Written Answers Nos. 360-381
360. Deputy Bernard J. Durkan asked the Minister for Health if and when full medical cards may be restored in the case of two persons (details supplied) whose medical needs are numerous and demanding; and if he will make a statement on the matter. [52645/22]
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.
361. Deputy Bernard J. Durkan asked the Minister for Health if and when a full medical card may issue in the case of a person (details supplied); and if he will make a statement on the matter. [52650/22]
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.
362. Deputy Bernard J. Durkan asked the Minister for Health if and when a medical card might issue in the case of a person (details supplied); and if he will make a statement on the matter. [52652/22]
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.
363. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the delivery of health services in the community and throughout the hospital service is geared to meet the challenges of the coming winter; and if he will make a statement on the matter. [52666/22]
Amharc ar fhreagraThe HSE Winter Plan for 2022-23 was published on the 11th of October. The Plan will support acute and community services this winter to respond to anticipated high levels of emergency attendances and admissions across the acute sector, long waiting times in EDs, and high occupancy rates in acute hospital settings.
The plan is estimated to cost up to €169 million to implement. Key measures of the plan include:
- the recruitment of 51 emergency medicine consultants and associated support staff
- an overall recruitment of an additional 608 whole time equivalents of a mix of different professions across the hospital system
- increased community intervention teams, GP supports and out of hours services to reduce the need for attendances at EDs
- increased community services for mental health, disability and palliative care
- increased community and acute diagnostics
- expansion of ambulance services, including the completion of 9 pathfinder teams to improve ambulance turnaround times
- a fund to support local, site-specific initiatives
The Winter Plan 2022/23 adopts a bottom-up approach with bespoke local plans that seek to address hospital-specific issues in conjunction with Community Healthcare Organisations.
The full Winter Plan 2022/23 is available on the HSE website (Winter Plan 2022-23 (hse.ie)
364. Deputy Bernard J. Durkan asked the Minister for Health the extent to which efforts are being made to replace GPs where the incumbents have retired leaving vacancies throughout the country; the number of such vacancies; and if he will make a statement on the matter. [52667/22]
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.
Under the GMS scheme, the HSE contracts GPs to provide medical services without charge to medical card and GP visit card holders. Where a vacancy arises in a practice with a GMS contract, the HSE becomes actively involved in the recruitment process to find a replacement GP. In the interim the HSE puts in place a locum or other appropriate arrangement to maintain GP services to the communities in question.
As of the 1st of October, there are 2,529 GPs contracted to provide services under the GMS Scheme. There were 25 GMS GP vacancies, approximately 1 percent of the total number of GMS panels. It is acknowledged that certain vacancies can be difficult to fill, often in rural areas. For this reason, in addition to the more general measures taken to increase the number of GPs in the State and the significant increases in investment into general practice, specific supports are in place to support GPs in rural areas.
Under the 2019 GP Agreement, the Government is increasing annual investment in general practice by approximately 40% (€210 million) between 2019 and 2023. The Agreement provides for an increase in capitation fees for GPs, additional services, improved family arrangements as well as a targeted €2 million fund to support to practices in deprived urban areas.
An enhanced supports package for rural GP practices was introduced previously to support rural GPs, these supports have been increased by 10% under the 2019 GP Agreement. In addition, practices in receipt of rural practice supports attract the maximum allowable rates for practice staff support subsidies and locum contributions for leave taking. Specific fees are also in place for dispensing doctors (who operate in rural areas), these have been increased by 28% under the Agreement.
A steady increase has been seen in the number of doctors entering GP training over recent years, rising from 120 in 2009 to 258 in 2022. Following, the transfer of 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.
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.
My Department and the HSE are preparing to commence shortly 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 sustainable general practice.
365. Deputy Bernard J. Durkan asked the Minister for Health the extent to which nursing staff throughout the public hospital staff is adequate or otherwise to meet the requirements; and if he will make a statement on the matter. [52668/22]
Amharc ar fhreagraIn 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.
366. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the number of consultant vacant positions are being filled as a matter of urgency in order to meet the challenges of the coming winter and the future in the health services; and if he will make a statement on the matter. [52669/22]
Amharc ar fhreagraIn 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.
367. Deputy Bernard J. Durkan asked the Minister for Health the degree to which the regulations relating to junior hospital doctors such as emergency taxation arising from relocation are being updated to avoid same; and if he will make a statement on the matter. [52670/22]
Amharc ar fhreagraFor some NCHDs, the rotation between different parts of the HSE, and / or between employers (HSE to Voluntary organisation or one Voluntary organisation to another), may lead to them being subject to emergency tax provisions. Typically each employer has a single ERN, however due to its scale and historic make-up, the HSE has a number of Employer Registration Numbers. This can result in the application of emergency tax after a rotation.
