Holly Cairns
Ceist:121. Deputy Holly Cairns asked the Minister for Health the steps he is taking to support women who choose to have home births. [7410/23]
Amharc ar fhreagraHealth Services
Ceisteanna (121)
Freagraí scríofa
As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
Medical Aids and Appliances
Ceisteanna (122)
Holly Cairns
Ceist:122. Deputy Holly Cairns asked the Minister for Health the steps he is taking to ensure children with disabilities are assessed and receive medical aids/equipment in a timely manner. [7411/23]
Amharc ar fhreagraFreagraí scríofa
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. These are provided through community services known as Community Funded Schemes and play a key role in assisting and supporting people to maintain everyday functioning, and to remain living in their homes and local community.Each Community Health Organisation (CHO) operates processes for the allocation of funding for medical and surgical aids and appliances. Each application within a CHO is assessed by the local Resource Allocation Group and a determination is made regarding approval based on clinical priority and the funding availability within local budgets.
Historically, many of these aids and appliances were not provided on a standardised basis across the country and did not have formal contracts in place governing their supply or price. This resulted in an inequality of access for some aids and appliances in some areas. It also did not allow the HSE to deliver best value for money in the provision of these aids and appliances.
In addition, at times, due to the demand for resources exceeding the available capacity, waiting lists may apply for some categories of items provided through the medical and surgical aids and appliances budget in a particular CHO. Waiting times also vary depending on the priority rating which is made by healthcare professionals based on clinical risk. Priority is given to clients with the greatest level of clinical need.
The effects of Brexit, global supply chains issues, and the rise in energy costs have unfortunately further impacted the sourcing of some appropriate aids and appliances for some applicants. However, CHOs do undertake a range of initiatives to ensure optimum use of resources, for example, through the efficient recycling of stock items such as wheelchairs and walking aids.
Therefore, CHOs endeavour to provide medical and surgical aids and appliances in accordance with clinical priorities and subject to budgetary and supply constraints.
The HSE established a National Service Improvement Programme for the Community Funded Schemes. This Programme is working on the development of standard operating procedures and guidelines with the aim of ensuring value for money, equity of access, and a management system that ensures compliance with those guidelines. The scale of this Programme is enormous given that many thousands of items are provided from community-based services across the country.
In respect of the aids and appliances stream, the category lists are completed, category specific information for prescribers is complete and the contracts for items under aids and appliances are in place. The lists and associated prescribing information have been communicated to CHOs and local health care workers. This should improve the equity of access to appropriate aids and appliances, following assessment, for all eligible persons, but especially for children with disabilities who need them.
Question No. 123 answered with Question No. 96.
Disability Services
Ceisteanna (124)
Joan Collins
Ceist:124. Deputy Joan Collins asked the Minister for Health if he plans to amend the Disability Act 2005; and if not, if he plans to introduce new legislation in order that all children receive services in a timely manner. [5041/23]
Amharc ar fhreagraFreagraí scríofa
There are currently no plans to progress a review of the Disability Act, although the Department does keep its legislative programme under ongoing review.
In the context of improving services, the Department of Health is currently working with the HSE in order to bolster the capacity of the respective Children's Disability Network Teams throughout the country, in order to provide both Assessments of Need and quicker access to therapy supports than are currently available.
In this regard, HSE recruitment for therapy posts continues and there is ongoing engagement with the Heads of Disability Services across the nine CHOs to review service provision. In parallel, detailed discussions are ongoing with relevant stakeholders and representative groups in relation to a revised approach to the Assessment of Need, one which seeks to be both legally compliant and ensure a timely pathway to therapeutic interventions.
Hospital Services
Ceisteanna (125)
Darren O'Rourke
Ceist:125. Deputy Darren O'Rourke asked the Minister for Health if he will provide an update on recent service reconfigurations at Navan Hospital and plans for further reconfiguration; and if he will make a statement on the matter. [6921/23]
Amharc ar fhreagraFreagraí scríofa
As the Deputy will be aware, the HSE has proposed a process of planned service changes at Our Lady's Hospital Navan and has advised that these changes are necessary to support safe service delivery on a sustained basis and are driven first and foremost by patient safety considerations.
No decision regarding the HSE’s proposal for the transition of the Emergency Department at Navan has been agreed by me or by government.
