Tuesday, 14 Feb 2023

Written Answers Nos. 552-569

Dental Services

Ceisteanna (552)

Kathleen Funchion

Ceist:

552. Deputy Kathleen Funchion asked the Minister for Health if a person (details supplied) can get an appointment to see a dentist as soon as possible in University Hospital Waterford. [6512/23]

Freagraí scríofa

Minister for Health

As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.

Question No. 553 answered with Question No. 537.

Ambulance Service

Ceisteanna (554)

Rose Conway-Walsh

Ceist:

554. Deputy Rose Conway-Walsh asked the Minister for Health the number of University of Limerick paramedic graduates that are recruited by the National Ambulance Service each year; the percentage of the NAS recruitment over the past five years who were graduates of UL, in tabular form; and if he will make a statement on the matter. [6522/23]

Freagraí scríofa

Minister for Health

As this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy, as soon as possible.

Ambulance Service

Ceisteanna (555)

Rose Conway-Walsh

Ceist:

555. Deputy Rose Conway-Walsh asked the Minister for Health further to Parliamentary Question No. 1180 of 18 January 2023, the reason that less than 5% of external pre-hospital emergency care council-registered qualified paramedics who applied for positions with the National Ambulance Service have been appointed, given the ongoing staffing issues at NAS; and if he will make a statement on the matter. [6523/23]

Freagraí scríofa

Minister for Health

As this is an operational matter for the National Ambulance Service (NAS) I have asked the Health Service Executive (HSE) to respond to the Deputy directly, as soon as possible.

Medicinal Products

Ceisteanna (556)

Michael Ring

Ceist:

556. Deputy Michael Ring asked the Minister for Health the process by which pregnant women experiencing extreme nausea and vomiting can obtain a drug (details supplied); and if he will make a statement on the matter. [6526/23]

Freagraí scríofa

Minister for Health

As part of Budget 2023, funding of €32.2 million was announced for Women’s Health Initiatives in 2023.

This included dedicated funding of €1.3m for Cariban® (doxylamine/pyridoxine) to help women who experience hyperemesis gravidarum, a severe form of nausea and vomiting, during pregnancy. Hyperemesis gravidarum is expected to affect about 1% of the pregnant population.

The Health Service Executive (HSE) has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drugs schemes, in accordance with the Health (Pricing and Supply of Medical Good s) Act 2013. Only licenced indications which have been granted market authorisation by the European Medicines Agency (EMA) or the Health Products Regulatory Authority (HPRA) can be added to the formal reimbursement list.

Within the European Union (EU), the pricing and reimbursement of medicines is a national competence. As Member States operate different pharmaceutical reimbursement systems across the EU, a direct comparison of the reimbursement of products is not possible. The competent authority for pricing and reimbursement in Ireland is the HSE.

Cariban® is an Exempt Medicinal Product (EMP), i.e., it is not licensed in Ireland and, therefore, cannot be added to the formal reimbursement list.

However, following the recommendations of the HSE Medicines Management Programme, and to address the unmet need of patients with hyperemesis gravidarum, reimbursement support for Cariban® (doxylamine/pyridoxine), an unlicensed Exempt Medicinal Product, has now been made available on an individual patient basis for those patients who meet the criteria and where Consultant Obstetrician initiated.

Under the community drug schemes, Exempt Medicinal Products must be Consultant initiated. However, whilst the original prescriber of Cariban® must be a consultant and specialist in the relevant field, the HSE will accept a GP prescription subsequent to the initial hospital prescription for approved patients.

The relevant HSE circular regarding the exceptional arrangement for Cariban® is available at:

www.hse.ie/eng/staff/pcrs/circulars/pharmacy/pharmacy-circular-001-23-cariban.pdf.

In order to obtain reimbursement support for Cariban® under this exceptional arrangement, the prescribing consultant must confirm whether the following apply:

- The individual has nausea and vomiting of pregnancy (NVP) which requires systemic treatment.

- The individual has been assessed using the pregnancy unique quantification of emesis and nausea (PUQE) assessment tool and the appropriate treatment algorithm has been followed.

- The individual has not responded to conservative management.

