Health

Health Questions

Posted November 13th, 2012

Charity funding – 14th July 2015

To ask the Minister for Health if he supports the work of a charity (details supplied); and if he will provide State funding to the charity.

Reply

Minister of State at the Department of Health (Aodhán Ó’Ríordáin)

Funding from the Department of Health’s Drugs Initiative Fund is allocated to the Local and Regional Drug and Alcohol Task Forces to support community based drugs initiatives.

Applications for funding for the organisation concerned should be made directly to the relevant Local or Regional Drug and Alcohol Task Force.

Activities for children with autism – 29th May 2015

To ask the Minister for Health his plans for supporting children with Autism Spectrum Disorder in extra-curricular activities that may improve their social skills, but do contribute to their quality of life, while young but also as they grow in to their teenage years (details supplied – article from Irish Times).

Reply

This question was answered by the HSE on behalf of the Minister. Click to view it.

Support for children with autism – 14th May 2015

To ask the Minister for Health his plans for supporting children with Autism Spectrum Disorder in extra-curricular activities that may improve their social skills, but do contribute to their quality of life, while young but also as they grow in to their teenage years (details supplied).

Reply

Minister for State at the Department of Health (Kathleen Lynch)

The Government is committed under the National Disability Strategy (NDS) to ensuring that people with autism are empowered by policy and programmes to participate meaningfully as citizens in Irish society. The NDS is driven by this basic but fundamentally important objective and is the most effective combination of legislation, policies, institutional arrangements and services to support and reinforce equal participation for all people with disabilities.

The Cabinet Committee on Social Policy has been examining issues around autism across Government Departments in association with the National Disability Authority (NDA). This work by the NDA, which has included consultation with families, will be of significant assistance in informing how best to address the needs of people with ASD, so that we can be sure that they are appropriately reflected and included in policies and actions.

The National Disability Strategy Implementation Group has already discussed the findings of the NDA consultation and mapping of services to people with autism. Further to the recommendations of this exercise, the NDA has been engaging bi-laterally with Departments and agencies to guide the development of actions under the umbrella of the National Disability Strategy Implementation Plan.

My Department has asked the Health Service Executive to respond to the Deputy in respect of the detailed operational aspects of the issue that he has raised insofar as it relates to the health service. If you have not received a reply from the HSE within 15 working days please contact my Private Office and they will follow up the matter with them.

Lifetime Community Rating and emigrants – 21st April 2015

To ask the Minister for Health if the new lifetime community rating late entry levy will apply to returning emigrants over the age of 35.

Reply

Minister for Health (Leo Varadkar)

Lifetime Community Rating (LCR) is being introduced to encourage people to take out private health insurance at a younger age. Encouraging more people to join the market at younger ages helps spread the costs of older and less healthy people across the market, helping to support affordable premiums for all.

The regulations provide for a grace period up until 30 April 2015, during which time as many people as want to can take out health insurance without incurring loadings. From 1 May 2015, late entry loadings will be applied to those who join the private health insurance market at age 35 or over.

Anybody who lives outside the State on 1 May 2015, and who returns or moves to take up residence in Ireland after that date, will have a grace period of 9 months to purchase private health insurance without incurring loadings.

Nursing Home Support scheme – 27th March 2015

To ask the Minister for Health when the review of the Nursing Home Support scheme will be completed.

Reply

Minister for State at the Department of Health (Kathleen Lynch)

The Review of the Nursing Homes Support Scheme is broader than was first envisaged and the various issues arising are now being systematically considered with a view to completion and publication as early as possible.

It is expected that the Review will be completed very shortly after which a report will then be made publicly available.

HSE service delivery – 12th March 2015

Reply

Minister for Health (Leo Varadkar)

To ask the Minister for Health if he will provide information on the following service delivery contracted out by the Health Service Executive (details supplied).

As the Deputy’s question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.  If the Deputy has not received a reply from the HSE within 15 working days, he can contact my Private Office and they will follow the matter up with the HSE.

Hereditary angioedema – 20th February 2015

To ask the Minister for Health his views on implementing best practices regarding hereditary angioedema (HAE) which have been outlined in a report (details supplied), and adopted in most European Union countries, specifically to make home infusions of C1-INH protein standard practice; his views on the report’s positive cost-benefit analysis of said practice and to educate medical professionals of the symptoms of HAE.

Reply

Minister for Health (Leo Varadkar)

As this is a service issue this question has been referred to the HSE for direct reply.

Click here to view reply.

Fatal foetal abnormality – 20th February 2015

To ask the Minister for Health further to Parliamentary Question No. 962 of 17 September 2014, and to the correspondence from the Health Service Executive (details supplied), his plans to introduce national policy in relation to antenatal screening and foetal abnormality testing.

Reply

Minister for Health (Leo Varadkar)

As this is a service issue this question has been referred to the HSE for direct reply.

Click here to view this reply.

Residential care – 13th February 2015

To ask the Minister for Health his views on implementing recommendations (details supplied) regarding residential care.

Reply

Minister for Health (Leo Varadkar)

Like others, I was shocked and distressed by the revelations of extremely poor and unacceptable standards of care and mistreatment of vulnerable adults in Áras Attracta. Every person who uses our disability services is entitled to expect and receive supports of the highest standard and to live in an atmosphere of safety and care.

