Written Answers Nos. 617-639
617. Deputy Verona Murphy asked the Minister for Health the provisions that his Department has in place to have a bike station installed on the grounds of Wexford General Hospital; and if he will make a statement on the matter. [50274/22]
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.
618. Deputy Eoin Ó Broin asked the Minister for Health if there is a policy regarding the appropriate use of domestic flights in his Department and bodies under the aegis of the Department. [50120/22]
Amharc ar fhreagraMy Department has a dedicated Policy on all matters relating to official travel by staff of the Department and its Offices, including air travel. The Policy is framed on the relevant circulars and advice from the Department of Public Expenditure and Reform and reflects the general principle of achieving efficiency and value for money and minimising travel and subsistence costs. The Policy is regularly reviewed. The last such review was completed in March of this year.
In respect of the Agencies that come within my remit, they are statutorily independent in their functions and this is an operational matter for them.
619. Deputy Bernard J. Durkan asked the Minister for Health when a child (details supplied) is likely to be offered an urgent tonsillectomy having had eight infections in five months; and if he will make a statement on the matter. [49461/22]
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.
620. Deputy Michael McNamara asked the Minister for Health if Coaguchek meters and self-test strips will be provided free of charge for warfarin patients; and if he will make a statement on the matter. [49469/22]
Amharc ar fhreagraThe Health Service Executive (HSE) has statutory responsibility for pricing and reimbursement decisions, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.
In making a relevant reimbursement decision, the HSE is required under the Act to have regard to a number of criteria including efficacy, the health needs of the public, cost effectiveness and potential or actual budget impact. The Minister for Health has no role in these decisions.The HSE have advised that CoaguChek® meters and International Normalised Ratio (INR) self-testing strips are not reimbursable under the General Medical Services (GMS) scheme, the Community Drug Schemes, or the Community Funded Schemes.
Whilst a range of diagnostics are available on the HSE's formal Reimbursement List for use in Diabetes, a change in HSE policy would be required to expand this to other therapeutic areas such as INR testing ancillaries.
The HSE have further advised that on very rare occasions, CoaguChek® strips were approved for reimbursement in the most exceptional circumstances under Discretionary Hardship Arrangements where it was clear that there was no other option for the patient i.e., the person was bed bound or could not travel to the INR clinic.
621. Deputy Barry Cowen asked the Minister for Health when a person (details supplied) can expect an appointment for admission to Limerick University Hospital. [49471/22]
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.
622. Deputy Michael Healy-Rae asked the Minister for Health if a hospital appointment will be expedited for a person (details supplied); and if he will make a statement on the matter. [49472/22]
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.
623. Deputy Claire Kerrane asked the Minister for Health the supports that are being put in place for children who require urgent orthodontic care as a result of a specific issue (details supplied) where the HSE have not yet accepted responsibility for transfer of care in this situation; and if he will make a statement on the matter. [49493/22]
Amharc ar fhreagraI am concerned at the situation that has arisen for patients of the orthodontic practice in Oranmore and their families. As this case is the subject of “in camera” High Court proceedings there are restrictions on the extent of information that can be made available.
Since this situation first came to the attention of my Department, my officials have been working with stakeholders seeking assurances that everything possible is being done by relevant parties to resolve the concerns of patients affected. I met with patient representatives and local representatives on 8th September to hear their specific concerns and consider what can be done to support these patients.
On 7 October, the Dental Council issued a communication to the patients of the practice detailing the undertakings that have now been given to the High Court by the incumbent registrant. These undertakings set out the process by which patients will be referred to an alternative specialist orthodontist or orthodontists, with patient consent. While the High Court process is continuing, this is a very positive development that will facilitate the process to ensure continuity of care for patients. Fortnightly updates will be provided by the incumbent registrant or her representatives to the Dental Council, to summarise the status of this process of patient referral. I am hopeful that this process will ensure that patients are referred so that their orthodontic treatment plans can continue.
The Orthodontic Society of Ireland (OSI) is also coordinating with its members in an effort to ensure that ongoing care is restored.
I appreciate that presently parents feel that this transfer of care is taking time and are very concerned. In view of this, my officials will continue to work with stakeholders to enable and support a solution for patients.
624. Deputy Claire Kerrane asked the Minister for Health if his attention has been drawn to situations with regard to children and young people who are discharged from CAHMS where these patients are referred to a HSE healthcare centre or day hospital to be seen by a psychologist which often have long waiting lists; if he will advise the supports that are in place to prevent the patient waiting for extended periods without a doctor appointment or prescription for medication; and if he will make a statement on the matter. [49495/22]
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.