The consultant must also make an Unlicensed Product Declaration and submit the completed application form by email to the Primary Care Reimbursement Service (PCRS).

Once reviewed by the PCRS, the prescriber and dispensing pharmacy are emailed (via secure email) with the reimbursement decision. The community pharmacy then dispenses the product under the specific patient’s community drug schemes eligibility and submits the claim using the relevant administrative code in their monthly submission to PCRS.

While reimbursement support is offered on the basis of the patient’s eligibility under the General Medical Services (GMS) Scheme or the Drugs Payment Scheme (DPS), Cariban® is not on the formal reimbursement list.

This exceptional arrangement has been put in place to ensure that those patients suffering from hyperemesis gravidarum have access to Cariban®. The dedicated funding that has been allocated is based on 1% of the pregnant population requiring treatment for hyperemesis gravidarum. The number of approved applications to date is in line with expectations and indicates that the budget allocated will be used in 2023. As of 10th February 2023, the number of applications received by the Primary Care Reimbursement Service (PCRS) stands at 384.

There are three other products containing doxylamine/pyridoxine, which are licensed in Ireland:

- Xonvea® gastro-resistant tablets.

- Navalem® modified-release hard capsules.

- Exeltis® gastro-resistant tablets.

The market authorisation holder of Xonvea® has not progressed the pricing and reimbursement application further with the HSE at this stage. The market authorisation holders for Exeltis® and Navalem® have not submitted pricing and reimbursement applications to the HSE.

The HSE therefore encourages clinicians, along with the Institute of Obstetricians and Gynaecologists and the National Clinical Programme for Obstetrics and Gynaecology, other healthcare professionals, and relevant representative bodies to encourage the market authorisation holders of the licensed medicinal products (Xonvea®, Exeltis® and Navalem®) to progress with the formal pricing and reimbursement process in Ireland.

Finally, the HSE provides general advice on treatments for hyperemesis gravidarum at:

www2.hse.ie/conditions/hyperemesis-gravidarum/treatment/

Question No. 557 answered with Question No. 537.

Medicinal Products

Ceisteanna (558, 596, 627, 640)

Martin Browne

Ceist:

558. Deputy Martin Browne asked the Minister for Health if he is aware that requiring a consultant prescription for pregnant women suffering from hyperemesis gravidarum to access cariban effectively limits the reimbursement scheme to those women with private healthcare given the vast majority of pregnant women in the public system do not see their consultant. [6528/23]

Claire Kerrane

Ceist:

596. Deputy Claire Kerrane asked the Minister for Health the reason that cariban cannot be prescribed by a GP under the drugs payment scheme to ensure easier access to it for pregnant women. [6593/23]

Jackie Cahill

Ceist:

627. Deputy Jackie Cahill asked the Minister for Health the reason cariban cannot be prescribed by GPs on the DPS; and if he will make a statement on the matter. [6685/23]

Niamh Smyth

Ceist:

640. Deputy Niamh Smyth asked the Minister for Health if matters (details supplied) in relation to cariban will be addressed in the interest of pregnant women in Ireland experiencing extreme nausea; and if he will make a statement on the matter. [6721/23]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 558, 596, 627 and 640 together.

As part of Budget 2023, funding of €32.2 million was announced for Women’s Health Initiatives in 2023.

This included dedicated funding of €1.3m for Cariban® (doxylamine/pyridoxine) to help women who experience hyperemesis gravidarum, a severe form of nausea and vomiting, during pregnancy. Hyperemesis gravidarum is expected to affect about 1% of the pregnant population.

The Health Service Executive (HSE) has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drugs schemes, in accordance with the Health (Pricing and Supply of Medical Good s) Act 2013. Only licenced indications which have been granted market authorisation by the European Medicines Agency (EMA) or the Health Products Regulatory Authority (HPRA) can be added to the formal reimbursement list.

Within the European Union (EU), the pricing and reimbursement of medicines is a national competence. As EU Member States operate different pharmaceutical reimbursement systems across the EU, a direct comparison of the reimbursement of products is not possible. The competent authority for pricing and reimbursement in Ireland is the HSE.