The safeguarding and protection of vulnerable people in the care of the health service is of paramount importance and the Director General of the HSE has written to all staff instructing them to take personal responsibility for ensuring that individuals supported by the HSE in any setting are treated with dignity and respect.

In December 2014 the HSE initiated both an expert investigation chaired by Mr Christy Lynch, and an independently chaired review of services at this facility led by Dr Kevin McCoy.

Mr Lynch’s investigation team is working independently of the HSE and its findings will be a precursor to any disciplinary process consideration at which the HSE will undertake. Mr Lynch is both nationally and internationally recognised as a champion for people with a disability and a leader in the implementation of innovative supports. His independence in relation to this issue should not be questioned, as his proven track record in fighting for people with a disability speaks for itself.

Dr McCoy is undertaking an Assurance Review of the services at Áras Attracta and the final report will include an individual plan for improvement in each bungalow within the complex. The review will identify system wide learning involving engagement with relevant expertise as well as input from staff.

A Garda investigation into allegations of abuse at the centre is ongoing and the Gardaí had requested that a stay be placed on HSE investigations until such time as the Garda investigation is completed. However, the HSE has informed me that Gardaí have now cleared the way for the investigation to commence. Following the lift of a Garda stay, I have asked the HSE to keep me informed of progress.

On 16 December 2014, the Director General of HSE announced the appointment of Ms Leigh Gath as Confidential Recipient in respect of complaints or disclosures of abuse of vulnerable persons in receipt of HSE funded services. Ms Gath has been a fearless advocate and a champion for people with a disability for many years and will, no doubt, provide a strong and independent voice in her role. I am informed by the HSE that Ms Gath took up her duties with effect from Monday 22nd December 2014

In line with Government policy, disability providers are delivering an increasing proportion of services and supports which are individualised and person-centred and the HSE is actively working with disability providers towards the migration of more services in 2015 to this person-centred supports model.

Further work is necessary before decisions can be taken on the form or forms which individualised budgeting will take, but the essence of it will be that the individual is given more choice and control over how the money allocated to meet their needs is utilised.

In the meantime there are demonstration projects underway which are looking at all aspects of providing more person-centred and accountable supports for people with disabilities and these projects are providing a valuable insight into the issues arising.

The other points made in the details attached by the Deputy touch on the responsibilities of a number of my colleagues as well as myself, and I will make sure that my colleagues are made aware of these.

I can assure the Deputy that my Department will monitor progress on the initiatives and processes commissioned by the HSE in relation to Áras Attracta, to ensure that the learning from this incident is promulgated throughout our health system.

Policy on antenatal screening – 6th February 2015

To ask the Minister for Health further to Parliamentary Question No. 962 of 17 September 2014, and to the correspondence from the Health Service Executive (details supplied), his plans to introduce national policy in relation to antenatal screening and foetal abnormality testing.

Reply

Minister for Health (Leo Varadkar)

The National Clinical Programme for Obstetrics and Gynaecology was established in 2010. One of the programme’s key objectives is to develop and disseminate national guidelines. Such guidelines provide standardised guidance for all maternity units in the country on a range of clinical issues relating to women’s health.

As the query raised relates to a service issue, I have asked the HSE to respond to you directly. If you have not received a reply from the HSE within 15 working days please contact my Private Office and my officials will follow the matter up.

Services for those with mental health difficulties – 6th February 2015

To ask the Minister for Health his plans to improve services for those with mental health difficulties in view of ongoing problems (details supplied).

Reply

Minister of State at the Department of Health (Kathleen Lynch)

In line with the Programme for Government, my priority as Minister has been to modernise our mental health services, notwithstanding the severe resource constraints overall in recent years, and to prioritise new resources to underpin implementation of A Vision for Change. In that regard, the Government has provided an additional €125 million and some 1,150 posts for mental health comprising €35m with 416 posts in 2012, €35m with 477 posts in 2013, €20m for the recruitment of approximately 250 posts in 2014 and a further €35 million in 2015.

The funding is being used to continue to strengthen Community Mental Health Teams for both adults and children, to enhance specialist community mental health services for older people with a mental illness, those with an intellectual disability and mental illness, forensic mental health services, and to enhance access counselling and psychotherapy in primary care and investment in suicide prevention measures.

In relation to the specific issue by the Deputy, there are a number of treatment options for depression. The best and most appropriate treatment option depends on the individual case, the likely cause of depression and the severity of symptoms. Treatment for depression usually involves a combination of medication, talking therapies – usually provided by a mental health professional, such as a counsellor, psychiatrist or psychologist – and self-help. In some cases, a combination of all three might be the most appropriate treatment plan for that individual.

There are many excellent counselling services currently provided across the country by both the HSE and voluntary sector. Counselling is provided across the health service including primary care, social care and within the mental health. The type of service can be provided by a range of trained health professionals and delivered to meet a clinical need at either primary or secondary care level. The Government, in keeping with its commitment in the Programme for Government to increase access to counselling and psychotherapy, has provided funding totalling €7.5 million to develop the Counselling in Primary Care (CIPC) service, which works closely with HSE Mental Health Service, under whose aegis this funding is provided.