625. Deputy Seán Haughey asked the Minister for Health if adequate funding will be provided for trainee educational and child psychologists; if a working group to examine the funding of educational and child psychologists will be established; and if he will make a statement on the matter. [49504/22]
Amharc ar fhreagraThe total allocation for mental health services in 2023 is over €1.2 billion, which is another record budget for mental health services. This significant investment will enable implementation of many of the short and medium-term measures in our national mental health policy, Sharing the Vision. It will enhance the provision of mental health supports across a broad continuum from mental health promotion, prevention and early intervention, to acute and specialist mental health service delivery. The funding will enable us to continue to deliver our vital services to as many people as possible, as we move into 2023.
In relation to the HSE Mental Health care programme, €750,000 has been provided in Budget 2023 to support counselling psychology training places. This funding demonstrates the Government’s commitment to strengthen access to psychology training. Further detailed discussions will now take place between the Department and HSE to progress both this and wider commitments of the 2023 Budget in the context of preparing the HSE Service Plan 2023. In addition, the Department of Health has been advised by the Department of Education that the Minister for Education and her Department very much value the work of all educational psychologists across the education system. I understand they are working proactively and intensively to find a positive resolution for the issue of fees for trainee educational psychologists.
The Department of Health will continue to work collaboratively with the Department of Education and other Government Departments as required on the issue of workforce planning for health and social care professionals, including on future planning in terms of psychology education, training, and placement. This approach will support the implementation of Sharing the Vision.
In terms of the issues raised by the Deputy, it should be noted that there is no specific professional grade of ‘child psychologist’ within the HSE. Only three types of psychologists are recognised by the HSE, namely Clinical Psychologist, Counselling Psychologist and Educational Psychologist.
626. Deputy James Lawless asked the Minister for Health if he will examine the case of a person (details provided); if he will request additional care to be provided; and if he will make a statement on the matter. [49510/22]
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.
627. Deputy Patrick Costello asked the Minister for Health if he will provide updated figures on the number of whole-time equivalent psychologist positions filled in CAMHS given that only 92.3 of the 190 positions recommend in the vision for change model 15 years ago have been filled as of February 2022. [49512/22]
Amharc ar fhreagraAs this is an operational matter, I have asked the Health Service Executive to respond directly to the Deputy.
628. Deputy Patrick Costello asked the Minister for Health the supports that his Department and HSE are putting in place to ensure that sufficient educational and child psychologists are being trained and retained to tackle staffing issues within CAMHS. [49513/22]
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.
629. Deputy Brian Stanley asked the Minister for Health when a person (details supplied) who worked in the frontline as an unpaid trainee in the child psychology and disability services during Covid and who has received no reimbursement to date, will receive payment. [49520/22]
Amharc ar fhreagraAwaiting reply from Department.
630. Deputy Brian Stanley asked the Minister for Health when a person (details supplied) who worked in the frontline as an unpaid trainee in the child psychology and disability services during Covid and who has received no reimbursement to date, will receive payment. [49520/22]
Amharc ar fhreagraFirstly, I would like to extend my sincere gratitude to all healthcare workers for their efforts during this most challenging period.
On January 19th, the Government announced a COVID-19 pandemic recognition payment for frontline public sector healthcare workers, to recognise their unique role during the pandemic. Following extensive engagement with healthcare unions on the matter, on 19th April the HSE published eligibility guidelines and FAQs, as apply to the HSE and Section 38 agencies, which are available on its website: www.hse.ie/eng/staff/resources/hr-circulars/hr-circular-012-2022-pandemic-special-recognition-payment.html. Payment is currently receiving priority across all Hospital Groups and Community Services in the HSE.
The HSE and the Department are currently examining progressing the rollout to the list of 6 non-HSE/non-Section 38 organisation types covered by the Government Decision. This measure will be ring fenced to staff working ordinarily onsite in COVID-19 exposed healthcare environments.
It is hoped that information will be published shortly for those certain non-HSE/Section 38 healthcare employees that are covered by the Government Decision and the process available to their employers to implement this measure for their eligible staff. This shall cover eligible staff in:
Private Sector Nursing Homes and Hospices (e.g. Private, Voluntary, Section 39 etc.);
Eligible staff working on-site in Section 39 long-term residential care facilities for people with disabilities;
Agency roles working in the HSE;
Health Care Support Assistants (also known as home help / home care / home support) contracted to the HSE;
Members of the Defence Forces redeployed to work in frontline Covid-19 exposed environments in the HSE;
Paramedics employed by Dublin Fire Brigade to deliver services on behalf of the HSE.