While recognising the very real clinical concerns identified, the Government is clear that several important issues, including additional capacity in other hospitals impacted and the continued ability of people in the Navan area to access emergency and urgent care, would need to be fully addressed before any proposed transition by the HSE.
For this reason, I have asked the HSE to undertake a review of capacity. The review has been received and is currently under consideration, and engagement in relation to this matter is ongoing.
The ambulance bypass protocols in place for Our Lady's Hospital Navan were updated in December 2022 to address urgent patient safety matters to include people who are critically ill or with any acute surgical problem. Existing bypass protocols are already in place for paediatrics, obstetrics, major trauma, STEMI care, and stroke care patients.
Health Services
Ceisteanna (126)
Pearse Doherty
Ceist:126. Deputy Pearse Doherty asked the Minister for Health when the option will be available in County Donegal to administer IV antibiotic therapy in the home setting; and if he will make a statement on the matter. [7714/23]
Amharc ar fhreagraFreagraí scríofa
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 (127)
Ruairí Ó Murchú
Ceist:127. Deputy Ruairí Ó Murchú 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 GPs on the drug payment scheme; the alternative to cariban that can be offered to women experiencing extreme sickness in the first 12 weeks of pregnancy; the number of cariban prescriptions processed through DPS in the previous 12 months; and if he will make a statement on the matter. [7548/23]
Amharc ar fhreagraFreagraí scríofa
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 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/.
General Practitioner Services
Ceisteanna (128)
James O'Connor
Ceist:128. Deputy James O'Connor asked the Minister for Health the steps his Department and the HSE are undertaking to address the growing shortage of GPs across County Cork and the rest of the country; and if he will make a statement on the matter. [7737/23]
Amharc ar fhreagraFreagraí scríofa
GPs 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. Currently there are 2,529 GPs contracted to provide services under the GMS Scheme.
The Government is aware of the workforce issues currently facing general practice and is working to ensure patients across the country continue to have access to GP services and that general practice is sustainable in all areas into the future.
Under the 2019 GP Agreement additional annual expenditure provided for general practice has been increased now by €211.6m. This provides for significant increases in capitation fees for participating GMS GPs, and new fees and subsidies for additional services. Improvements to GP’s maternity and paternity leave arrangements, increased rural practice supports and a support for GPs in disadvantaged urban areas, have also been provided for.
The number of doctors entering GP training has increased approximately ten percent year on year from 2019, rising from 193 in 2019 to 258 in 2022, and a further large increase is planned for this year. Following the transfer of responsibility for GP training from the HSE to the Irish College of General Practitioners (ICGP), it is aimed to have 350 training places available for new entrants per year by 2026.
These measures will make general practice in Ireland a more attractive career choice and will see an increase in the number of GPs working in the State, improving access to GP services for patients throughout the country.
Furthermore, a strategic review of GP services is to commence shortly and will be completed this year. The review, with input from key stakeholders, will examine the broad range of issues affecting general practice and will set out the measures necessary to deliver a sustainable general practice into the future.
Hospital Facilities
Ceisteanna (129)
Catherine Connolly
Ceist:129. Deputy Catherine Connolly asked the Minister for Health further to Parliamentary Question Number 29 of 8 December 2022, the status of the examination by his Department of the strategic assessment report regarding the new emergency department at University Hospital Galway; if the SAR examination has been completed to date; if the SAR has been submitted to the Department of Public Expenditure, National Development Plan Delivery and Reform for review; the expected timeline for the proposal to be developed into a preliminary business case; and if he will make a statement on the matter. [7238/23]
Amharc ar fhreagraFreagraí scríofa
In December 2022 I noted that the review of the Strategic Assessment Report (SAR) for the proposed Emergency Department (ED), Women and Children’s block in University Hospital Galway was expected to be concluded in early 2023. This timeline remains on track and the SAR review is close to finalization.
I am acutely aware that the Galway ED project has been discussed for over 10 years. One of the reasons the project remains in development phase is that there has been a very significant increase in the scale and ambition for the solution there, with the combination of the new ED with a new Women and Children’s block.
However, the new interim ED, which represents an investment of €13m, was completed in July 2022 and has been operational since October 2022. This is providing new segregated waiting areas, segregated treatment areas, isolation rooms, additional resuscitation spaces and additional support accommodation to take account of requirements to treat Covid-19 patients and improved Infection Control and Prevention requirements for the ED. This early investment in the campus will also serve as enabling work for the larger project, should it be approved, freeing up the site required for the proposed new block.