Cariban® is an Exempt Medicinal Product (EMP), i.e., it is not licensed in Ireland and, therefore, cannot be added to the formal reimbursement list.

However, following the recommendations of the HSE Medicines Management Programme, and to address the unmet need of patients with hyperemesis gravidarum, reimbursement support for Cariban® (doxylamine/pyridoxine), an unlicensed Exempt Medicinal Product, has now been made available on an individual patient basis for those patients who meet the criteria and where Consultant Obstetrician initiated.

Under the community drug schemes, Exempt Medicinal Products must be Consultant initiated. However, whilst the original prescriber of Cariban® must be a consultant and specialist in the relevant field, the HSE will accept a GP prescription subsequent to the initial hospital prescription for approved patients.

The relevant HSE circular regarding the exceptional arrangement for Cariban® is available at:

www.hse.ie/eng/staff/pcrs/circulars/pharmacy/pharmacy-circular-001-23-cariban.pdf.

In order to obtain reimbursement support for Cariban® under this exceptional arrangement, the prescribing consultant must confirm whether the following apply:

- The individual has nausea and vomiting of pregnancy (NVP) which requires systemic treatment.

- The individual has been assessed using the pregnancy unique quantification of emesis and nausea (PUQE) assessment tool and the appropriate treatment algorithm has been followed.

- The individual has not responded to conservative management.

The consultant must also make an Unlicensed Product Declaration and submit the completed application form by email to the Primary Care Reimbursement Service (PCRS).

Once reviewed by the PCRS, the prescriber and dispensing pharmacy are emailed (via secure email) with the reimbursement decision. The community pharmacy then dispenses the product under the specific patient’s community drug schemes eligibility and submits the claim using the relevant administrative code in their monthly submission to PCRS.

While reimbursement support is offered on the basis of the patient’s eligibility under the General Medical Services (GMS) Scheme or the Drugs Payment Scheme (DPS), Cariban® is not on the formal reimbursement list.

This exceptional arrangement has been put in place to ensure that those patients suffering from hyperemesis gravidarum have access to Cariban®. The dedicated funding that has been allocated is based on 1% of the pregnant population requiring treatment for hyperemesis gravidarum. The number of approved applications to date is in line with expectations and indicate that the budget allocated will be used in 2023. As of 10th February 2023, the number of applications received by the Primary Care Reimbursement Service (PCRS) stands at 384.

There are three other products containing doxylamine/pyridoxine, which are licensed in Ireland:

- Xonvea® gastro-resistant tablets.

- Navalem® modified-release hard capsules.

- Exeltis® gastro-resistant tablets.

The market authorisation holder of Xonvea® has not progressed the pricing and reimbursement application further with the HSE at this stage. The market authorisation holders for Exeltis® and Navalem® have not submitted pricing and reimbursement applications to the HSE.

The HSE therefore encourages clinicians, along with the Institute of Obstetricians and Gynaecologists and the National Clinical Programme for Obstetrics and Gynaecology, other healthcare professionals, and relevant representative bodies to encourage the market authorisation holders of the licensed medicinal products (Xonvea®, Exeltis® and Navalem®) to progress with the formal pricing and reimbursement process in Ireland.

Finally, the HSE provides general advice on treatments for hyperemesis gravidarum at:

www2.hse.ie/conditions/hyperemesis-gravidarum/treatment/

Medicinal Products

Ceisteanna (559)

Martin Browne

Ceist:

559. Deputy Martin Browne asked the Minister for Health if he will provide in full the instructions given to consultants and midwives on the prescription of Cariban. [6529/23]

Freagraí scríofa

Minister for Health

As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.

