Written Answers Nos. 751-770
751. Deputy Róisín Shortall asked the Minister for Health the number of children on a school dental screening service waiting list by age, wait time, LHO and CHO in each of the years 2018 to 2021 and to date in 2022, in tabular form. [58081/22]
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.
752. Deputy Paul Kehoe asked the Minister for Health if he will provide a breakdown of the number of staff in each children's disability network team in Dublin north and county, including social workers, psychologists, speech and language therapists, occupational therapists and so on, by full-time equivalent; and if he will make a statement on the matter. [58086/22]
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.
753. Deputy Pádraig Mac Lochlainn asked the Minister for Health if he will ensure that a bed will be made available in Galway University Hospital for a person (details supplied) in County Donegal; and if he will make a statement on the matter. [58088/22]
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.
754. Deputy Catherine Connolly asked the Minister for Health his plans to open a walk-in warfarin clinic in Galway; and if he will make a statement on the matter. [58115/22]
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.
755. Deputy Catherine Connolly asked the Minister for Health the consideration that has been given to the reimbursement of international normalised ratio test strips and machines for warfarin patients, in view of the considerable upfront, as well as long-term, financial costs of treatment; and if he will make a statement on the matter. [58116/22]
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.
756. Deputy Catherine Connolly asked the Minister for Health his plans to add antiphospholipid syndrome to the list of medical conditions that qualify under the long-term illness scheme; and if he will make a statement on the matter. [58117/22]
Amharc ar fhreagra757. Deputy Catherine Connolly asked the Minister for Health his plans to add lupus to the list of medical conditions that qualify under the long-term illness scheme; and if he will make a statement on the matter. [58118/22]
Amharc ar fhreagraI propose to take Questions Nos. 756 and 757 together.
The Long-Term Illness (LTI) scheme was established under Section 59(3) of the Health Act 1970 (as amended). Regulations were made in 1971, 1973 and 1975, prescribing 16 illnesses covered by the scheme. These are: acute leukaemia; mental handicap; cerebral palsy; mental illness (in a person under 16); cystic fibrosis; multiple sclerosis; diabetes insipidus; muscular dystrophies; diabetes mellitus; parkinsonism; epilepsy; phenylketonuria; haemophilia; spina bifida; hydrocephalus; and conditions arising from the use of Thalidomide.
Under the LTI scheme, patients receive drugs, medicines, and medical and surgical appliances directly related to the treatment of their illness, free of charge.
While there are no plans currently to extend the list of illnesses covered by the LTI scheme, the scheme will be included as part of a review of the current eligibility framework, including the basis for existing hospital and medication charges, to be carried out under commitments given in the Sláintecare Implementation Strategy.
In the meantime, for people who are not eligible for the LTI scheme, there are other arrangements which protect them from excessive medicine costs.
Under the Drug Payment Scheme, no individual or family pays more than €80 a month towards the cost of approved prescribed medicines. The scheme 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. 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.
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%.
758. Deputy Mairéad Farrell asked the Minister for Health if there are plans to include lupus and antiphospholipid syndrome in the long-term illness scheme; the reason that these conditions have been excluded up until this point; and if he will make a statement on the matter. [58119/22]
Amharc ar fhreagraThe Long-Term Illness (LTI) scheme was established under Section 59(3) of the Health Act 1970 (as amended). Regulations were made in 1971, 1973 and 1975, prescribing 16 illnesses covered by the scheme. These are: acute leukaemia; mental handicap; cerebral palsy; mental illness (in a person under 16); cystic fibrosis; multiple sclerosis; diabetes insipidus; muscular dystrophies; diabetes mellitus; parkinsonism; epilepsy; phenylketonuria; haemophilia; spina bifida; hydrocephalus; and conditions arising from the use of Thalidomide.
Under the LTI scheme, patients receive drugs, medicines, and medical and surgical appliances directly related to the treatment of their illness, free of charge.
While there are no plans currently to extend the list of illnesses covered by the LTI scheme, the scheme will be included as part of a review of the current eligibility framework, including the basis for existing hospital and medication charges, to be carried out under commitments given in the Sláintecare Implementation Strategy.
In the meantime, for people who are not eligible for the LTI scheme, there are other arrangements which protect them from excessive medicine costs.
Under the Drug Payment Scheme, no individual or family pays more than €80 a month towards the cost of approved prescribed medicines. The scheme 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. 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.
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%.
759. Deputy Mairéad Farrell asked the Minister for Health the position in relation to the reimbursement of internationalised normalised ratio test strips and machines for persons who require long-term oral anticoagulant therapy with warfarin; and if he will make a statement on the matter. [58120/22]
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.