The above 6 areas only are covered by this Government Decision and all eligible workers will be paid in accordance with the overarching eligibility criteria in place.
The Government is mindful of other workers who played an important role during this difficult period in sustaining other services. It was very tough to draw a line on this matter. In recognition of the efforts of all workers, volunteers, and the general public during the COVID-19 pandemic, and in remembrance of people who lost their lives due to the COVID-19 pandemic, the Government announced a public holiday which took place on 18 March 2022. From February next year there will also be a new permanent public holiday established to mark Imbolc/St Brigid’s Day.
631. Deputy Michael Ring asked the Minister for Health if he will provide an update in relation to a project (details supplied); if the construction work has recommenced; the estimated timeframe for when the facility will be completed in light of the construction downtime; and if he will make a statement on the matter. [49521/22]
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.
632. Deputy Rose Conway-Walsh asked the Minister for Health if he will provide details on plans to fund counselling psychology training; when the funding will be made available; the areas that the funding will cover; and if he will make a statement on the matter. [49524/22]
Amharc ar fhreagraThe total allocation for mental health services in 2023 is over €1.2 billion, which is another record budget for mental health services. This significant investment will enable implementation of many of the short and medium-term measures in our national mental health policy, Sharing the Vision. It will enhance the provision of mental health supports across a broad continuum from mental health promotion, prevention and early intervention, to acute and specialist mental health service delivery. The funding will enable us to continue to deliver our vital services to as many people as possible, as we move into 2023.
In relation to the HSE Mental Health care programme, €750,000 has been provided in Budget 2023 to support counselling psychology training places. This funding demonstrates the Government’s commitment to strengthen access to psychology training. Further detailed discussions will now take place between the Department and HSE to progress both this and wider commitments of the 2023 Budget in the context of preparing the HSE Service Plan 2023. In addition, the Department of Health has been advised by the Department of Education that the Minister for Education and her Department very much value the work of all educational psychologists across the education system. I understand they are working proactively and intensively to find a positive resolution for the issue of fees for trainee educational psychologists.
The Department of Health will continue to work collaboratively with the Department of Education and other Government Departments as required on the issue of workforce planning for health and social care professionals, including on future planning in terms of psychology education, training, and placement.
633. Deputy Claire Kerrane asked the Minister for Health if fees paid by families under the fair deal scheme will be reviewed given the high costs for families; and if he will make a statement on the matter. [49535/22]
Amharc ar fhreagra634. Deputy Claire Kerrane asked the Minister for Health the rules that are in place concerning costs under the fair deal scheme after the person has been in nursing care for three years; and if he will make a statement on the matter. [49536/22]
Amharc ar fhreagraI propose to take Questions Nos. 633 and 634 together.
The Nursing Homes Support Scheme (NHSS), commonly referred to as Fair Deal, is a system of financial support for people who require long-term residential care. Participants contribute to the cost of their care according to their means while the State pays the balance of the cost. The Scheme aims to ensure that long-term residential care is accessible and affordable for everyone and that people are cared for in the most appropriate settings. All participants within the NHSS contribute up to 80% of their income (40% if part of a couple) and 7.5% per annum of the value of their assets (3.75% if part of a couple). The first €36,000 (€72,000 if part of a couple) is excluded from assessment. Assets assessed include cash assets as well as non-cash assets such as the principal private residence, other property and land, including farmland. For the purposes of financial assessment, income includes:- Earnings, including income from farming or business activities- Pension income- Social welfare benefits/allowances- Rental income- Income from holding an office or directorship- Income from fees, commissions, dividends or interest Transferred assets and income, defined as assets or income transferred to another person up to five years before a person's application to the scheme, are also assessed. The capital value of an individual’s principal private residence is only included in the financial assessment for the first three years of their time in care. This is known as the three-year cap, which is intended to protect the value of a principal private residence. Last year, the Department of Health introduced the Nursing Homes Support Scheme (Amendment) Act 2021, which became operational in October 2021. This introduced a three-year cap on contributions from family farm and business assets, provided that a family successor is appointed to run the asset for at least 6 years. The Act also extended the three-year cap to the proceeds of sale of a principal residence, which means that, from the fourth year in care onwards and provided the house was sold while the person is in care, a nursing home resident may sell their principal private residence without incurring additional costs.