CICP is one of a range of initiatives taken by the HSE to build the capacity of primary care services to respond to mental health needs of individuals. I was pleased to note that the HSE in its National Service Plan 2015 has committed to “reviewing and improving access to psychotherapy and psychotherapeutic interventions”.

Risks associated with SSRIs – 6th February 2015

To ask the Minister for Health his views on the use of the anti-depressant Selective Serotonin ReUptake Inhibitor and if his attention has been drawn to studies that link it to increased cases of suicide and violence.

Reply

Minister of State at the Department of Health (Kathleen Lynch)

Selective serotonin re-uptake inhibitors or SSRIs are anti-depressants available on prescription only. They are authorised for use in Ireland and across the EU for the treatment of depressive disorders and some anxiety related conditions.

Depression may be associated with an increased risk of suicidal thoughts, self-harm and suicide. This risk may persist, particularly in the early stages of treatment with anti-depressants such as the SSRIs when a patient starts treatment and until significant remission of their depression occurs. Healthcare professionals and patients are advised of this risk through the product information for the individual medicines which specifically highlight the need for monitoring of the patient following initiation of treatment.

The approved product information accompanying these products advises that patients and their care-givers should be alerted to the need to monitor for any clinical worsening, suicidal behaviour or thoughts, or unusual changes in behaviour and to seek medical advice immediately if these symptoms appear.

The risk of suicide was reviewed at EU level on a number of occasions, most recently in 2008. During this safety review the existing warnings contained in the SSRI product information were further strengthened throughout Europe and manufacturers of SSRIs were obliged to update the product information on all SSRIs. The updated warnings were communicated by the Health Products Regulatory Authority (formerly known as the Irish Medicines Board) to doctors and pharmacists.

The Health Products Regulatory Authority (HPRA), in conjunction with medicines authorities in other member states continuously monitors the safety of medicines in a collaborative way and takes actions, as necessary, to ensure that medicines continue to have a favourable benefit-risk profile for patients. As part of the system of monitoring medicines safety, there is a spontaneous reporting system whereby healthcare professionals and patients can report suspected adverse reactions to medicines.

The HPRA also reviews, approves and continuously updates the product information and package leaflet of medicines to reflect the current state of knowledge of each medicine and the risks associated with its use. New and emerging safety data is assessed in conjunction with EU medicines authorities.

Huntington’s disease – resources being invested – 28th November 2014

To ask the Minister for Health if he will provide details of those resources being invested to assist in research into Huntington’s disease and care for Huntington’s disease patients.

Reply

Minister of State at the Department of Health (Kathleen Lynch)

he supports provided by the Health Service Executive (HSE) to people with Huntington’s Disease involve a multi-disciplinary team approach. This approach incorporates the provision of health and personal supports and incorporates Acute Hospital Services, Primary Care, Community Services and specialist disability supports and services. The HSE recognises the valuable contribution made by the Huntington’s Disease Association of Ireland to those who suffer from the disease, and to their families and carers and it provided a grant of €68,887 to support the Association with their work in 2013.

I have arranged for the aspect of the Deputy’s question which relates to research to be referred to the HSE for investigation and a direct reply to the Deputy. If the Deputy has not received a reply from the HSE within 15 working days, he can contact my Private Office and they will follow the matter up with the HSE.

Drug abuse in Dublin – 18th November 2014

To ask the Minister for Health his views that the Government is doing enough to address the drug addiction and drug abuse problem in Dublin city centre, including with discrepancies in the law (details supplied).

Details Supplied: for example where a pensioner found guilty of public intoxication and causing a breach of the peace, without previous convictions, is banned from all licensed premises in Dublin for three months, but a person caught injecting themselves with heroin in public, caught in possession of cannabis, is abusive to Gardai, has 118 previous convictions, only receives a suspended sentence.

Reply

Minister for Health (Leo Varadkar)

In line with the National Drugs Strategy, the Health Service Executive (HSE) has developed a national treatment and rehabilitation service that provides drug free and harm reduction approaches for problem substance users. The HSE provide a variety of drug treatment interventions to reduce drug-related harm and which encourage problem substance users to engage with, and avail of such services. These services include needle exchange provision, together with evidence-based treatment options such as methadone maintenance treatment, counselling and community and residential rehabilitation.

In an effort to respond to the problem of drug-related anti-social behaviour in Dublin city centre, the HSE, in partnership with a local voluntary service provider, Dublin City Council and an Garda Síochána have set up an assertive case management programme to engage with the cohort who are involved in public drug use. The pilot programme, which will be monitored and evaluated, is designed to provide best possible outcomes for these individuals and address their issues of homelessness and addiction using shared resources. The HSE also cooperate with the local community representatives of the North and South Inner City and with local Gardaí to minimise any negative public order issues that may arise in the vicinity of its treatment centres.

The National Drugs Strategy is a high priority in Government and I work closely with my cabinet colleagues, including the Minister for Justice, to ensure its full implementation. The Oversight Forum on Drugs, which I chair, monitors progress on the delivery of frontline services and addresses operational difficulties and blockages in implementing the Strategy. This forum brings together the key Government departments and agencies involved in the implementation of the Strategy.

In relation to the particular matter raised, the Deputy will appreciate that judges are independent in the matter of sentencing, as in other matters concerning the exercise of judicial functions, subject only to the Constitution and the law.