I have written to the HSE asking that this issue be resolved through the establishment of a single payroll system. The HSE has confirmed it is committed to addressing the issue as a priority and has commenced arrangements to do so.
368. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the various changes and requirements needed to fully introduce Sláintecare are being pursued at present; and if he will make a statement on the matter. [52671/22]
Amharc ar fhreagraFor some NCHDs, the rotation between different parts of the HSE, and / or between employers (HSE to Voluntary organisation or one Voluntary organisation to another), may lead to them being subject to emergency tax provisions. Typically each employer has a single ERN, however due to its scale and historic make-up, the HSE has a number of Employer Registration Numbers. This can result in the application of emergency tax after a rotation.
I have written to the HSE asking that this issue be resolved through the establishment of a single payroll system. The HSE has confirmed it is committed to addressing the issue as a priority and has commenced arrangements to do so.
369. Deputy Bernard J. Durkan asked the Minister for Health the extent to which Sláintecare provisions are currently embedded in the health service, with particular reference to the need to ensure regional representation on the Board of the HSE; and if he will make a statement on the matter. [52672/22]
Amharc ar fhreagra370. Deputy Bernard J. Durkan asked the Minister for Health the extent to which patients seeking a scoliosis surgery have been accommodated in the past twelve months; the degree to which it is now proposed to accelerate the programme; and if he will make a statement on the matter. [52673/22]
Amharc ar fhreagraI propose to take Questions Nos. 369 and 370 together.
The Government is fully committed to achieving the Sláintecare vision of a universal single-tier health and social care system in which the people of Ireland can access the right care in the right place at the right time, regardless of their ability to pay.
To this end, the Sláintecare Programme Board was established by the Minister in late 2021. It is chaired by the Secretary General of the Department of Health and the CEO of the HSE. The Board ensures that Sláintecare implementation is fully embedded and owned across the Department of Health and the HSE. The Board engages with the Joint Committee on Health on a regular basis.
The Sláintecare Implementation Strategy 2021-2023, and the 2022 Sláintecare Action Plan are focused on two reform programmes:
1. Improving Safe, Timely Access to Care and Promoting Health & Wellbeing, and
2. Addressing Health Inequalities — towards Universal Healthcare
Despite the ongoing challenges presented by COVID-19 and a major cyber-attack, learnings were made and significant Sláintecare reform and innovation is being delivered across our health and social services. Innovations and reforms have been made across a wide number of areas including community care, integrating care pathways, eHealth, increasing capacity, strategic organisation, healthy living, including:
- We recruited over 2,158 staff to the Enhanced Community Care Programme, and we established 18 of the 19 Community Care Local Development Officers. The Home Support Pilot integrates GPs with community teams in 4 Community Health Care Networks. We established 90 of the planned 96 CHNs. Services to Older Persons and those with Chronic Disease are now provided by 33 new Community Specialist Teams. Timely community or home care is provided by 21 new Community Intervention Teams, reducing hospital admissions, and waiting lists.
- Opening new Primary Care Centres (PCCs) brought their total number to 152. The GP Chronic Disease Management (CDM) Programme and the GP Access to Diagnostics programmes are ongoing. The Opportunistic Case Finding (OCF) and Prevention Pilot Programmes are using a Population Segmentation approach to apply bespoke interventions for those at risk, reducing ED attendance and waiting lists. Funding of €350m for 45 actions will further reduce waiting lists and initiate long-term reforms in acute care.
- Preliminary Business Cases were completed for new elective centres in Cork and Galway are at the final stage of review and a Memorandum for Government expected to be presented for consideration in the very near future.
- Sláintecare Integration Funding (SIF) of €28 million delivered 106 successful HSE and NGO projects that have been either mainstreamed or scaled by the HSE. Appraisal of applications for a second round of funding is underway with decisions on successful applicants due in the near future.
- Progress on strategic change is shown by strong support for the implementation of the six Regional Health Areas. The RHA Implementation Team is comprised of senior members of the HSE, DoH, and DCEDIY staff working across six different workstreams along with colleagues from the Hospital Groups and CHOs for the RHA design and implementation phase. To note, the RHAs will serve one population in one region with one budget as formal regional divisions of the HSE, and as such, RHAs will report to the HSE Board. This policy direction balances the need for national consistency with regional autonomy and associated accountability. This will ensure national policies can be implemented consistently and disruption to the system will be minimised as we make this transition. This is in line with core Sláintecare.