In addition, the Government has made a policy change to the NHSS to remove a disincentive for participants in the Scheme to rent out their principal residence after they have entered long term residential care. The rate of assessment on rental income from the principal residence will be reduced from 80% to 40%. This will be reviewed after six months of operation, with the potential for further amendment after that point. This policy change addresses the commitments made under Housing For All Action 19.8. The change was made through Committee-Stage amendment to the Regulation of Providers of Building Works and Building Control (Amendment) Bill 2022. The Bill was approved by the Oireachtas on 30th June and signed into law by President Higgins in July. It is expected that the necessary administrative and operational changes will soon be in place and the amendment will become fully operational shortly thereafter. It should be noted that the NHSS covers the cost of the standard components of long-term residential care which are: - Nursing and personal care appropriate to the level of care needs of the person - Bed and board - Basic aids and appliances necessary to assist a person with the activities of daily living - Laundry service - A person's eligibility for other schemes, such as the medical card scheme or the drugs payment scheme, is unaffected by participation in the NHSS or residence in a nursing home. In determining the services covered by the NHSS it was considered very important that the care recipient and the taxpayer would be protected and would not end up paying for the same services twice. For this reason, medications and aids that are already prescribed for individuals under an existing scheme are not included in the services covered by the NHSS, as this would involve effectively paying twice for the same service. Although the NHSS covers core living expenses, residents can still incur some costs in a nursing home, such as social programmes, newspapers or hairdressing. In recognition of this, anyone in receipt of financial support under the NHSS retains at least 20% of their income. The minimum amount that is retained is the equivalent of 20% of the State Pension (Non-Contributory). An operator should not seek payment from residents for items which are covered by the NHSS, the medical card or any other existing scheme.
635. Deputy Claire Kerrane asked the Minister for Health the number of beds that are in the mental health unit at Roscommon County Hospital; if there is a waiting list; the extent of same; the average time spent by a person on the waiting list; the current staffing levels in the unit; and if he will make a statement on the matter. [49537/22]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon possible.
636. Deputy James Lawless asked the Minister for Health the reason for the withdrawal of a medical card of a person (details supplied); and if he will make a statement on the matter. [49538/22]
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.
637. Deputy Maurice Quinlivan asked the Minister for Health the status of the case of a person (details supplied) who has been wanting for a hospital appointment since October 2019; and if he will make a statement on the matter. [49539/22]
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.
638. Deputy Cormac Devlin asked the Minister for Health the status of the proposed changes to the fair deal arrangements regarding the treatment of rental income; and if he will make a statement on the matter. [49568/22]
Amharc ar fhreagraThe Government has approved a policy change to the Nursing Homes Support Scheme, also known as “Fair Deal”, to remove disincentives for participants in the Scheme to rent out their principal residence after they have entered long term residential care. The rate of assessment for rental income from all principal residences will be reduced from 80% to 40%. This will be reviewed after six months of operation, with the potential for further amendment after that point. This policy change addresses the commitments made under Housing For All Action 19.8.
The change was made through Committee-Stage amendment to the Regulation of Providers of Building Works and Building Control (Amendment) Bill 2022. The Bill was approved by the Oireachtas on 30th June and signed into law by President Higgins in July. It is expected that the necessary administrative and operational changes will soon be in place and the amendment will become fully operational shortly thereafter.
639. Deputy Pádraig O'Sullivan asked the Minister for Health if he will report on the availability of a drug (details supplied); and if he will make a statement on the matter. [49572/22]
Amharc ar fhreagraI thank the Deputy for clarifying that he wishes to ask about the use of Nivolumab (Opdivo®) for the treatment of oesophageal cancer.
The HSE is committed to providing access to as many medicines as possible, in as timely a fashion as possible, from the resources available (provided) to it.
The HSE robustly assesses applications for pricing and reimbursement to make sure that it can stretch available resources as far as possible and to deliver the best value in relation to each medicine and ultimately more medicines to Irish citizens and patients.
HSE decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds.
There are formal processes which govern applications for the pricing and reimbursement of medicines, and new uses of existing medicines, to be funded and / or reimbursed.
The first step in the process is the submission of a Rapid Review dossier (a clinical and economic dossier) to the National Centre for Pharmacoeconomics (NCPE) for assessment. The NCPE may advise that a full Health Technology Assessment (HTA) is recommended, which would then be commissioned by the HSE as per the agreed processes.
The HSE Corporate Pharmaceutical Unit (CPU) is the interface between the HSE and the Pharmaceutical Industry in relation to medicine pricing and reimbursement applications.