Foetal abnormality testing, state support and policy guidelines – 26th September 2014

To ask the Minister for Health the Health Service Executives policy on foetal abnormality testing; the State support provided; and the guidelines or policy that is in place for the HSE in dealing with religious and cultural beliefs that may be at odds with the welfare of women in this State.

Reply

Minister for Health (Leo Varadkar)

Antenatal screening i.e. tests that assess whether your unborn baby is at risk of certain conditions or abnormalities is part of the antenatal care provided to women during their pregnancy. The provision of antenatal screening is the responsibility of the Health Service Executive and as such, I have referred this question to the Health Service Executive for attention and direct reply.

Best practices regarding hereditary angioedema (HAE) – 26th September 2014

To ask the Minister for; Minister for Health his views on implementing best practices regarding hereditary angioedema (HAE) which have been outlined in a report (details supplied), and adopted in most European Union countries, specifically to make home infusions of C1-INH protein standard practice; his views on the report’s positive cost-benefit analysis of said practice and to educate medical professionals of the symptoms of HAE.

Reply

Minister for Health (Leo Varadkar)

As this is a service matter, it has been referred to the Health Service Executive for direct reply to the Deputy.

Multiple sclerosis drug – Fampyra – 15th July 2014

To ask the Minister for Health if he will consider adding the multiple sclerosis drug Fampyra to the drug payment scheme.

Reply

Minister for Health (Leo Varadkar)

The Health Service Executive (HSE) has statutory responsibility for decisions on pricing and reimbursement of medicinal products under the community drug schemes in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013.

The HSE received an application for the inclusion of Fampridine (Fampyra®) in the GMS and community drugs schemes. The application was considered in line with the procedures and timescales agreed by the Department of Health and the HSE with the Irish Pharmaceutical Healthcare Association (IPHA) for the assessment of new medicines.

In accordance with these procedures, the National Centre for Pharmacoeconomics (NCPE) conducted a pharmacoeconomic evaluation of Fampridine and concluded that, as the manufacturer was unable to demonstrate the cost effectiveness of fampridine in the Irish healthcare setting, it was unable to recommend the reimbursement of the product. The report is available on the NCPE’s website (www.ncpe.ie). The NCPE report is an important input to assist the HSE in its decision making process and informs further discussions between the HSE and the manufacturer of the drug.

The HSE assessment process is intended to arrive at a decision on the funding of new medicines that is clinically appropriate, fair, consistent and sustainable. In these circumstances, the HSE has not approved the reimbursement of Fampridine under the GMS or other community drug schemes.

However, I am aware that studies are ongoing to assess the wider impact of Fampridine on both walking and quality of life for persons diagnosed with MS. The results of these studies will contribute to the evidence base demonstrating the clinical effectiveness of the product which can be used to support future applications for its inclusion on the lists of reimbursable items supplied under the GMS and other community drugs scheme.

The HSE met with Biogen Idec recently to discuss a potential revised application. The HSE expects that Biogen Idec will submit a revised application. The HSE will then re-consider the application in as timely a fashion as possible in line with the agreed procedures and timescales for the assessment of new medicines.

Medical practitioners receiving industry gifts – 15th July 2014

To ask the Minister for Health if it is the case that members of the dentistry profession or any medical profession have to disclose gifts received by industry, for example, hospitality, entertainment or travel; the way such disclosures are policed or regulated; and if he is satisfied with current practice in this area.

Reply

Minister for Health (Leo Varadkar)

Under the Ethics in Public Office Act 1995 and the Standards in Public Office Act 2001 certain prescribed bodies must furnish a statement of compliance with legislation to the Standards in Public Office Commission. These bodies include Government Departments, public officials and public servants. Compliance with legislation is overseen by the Standards in Public Office Commission.  Public servants in designated positions of employment must complete an annual compliance statement in the context of the Ethics in Public Office Acts, which provides details of occupational income, shares, directorships, land (excluding private home), travel and accommodation, meals (supplied free of charge or at a price that was less than the commercial price), other remunerated positions, public service contracts, gifts, property and services given and other interests. However, this requirement does not apply to private individuals or other agents contracted by the public sector to provide certain services.

The Dental Council advises the dental profession and the public on matters relating to dental ethics and professional behaviour. It has not issued guidance on the acceptance of gifts or hospitality from industry and this issue has not been raised with the Dental Council. In relation to the medical profession, the Medical Council has issued guidance (October 2012) in this area ” Guide to Professional Conduct and Ethics for Registered Medical Practitioners”. This document clarifies the ethical guidance which the Medical Council gives to doctors’ interactions with pharmaceutical and medical device companies.

Delays in amending the Misuse of Drugs Regulations (1988) – 13th May 2014

To ask the Minister for Health when will the draft Misuse of Drugs (Amendment) Regulations, which will amend the Misuse of Drugs Regulations 1988, be submitted to Government seeking the Government’s approval to notify the draft regulations to the EU Commission; the reason for the delay in submitting the draft regulations for Government approval; and if he will make a statement on the matter.

REPLY.

The Minister of State at the Department of Health (Alex White):

Work is ongoing on the drafting of regulations to amend the Misuse of Drugs Regulations 1988. This process is taking longer than anticipated because it is a complex and technical body of work. The regulations will be finalised as soon as possible.