Detailed progress on implementing Sláintecare to date is contained in the published progress reports and are available on the Government website (please see link: gov.ie - Sláintecare: Publications (www.gov.ie)). Voices of patients recorded in the Sláintecare 2021 end-of-year report, demonstrate how Sláintecare is improving people’s lives. They illustrate the outstanding work being done throughout the health system to adapt, to innovate and to move towards the provision of integrated services that put patients first.
The government remains strongly committed to implementing the health reform and will continue to focus on the implementation of Sláintecare.
371. Deputy Bernard J. Durkan asked the Minister for Health the number of primary care centres fully operational in County Kildare and throughout the country at the present time; and if he will make a statement on the matter. [52674/22]
Amharc ar fhreagraPrimary Care Centres are an essential part of our Government’s significant investment to date in the delivery of high quality, integrated care to people in their own communities, as evidenced by the 160 operational Primary Care centres nationwide.
There are 8 Primary Care Centres operational in County Kildare – Athy/Castledermot, Celbridge, Clane/Kilmeague, Kilcock, Kildare Town, Naas, Newbridge and Rathangan.
In addition to those outlined, locations have been identified for the provision of Primary Care Centres in Maynooth and Leixlip.
Both of these projects are at the early planning stages.
372. Deputy Bernard J. Durkan asked the Minister for Health the degree by which it is intended to reduce the numbers on hospital waiting lists by whatever means over the next twelve months; and if he will make a statement on the matter. [52675/22]
Amharc ar fhreagraPrimary Care Centres are an essential part of our Government’s significant investment to date in the delivery of high quality, integrated care to people in their own communities, as evidenced by the 160 operational Primary Care centres nationwide.
There are 8 Primary Care Centres operational in County Kildare – Athy/Castledermot, Celbridge, Clane/Kilmeague, Kilcock, Kildare Town, Naas, Newbridge and Rathangan.
In addition to those outlined, locations have been identified for the provision of Primary Care Centres in Maynooth and Leixlip.
Both of these projects are at the early planning stages.
373. Deputy Jim O'Callaghan asked the Minister for Health his response to correspondence (details supplied) in relation to nursing students; and if he will make a statement on the matter. [52677/22]
Amharc ar fhreagraA key Government priority is to protect and support the education of all students, including student nurses and midwives. Undergraduate nursing and midwifery education programmes require students to undertake mandatory practice placements as a key requirement for the attainment of clinical competencies. These mandatory practice placements account for over 50% of the entire four-year undergraduate programme. Placement sites are chosen by the undergraduate programme provider to best support the student to acquire specific clinical competencies. The variances in the distance students are required to travel depends on the undergraduate programme the student is undertaking, the location of that programme and the availability of placements.
Practice placements for student nurses and midwives account for 81 weeks of the entire four-year undergraduate programme and students have a minimum of 4 hours protected time for reflection each week throughout the undergraduate programme. However, 36 weeks (internship) of these occur during the fourth year. The salary for student nurses and midwives on their final-year internship placement has increased and now stands at €23,416 (annualised) for general nursing and midwifery students and €23,911 (annualised) for psychiatric nursing students. The salary is reflective of the increased level of responsibility for care delivery that the internship period facilitates while remaining part of the students clinical learning requirement.
The remaining 45 weeks of mandatory supernumerary practice placements occur from year 1 of the programme right through to the first semester of year four. Student nurses and midwives are entitled to claim a reimbursement of necessarily incurred travel expenses while attending practice placements. The Deputy will be aware that, aside from being able to recoup travel cost incurred while attending practice placements, the Transport For Ireland (TFI) 90 Minute Fare has reduced to €1.00 for young adults (19-23) and students. This is a substantial reduction which benefits all students, including student nurses and midwives as they travel between home, college, and elsewhere. Some students require overnight accommodation away from their normal place of residence in order to attend some of their clinical placements. The current overnight accommodation allowance for students is capped at €100 per week, up from €50.79 per week which was the amount from 2004 until September 2021 (receipts are required).
On 4 November 2021, following the publication of Longer-Term Review of Matters relating to Student Nurses and Midwives, an independent review, conducted by Mr. Seán McHugh at my request (McHugh Report), I announced that the Government had approved my proposal to provide significant additional supports, worth €12m, for student nurses and midwives while attending their clinical placements. Among these temporary measures, I extended the Pandemic Placement Grant (PPG) of €100 per week to all eligible nursing and midwifery students on supernumerary placement to the end of the academic year 2021/22.
