Written Answers Nos. 677-700
677. Deputy Paul Kehoe asked the Minister for Health what plans are in place for the recruitment of a consultant neurologist for Wexford hospital and a dedicated outpatient neurology service, as recommended in the 2016 National Model of Care for Neurology Services in Ireland; and if he will make a statement on the matter. [18991/24]
View answerAs this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.
678. Deputy Brendan Griffin asked the Minister for Health when a person in County Kerry (details supplied) will be prioritised for an appointment; and if he will make a statement on the matter. [18994/24]
View answerAs this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.
679. Deputy Pa Daly asked the Minister for Health when a person (details supplied) can expect to receive an appointment with the ENT clinic in Cork; and if he will make a statement on the matter. [19009/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
680. Deputy Michael Lowry asked the Minister for Health the current WTE posts filled and unfilled, respectively in south Tipperary primary care services, broken down by discipline for physiotherapy, occupational therapist, speech and language therapy, psychology, dietician, audiology and ophthalmology; and if he will make a statement on the matter. [19010/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
681. Deputy Michael Lowry asked the Minister for Health the steps that have been taken to reduce paediatric primary care wait lists in south Tipperary; if he will give a commitment to improve the waiting times for children waiting to access these much-needed appointments in 2024, many of whom are waiting over 12 months for an appointment; and if he will make a statement on the matter. [19011/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
682. Deputy Pádraig O'Sullivan asked the Minister for Health his plans for the €20 million in medicines savings which his Productivity and Savings Taskforce intends to achieve in 2024; whether it is intended that all of these savings will be reinvested in new medicines; and if he will make a statement on the matter. [19014/24]
View answerI published the Productivity and Savings Taskforce Action Plan on the 15th of April 2024.
This Action Plan sets out an ambitious and realistic programme of savings targets aimed at minimising the level of financial risk the HSE is facing in 2024; and a range of productivity measures that aim to maximise access to health services for patients.
Substantial savings of approximately €424 million in 2024 (€554 million full year saving) are being targeted including medicines expenditure, non-pay costs, procurement costs, the cost of care in long term residential care for older people, and management consultancy costs.
These savings are intended to reduce the extent of the financial risk facing the health sector in 2024. They are balanced, however, with the fundamental need to deliver safe and quality care and services to patients.
The €20m savings on Medicines is part of this and the Medicines Sustainability Taskforce is examining these issues and wider reform to enhance the sustainability of medicines expenditure. The Medicines Taskforce will undertake a systemic review of medicines expenditure, to include for example, the examination of measures to enhance the use of generic and, in particular, biosimilar medicines.
However, notwithstanding the overarching financial risk this year, I have already committed €20m of new funding for new medicines. Further as I announced on the 15th of December 2023, that I will ensure that €10m of savings delivered will be available for reinvestment in new medicines this year ensuring that in addition to the anticipated €3bn plus expenditure this year, €30m of funding will see enhanced access to more patients.
This continues the investment of €98 million allocated for new medicines between 2020 and 2023. 171 new medicines were approved for reimbursement by the HSE, to include 61 medicines for the treatment of cancer, and 47 for the treatment of rare diseases.
To date in 2024, an additional 13 new medicines have been approved by the HSE for reimbursement.
683. Deputy Róisín Shortall asked the Minister for Health if he will add endometriosis to the long-term illness scheme; if this is being considered as part of the development of the National Endometriosis Framework; and if he will make a statement on the matter. [19030/24]
View answerThe HSE’s National Women & Infants Health Programme (NWIHP) is finalising the National Framework for Endometriosis in collaboration with the Irish College of General Practitioners, which sets out a defined clinical care pathway for women with endometriosis. This Framework identifies how care needs to be delivered for women in this area, with this care spanning primary care to local hospital care to specialist complex care through multidisciplinary teams.
