-communication solutions between GP and hospital care to improve patient safety, optimise referral rates and overall, to support secondary care; and if he will make a statement on the matter. [46995/22]
Amharc ar fhreagraGP ICT systems have undergone a series of significant developments in recent years. During the pandemic we saw the rapid deployment of a new facilities to support electronic transfer of prescriptions, access to teleconsultations, electronically refer patients for Covid testing, submit Covid vaccination data to facilitate national data collection and the issuance of EU Digital Covid Certificates in accordance with EU regulations. Whilst the impact of these initiatives was in some cases to push other planned work back, they were nonetheless important and necessary in terms of pandemic response. Under the 2019 Agreement with GPs, a commitment has been given to facilitate the introduction of summary and shared care records. Plans remain in place within the Department and HSE to pursue this and other ICT related initiatives.
518. Deputy Colm Burke asked the Minister for Health if consideration will be given to providing a standardised approach to electronic hospital discharges on a nationwide basis, to be delivered using health-mail which is a secure email source to dramatically improve patient care which would lead to many efficiencies, both within hospitals and the community. [46996/22]
Amharc ar fhreagraDeveloping a standardised approach to the provision of electronic discharges is something the department is considering and indeed has engaged with the HSE on as part of the Sláintecare programme. There are some sites that already issue discharges electronically - some are simple notifications of discharge whilst others are full discharge notes. Bringing more consistency to the discharge process and associated discharge notes (including clear information on medications) is recognised as a patient safety issue which also enables better continuity of care between the acute and community health settings. Whether 'Healthmail' (which was used to good effect during to pandemic to enable the electronic transfer of prescriptions from GPs to community pharmacy), 'Healthlink' (used for electronic referrals and in many electronic discharge solutions today), or some other technical solution for sending the discharge is not the key issue - the challenge is improving the current discharge process and bringing some consistency to that across all departments in all hospitals before overlaying the technology. If the former is not done first, then we will continue to see inconsistency in terms of the content and layout of information provided when patients are discharged from hospital. The Department will continue to engage with the HSE in relation to this topic, in the context of Sláintecare health service reform, better integrated care, patient safety and the eHealth agenda.
519. Deputy Colm Burke asked the Minister for Health if additional resources will be applied to general practices to enable sessional psychological and counselling services to be financed; and if he will make a statement on the matter. [46997/22]
Amharc ar fhreagraGPs are private practitioners, most of whom hold a GMS contract with the HSE for the provision of medical services to medical card and GP visit card holders without charge. Under the GMS contract, GPs are to provide eligible patients with "all proper and necessary treatment of a kind usually undertaken by a general practitioner". While GPs will often be the first point of contact for patients experiencing psychological or mental health difficulties, rather than providing long-term counselling support patients can be referred to dedicated mental health supports.
The HSE National Counselling Service (NCS) is available free of charge across the country to residents in the Republic of Ireland. The aim of the NCS is to support clients to improve their quality of life and reduce their psychological distress through the provision of evidence-based, professional, client centred counselling.
The Counselling in Primary Care (CIPC) service provides time limited counselling to adult medical card holders experiencing mild to moderate psychological and emotional difficulties such as: depression, anxiety, panic reactions, relationship problems, loss issues, stress. Counselling approaches include person centred, cognitive behavioural, psychodynamic, integrative and supportive therapies. Referral to CIPC is through a GP or local primary care team.
HSE Child and Adolescent Mental Health Services (CAMHS) provide assessment and treatment for young people and their families who are experiencing mental health difficulties. CAMHS provides specialist mental health treatment delivered through a multidisciplinary team and access is provided through GP referral.
Furthermore, there are a range of resources available for adults and children with mental health difficulties provided by agencies with the support of the HSE, most of which can be accessed without GP referral.
520. Deputy Colm Burke asked the Minister for Health if there will be an increase in the number of allied primary care professionals, including psychologists, community psychiatric nurses and mental health therapists in the health system; and if he will make a statement on the matter. [46998/22]
Amharc ar fhreagraMy officials review and consider pre-budget submissions received as part of the budgetary planning process each year. Currently, the Department is engaging in dialogue with the Department of Public Expenditure and Reform and the HSE in relation to the 2023 Estimates. Until these discussions are concluded it would not be appropriate for me to comment on this matter. However, I am committed to ensuring the continued enhancement of mental health services through the allocation of additional funding for mental health in 2023.
