Tuesday, 14 Feb 2023

Health Services

Ceisteanna (854)

Alan Farrell

Ceist:

854. Deputy Alan Farrell asked the Minister for Health the way persons can access post-exposure prophylaxis on weekends; and if he will make a statement on the matter. [7345/23]

Amharc ar fhreagra

Freagraí scríofa

Minister of State at the Department of Health

Sexual health and wellbeing is a priority for this Government. Sexual health services are being further developed and implemented in accordance with the recommendations set out in the National Sexual Health Strategy 2015 - 2020. The Strategy's lifetime has been extended to 2022. An independent Review of the Strategy is currently being finalised and will be published on the Healthy Ireland website once complete.

In recent years we have seen the launch of a number of major initiatives in the fight against HIV and other STIs in Ireland.

Key achievements in relation to HIV prevention to date include:

- Ireland (Dublin, Cork, Limerick and Galway) joining the HIV Fast-Track Cities programme in 2019.

- Establishing a national HIV Pre-Exposure Prophylaxis (PrEP) programme in November 2019, following a HIQA HTA, which concluded that the introduction of HIV PrEP would be safe, effective and cost saving, potentially reducing the number of people who contract HIV following exposure. A measure of its success has been high demand; existing capacity for PrEP will be looked at as part of the forthcoming development of the new National Sexual Health Strategy.

- In 2021, given ongoing pandemic impacts on attending clinical services in person, coupled with a national outbreak of early infectious syphilis, the Sláintecare Integration Fund initially supported a pilot programme to provide access to online STI testing, in Dublin, Cork and Kerry.

- This pilot was very successful and was expanded, receiving €3m in support in Budget 2022 and an additional €600,000 in Budget 2023. The national online STI testing service was launched on a nationwide basis in October, 2022, and, as a result of privacy and convenience, has been very successful in reaching cohorts that may have been reluctant to access STI clinics in person.

- The HPV (human papillomavirus) vaccine was extended to men and women living with HIV up to and including 26 years; and to gay, bisexual and other men who have sex with men (MSM), including MSM living with HIV. Over 7,400 MSM and people living with HIV have commenced the vaccine to date.

- Establishment of the National Condom Distribution Service (NCDS) in 2015 and subsequent expansion -the NCDS functions as a central point for distributing free condoms and lubricant sachets to HSE services and other organisations working with individuals and groups at increased risk of negative sexual health outcomes - young people; migrants; gay, bisexual and other men who have sex with men; sex workers; people living with addiction issues and people living with HIV. Products are available through public sector bodies, including STI clinics, hospitals, and HSE health promotion & improvement, third-level institutions, public STI clinics, and NGOs.

HIV post-exposure prophylaxis (PEP) is a course of HIV medication that aims to prevent HIV infection following possible recent exposure to HIV. PEP is only available following an assessment by a doctor or a nurse. Not everyone who presents for PEP will need it.

PEP can be accessed through STI clinics (typically during clinic hours and often by appointment). Publicly funded STI Clinics are free of charge for people using the service, including cost-free treatment for STIs and HIV. In terms of out of hours access, including weekends, PEP is available from some minor injury units and from Emergency Departments. Attendance at EDs should be reserved for situations where there is an injury requiring urgent medical attention or where it is not possible to get PEP from a local STI or ID clinic within 72 hours.

Attendance at ED is free of charge with a referral letter from a GP. Individuals who attend an Emergency Department, without a referral letter, will be charged for that attendance (€100 for EU residents). Medical card holders and some other groups are exempt from this charge.

A list of clinics and Emergency Departments, with details of how to access PEP in Ireland can be downloaded from the HSE sexualwellbeing website as follows: www.sexualwellbeing.ie/need-urgent-information-and-care-/post-exposure-prophylaxis/pep-availability-in-ireland-.pdf.

As there may be more information available from the HSE, and as this is a service matter, I have also asked the Health Service Executive to respond to the deputy directly, as soon as possible.

Health Services

Ceisteanna (855)

Róisín Shortall

Ceist:

855. Deputy Róisín Shortall asked the Minister for Health when he intends to increase the standard eye exam fee paid to opticians for medical card holders in relation to the community ophthalmic services scheme; the amount the increase will be; and if he will make a statement on the matter. [7351/23]

Amharc ar fhreagra

Freagraí scríofa

Minister for Health

The Community Ophthalmic Services Scheme (COSS) is a national fee-per-item scheme which was introduced in 1979. Under the COSS, medical card holders aged over 16 years can be seen by ophthalmologists, community ophthalmic physicians, optometrists or dispensing opticians.

Eligible patients can receive an eye examination and be provided with prescribed optical appliances in accordance with a national schedule of approved optical appliances.

The Health Professionals (Reduction of Payments to Ophthalmologists, Optometrists and Dispensing Opticians) Regulations 2013 (SI 274 of 2013) sets the fees for optometrists and dispensing opticians under the Community Optometric Services, Community Spectacle Dispensing Services and Health Amendment Act Card Schemes.