I also announced additional support to nursing and midwifery students who require overnight accommodation away from their normal place of residence in order to attend some of their clinical placements. I doubled the cap on the vouched accommodation allowance to €100 per week of placement. Student nurses and midwives (for Academic Year 2021/22) on paid internship placement received additional financial support (50% of the PPG: totalling to €1,800 for the academic year) for the duration of their internship, from 1 January 2022.
These additional supports arose following the publication of the McHugh report which set out a number of recommendations, including an enhanced Travel and Subsistence scheme for students while attending their supernumerary clinical placements. As this is a significant departure from the current position, I have committed to bringing a further proposal to Government setting out how to deal with this recommendation with effect from the start of the 2022/2023 academic year. Along with my Department I have considered a number of options in relation to this recommendation so that an enhanced scheme can shortly be put in place that will provide a targeted and more equitable approach to supporting students in undertaking their supernumerary clinical placements.
374. Deputy Peter Fitzpatrick asked the Minister for Health the average wait time in County Louth for a hip replacement; and if he will make a statement on the matter. [52683/22]
Amharc ar fhreagra376. Deputy Peter Fitzpatrick asked the Minister for Health if he will confirm whether the proposed tax on concrete and concrete products will incur additional cost with regard to the development of the new children’s hospital; and if he will make a statement on the matter. [52686/22]
Amharc ar fhreagraThe National Paediatric Hospital Development Board (NPHDB) has statutory responsibility for planning, designing, building and equipping the new children's hospital. I have therefore referred your question to the NPHDB for direct reply.
377. Deputy Peter Fitzpatrick asked the Minister for Health if there is a funding stream available for those in palliative care or those with medical devices that increases their electricity bills to support them in paying these bills; and if he will make a statement on the matter. [52687/22]
Amharc ar fhreagraThe Government is committed to providing accessible and affordable health care.
The Health Service Executive (HSE) provides a wide range of medical and surgical aids and appliances, free of charge to eligible persons following assessment by a relevant health professional.
Palliative care can be provided at home, in hospitals, in community settings and nursing homes as well as hospices and there are a range of aids and appliances available to meet their needs in each of these settings. Individuals living in the community who are attending palliative care services enjoy the same access to community services as other members of the community.
There are also a range of schemes that assist individuals in meeting their medical costs.
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. In accordance with the provisions of the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE. Medical card eligibility is primarily based on an assessment of means and is not granted on the basis of any particular condition.
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, which entitles the applicant to GP visits without charge.
The Drug Payment Scheme (DPS) ensures that no individual or family pays more than €80 a month towards the cost of approved prescribed medicines. The DPS significantly reduces the cost burden for families and individuals with ongoing expenditure on medicines who are not eligible for a medical card.
Individuals may also be entitled to claim tax relief on the cost of their medical expenses, including medicines prescribed by a doctor, dentist, or consultant. Relief is at the standard tax rate of 20%.
The Department of Social Protection administer the Supplementary Welfare Allowance (SWA) Scheme and the Fuel allowance, which may assist individuals with their energy costs. Further information on these can be found at:
www.gov.ie/en/collection/d5554-supplementary-welfare-allowance/
www.gov.ie/en/service/00aa38-fuel-allowance/.
Finally, as announced in Budget 2023, every household in Ireland will receive three €200 energy credits, totalling €600, towards the costs of their electricity over the coming months.
378. Deputy Michael Creed asked the Minister for Agriculture, Food and the Marine the expected average annual payment for farmers participating in the agri-climate rural environmental scheme; and if he will make a statement on the matter. [52514/22]
Amharc ar fhreagraUnder Ireland’s CAP Strategic Plan 2023 – 2027, the Agri-Climate Rural Environment Scheme or ACRES has been developed. ACRES is now open for applications until 21st November 2022.
ACRES is expected to deliver significant long-term environmental improvement through participation by a significant number of farmers in the Scheme. Using a habitats-based approach, delivered through both multi-functional prescription and results-based actions, ACRES aims to contribute significantly to achieving improved biodiversity, climate, air and water quality outcomes.
The Scheme has two approaches:
- ACRES Co-operation Project (CP), which applies in eight mapped zones that are areas of high nature value, hold significant carbon stores and are home to some of the most pristine waters in the country. Farmers participating in this approach will have the assistance of a local Co-operation Project (CP) Team, who will assist with implementation of the scheme at local level.
- ACRES General, for all other farmers not falling within CP Zones.