The Government’s clear commitment to enhancing mental health services, is shown by significant mental health funding increases in recent years. I would note for the Deputy that 2022 saw a record budget for mental health of €1.149 billion, including €24 million for new developments, €10 million for mental health initiatives in response to COVID-19 and €13 million for existing levels of service.
This Budget, which is the largest mental health budget in the history of the state, is supporting the continued implementation of new developments under our national mental health policy, Sharing the Vision, including out of hours supports, CAMHS services, crisis resolution team, the national clinical programmes, and specialist mental health services for older people.
The additional once off €10 million for mental health supported the following work. €1m of this was provided for MyMind to continue to deliver free of charge counselling sessions, to clients impacted negatively by the COVID-19 pandemic. This scheme has been extended to those affected by the Ukrainian crisis and defective concrete blocks in Donegal and Mayo. €1m was also provided to Mental Health Ireland to manage a grant scheme on behalf of the Department for community and voluntary agencies promoting mental health and wellbeing.
Funding allocated to mental health services in recent years has allowed for the continued investment in the mental health national clinical programmes and models of care, which has led to significant service improvements, including the full implementation of specialist perinatal mental health network provided for and the on-going expansion of specialist mental health teams for eating disorders, ADHD in adults, and dual diagnosis.
Importantly, as budgets increase, we need to ensure that we have plans and strategies in place so that those resources are used effectively and efficiently to the benefit of people using our mental health services. All aspects of mental health services are being improved and developed, through Sharing the Vision in the short to longer term. Sharing the Vision aims to enhance the provision of mental health services and supports across a broad continuum, from mental health promotion, prevention, and early intervention to acute and specialist mental health service delivery, during the period 2020-2030.
522. Deputy Michael Healy-Rae asked the Minister for Health if a child (details supplied) will be called for a medical appointment; and if he will make a statement on the matter. [47001/22]
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.
523. Deputy Gary Gannon asked the Minister for Health the amount of the €200 million allocated to the HSE for waiting lists has been spent to date in 2022; the amount spent in private and public hospitals; and if he will provide a breakdown of the spend in each hospital. [47005/22]
Amharc ar fhreagraThe 2022 Waiting List Action Plan was launched with €350m of funding on 25 February this year following extensive engagement between my Department, the HSE and the National Treatment Purchase Fund (NTPF).
The Action Plan contains 45 actions to reduce and reform waiting lists across four main areas of work: delivering capacity, reforming scheduled care, enabling scheduled care reform, and addressing community care access and waiting lists. One of these actions is to develop and agree a multi-annual waiting list reduction plan to support the achievement of the Government maximum wait time targets.
Implementation of the Action Plan is being governed by a Waiting List Task Force, co-chaired by the Secretary General of the Department of Health and CEO of the HSE, who are meeting regularly.
As of the end of August, the HSE reported that it has spent €58.7 million of the €200 million allocated under the 2022 Waiting List Action Plan. This includes €29.1 million spent on additional inpatient / day case (IP/DC) procedures, €6.2 million on additional outpatient appointments (OPD), €7.5 million on additional gastrointestinal endoscopy (GI) scopes, and €400,000 on diagnostics.
In addition, €10.8m has been spent on additional activity to reduce community waiting lists (including orthodontics, primary care child psychology, counselling in primary care, child and adolescent mental health services (CAMHS)), €800,000 on Faecal Immunochemical Test (FIT) teams, €2.7 million on the Scheduled Care transformation team, €900,000 on administration staff for validation in hospitals, and €300,000 has been spent on reform support (mainly ICT related).
A detailed breakdown of the amount spent in private and public hospitals has been requested from the HSE and will be provided once received.