This Model of Care will ensure that women receive timely and effective treatment through 2 supra-regional specialist centres in Tallaght and Cork supported by 5 regional endometriosis hubs in The Rotunda, Coombe, NMH, Limerick and Galway. All hubs and supra-regional sites are currently operational and taking referrals.
It is expected that the framework will be published in the coming weeks following final consultations with stakeholders. Funding recently announced through the Women’s Health Action plan will see Phase 1 of the Endometriosis Framework fully funded.
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 conditions 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.
While there are currently no plans to extend the list of conditions, it is important to remember that the LTI Scheme exists within a wider eligibility framework. This Government has put a significant focus on improving access to and the affordability of healthcare services, advancing substantial policy, legislation and investment to deliver expanded eligibility.
In 2022, a range of measures were delivered including the abolition of public in-patient charges for children, reductions in the Drug Payment Scheme threshold to €80 per month, and the introduction of free contraception for women aged 17-25.
In 2023, further measures have facilitated better access to affordable, high-quality healthcare, including an expansion of GP care without charges to children aged 6 and 7, and to people earning no more than the median household income, the abolition of all public in-patient hospital charges for adults, and the extension of the free contraception scheme to include women aged 26-30 (extended to those aged 31 from 1 January 2024). These measures continue to create a health and social care service that offers affordable access to quality healthcare.
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 under the General Medical Services (GMS) Scheme. 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.
Under the Drug Payment Scheme (DPS), no individual or family pays more than €80 a month towards the cost of approved prescribed medicines. The DPS is not means tested and is available to anyone ordinarily resident in Ireland. The DPS significantly reduces the cost burden for families and individuals with ongoing expenditure on medicines.
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%.
684. Deputy Róisín Shortall asked the Minister for Health the status of the National Endometriosis Framework; the timeline he is working towards for publication; and if he will make a statement on the matter. [19031/24]
View answerThe HSE’s National Women & Infants Health Programme (NWIHP) is finalising the National Framework for Endometriosis in collaboration with the ICGP.
This Framework sets out a defined clinical care pathway for women with endometriosis with the care pathway spanning primary care to local hospital care to specialist complex care through multidisciplinary teams.
This Model of Care will ensure that women receive timely, and effective treatment through by 5 regional endometriosis hubs in The Rotunda, Coombe, NMH, Limerick and Galway and 2 supra-regional specialist centres in Tallaght and Cork. All hubs and supra-regional sites are currently operational and taking referrals.
GP referrals for the endometriosis care pathway will be through general gynaecology services. Patients can then be referred for care to the hubs/supra-regional sites if clinically required.
The framework is expected to be published in the coming weeks following final consultations with stakeholders.
685. Deputy Róisín Shortall asked the Minister for Health if he will consider changes to the age and body mass index limits for fertility treatment; if clinicians have discretion to treat patients over those limits in certain circumstances (details supplied); and if he will make a statement on the matter. [19032/24]
View answerAs the Deputy may be aware, a commitment to “introduce a publicly funded model of care for fertility treatment” is included in the Programme for Government.
The Model of Care for Fertility was developed by the Department of Health in conjunction with the HSE’s National Women & Infants Health Programme (NWIHP) in order to ensure that fertility-related issues are addressed through the public health system at the lowest level of clinical intervention necessary.
This Model of Care comprises three stages, starting in primary care (i.e., GPs) and extending into secondary care (i.e., the six Regional Fertility Hubs located across the country) and then, where necessary, AHR (assisted human reproduction) treatment (e.g., IVF (in-vitro fertilisation) and ICSI (intra-cytoplasmic sperm injection)), with patients being referred onwards through structured pathways.
Phase One of the roll-out of the Model of Care has involved the establishment, at secondary care level, of Regional Fertility Hubs within maternity networks, in order to facilitate the management of a significant proportion of patients presenting with fertility-related issues at this level of intervention. Patients are referred by their GPs to their local Regional Fertility Hub, which provides a range of treatments and interventions.
Phase Two of the roll-out of the Model of Care relates to the introduction of AHR treatment, including IVF, provided through the public health system at tertiary level.