I am committed to increasing the fees payable to contractors for a standard eye examination under the COSS. This is a priority for my Department, and work with stakeholders is ongoing to implement this change in 2023.

Health Services Staff

Ceisteanna (856)

Seán Sherlock

Ceist:

856. Deputy Sean Sherlock asked the Minister for Health the number of care assistants that have exited the profession in each hospital in 2021, 2022 and to date in 2023 including the expected amount to leave in the forthcoming months if already flagged by staff, in tabular form. [7352/23]

Amharc ar fhreagra

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.

Health Services

Ceisteanna (857)

Peter Burke

Ceist:

857. Deputy Peter Burke asked the Minister for Health when cardiopathy will be listed and covered under the long-term illness scheme; and if he will make a statement on the matter. [7358/23]

Amharc ar fhreagra

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.

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%.

Question No. 858 answered with Question No. 550.

Healthcare Policy

Ceisteanna (859)

Ivana Bacik

Ceist:

859. Deputy Ivana Bacik asked the Minister for Health if he plans to extend the three-year deadline under section 26(5) of the Child and Family Relationships Act 2015, for use of anonymous gametes in existence prior to the commencement of the Act to five years in line with the conventional period of storage of gametes and embryos within fertility clinics in Ireland; and if he will make a statement on the matter. [7362/23]

Amharc ar fhreagra

Freagraí scríofa

Minister for Health

The Children and Family Relationships Act 2015 commenced on 4th May 2020. The principal function of the 2015 Act, as it relates to the use of gametes and embryos in Donor Assisted Human Reproduction (DAHR) procedures, is to protect the rights of donor-conceived persons to know their genetic identity in future years.

To this end, Section 26 (1) of the 2015 Act prohibits the use of anonymous gametes in a DAHR procedure performed in a DAHR facility in the State in most circumstances.

Section 26 of the 2015 Act does, however, establish limited exceptions to the general prohibition on the use of anonymous gametes in DAHR procedures.

Under Section 26 (5) of the Act, intending parent(s) can use anonymous gametes in a DAHR procedure for a period of three years from commencement of the 2015 Act (up to 4th May 2023). This is providing the anonymous gametes were in storage in the DAHR facility in the State prior to commencement of the 2015 Act and the intending parent(s) are the parent(s) of a child born as a result of a DAHR procedure performed before commencement, where the gamete used in that procedure was provided by the same anonymous donor.

Given the recognised importance of ensuring that donor-conceived persons can access information as regards their genetic origins, this exception to the general prohibition on the use of anonymous gametes has been limited to a period of three years after commencement.

The period between the enactment and commencement of the 2015 Act, coupled with the three year transitional period provided for in the Act, has further assisted in providing a reasonable timeframe to intending parents for the use of anonymous gametes in these circumstances of approximately eight years.

You may also wish to note that the Department had previously advised the DAHR facilities operating in the State to communicate with their clients who may be impacted by the conclusion of the three year transitional period as necessary and in early course to ensure that they have been fully informed of and are aware of the legislation and the associated requirements.

Health Services Staff

Departmental Expenditure

Ceisteanna (872)

Eoin Ó Broin

Ceist:

872. Deputy Eoin Ó Broin asked the Minister for Health the total funding provided by his Department for a number of programmes (details supplied); and if he will provide, in tabular form, a breakdown of the funding drawn down for each programme by postcode; for the years 2020, 2021 and 2022.. [7395/23]

Amharc ar fhreagra

Awaiting reply from the Department.

Medicinal Products

Ceisteanna (873)

Louise O'Reilly

Ceist:

873. Deputy Louise O'Reilly asked the Minister for Health the process by which pregnant women experiencing extreme nausea and vomiting can obtain the drug cariban; the reason the drug cannot be prescribed by a GP on the drugs payment scheme as the majority of women do not see a consultant until after 12 weeks; if the current prescription process for the drug is out of line with standard practice in other EU countries; the steps that pregnant women can take to combat extreme nausea and vomiting for the first 12 weeks of pregnancy until they see a consultant who can prescribe the drug; and the number of cariban prescriptions that have been processed through the DPS to date, in tabular form. [7413/23]

Amharc ar fhreagra

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 Goods) 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 under an exceptional arrangement for specific patients who meet the criteria and where Consultant Obstetrician initiated.

Under the community drug schemes, Exempt Medicinal Products must be Consultant initiated. The HSE advise that it has been a long-standing governance practice of such exceptional arrangements that unlicensed medicines are 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/.

Medicinal Products

Ceisteanna (874)

Holly Cairns

Ceist:

874. Deputy Holly Cairns asked the Minister for Health the steps he is taking to ensure that medications (details supplied) which are essential for immunocompromised persons to participate in socio-cultural life and employment will be made available under the drugs payment scheme. [7433/23]

Amharc ar fhreagra

Freagraí scríofa

Minister for Health

As 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 Goods) Act 2013, I have asked HSE to respond to the Deputy directly as soon as possible.