Medicinal Products

Ceisteanna (560, 565, 588, 609, 611, 628, 633, 654, 667, 670, 671, 749)

Michael Ring

Ceist:

560. Deputy Michael Ring asked the Minister for Health the reason GPs cannot prescribe a drug (details supplied) on the drugs payment scheme considering that the majority of women in need of the medication would not be seen by their consultant until well into their second trimester; and if he will make a statement on the matter. [6530/23]

David Stanton

Ceist:

565. Deputy David Stanton asked the Minister for Health if he will allow GPs to prescribe cariban to patients under the community drugs scheme, the general medical services scheme and the drug payment scheme without it being consultant initiated; and if he will make a statement on the matter. [6537/23]

Richard O'Donoghue

Ceist:

588. Deputy Richard O'Donoghue asked the Minister for Health the drug cariban cannot be prescribed by a GP on the drugs payment scheme; and if he will make a statement on the matter. [6582/23]

Éamon Ó Cuív

Ceist:

609. Deputy Éamon Ó Cuív asked the Minister for Health the limitations on the availability of a drug (details supplied) under the drugs payment scheme; if it can be prescribed by a general practitioner; if it requires prescription by a consultant; if so, the reasons for this; and if he will make a statement on the matter. [6635/23]

Michael Moynihan

Ceist:

611. Deputy Michael Moynihan asked the Minister for Health the reasons that a GP cannot prescribe cariban to their patients through the drugs payment scheme, given that many women do not see a consultant until after 12 weeks into pregnancy and suffer from extreme nausea and vomiting in this time; and if he will make a statement on the matter. [6640/23]

Jackie Cahill

Ceist:

628. Deputy Jackie Cahill asked the Minister for Health the other options that are available to pregnant people who experience Hyperemesis Gravidarum in the first 12 weeks of pregnancy given the current inability to obtain a prescription for cariban without first being seen by a consultant; and if he will make a statement on the matter. [6686/23]

Neasa Hourigan

Ceist:

633. Deputy Neasa Hourigan asked the Minister for Health the reason cariban is only available under the community drug schemes when consultant obstetrician initiated as opposed to a general practitioner; and if he will make a statement on the matter. [6692/23]

Róisín Shortall

Ceist:

654. Deputy Róisín Shortall asked the Minister for Health if he will amend the reimbursement scheme for cariban in order that it can be prescribed by a GP; the reason only consultant obstetricians can prescribe this treatment under the drugs payment scheme, given that the majority of women do not see a consultant until they are at least 12 weeks pregnant; and if he will make a statement on the matter. [6766/23]

Pa Daly

Ceist:

667. Deputy Pa Daly asked the Minister for Health his views on allowing GPs to prescribe a drug (details supplied). [6811/23]

Thomas Pringle

Ceist:

670. Deputy Thomas Pringle asked the Minister for Health if a general practitioner will be able to make a determination and recommend the prescription of cariban; and if he will make a statement on the matter. [6814/23]

Thomas Pringle

Ceist:

671. Deputy Thomas Pringle asked the Minister for Health the reason cariban is not being made available under the drugs payment scheme; and if he will make a statement on the matter. [6815/23]

Paul Murphy

Ceist:

749. Deputy Paul Murphy asked the Minister for Health the reason cariban cannot be prescribed by a GP on the drug payment scheme; if he agrees with these reasons; and if he will make a statement on the matter. [7101/23]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 560, 565, 588, 609, 611, 628, 633, 654, 667, 670, 671 and 749 together.

As part of Budget 2023, funding of €32.2 million was announced for Women’s Health Initiatives in 2023.

This included dedicated funding of €1.3m for Cariban® (doxylamine/pyridoxine) to help women who experience hyperemesis gravidarum, a severe form of nausea and vomiting, during pregnancy. Hyperemesis gravidarum is expected to affect about 1% of the pregnant population.

The Health Service Executive (HSE) has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drugs schemes, in accordance with the Health (Pricing and Supply of Medical Good s) Act 2013. Only licenced indications which have been granted market authorisation by the European Medicines Agency (EMA) or the Health Products Regulatory Authority (HPRA) can be added to the formal reimbursement list.

Within the European Union (EU), the pricing and reimbursement of medicines is a national competence. As EU Member States operate different pharmaceutical reimbursement systems across the EU, a direct comparison of the reimbursement of products is not possible. The competent authority for pricing and reimbursement in Ireland is the HSE.

Cariban® is an Exempt Medicinal Product (EMP), i.e., it is not licensed in Ireland and, therefore, cannot be added to the formal reimbursement list.