The proposals for the much larger project are now projected to be in the hundreds of millions of euros and, as the Deputy will be aware, all projects proposed in excess of €100m must be subject to the full scrutiny of the Public Spending Code process to ensure that proposals continue to represent value for money for the taxpayer and the best solution to the underlying problems.
If the finalised review finds that the SAR provides a basis to proceed, approval to develop the proposal by means of a Preliminary Business Case can be granted. The proposal will then proceed through the various Decision Gates of the PSC as long as the proposal satisfies the requirements laid down in code.
The timeline for the new ED, together with the Women and Children’s block, cannot estimated be made until after the completion of a tender competition and submission of the Final Business case to Government for approval.
Covid-19 Pandemic
Ceisteanna (130)
David Cullinane
Ceist:130. Deputy David Cullinane asked the Minister for Health if he will advance an inquiry into nursing homes during the pandemic to address significant and particular shortcomings across that sector; and if he will make a statement on the matter. [7555/23]
Amharc ar fhreagraFreagraí scríofa
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.
My colleague 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, it is appropriate 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.
Primary Care Centres
Ceisteanna (131)
Paul McAuliffe
Ceist:131. Deputy Paul McAuliffe asked the Minister for Health to provide an update on the new primary health care centre for Finglas; and if he will make a statement on the matter. [7671/23]
Amharc ar fhreagraFreagraí scríofa
As the Health Service Executive is responsible for the delivery of public healthcare infrastructure projects, I have asked the HSE to respond to you directly in relation to this matter.
Disability Services
Ceisteanna (132, 169)
Niamh Smyth
Ceist:132. Deputy Niamh Smyth asked the Minister for Health the way his Department envisages addressing the waiting list in children's disability network teams (Enable Ireland) services in counties Cavan and Monaghan; and if he will make a statement on the matter. [7443/23]
Amharc ar fhreagraNiamh Smyth
Ceist:169. Deputy Niamh Smyth asked the Minister for Health the number of new appointments that have been made to the children's disability network teams (Enable Ireland) services in counties Cavan and Monaghan since January 2022, in light of the very high vacancy rate within the service. [7444/23]
Amharc ar fhreagraFreagraí scríofa
I propose to take Questions Nos. 132 and 169 together.
As these are service matters, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
Disability Services
Ceisteanna (133)
Matt Carthy
Ceist:133. Deputy Matt Carthy asked the Minister for Health the reason eligibility criteria in relation to respite care for children with disabilities varies across different regions. [6871/23]
Amharc ar fhreagraFreagraí scríofa
As this question refers to service matters, I have asked the Health Service Executive (HSE) to respond to the Deputy directly, as soon as possible.
Medicinal Products
Ceisteanna (134)
Pádraig O'Sullivan
Ceist:134. Deputy Pádraig O'Sullivan asked the Minister for Health when his Department will publish a report (details supplied) in respect of the drug reimbursement process; when the report and the key recommendations are expected to be published; and if he will make a statement on the matter. [7505/23]
Amharc ar fhreagraFreagraí scríofa
I intend to publish the Mazars Report this month.
Hospital Services
Ceisteanna (135)
Brendan Griffin
Ceist:135. Deputy Brendan Griffin asked the Minister for Health when fibronectin tests will be available to expectant mothers at University Hospital Kerry; when approval was given for this; if and when a supplier has provided a price for this; if the price is agreeable; and if he will make a statement on the matter. [7639/23]
Amharc ar fhreagraFreagraí scríofa
As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
Health Services
Ceisteanna (136)
Violet-Anne Wynne
Ceist:136. Deputy Violet-Anne Wynne asked the Minister for Health if he will explain the decision not to provide additional resources at Ennis medical assessment unit following engagement of a new 112/999 pathway; and if he will make a statement on the matter. [7732/23]
Amharc ar fhreagraFreagraí scríofa
As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
Health Services
Ceisteanna (137)
Brendan Griffin
Ceist:137. Deputy Brendan Griffin asked the Minister for Health the planned timeline for the rollout of oral immunotherapy for children; where the treatment will be dispensed to patients; the allocations involved; and if he will make a statement on the matter. [7629/23]
Amharc ar fhreagraFreagraí scríofa
As this is a service matter I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
Hospital Facilities
Ceisteanna (138)
Matt Carthy
Ceist:138. Deputy Matt Carthy asked the Minister for Health when the minor injuries unit at Monaghan Hospital will be operational at weekends and on bank holidays. [6872/23]
Amharc ar fhreagraFreagraí scríofa
As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly as soon as possible.