Based on learnings from other results-based schemes trialled by the Department and experience in GLAS, the average annual payment is estimated to be approximately €7,000 for farmers in the ACRES CP measure and €5,000 for farmers in the ACRES General measure.
379. Deputy Michael Creed asked the Minister for Agriculture, Food and the Marine the number of farmers whose participation in GLAS will expire in the current calendar year; the number of farmers expected to be accommodated in the new agri-climate rural environment scheme; the funding available for this scheme; and if he will make a statement on the matter. [52515/22]
Amharc ar fhreagraThe Agri-Climate Rural Environment Scheme (ACRES) is the agri-environment climate measure which forms part of Ireland’s CAP Strategic Plan 2023 – 2027 and is the successor to the Green Low Carbon Agri-environment Scheme (GLAS) which was available under Ireland’s Rural Development Programme 2014-2020.
I was pleased, given the delay in negotiating and finalising the new Common Agricultural Policy (CAP) and associated regulations for the next CAP period, to have been able to offer GLAS participants an extension to the end of 2022. While over 43,500 GLAS contracts remain active, all will expire on 31 December 2022.
The Government has committed €1.5bn to ACRES over its duration, which is the largest amount ever committed to an agri-environment scheme. The budget allocation will facilitate the participation of 50,000 participants in ACRES overall. Farmers may apply for one of the approaches available under ACRES, namely the ACRES General approach or the ACRES Co-operation approach depending on the location of their holding.
It is currently envisaged that the split will be 30,000 participants in ACRES General and 20,000 participants in ACRES Co-operation – this will, however, be ultimately subject to the level of interest in each approach. The intake into the scheme will be phased, with at least two tranches, to spread the workload on advisors and enable them to allocate sufficient time for the preparation of applications, and the completion of the Farm Sustainability Plan (FSP) and selection of appropriate actions.
380. Deputy Paul Kehoe asked the Minister for Agriculture, Food and the Marine the projected area of afforestation which will be planted in November and December 2022; and if he will make a statement on the matter. [52542/22]
Amharc ar fhreagra390. Deputy Paul Kehoe asked the Minister for Agriculture, Food and the Marine the area of GPC3 afforestation approved since 1 January 2021 which has not yet progressed to planting; and if he will make a statement on the matter. [52607/22]
Amharc ar fhreagraI propose to take Questions Nos. 380 and 390 together.
Considering the voluntary nature of the Scheme, it is not possible to determine the area that will be planted in November and December.
However, there are currently valid licences issued for approximately 7,000ha that could be utilised before the end of 2022. Of these 3,417ha represents 1,048 applications with a GPC3 component, approved since 1st January 2021.
The Department wrote out to all applicants with a valid licence in February this year encouraging them to utilise their licence and I would encourage anyone with a valid afforestation licence to contact their forester and arrange planting.
Positive messaging around the benefit of afforestation is the responsibility of all, particularly those with a direct line of communication to farmers and landowners. I am aware that some applicants are keen to have certainty in relation to transitional arrangements in terms of the new Forestry Programme. We are in dialogue with the European Commission on the matter and I expect to be in a position to clarify arrangements in the near future.
381. Deputy John McGuinness asked the Minister for Agriculture, Food and the Marine if the cap on work permits in the meat processing sector will be increased as a matter of urgency given that some companies in the sector are experiencing a shortage of skills and are being forced to recruit abroad; and if he will make a statement on the matter. [52557/22]
Amharc ar fhreagraArising from ongoing engagement with sector stakeholders, my Department is in regular contact with the Department of Enterprise, Trade and Employment (DETE) regarding the labour shortages that exist in certain sub-sectors of agri-food, including meat processing.
The Deputy will be aware that DETE has lead responsibility for this issue and in November 2021 announced quotas of 500 general employment permits for meat deboners and 1,500 for meat processing operatives, along with other quotas for the agriculture sector. An additional quota extension of 425 meat processing operative permits was also established in June 2022. DETE has advised that they continue to keep the employment permits system under review in light of changing labour market circumstances and the timing of future quota allocations will be kept under consideration.
While this is one method for helping to fill labour shortages, it should be considered as a last resort. The Department of Social Protection are involved in helping employers recruit from the domestic and European labour market. Sectors also need to have appropriate labour attraction and retention policies in place.
The new Food Vision 2030 strategy includes a goal to “Attract and Nurture Diverse and Inclusive Talent” and this recommends actions for the sector, including that employers in the agri-food industry will develop an education, skills and talent attraction and retention strategy. I look forward to progressing these actions with the sector through the Food Vision implementation process.