However, following the recommendations of the HSE Medicines Management Programme, and to address the unmet need of patients with hyperemesis gravidarum, reimbursement support for Cariban® (doxylamine/pyridoxine), an unlicensed Exempt Medicinal Product, has now been made available on an individual patient basis for those patients who meet the criteria and where Consultant Obstetrician initiated.

Under the community drug schemes, Exempt Medicinal Products must be Consultant initiated. However, whilst the original prescriber of Cariban® must be a consultant and specialist in the relevant field, the HSE will accept a GP prescription subsequent to the initial hospital prescription for approved patients.

The relevant HSE circular regarding the exceptional arrangement for Cariban® is available at:

www.hse.ie/eng/staff/pcrs/circulars/pharmacy/pharmacy-circular-001-23-cariban.pdf.

In order to obtain reimbursement support for Cariban® under this exceptional arrangement, the prescribing consultant must confirm whether the following apply:

- The individual has nausea and vomiting of pregnancy (NVP) which requires systemic treatment.

- The individual has been assessed using the pregnancy unique quantification of emesis and nausea (PUQE) assessment tool and the appropriate treatment algorithm has been followed.

- The individual has not responded to conservative management.

The consultant must also make an Unlicensed Product Declaration and submit the completed application form by email to the Primary Care Reimbursement Service (PCRS).

Once reviewed by the PCRS, the prescriber and dispensing pharmacy are emailed (via secure email) with the reimbursement decision. The community pharmacy then dispenses the product under the specific patient’s community drug schemes eligibility and submits the claim using the relevant administrative code in their monthly submission to PCRS.

While reimbursement support is offered on the basis of the patient’s eligibility under the General Medical Services (GMS) Scheme or the Drugs Payment Scheme (DPS), Cariban® is not on the formal reimbursement list.

This exceptional arrangement has been put in place to ensure that those patients suffering from hyperemesis gravidarum have access to Cariban®. The dedicated funding that has been allocated is based on 1% of the pregnant population requiring treatment for hyperemesis gravidarum. The number of approved applications to date is in line with expectations and indicate that the budget allocated will be used in 2023. As of 10th February 2023, the number of applications received by the Primary Care Reimbursement Service (PCRS) stands at 384.

There are three other products containing doxylamine/pyridoxine, which are licensed in Ireland:

- Xonvea® gastro-resistant tablets.

- Navalem® modified-release hard capsules.

- Exeltis® gastro-resistant tablets.

The market authorisation holder of Xonvea® has not progressed the pricing and reimbursement application further with the HSE at this stage. The market authorisation holders for Exeltis® and Navalem® have not submitted pricing and reimbursement applications to the HSE.

The HSE therefore encourages clinicians, along with the Institute of Obstetricians and Gynaecologists and the National Clinical Programme for Obstetrics and Gynaecology, other healthcare professionals, and relevant representative bodies to encourage the market authorisation holders of the licensed medicinal products (Xonvea®, Exeltis® and Navalem®) to progress with the formal pricing and reimbursement process in Ireland.

Finally, the HSE provides general advice on treatments for hyperemesis gravidarum at:

www2.hse.ie/conditions/hyperemesis-gravidarum/treatment/

Question No. 561 answered with Question No. 541.

Medicinal Products

Ceisteanna (562, 629)

Michael Ring

Ceist:

562. Deputy Michael Ring asked the Minister for Health the current standard practice in other EU countries in relation to the prescribing of a specific drug (details supplied); and if he will make a statement on the matter. [6534/23]

Jackie Cahill

Ceist:

629. Deputy Jackie Cahill asked the Minister for Health the current standard of practice in other EU countries for the prescription of cariban; and if he will make a statement on the matter. [6687/23]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 562 and 629 together.

As part of Budget 2023, funding of €32.2 million was announced for Women’s Health Initiatives in 2023.

This included dedicated funding of €1.3m for Cariban® (doxylamine/pyridoxine) to help women who experience hyperemesis gravidarum, a severe form of nausea and vomiting, during pregnancy. Hyperemesis gravidarum is expected to affect about 1% of the pregnant population.

The Health Service Executive (HSE) has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drugs schemes, in accordance with the Health (Pricing and Supply of Medical Good s) Act 2013. Only licenced indications which have been granted market authorisation by the European Medicines Agency (EMA) or the Health Products Regulatory Authority (HPRA) can be added to the formal reimbursement list.