Nursing Homes
Ceisteanna (139)
Ruairí Ó Murchú
Ceist:139. Deputy Ruairí Ó Murchú asked the Minister for Health if he will provide an update on engagements by his Department in relation to the establishment of a care partner scheme for nursing and care home residents; and if he will make a statement on the matter. [6877/23]
Amharc ar fhreagraFreagraí scríofa
I understand the Deputy is referring to the Care Partner Scheme provided for in Northern Ireland. I understand that this Scheme was originally put in place during the pandemic as an additional support to people in health and social care settings in addition to the normal visiting arrangements.
As the Deputy may be aware, a similar arrangement was introduced by the HSE in visiting guidance that first came into effect in February 2022. That guidance provided that each resident should have the opportunity to identify a nominated support person who will have unrestricted access to the resident for most of the day and is considered a partner in care. This partner in care is in addition to and not instead of visitor access.
The full guidance is available on the HPSC website www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/guidance/infectionpreventionandcontrolguidance/residentialcarefacilities/IPC%20and%20PH%20guidance%20for%20outbreaks.pdf.
It should also be noted that a new system of decision support arrangements will shortly be introduced when the Assisted Decision Making (Capacity) Act is commenced. These new arrangements are intended to support people who have challenges with their capacity and may need support to make certain decisions.
I understand that the Department of Children, Equality, Disability, Integration and Youth is now preparing the necessary commencement orders and regulations to allow for full commencement of the Act.
More about the different support arrangements can be found on the Decision Support Service website decisionsupportservice.ie/.
Nursing Homes
Ceisteanna (140)
Brendan Smith
Ceist:140. Deputy Brendan Smith asked the Minister for Health if he will ensure that there is equal treatment of private nursing homes in relation to subvention payments regardless of their location; if the sizeable divergence in payments at present will be removed without delay; and if he will make a statement on the matter. [7648/23]
Amharc ar fhreagraFreagraí scríofa
I am acutely aware of the specific challenges faced by the nursing homes sector related to price inflation and increased energy costs.The Government has provided substantial supports to the nursing home sector over the course of the pandemic. Over €147 million has been claimed by nursing homes under the Temporary Assistance Payment Scheme (TAPS) since its introduction in 2020. Substantial additional supports have also been provided by the HSE in terms of serial testing, PPE, the deployment of specialist teams and other services. A €10 million Temporary Inflation Payments Scheme (TIPS) was established to support private and voluntary nursing homes with increases in energy costs, covering 75% of year-on-year cost increases up to a monthly cap of €5,250 per nursing home, over the period of July-December 2022 (€31,500 per nursing home). The Department of Health intends to extend the Temporary Assistance Payment Scheme (TAPS) COVID-19 Outbreak Assistance to the end of March 2023 and to expand the scope of the Temporary Inflation Payment Scheme (TIPS). Any further extension or expansion of either scheme will be kept under review.Funding to support people to access services in the sector continues to be provided in line with the long-established statutory mechanisms under the Nursing Homes Support Scheme Act 2009. This is the mechanism established by the Oireachtas to provide for the processes relating to funding under the NHSS and the negotiation of prices for services for private and voluntary providers with the designated State agency, the National Treatment Purchase Fund (NTPF). Maximum prices for individual nursing homes are agreed with the NTPF following negotiations and based on the NTPF’s cost criteria. These criteria include costs reasonably incurred by the nursing home, local market prices, historic prices and overall budgetary capacity. The NTPF carry out this role independently under the NHSS Act 2009. The NTPF has statutory independence, and there is no role for Ministers or the Department of Health in these negotiations. The Department of Health published a review of the NTPF pricing system in June 2021. It recommended several actions to improve the pricing system which are now being taken forward by the Department of Health and the NTPF. One of these actions relates to exploring a new geographical pricing model for the sector.
Budget 2023 saw over €40 million in additional funding for the NHSS which will provide for an uplift in the maximum prices chargeable by private and voluntary nursing homes, as negotiated. I am currently in discussions with Departmental officials to examine ways in which funding can also continue to be used to provide support, where necessary and appropriate, to those nursing homes who are not scheduled to renegotiate their Deeds of Agreement this year. Other options to support nursing homes are also being explored.