Funding has been made available to support access to AHR treatment via private providers. As well as IVF and ICSI, this allocation is also being used to provide, in private clinics, IUI (intrauterine insemination), which can, for certain cohorts of patients, be a potentially effective, yet less complex and less intrusive treatment.
Referrals for AHR treatment by private providers commenced in the week beginning September 25th 2023. Criteria which prospective patients should meet in order to access fully-funded AHR services and the services to be initially funded were agreed by the Department and NWIHP and discussed at Cabinet in July 2023.
The approach adopted by the Department of Health in relation to defining clear parameters regarding clinical criteria for AHR is in line with European and international counterparts, allowing for necessary accountability for the cost-effectiveness use of public funds and the safety of patients and any consequent pregnancy that may result. More details on public fertility services, including information on the new publicly-funded AHR treatment initiative, are available from the HSE at: www2.hse.ie/conditions/fertility-problems-treatments/fertility-treatment/
The criteria were developed and finalised following engagement and consultation with experts in the field of reproductive medicine, taking into account the clinical parameters of the access criteria including the assessment of such areas as age, body mass index (BMI) and other health and well-being elements.
These clinical parameters were reviewed in the context of both the potential success or otherwise of the advanced fertility treatment itself but also the health and well-being of the intending birth mother and any resultant pregnancy, inclusive of the management of maternity care, delivery and health of any child.
In relation to the clinical parameter of age, as advised by the clinical experts in the HSE, it is important to note that age affects the fertility of both women and men. Fertility starts to reduce after the age of 30 and this reduction happens faster after the age of 35. The reason for the reduced fertility is two-fold. The first reason is related to the fact that poorer quality, older eggs are less likely to lead to pregnancy. Secondly, the chance of genetic or chromosomal abnormalities rises significantly over the age of 40.
It should be noted that age can also increase the risk of certain complications during pregnancy. This includes miscarriage, pre-eclampsia, gestational diabetes or having a baby with a chromosomal abnormality. It is for these known risks and the significantly reduced chances of successful treatment that a defined parameter regarding the age of the intending birth mother was established for the purposes of publicly-funded AHR services.
Specifically in relation to the clinical parameter of BMI, it should be noted that women presenting with high BMIs are at a high risk of reproductive health complications, as are their babies. The risk of sub-fecundity and infertility, low conception rates, miscarriage rates, and pregnancy complications are increased in women with raised BMI, in both natural and assisted conceptions. Furthermore, reproductive outcomes for all fertility treatments are poor in this cohort. Obesity may impair reproductive functions by affecting both the ovaries and endometrium. It is because of these safety concerns and poor outcome facts that it is recommended, in line with the UK, the BMI parameters for intending birth mothers are a minimum of 18.5 kg/m2 and a maximum of 30.0 kg/m2.
The approach adopted by the Department of Health in relation to defining clear parameters regarding specific clinical criteria for AHR is in line with many European and international counterparts, allowing for necessary accountability for the cost-effectiveness use of public funds, and the safety of patients and any consequent pregnancy that may result.
The access criteria and the AHR treatment scheme will be kept under review as new evidence becomes available, an understanding of how the service provision is working in practice emerges, and when the AHR legislation – currently at Report Stage in the Dáil – is finalised.
It should be noted that some of the criteria to be met in order to avail of the secondary fertility care services at the Regional Fertility Hubs have broader parameters. These Hubs can successfully manage a significant proportion of patients presenting with fertility-related issues at this level of intervention without requiring them to undergo often extremely invasive and arduous IVF or ICSI treatment.
My Department and the Government are focused, through the full implementation of the Model of Care for Fertility, on ensuring that patients receive care at the appropriate level of clinical intervention and then those requiring, and eligible for, advanced AHR treatment such as IVF will be able to access same through the public health system.