Within the European Union (EU), the pricing and reimbursement of medicines is a national competence. As EU Member States operate different pharmaceutical reimbursement systems across the EU, a direct comparison of the reimbursement of products is not possible. The competent authority for pricing and reimbursement in Ireland is the HSE.

Cariban® is an Exempt Medicinal Product (EMP), i.e., it is not licensed in Ireland and, therefore, cannot be added to the formal reimbursement list.

However, following the recommendations of the HSE Medicines Management Programme, and to address the unmet need of patients with hyperemesis gravidarum, reimbursement support for Cariban® (doxylamine/pyridoxine), an unlicensed Exempt Medicinal Product, has now been made available on an individual patient basis for those patients who meet the criteria and where Consultant Obstetrician initiated.

Under the community drug schemes, Exempt Medicinal Products must be Consultant initiated. However, whilst the original prescriber of Cariban® must be a consultant and specialist in the relevant field, the HSE will accept a GP prescription subsequent to the initial hospital prescription for approved patients.

The relevant HSE circular regarding the exceptional arrangement for Cariban® is available at:

www.hse.ie/eng/staff/pcrs/circulars/pharmacy/pharmacy-circular-001-23-cariban.pdf.

In order to obtain reimbursement support for Cariban® under this exceptional arrangement, the prescribing consultant must confirm whether the following apply:

- The individual has nausea and vomiting of pregnancy (NVP) which requires systemic treatment.

- The individual has been assessed using the pregnancy unique quantification of emesis and nausea (PUQE) assessment tool and the appropriate treatment algorithm has been followed.

- The individual has not responded to conservative management.

The consultant must also make an Unlicensed Product Declaration and submit the completed application form by email to the Primary Care Reimbursement Service (PCRS).

Once reviewed by the PCRS, the prescriber and dispensing pharmacy are emailed (via secure email) with the reimbursement decision. The community pharmacy then dispenses the product under the specific patient’s community drug schemes eligibility and submits the claim using the relevant administrative code in their monthly submission to PCRS.

While reimbursement support is offered on the basis of the patient’s eligibility under the General Medical Services (GMS) Scheme or the Drugs Payment Scheme (DPS), Cariban® is not on the formal reimbursement list.

This exceptional arrangement has been put in place to ensure that those patients suffering from hyperemesis gravidarum have access to Cariban®. The dedicated funding that has been allocated is based on 1% of the pregnant population requiring treatment for hyperemesis gravidarum. The number of approved applications to date is in line with expectations and indicate that the budget allocated will be used in 2023.

There are three other products containing doxylamine/pyridoxine, which are licensed in Ireland:

- Xonvea® gastro-resistant tablets.

- Navalem® modified-release hard capsules.

- Exeltis® gastro-resistant tablets.

The market authorisation holder of Xonvea® has not progressed the pricing and reimbursement application further with the HSE at this stage. The market authorisation holders for Exeltis® and Navalem® have not submitted pricing and reimbursement applications to the HSE.

The HSE therefore encourages clinicians, along with the Institute of Obstetricians and Gynaecologists and the National Clinical Programme for Obstetrics and Gynaecology, other healthcare professionals, and relevant representative bodies to encourage the market authorisation holders of the licensed medicinal products (Xonvea®, Exeltis® and Navalem®) to progress with the formal pricing and reimbursement process in Ireland.

Finally, the HSE provides general advice on treatments for hyperemesis gravidarum at:

www2.hse.ie/conditions/hyperemesis-gravidarum/treatment/

Departmental Staff

Ceisteanna (563)

Róisín Shortall

Ceist:

563. Deputy Róisín Shortall asked the Minister for Health the number of staff who have left his Department in each of the years 2018 to 2022, by grade, and to date in 2023, in tabular form. [6535/23]

Freagraí scríofa

Minister for Health

A breakdown of the number of staff who have left my Department in 2018 to 2022 and to date in 2023 is set out by grade below.