760. Deputy Éamon Ó Cuív asked the Minister for Health when a decision will be made by his Department on a project for Galway University Hospital (details supplied) that was forwarded to his Department for approval in June 2022; and if he will make a statement on the matter. [58126/22]
Amharc ar fhreagraThe proposed new Emergency Department (ED) and Women & Children’s project at University Hospital Galway (UHG) is a large and complex proposal, which is in the early stages of design development.
The delivery of capital projects is a dynamic process and is subject to the successful completion of the various approval stages, in line with the new lifecycle approach of the updated Public Spending Code (PSC).
Since there has been a very significant increase in the scale and ambition for the proposals, now costed in the hundreds of millions, they are now subject to full scrutiny of the PSC for projects in excess of €100m. These are defined processes which all Departments and agencies are subject to and must follow to ensure that Government, as the approving authority for all major projects, can be satisfied that the project is the best means to achieve a policy goal and that we achieve maximum value for money for taxpayers.
The Strategic Assessment Report (SAR) for the proposed Emergency Department (ED), Women & Children’s block at University Hospital Galway has been submitted to the Department and is currently being reviewed to ensure that it aligns with strategic policy considerations for the services proposed. If Departmental review is successful, the SAR will be submitted to the Department of Public Expenditure and Reform (D/PER) for review in due course in line with PSC Gate 0 requirements. This additional scrutiny, required under the PSC, can ensure fuller risk mitigation, early identification of potential obstacles, and smoother execution of later stages of the project lifecycle.
If approval to develop the proposal is granted, a preliminary business case can be developed by the HSE and be brought forward for PSC Gate 1 review.
In the meantime, approval was granted for an interim emergency department at UHG, including additional resuscitation spaces, support accommodation and improved infection prevention and control measures. This interim ED and associated works can also serve as enabling works for the larger proposals; freeing up the site required for the proposed new block. Practical completion of the interim ED was achieved in July 2022 and became operational in October 2022.
761. Deputy Éamon Ó Cuív asked the Minister for Health when a decision will be made by his Department on the proposal to build new elective hospitals at various locations including the Merlin Park site of Galway University Hospital; and if he will make a statement on the matter. [58127/22]
Amharc ar fhreagraIn December 2021 the Government agreed, subject to the necessary approvals and requirements under the Public Spending Code being met, a new National Elective Ambulatory Care Strategy. This new strategy aims to change the way in which day case, scheduled procedures, surgeries, scans and outpatient services can be better arranged to ensure greater capacity in the future and help to address waiting lists. The development of additional capacity will be provided through dedicated, standalone Elective Hospitals in Cork, Galway and Dublin.
The locations chosen will allow for new facilities of a size and scale to implement a national elective care programme that will tackle waiting lists on a national basis. This means that the new facilities will be designed to maximise their capacity and in doing so will operate to cover as wide a catchment area as possible, extending beyond existing and future health areas. Locating the new facilities in Cork, Dublin and Galway will enable the provision of a national service while aiming to maximise the coverage of the Elective Hospitals as far as is reasonably possible. The introduction of this new delivery capability into the Public Healthcare System will benefit the whole population, including those who do not fall within the immediate geographical catchment.
Preliminary Project Business Cases have been developed for the new Elective Hospitals in Cork and Galway and have been subject to detailed internal and external assurance. These will be presented to Government shortly for approval-in-principal at Decision Gate 1 of the Public Spending Code. Subject to passing through Gate 1, the projects can then move to Gate 2 (detailed project brief and procurement strategy). The Preliminary Project Business Case for Dublin will follow the same process in due course.
762. Deputy Michael Ring asked the Minister for Health when funding will be restored in respect of a person (details supplied); the reason no response has issued from the HSE to this query which was sent to them on 18 October 2022; and if he will make a statement on the matter. [58130/22]
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.
763. Deputy David Cullinane asked the Minister for Health if his attention has been brought to the waiting times in pain management clinic in Sligo University Hospital; if there are plans to address the capacity crisis and recruit additional staff; and if he will make a statement on the matter. [58146/22]
Amharc ar fhreagraIt is recognised that waiting times for scheduled appointments and procedures have been affected by the Covid-19 pandemic. While significant work continues to positively impact on waiting times and improve pathways to elective care, acute hospitals are still impacted by operational challenges arising from the pandemic.
The HSE has confirmed to the Department that patient safety remains at the centre of all hospital activity and elective care scheduling. To ensure services are provided in a safe, clinically-aligned and prioritised way, hospitals are following HSE clinical guidelines and protocols.