Entitlement to public hospital inpatient services for those with private health insurance – 1st April 2014

To ask the Minister for Health if he will clarify the following issue regarding entitlements under PRSI (details supplied).

Details: I have always understood that I am entitled, through my PRSI etc, to public hospital inpatient service subject to a possible per diem fee of €75 euro (aggregate max of €750 in any year). Has this changed and, if not, on what basis can Dr Reilly decide that I will have to pay over €800 per diem because I have private health insurance?

Reply:

Minister for Health (James Reilly):

The Health Act 1970 (as amended) provides that all persons ordinarily resident in the country are entitled, subject to certain charges, to all in-patient public hospital services in public wards including consultant services and out-patient pubic hospital services including consultants services. For persons availing of public in-patient services, the current public hospital statutory in-patient charge is €75 per night, subject to a maximum of €750 in any twelve consecutive months. Medical card holders are exempt from public hospital charges.

Section 55 of the Health Act 1970 (as amended) provides for the charging of private in-patients. An essential element of the eligibility arrangements is that the public or private status of a patient must be specified on admission to hospital. Where a patient elects to be treated privately by a consultant the hospital must treat that patient as a private patient. Persons who opt to be private on admission to hospital are liable for the fees of all consultants involved in his or her care and for such charges under Section 55 for that episode of care.

With effect from 1st January 2014, private hospital charges, as provided for in the Health (Amendment) Act 2013 can be found here.

Allocation of resources by county, region and type of spending – 27th February 2014

To ask the Minister for Health if he will provide a breakdown of the allocation of resources to healthcare by county and region and by type of spending for example human resources, infrastructure and so on.

Reply:

Minister for Health (James Reilly):

The HSE published its 2014 National Service Plan, setting out the type and volume of health services it proposes to deliver during the course of this year on the 18th December last, after consideration at Government and approval by the Minister for Health. This year’s National Service Plan is the first Service Plan presented by the Directorate of the Health Service Executive following the enactment of the HSE Governance Act, 2013. The 2014 Service Plan sets out the overall funding framework within which the HSE will operate during the year along with details of the health care resources allocated across each of the service Divisions. This National Service Plan is supported by Operational Plans which set out in detail the services to be delivered by each service Division ( Acute, Health and Wellbeing, Primary Care, Mental Health and Social Care) and by the National Ambulance Service. These Operational Plans were published by the HSE on 30th January last and are available under the publications heading on the HSE website at www.hse.ie.

A) Breakdown of the burden of disease across counties & regions by socio-economic strata – 27th  February 2014

To ask the Minister for Health if he will provide a breakdown of the burden of disease across counties and regions in Ireland by socio-economic strata.

B) Breakdown of the distribution of health problems by disease type, county & region – 27th February 2014

To ask the Minister for Health if he will provide a breakdown of the distribution of health problems broken down by disease type and county and region within Ireland.

Reply:

Minister for Health (James Reilly):

The Health Status and Health Utilisation module of the Quarterly National Household Survey is carried out periodically, most recently in 2010.  The report from this survey may be accessed on the CSO Website at:

http://www.cso.ie/en/media/csoie/releasespublications/documents/labourmarket/2010/healthstatusq32010.pdf.

Table 3 in the report sets out the percentage of adults who self reported doctor diagnosed health conditions for 21 different health conditions broken down by a number of categories, including region and high level ILO Economic Status.   The survey only samples adults (18+) in private households.  As highlighted by CSO, some percentages quoted are based on small numbers and should be interpreted with caution.

Breakdown of mental health services per county and region – 27th February 2014

To ask the Minister for Health if he will provide a breakdown of mental health services per county and region; the number of staff in each unit; their grade; the number of patients; and the total level of funding provided by region on such services over the past three years.

Reply:

Minister for Health (James Reilly):

As this is a service issue this question has been referred to the HSE for direct reply.

Click here to view this reply.

Government policy on e-cigarettes – 27th February 2014

To ask the Minister for Health if he has any concerns regarding the possible impact of e-cigarettes on young people in terms of encouraging them to become smokers; if he is concerned that tobacco manufacturing and same companies are investing in and procuring e-cigarette companies; if it is Government health policy that the e-cigarette industry be subsidised in any way here through grant aid, agency support and so on.

Reply:

Minister for Health (James Reilly):

The current position in relation to e-cigarettes in Ireland is that if e-cigarettes are not presented as medicinal products for smoking cessation or as medical devices with a therapeutic purpose, they do not fall under the medicinal products or medical devices legislation. As e-cigarettes do not contain tobacco they are currently not regulated under our tobacco legislation.

Guidelines developed under the World Health Organisation Framework Convention on Tobacco Control contain recommendations that countries should not grant aid the tobacco industry. However, it is important to note that these guidelines were developed in the context of the industry producing tobacco containing products.

Tobacco Free Ireland, Ireland’s tobacco control policy, states that the general consensus at European level is that there is a lack of research in relation to the long term health effects of e-cigarettes and a lack of sufficient evidence that they aid with smoking cessation. There is a concern that e-cigarettes may act as a gateway to tobacco smoking.