The Drugs Group is the national committee which the HSE has in place to make recommendations on the pricing and reimbursement of medicines. The membership of the HSE Drugs Group includes public interest members. The pharmacoeconomic report will be reviewed by the HSE Drugs Group along with the outputs of commercial negotiations, and any patient group submission(s) received. The HSE Drugs Group will consider all of the evidence and make a recommendation to the HSE Executive Management Team.
The decision-making authority in the HSE is the HSE Executive Management Team. The HSE Executive Management Team decides on the basis of all the demands it is faced with (across all services) whether it can fund a new medicine, or new use of an existing medicine, from the resources that have been provided to it in line with the Health (Pricing and Supply of Medical Goods) Act 2013.
1. In terms of the specific details of the application(s) for pricing and reimbursement of Nivolumab (Opdivo®) received by the HSE (as of 10th October 2022) for licensed indications in oesophageal cancer are listed below. The HSE cannot make any comment on possible outcomes from the ongoing assessment processes.
- The HSE received an application for pricing / reimbursement of a new indication for Nivolumab (Opdivo®) monotherapy on the 14th December 2020 from BMS (the applicant) for the treatment of adult patients with unresectable advanced, recurrent or metastatic oesophageal squamous cell carcinoma after prior fluoropyrimidine and platinum-based combination chemotherapy.
- The HSE commissioned the Rapid Review process on the 15th December 2020. The assessment report was received by the HSE on the 13th January 2021. The NCPE did not recommend a full HTA and recommended this application not be considered for reimbursement at the submitted price. CPU engaged in commercial negotiations with the applicant in March 2021. The Rapid Review report?was reviewed by the HSE Drugs Group, along with the outputs of commercial negotiations. The HSE Drugs Group did not recommend in favour of reimbursement of Nivolumab (Opdivo®) for this indication at their September 2021 meeting.
2. The HSE received an application for pricing / reimbursement of a new indication for Nivolumab (Opdivo®) on the 30th June 2022 from BMS (the applicant) for Nivolumab (Opdivo®) in combination with fluoropyrimidine- and platinum-based combination chemotherapy for the first-line treatment of adult patients with unresectable advanced, recurrent or metastatic oesophageal squamous cell carcinoma (OSCC) with tumour cell PD-L1 (programmed death ligand 1) expression 1%.
- The HSE commissioned the Rapid Review process on the 1st July 2022. The assessment report was submitted to the HSE on the 29th of July 2022. The NCPE recommended a full HTA for this indication, which was commissioned by the HSE on the 31st of August 2022. The HSE Drugs Group will consider all of the evidence and make a recommendation to the HSE Executive Management Team.
3. The HSE received an application for pricing-reimbursement of a new indication for Nivolumab (Opdivo®) on the 21st September 2021 from BMS (the applicant) for Nivolumab (Opdivo®) as monotherapy for the adjuvant treatment of adult patients with oesophageal, or gastro-oesophageal junction cancer who have residual pathologic disease following prior neoadjuvant chemoradiotherapy.
- The HSE commissioned the Rapid Review process on the 21st September 2021. The assessment report was received by the HSE on the 20th October 2021. The NCPE recommended a full HTA for this indication, which was commissioned by the HSE on the 28th of October 2021. The HSE Drugs Group will consider all of the evidence and make a recommendation to the HSE Executive Management Team.
4. The HSE received an application for pricing / reimbursement of a new indication for Nivolumab (Opdivo®) on the 29th October 2021 from BMS (the applicant) for Nivolumab (Opdivo®) in combination with fluoropyrimidine- and platinum-based combination chemotherapy for the first line treatment of adult patients with HER2 negative advanced or metastatic gastric, gastro oesophageal junction or oesophageal adenocarcinoma whose tumours express PD-L1 with a combined positive score (CPS) 5.
- The HSE commissioned the Rapid Review process on the 1st November 2021. The assessment report was received by the HSE on the 29th November 2021. The NCPE recommended a full HTA for this indication, which was commissioned by the HSE on the 7th of December 2021. The HSE Drugs Group will consider all of the evidence and make a recommendation to the HSE Executive Management Team.
5. The HSE has not received an application (as of 10th October 2022) for ‘Nivolumab in combination with Ipilimumab indicated for the first-line treatment of adult patients with unresectable advanced, recurrent or metastatic oesophageal squamous cell carcinoma with tumour cell PD-L1 expression 1%’.