The Department of Health continues to work with the HSE and the National Treatment Purchase Fund (NTPF) to identify ways to improve access to care, including through increased use of private hospitals, funding weekend and evening work in public hospitals, funding “see and treat” services, providing virtual clinics, and increasing capacity in the public hospital system.
The 2022 Waiting List Action Plan allocates €350 million to the HSE and NTPF to reduce waiting lists. Under this plan the Department, HSE, and NTPF will deliver urgent additional capacity for the treatment of patients, as well as investing in longer term reforms to bring sustained reductions in waiting lists.
For 2023, funding of €443 million is being allocated to tackle Waiting Lists. This includes:
- €123 million in funding for delivery of the HSE Waiting List Action Plan, including priority areas such as Obesity/Bariatrics, Spina Bifida/Scoliosis and Gynaecology, as well as progressing longer-term reforms to sustainably enhance capacity. Other actions in the Action Plan will streamline and reconfigure care pathways.
- €150 million for the NTPF to procure additional capacity to reduce waiting lists.
- €90m for additional short-term measures to address acute scheduled care waiting list backlogs.
In relation to the particular queries raised, as these are service matters, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
764. Deputy David Cullinane asked the Minister for Health the waiting times for the pain management clinic at Sligo University Hospital in each of the years 2018 to 2020 and to date in 2022, in tabular form; and if he will make a statement on the matter. [58147/22]
Amharc ar fhreagraIn relation to the particular query raised by the Deputy, this information is published monthly and is available on the National Treatment Purchase Fund (NTPF) website at: www.ntpf.ie/home/nwld.htm
766. Deputy Thomas Pringle asked the Minister for Health if his attention has been drawn to the fact that the general practitioner who runs the practice in Dunkineely Health Centre, Dunkineely, County Donegal, has informed patients that the practice will close with immediate effect (details supplied); the steps that he will take to ensure that there is a replacement doctor as soon as possible; and if he will make a statement on the matter. [58159/22]
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 the issue of GMS vacancies is a service matter, I have asked the Health Service Executive to respond to the Deputy directly regarding the GP service at Dunkineely Health Centre, as soon as possible.
767. Deputy Catherine Murphy asked the Minister for Health if his attention has been drawn to matters raised in correspondence (details supplied); if he will ensure that a response issues; and if he will address the points raised. [58163/22]
Amharc ar fhreagraI can confirm that a response has issued in relation to the particular correspondence to which the Deputy is referring.
I am aware of the current pressures facing Our Lady's Children Hospital Crumlin and I wish to acknowledge the distress overcrowded Emergency Departments cause to patients, their families, and frontline staff working in very challenging conditions in the hospital.
We are experiencing a very challenging start to winter, and already our Emergency Departments are experiencing high levels of daily presentations and congestion.
The 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. Specific initiatives for Our Lady's Children Hospital Crumlin include:
- The development of a CHI Rapid Access Clinic, which will be supported by the recruitment of 1 Grade VII to work across the three CHI group sites.
- The recruitment of 2 Clinical Nurse Manager 2 positions will be recruited as ED Nursing Senior Flow Lead.
- The pilot introduction of 3 Multitask Attendants to release nursing time and improve patient flow in ED.
- The provision of funding to support use of a step-down bed across the CHI group in Laura Lynn this winter.
- The recruitment of 2 Medical Scientists to increase availability of Lab Scientists at weekends.
- The recruitment of 2 Pharmacists to increase the availability of and enhance pharmacy flow at weekends.
- Investment to increase Health and Social Care Professionals across CHI sites to enhance discharge including 1.8 Medical Social Workers, 1 Staff Grade Dietician and 2 Staff Grade Speech & Language Therapists.
- The provision of investment for a Bumbelance Kids ambulance to optimise cross hospital transfers and activity via dedicated transport across the CHI group.
- The recruitment of 1 Clinical Nurse Managed 2 as a Discharge Coordinator for community liaison.
While we are doing a huge amount to increase capacity in our health service by funding and unprecedented increase in staff and beds, I acknowledge that more needs to be done. The HSE is also developing a three-year unscheduled care improvement programme with a key focus on improving ED patient experience time. My Department is working closely with the HSE on developing this plan, which will be published in due course.
768. Deputy Duncan Smith asked the Minister for Health if he will sanction that all medical card holders be entitled to the entresto heart drug, regardless of their LVEF level, given that a person (details supplied) is finding purchasing the drug a financial burden due to their level not being below LVEF 35; and if he will make a statement on the matter. [58166/22]
Amharc ar fhreagraUnder the Health (Pricing and Supply of Medical Goods) Act 2013, the HSE has statutory responsibility for the administration of the community drug schemes; therefore, the matter has been referred to the HSE for attention and direct reply to the Deputy.