The underlying aim of the policy to provide a model of funding for AHR, within the broader new AHR regulatory framework, is to improve accessibility to AHR treatments, while at the same time embedding safe and appropriate clinical practice and ensuring the cost-effective use of public resources.
686. Deputy Aengus Ó Snodaigh asked the Minister for Health when a child (details supplied) will get a procedure in Our Lady’s Hospital, Crumlin. [19037/24]
View answer“As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible
687. Deputy Aengus Ó Snodaigh asked the Minister for Health when a child (details supplied) will be seen in the sleep apnoea clinic. [19039/24]
View answer“As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible
688. Deputy Cathal Crowe asked the Minister for Health if he will address a number of issues (details supplied) with regard to services for children within the health system with mental health and neurodivergent conditions; and if he will make a statement on the matter. [19042/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
689. Deputy Marian Harkin asked the Minister for Health for an update on a medical appointment for a person (details supplied). [19049/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
690. Deputy Duncan Smith asked the Minister for Health if workers in a facility (details supplied) will receive the pandemic special recognition payment, given this facility provides 24-hour care to vulnerable and at-risk young people; and if he will make a statement on the matter. [19061/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy.
691. Deputy Cathal Crowe asked the Minister for Health the steps his Department will take to ensure that medical card patients can access dental appointments (details supplied); and if he will make a statement on the matter. [19069/24]
View answer730. Deputy Pádraig O'Sullivan asked the Minister for Health the provisions that are in place for persons whose dentist withdraws from the medical card service or does not accept medical card patients; and if he will make a statement on the matter. [19413/24]
View answerThe Dental Treatment Services Scheme (DTSS) provides dental care, free of charge, to medical card holders aged 16 and over. Services available annually and on demand include an examination including preventative elements, two fillings, extractions, and a scale and polish. More complex care, such as dentures, additional fillings and a broader range of treatments for patients with additional needs and high-risk patients, are available subject to the approval of the local HSE Principal Dental Surgeon. To support practitioners to provide care under the Scheme, I approved a range of measures that were put in place on 1 May 2022 to introduce and reintroduce elements of preventative care and increase the fees paid to dental contractors for most treatment items by 40-60%. In 2023, 154,864 additional treatments were provided under the DTSS, with over 26,700 extra patients treated when compared with 2022. In the longer term, the Government is committed to reforming dental services, including the DTSS, through the implementation of the National Oral Health Policy (NOHP), Smile agus Sláinte. An implementation plan for the 2024-2026 phase of rollout is being drafted by my Department and the HSE. The HSE's Strategic Reform Lead is driving policy implementation across the organisation and developing new services. The HSE's National Service Plan (NSP) for 2024 captures a range of priorities that are essential prerequisites to a new contract for care for adult medical card holders: - Development of a comprehensive phased policy implementation plan for the range of actions identified in the policy, including stakeholder engagement and resource identification; and - The design of clinical elements for reformed preventative care for adult medical cardholders as referenced in the policy. (Progression of oral healthcare packages for children aged from birth to seven years of age is also an NSP priority for 2024.) The National Oral Health Policy also contains a range of strategic workforce planning actions to increase workforce capacity, in support of improving patient's access to care. To support this work, my Department is currently finalising a workforce census for oral healthcare.
692. Deputy Richard Boyd Barrett asked the Minister for Health if he is aware of the extensive waiting lists to receive gender-affirming healthcare at the gender clinic in St. Columcille's Hospital, Loughlinstown (details supplied); if there are plans to employ more gender-affirming healthcare professionals in this facility or others; and if he will make a statement on the matter. [19073/24]
View answerAs this a service issue I have referred the matter to the HSE for direct reply to the Deputy.
693. Deputy Carol Nolan asked the Minister for Health further to Parliamentary Question No. 1586 of 9 April 2024, to provide a breakdown of funding made under the sexual health and crisis pregnancy programme to organisations which focus on crisis pregnancy counselling, in each of the years 2019 to 2024, in tabular form; and if he will make a statement on the matter. [19075/24]
View answerAs the Deputy's question relates to service matters, I have referred it to the HSE for direct reply.