In order to harmonise regulation of e-cigarettes across EU Member States, the new Tobacco Products Directive,which still has to be formally adopted at European level will, inter alia, provide for the regulation of e-cigarettes. The Tobacco Directive will
– set mandatory safety and quality requirements e.g. on nicotine content, ingredients and devices, as well as refill mechanisms etc., for e-cigarettes.
– make health warnings and information leaflets obligatory,
– introduce notification requirements for manufacturers and importers of e-cigarettes,
– impose stricter rules on advertising and monitoring of market developments.

In view of the lack of sufficient research and information regarding e-cigarettes, my Department will continue to monitor existing and emerging evidence on the potential harm and the potential benefits of e-cigarettes.

Tackling the emerging hospital consultant recruitment crisis – 18th February 2014

To ask the Minister for Health his plans to tackle the emerging hospital consultant recruitment crisis.

Reply:

Minister for Health (James Reilly):

Notwithstanding the need to reduce the numbers employed across the public service in order to meet fiscal and budgetary targets, the HSE has the capacity to recruit consultants. Arrangements are in place in the HSE to allow the recruitment of front-line staff where there is an established service need. More generally, in order to mitigate the impact on frontline services of the reduction in employment numbers, the priority is to reform how health services are delivered in order to ensure a more productive and cost effective health system.

It is Government policy to move to a consultant delivered service and there has been a significant increase in the number of consultants (Whole Time Equivalents) over the past 5 years, the number increased from 2,260 in December 2008 to 2,555 in December 2013. However there are some specialties in which there is an international shortage and which have been traditionally difficult to fill, regardless of the salary scale. There are also some hospitals to which it has historically been difficult to attract applicants, in particular smaller hospitals that have onerous rosters due to the limited number of consultants. The establishment of Hospital Groups will help to address this issue, as this will allow doctors to be appointed as group resources – instead of to just one hospital.

The ability of the public service to attract and retain high quality consultants shapes the extent to which the HSE can maintain and develop the range of health services required. If the health services are to continue to provide consultant-level opportunities for doctors to replace consultants who retire and eventually to expand overall capacity, this can only happen on the basis of a lower-cost model, hence the decision to reduce the pay of new consultants by 30%. This decision is being modified to enable consultants currently working in permanent posts within the public service to move to different posts, while retaining their existing salaries. Application of the revised guidance will support consultant mobility. Allowing serving clinical consultants retain their existing salaries will remove a blockage on movement within the system at present. This mobility will, in due course, also facilitate the roll-out of the Hospital Group model with staff appointed to the Group rather than being confined to specific locations.

I set up  a group under the chairmanship of Professor Brian McCraith last July to carry out a strategic review of medical training and career structures. The Group submitted an interim Report focused on training to me in December and is now progressing examination of the career structure to apply on completion of specialist training with a view to reporting to me by the end of March. Broader issues relating to recruitment and retention of NCHDs and consultants will be given further consideration on receipt of this report.

Efforts to keep private health insurance affordable – 13th February 2014

To ask the Minister for Health if he will provide an update on his efforts with health insurance providers regarding the increasing cost of private insurance, the need to encourage younger people to secure private insurance, and continued preparations towards the provision of a universal healthcare system.

Reply:

Minister for Health (James Reilly):

There are currently just over 2 million people, or 44.6% of the population with private health insurance.  While this has fallen from a peak of 50.9% in 2008, Ireland continues to retain a high level of population holding voluntary private health insurance. There are a number of measures being progressed by my Department to help maintain a competitive and sustainable private health insurance market.

My immediate focus is to keep health insurance affordable for as many people as possible. I have been strongly seeking much greater cost control in the private health insurance industry and established the Consultative Forum on Health Insurance, comprising representatives from the private health insurance companies, my Department, and the Health Insurance Authority,  to generate ideas to address health insurance costs. Last year, I appointed an independent Chairperson Mr. Pat McLoughlin, to work with my Department and the insurers under the auspices of the Forum on a review process to give effect to real cost reductions in the private health insurance market. Mr. McLoughlin’s first report was published on 26 December 2013, and the second phase of the review has commenced and will report within three months. In particular it will study further the drivers behind rising costs in the PHI industry and seek to address them.

I am supportive of the concept of Lifetime Community Rating (LCR) as a potential means of helping to address decreasing membership of the private health insurance market, in particular to provide an incentive for people to take out private health insurance at a younger age. This is important as the health insurance market requires a sizeable cohort of younger members, who are generally healthier, to offset the high cost of older and less healthy members, which is critical to the sustainability of our system of community-rated health insurance.  My Department is working on proposals in this regard and will work, in conjunction with the Health Insurance Authority and industry stakeholders, to develop these further over the coming months.

With regard to the provision of a universal healthcare system, intensive work is currently underway on the preparation of a White Paper on Universal Health Insurancewhich will provide more detail on the UHI model for Ireland, including the overall design of the model, the standard package of services, funding mechanisms and the key stages of the journey to UHI. Drafting is at an advanced stage and I intend to bring the White Paper to Government very shortly with a view to publication as soon as possible.

Methadone clinics in the city centre – 4th February 2014

A) To ask the Minister for Health if the Health Service Executive is considering changing its policy of concentrating methadone clinics in the city centre, particularly in tourist areas; and if they are considering alternatives such as mobile clinics.

B) To ask the Minister for Health his views on the concentration of methadone clinics in the city centre and social order issues that arise as a result of same; and the negative impact this has on those visiting the city, as well as on tourism businesses to operate in the city centre.