524. Deputy Jennifer Murnane O'Connor asked the Minister for Health if there are plans to support general practitioners and dentists to begin to accept new patients covered by medical cards; and if he will make a statement on the matter. [47016/22]
Amharc ar fhreagraWhile medical card and GP visit card holders that experience difficulty in finding a GP to accept them as a patient can be assigned to a GP's GMS patient list by the HSE, I am aware that general practice workforce issues can impede access to GP services in certain areas. To increase the number of GPs in Ireland, the Government has provided significant further investment and taken steps to make general practice a more attractive career choice.
Under the 2019 GP Agreement additional annual expenditure provided for general practice has to date been increased by €206.6m and is set to increase to €211.6m per annum next year when the Agreement is fully rolled out. This provides for significant increases in capitation fees for participating GMS GPs, and new fees and subsidies for additional services. Improvements to GP’s maternity and paternity leave arrangements, increased rural practice supports and a support for GPs in disadvantaged urban areas, have also been provided for.
The number of GPs entering training has increased steadily over the past number of years, rising from 120 in 2009 to 258 in 2022. The transfer of GP training from the HSE to the Irish College of General Practitioners (ICGP) which was concluded in 2021 will allow for the introduction of a new service model for GP training in Ireland and the further expansion GP training capacity in the years ahead. The ICGP aims to have 350 training places available for new entrants per year by 2026.
The Dental Treatment Services Scheme (DTSS) provides dental care free of charge to medical card holders aged 16 and over. In response to concerns that medical card patients in some parts of the country have been experiencing problems in accessing dental services, I secured an additional €10 million in Budget 2022 to provide for expanded dental health care for medical card holders including the reintroduction of Scale and Polish. To address the concerns of contractors about the Scheme, I am using an estimated €16 million of an underspend in this year’s estimate allocation (€56 million) to award fee increases across a number of items including fillings. The combination of these two measures represents an estimated total additional investment of €26 million in the Scheme this year over and above what was spent on the Scheme in 2021, €40 million.
Following consultation with the Irish Dental Association, these new measures came into effect on 1st May. I would hope that this substantial additional investment in the Scheme will encourage more and more dentists to provide care to medical card patients. The numbers of patients being seen and the numbers of treatments being provided under the DTSS have started to increase in recent months. Patients are also accessing the preventative scale and polish which has been reintroduced, which is a positive development.
525. Deputy Jennifer Murnane O'Connor asked the Minister for Health if he will report on the provision of a new ambulance base in Carlow; and if he will make a statement on the matter. [47017/22]
Amharc ar fhreagraAs the Health Service Executive is responsible for the delivery of public healthcare infrastructure projects, I have asked the HSE to respond to you directly in relation to this matter.
526. Deputy Jennifer Murnane O'Connor asked the Minister for Health the circumstances under which medical card patients are exempt from charges for phlebotomy services; if he finds it acceptable that medical card patients are being charged a €15 courier fee to deliver bloods to a centralised location; and if he will make a statement on the matter. [47018/22]
Amharc ar fhreagraUnder the terms of the current GMS contract, GPs are required to provide eligible patients with ''all proper and necessary treatment of a kind usually undertaken by a general practitioner and not requiring special skill or experience of a degree or kind which general practitioners cannot reasonably be expected to possess". Persons who hold a medical card or a GP visit card are not subject to any co-payments or other charges in respect of such services including GP consultations.
The issue of GPs charging GMS patients for phlebotomy services (blood tests) is complex given the numerous reasons and circumstances under which blood tests are taken. Clinical determinations as to whether a blood test should taken to either assist in the diagnosis of illness or the treatment of a condition are made by the GP concerned. There is no provision under the GMS GP contract for persons who hold a medical card or GP visit card to be charged for such blood tests. In addition, blood tests undertaken in the context of services provided under the GP Chronic Disease Management programme are covered by the fees paid to GPs by the HSE for this care.
Where a patient who holds a medical card or GP visit card believes he or she has been incorrectly charged for routine phlebotomy services by his or her GP, or has been charged for a blood test provided under the Chronic Disease Management programme, then that patient should report the matter to their HSE Local Health Office. The local management, upon being notified of potential inappropriate charging of GMS patients, carry out an investigation into each complaint and will, where appropriate, arrange for a refund of charges incorrectly applied by the GP.