Grades	2018	2019	2020	2021	2022	2023
Administrative Officer	5	5	3	15	24	3
Assistant Principal	17	14	17	35	44	2
Assistant Secretary	1		3	3	2
Clerical Officer	7	9	12	14	16	2
Deputy Secretary			1	2	2
Executive Officer	9	10	7	2	14	4
Higher Executive Officer	7	13	9	15	24
Principal Officer	8	6	8	18	17	6
Secretary General			1
Services Officer			1	1	1
Temporary Clerical Officer	3	5	9	21	6

Question No. 564 answered with Question No. 541.

Question No. 565 answered with Question No. 560.

Medicinal Products

Ceisteanna (566)

David Stanton

Ceist:

566. Deputy David Stanton asked the Minister for Health the number of prescriptions for cariban that have been processed through the drug payment scheme in 2021 and in 2022; and if he will make a statement on the matter. [6538/23]

Freagraí scríofa

Minister for Health

Following the recommendations of the HSE Medicines Management Programme, and to address the unmet need of those patients with hyperemesis gravidarum (a severe form of nausea and vomiting during pregnancy), reimbursement support for Cariban® (doxylamine/pyridoxine) has been made available since 1st January 2023 under an exceptional arrangement on an individual patient basis where consultant initiated. Hyperemesis gravidarum is expected to affect about 1% of the pregnant population.

There were no applications processed through the Drug Payment Scheme in 2021 and 2022.

However, as of 10th February 2023, the number of applications received by the Primary Care Reimbursement Service (PCRS) under the new exceptional arrangement was 384. This is in line with expectations.

Healthcare Policy

Ceisteanna (567)

Robert Troy

Ceist:

567. Deputy Robert Troy asked the Minister for Health if he will ensure patients who suffer with amyloidosis can be approved on the long-term illness scheme. [6539/23]

Freagraí scríofa

Minister for Health

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. All chronic long-term illnesses, including those not covered by the LTI scheme, require regular clinical reassessment by a medical professional.

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%.

Covid-19 Pandemic

Ceisteanna (568, 573)

Patricia Ryan

Ceist:

568. Deputy Patricia Ryan asked the Minister for Health when a public inquiry will be held into deaths that occurred in nursing homes during the Covid-19 pandemic; whether it will follow the PANEL principles for a Human Rights based approach; and if he will make a statement on the matter. [6548/23]

Patricia Ryan

Ceist:

573. Deputy Patricia Ryan asked the Minister for Health if the public inquiry into deaths that occurred in nursing homes during the Covid-19 pandemic will include both private and public nursing homes; and if he will make a statement on the matter. [6553/23]

Freagraí scríofa

Minister of State at the Department of Health

I propose to take Questions Nos. 568 and 573 together.

I would like to again express my sympathy to all those who lost loved ones during the pandemic.

Since the start of the pandemic, the national response has continuously evolved to take account of emerging evidence and learnings both nationally and internationally. Throughout, this has included a specific focus on older people, in particular, those resident in nursing homes.

Significant supports were put in place for nursing homes, and the situation at both a local and a national level was kept under ongoing and active review. An independent Nursing Homes Expert Panel was established early in the pandemic to examine the management of COVID-19 in nursing homes and provide real-time learnings and recommendations to inform the ongoing response. The Expert Panel reported in August 2020 and significant progress has been made in implementing its recommendations.

The Taoiseach has indicated that a comprehensive evaluation of how the country managed COVID-19 will be established in 2023. It will provide an opportunity to learn lessons from our experiences in dealing with a pandemic and it will help ensure that we are in a better, stronger position if another pandemic or another similar type emergency arrives.

The Minister for Health has already stated that a review of the management and impact of COVID-19 in nursing homes is warranted. Given the Taoiseach’s most recent commitments to establish a COVID-19 evaluation process in 2023, I believe that any review of the experience in nursing homes should be considered in the first instance as part of this proposed process. The model for this process is under consideration.

Home Care Packages

Ceisteanna (569)

Patricia Ryan

Ceist:

569. Deputy Patricia Ryan asked the Minister for Health the number of people who have been assessed for homecare and are waiting on that provision; and if he will make a statement on the matter. [6549/23]

Freagraí scríofa

Minister of State at the Department of Health

As this is an operational matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.