Reply

The Minister of State at the Department of Health (Alex White):

The HSE provides opioid substitution (mainly methadone) in a number of treatment settings to meet the needs of individual drug users.  These settings  include:

– primary care through GPs and community pharmacies;
– satellite clinics that facilitate opioid substitution provision through community pharmacies;
– treatment centres where opioid substitution treatment is dispensed on site; and
– residential rehabilitation facilities.

The HSE recognises that drug treatment is best provided at the lowest level of complexity, matching the patient’s needs and as close to the patient’s home as possible. There are currently 54 clinics within the four Dublin Local Authority Areas of which only 6 are based in the city centre at:

– City Clinic, Amiens Street
– Bride St
– Merchants Quay Project
– National Drug Treatment Centre, Pearse Street
– Castle St Clinic
– Cork St Clinic

The HSE Addiction Service continues to co-operate with the local community representatives of the North and South Inner City and the local Gardaí in minimising any negative public order issues that may arise in the vicinity of its treatment centres.

There are no plans to introduce alternatives to the opioid treatments services outlined above such as mobile clinics.

Delays in HSE physiotherapy appointments in Pembroke-South Dock – 19th December 2013

To ask the Minister for Health the reason there is a delay in processing and arranging Health Service Executive physiotherapy appointments in the Pembroke-South Dock area.

Reply:

Minister for Health (James Reilly):

As this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.

Click here to see the HSE’s response.

Tobacco products subject to plain packaging laws – 4th December 2013

To ask the Minister for Health if he is considering, as part of the new plain packaging laws, excluding cigar and pipe tobaccos, as was the case with the display ban introduced for cigarettes.

Reply:

Minister for Health (James Reilly):

As the Deputy will be aware, Government approval was received on 19th November 2013 for the publication of the General Scheme of a new Public Health (Standardised Packaging of Tobacco) Bill 2013 and to proceed with the drafting of the legislation based on this General Scheme. It is proposed that all tobacco products will have to comply with this legislation.

Accountability of Hospital CEOs regarding their budgeting performance – 26th November 2013

To ask the Minister for Health if the chief executive officers of individual hospitals or areas of the health service are responsible for their performance regarding budgeting and so on; and if so to whom are they responsible.

Reply:

Minister for Health (James Reilly):

Each agency under the aegis of the Department of Health has set out the respective roles of its Accounting Officer and Chief Executive Officer. For bodies which have a Board, the Board is responsible for the body’s system of internal controls, including financial, operational and compliance controls and risk management. The Chief Executive Officer is answerable to the Board.

Each State body has a properly constituted internal audit function or should engage appropriate external expertise in this regard and should operate within the provisions set out in the Department of Finance’s “Code of Practice for the Governance of State Bodies”.

In relation to the specific arrangements in relation to hospitals and agencies for which the HSE is responsible I have forwarded the question to the HSE for direct reply to the Deputy.

Click here to see direct reply.

Medical card eligibility for those with UK pensions – 12th November 2013

To ask the Minister for Health if those who receive a UK pension but are living here are automatically entitled to a medical card.

Reply:

Minister for Health (James Reilly):

Regulation (EC) 883/04 and Implementing Regulation 987/09 provide for the coordination of social security systems, including healthcare, within the EU/EEA and Switzerland, with the aim of ensuring the free movement of persons. This objective of the Regulation is to ensure that persons exercising their right to move and to stay freely within the EU/EEA and Switzerland do not suffer disadvantage.

In Ireland, a Medical Card may be issued to EU\EEA citizens under EU Regulation 883/04 if the person is in receipt of a qualifying payment from one, or more, of the Member States, provided they are not subject to Irish social insurance legislation. It is the person with the qualifying payment who is assessed for a medical card. Family members of persons with an entitlement under the EU Regulations may also be entitled to a medical card provided they (the family member(s)) are not subject to Irish social security legislation.

Access to Primary Care Services – 17th July 2013

To ask the Minister for Health his plans to set national criteria for access to primary care services in view of the geographic discrimination that applies when accessing healthcare, for example physiotherapy and mental health services.

Reply:

Minister for Health (James Reilly)

This Government is committed to reforming our model of delivering healthcare so we can reduce the cost of achieving the best health outcomes for our citizens.

The implementation of the Primary Care Strategy continues to be a priority for this Government. The objective is to develop services in the community which will give people direct access to integrated multi-disciplinary teams of general practitioners (GPs), nurses, physiotherapists, occupational therapists, speech and language therapists and others. At the end of May 2013, there were 418 Primary Care Teams operating, i.e. holding clinical team meetings, involving GPs and HSE staff. The HSE’s 2013 National Service Plan commits to having 484 operational Teams in place by the end of this year.

In 2012, the HSE completed a detailed analysis of the numbers and distribution of public health nurses, registered general nurses, occupational therapists, physiotherapists and speech and language therapists. The analysis revealed considerable variation across the HSE’s 17 Integrated Service Areas in ratios of health care professionals to population, and to population numbers in areas of high deprivation.

Based on this exercise, in 2013, Primary Care funding of €20 million, nationally, will be invested to support the recruitment of prioritised front-line primary care team posts and enhance the capacity of the primary care sector.