695. Deputy Niamh Smyth asked the Minister for Health the reason a person (details supplied) is waiting so long for a hip assessment and operation; and if he will make a statement on the matter. [19081/24]
View answer“As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible
696. Deputy Duncan Smith asked the Minister for Health if he will ensure that an individual (details supplied) is provided home care supports due to their medical situation; and if he will make a statement on the matter. [19094/24]
View answerAs this is an operational matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible
697. Deputy Duncan Smith asked the Minister for Health if his Department could examine the circumstances surrounding the removal of home care hours for a person (details supplied); to provide the details behind why these supports were reduced; if he could have this decision reversed; and if he will make a statement on the matter. [19095/24]
View answerAs this is an operational matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible
698. Deputy John McGuinness asked the Minister for Health if an appointment will be arranged as a matter of urgency for a child (details supplied) with a child and adolescent psychiatrist, as they have been refused and their medical team is insisting on an appointment to deal with the child’s anxiety, poor sleep pattern and other mental health issues; if he will expedite the matter; and if he will make a statement on the matter. [19096/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
699. Deputy James Lawless asked the Minister for Health to examine an issue (details supplied). [19116/24]
View answerI understand the Deputy may be seeking information on the EU Cross Border Directive.
The EU Cross Border Directive (CBD) provides rules for the reimbursements to patients of the cost of receiving treatment abroad, where the patient would be entitled to such treatment in their home Member State, and supplements the rights that patients already have at EU level. The HSE operates the EU Cross Border Directive (CBD) in Ireland. Under the terms of the CBD, patients in Ireland can seek to be referred to another EU/EEA country for medical treatment that is available in the public health service in Ireland. The patient may access the overseas service in either the public or private health sector of the country they choose to receive the service in. The patient pays for the treatment and claims reimbursement from the HSE at the cost of that treatment in Ireland or the cost of it abroad, whichever is the lesser. The HSE, in fulfilling its role as the National Contact Point (NCP) in Ireland, provides information for patients on the operation of the CBD, including contact details on its website. www2.hse.ie/services/schemes-allowances/cross-border-directive/
As the correspondence concerns a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
700. Deputy Carol Nolan asked the Minister for Health to clarify the difficulties he has identified with the independent scoring assessment conducted with respect to the new Offaly hospice; if he has engaged in consultation with any developers regarding the new Offaly hospice and if his Department has conducted any public consultation on the preferred site for the hospice; and if he will make a statement on the matter. [19119/24]
View answerThe development of a site at Tullamore is a named priority area for action in the HSE National Service Plan 2023, HSE Capital Plan 2023 and Three-Year Palliative Care Services Development Framework (2017 – 2019). A commitment was given as part of NSP 2024 to progress the development of plans for the new specialist palliative care inpatient unit at the Tullamore location. It is also a commitment in the Programme for Government.
As Minister, I am fully committed to the building of a new hospice in the Midlands. In September 2022, the government announced €20 million in capital funding for the development of a 20-bed specialist palliative care inpatient unit in the Midlands. The proposed new build 20 bed inpatient unit will have an all-single room configuration and offer access based on identified need for those who require specialist palliative care in an inpatient setting. Clinical care at this new facility will also be consultant led and delivered by a full multi-disciplinary specialist team.
I can confirm that a tender competition took place in 2023 to secure the services of a design team for this project. The design process is ongoing and three potential sites have been identified. I have met with the HSE, Design, Clinical, Estates and Management teams. In February of this year, I visited Tullamore and met with representatives from the Hospice Groups, and the HSE Clinical Team.
It is anticipated that a decision on the chosen site for the new Midlands Hospice will be announced shortly. The selected site will provide the best palliative care to the people of the Midlands.
My department will continue to progress developments for palliative care services in Ireland, working towards the highest possible quality of end-of-life care and support for people with life limiting illnesses across the country.