769. Deputy Duncan Smith asked the Minister for Health if he has plans to approve the drug (details supplied); the criteria used to disapprove the drug; and his views on the lack of access to the drug in Ireland, despite its widespread use across Europe for persons with compromised immune systems. [58171/22]
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.
770. Deputy Duncan Smith asked the Minister for Health his views on the situation that persons who are immunocompromised and who are prevented from ending the quarantine face, despite the lifting of Covid-19 restrictions; if his Department records data as to the number of such persons who are affected; his plans to support such persons to resume entering congregated public spaces; and if he will make a statement on the matter. [58172/22]
Amharc ar fhreagraFrom the outset, our response to the pandemic has been supported by a strong cross-Government COVID-19 oversight structure to ensure a public health-led, whole-of-society approach to the COVID-19 response.
Our approach to decision making in the pandemic has been underpinned by the core national priorities of protecting the most vulnerable in society from the severe impacts of COVID-19, minimising the burden on the healthcare system, and continuing to keep schools and childcare facilities open. The approach has also been guided by a number of core ethical principles: a duty to provide care, equity, solidarity, fairness, minimising harm, proportionality, reciprocity, and privacy.
In late 2021, our national response transitioned from a focus on regulation and population-wide restrictions to public health advice, personal judgement, and personal protective behaviours.
While Ireland’s approach to managing COVID-19 is now underpinned by individual risk assessment and personal judgement, considerable efforts continue to be made to protect vulnerable people, including those who are immunocompromised.
The Office of the Chief Medical Officer (CMO) continues to monitor COVID-19 data closely and advise the Minister for Health and Government in relation to ongoing decision-making processes in respect of the COVID-19 pandemic.
Letters from the CMO to the Minister in relation to COVID-19 are available to read here.
The CMO’s weekly epidemiological updates to the Minister are published on the Department of Health website here, along with the current key public health advice:
- Anyone who has symptoms of COVID-19 should self-isolate until 48 hours after symptoms have substantially or fully resolved – please do not attend any social events, work, school or college if you have symptoms.
- Anyone diagnosed with COVID-19 should self-isolate for 7 days from date of onset of symptoms, or if asymptomatic, date of first positive test. Anyone exiting self-isolation at day seven should continue to adhere to other public health protective measures.
- Mask wearing is advised on public transport and in healthcare settings. Mask wearing is also advised based on individual risk assessment. Anyone who wishes to wear a mask should not be discouraged from doing so. Individuals who are vulnerable to COVID-19 are further advised to be aware of the risk associated with activities they may choose to engage in and to take measures to optimally protect themselves. Vulnerable individuals are advised to consider wearing masks in crowded indoor settings, such as may relate, for example, to social gatherings or other activities and events.
- Continue to practise good hand and respiratory hygiene by washing and sanitising hands regularly and coughing/sneezing into your elbow. Maintain a physical distance where possible.
- Meet up outdoors if possible. When meeting indoors, avoid poorly ventilated spaces and keep windows open if possible.
- Many people who were infected with COVID-19 in late 2021 and earlier in 2022 will now be eligible for a booster dose of COVID-19 vaccine.
On 12th October, under the leadership of the CMO, the Department of Health published a strategic report on the management of COVID-19 for the winter period 2022/23. This report sets out the Department of Health’s strategy for the management of COVID-19 for Autumn/Winter 2022/2023 and places a particular emphasis on preparedness and contingency planning. The report has been informed by ongoing, comprehensive monitoring of the epidemiological situation, international guidance, ongoing engagement across the various functions of the Department and the HSE, and by the work of the COVID-19 Advisory Group and the Public Health Reform Expert Advisory Group. The report is available to read here.
The HSE has a webpage with advice on how those who are at higher risk can protect themselves from COVID-19, available here.
The Health Protection and Surveillance Centre (HPSC) also has detailed guidance on its website for people at risk of severe disease which includes advice about available treatments / to seek treatment early if unwell and emphasises the importance of continuing to attend other medical appointments: here
Government communication campaigns continue to emphasise the personal behaviours that protect from COVID-19, with a focus on:
- encouraging everyone to come forward for vaccines and boosters to protect not only themselves but others who they may come into contact with
- reminding of the public health advice to stay at home if sick to reduce the risk of transmission
There is also a specific strand of communication (You never know ) acknowledging that as we interact with people in our daily lives, we do not know who amongst them may be at risk from COVID-19, but we do know how to protect them: vaccination, staying home if sick, washing hands, wearing masks, and opening windows.