I issued approval to the HSE on the 27th March 2013 to commence recruitment to Primary Care Teams with immediate effect of the following additional 251 Primary Care posts:

70 Public Health Nurses;
37 Registered General Nurses;
51 Occupational Therapists;
46 Physiotherapists; and
47 Speech & Language Therapists.

The allocation and distribution of the above posts is based on bringing each Integrated Service Area, where staffing is below the national average, towards the national average.

This Government recognised the pivotal role that Primary Care has in addressing the mental health needs of the population and committed in the Programme for Government to the provision of counselling services in primary care, specifically for people with mental health problems. Budget 2012 provided a special allocation of €35 million for mental health from which €5m was made available for the provision of psychological and counselling services in primary care, specifically for people with mental health problems who are eligible under the General Medical Services. A further €2.5 million was made available from this year’s special allocation for mental health. Ten Counsellor Coordinators, who will be responsible for the set-up, roll-out, management and monitoring of the service, have now been appointed.

Last week, I was delighted to join my colleague, the Minister with responsibility for Mental Health, Kathleen Lynch, T.D, at the launch of the Counselling in Primary Care Initiative. This Initiative will be working to improve access to counselling to people with mild to moderate psychological difficulties who are medical card holders under the General Medical Services Scheme.

It is expected that the start date for the service will vary according to when the Counsellor Coordinator takes up the post but the first services will begin to roll-out this month.

Labeling of GMO ingredients in foods – 12th July 2013

To ask the Minister for Health his policy in relation on the labeling of GMO ingredients in foods.

Reply:

Minister for Health (James Reilly)

Ireland adopts a “positive but precautionary” stance on GMO food and feed matters, considers the advice of EFSA with regard to authorisations, and votes with the European Commission once assured of the safety of the product. The only GM food ingredients that are authorised in the EU and that may, as a consequence, be marketed in Ireland are soya bean, maize, oilseed rape, cotton, sugar beet and starch potato. Under current EU legislation, if more than 0.9% of a food or a food ingredient is derived from a GM source, then it must be labelled accordingly. Even if the GM ingredient is present in a food but below the 0.9% threshold level, operators must be in a position to demonstrate that they tried to obtain the food or ingredient from a non-GM source and that its presence is due to cross contamination. Non-authorised GMOs are not allowed at any level.

Adding Addison’s Disease to the Long Term Illness scheme– 26th June 2013

To ask the Minister for Health if he is considering categorising Addison’s disease as an illness under the long term illness scheme.

Reply:

Minister for Health (James Reilly)

There are no plans to extend the list of conditions covered by the Long Term Illness scheme.

Under the Drug Payment Scheme, no individual or family pays more than €144 per calendar month towards the cost of approved prescribed medicines. The scheme significantly reduces the cost burden for families and individuals incurring ongoing expenditure on medicines.

In addition, people who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be entitled to a medical card. In the assessment process, the Health Service Executive can take into account medical costs incurred by an individual or a family. Those who are not eligible for a medical card may still be able to avail of a GP visit card, which covers the cost of GP consultations.

Free GP care for children with Special Needs – 26th June 2013

To ask the Minister for Health if a date has been set for the rolling out of the free general practitioner scheme for children with special needs.

Reply:

Minister for Health (James Reilly)

No date has been set, nor was a commitment given to set a date, for the provision of a general practitioner scheme for children with special needs. However, the Government is committed to introducing, on a phased basis, a universal GP service without fees within its first term of office, as set out in the Programme for Government and the Future Health strategy framework. This policy constitutes a fundamental element in the Government’s health reform programme. There has been no change to the Government’s over-arching commitment to this goal. This Government is the first in the history of this State to have committed itself to implementing a universal GP service for the entire population.

Currently, I am exploring a number of alternative options with regard to the phased implementation of a universal GP service without fees. Minister Reilly and I expect to report back to the Cabinet Committee in the near future. As part of this work, consideration will be given to the approaches, timing and financial implications of the phased implementation this universal health service. This Government is determined to expedite the implementation of a national GP service for the entire population, something to which no previous Government has ever aspired.

 Diabetes Nursing Posts – 21st June 2013

To ask the Minister for Health if he will provide an update on the filling of the five sanctioned integrated diabetes nursing posts.

Reply

The Minister for Health (James Reilly):

The National Integrated Care Diabetes Programme is being implemented on a phased basis. The programme will improve patient access and manage patient care in an integrated manner across service settings, resulting in better outcomes, enhanced clinical decision making and the most effective use of resources.

The Government has approved funding for the appointment of 17 Integrated Care Diabetes Nurse Specialists (one per HSE Integrated Service Area) to support the phased roll out of the programme. These Diabetes Nurse Specialists will work 1 day per week in a hospital setting and 4 days per week in primary care. They will play a key role in the development of clinically sound collaborative links between primary care and secondary care providers and will also be an essential resource in empowering patients to achieve optimum diabetes control. To date 15 posts have been offered or accepted, subject to Garda clearance, etc. It is anticipated that all 17 positions will be filled soon.

Meetings with the Irish Thalidomide Association and the Irish Thalidomide Survivors Society – 16 April 2013

To ask the Minister for Health if he has had any recent meetings with the Irish Thalidomide Association or the Irish Thalidomide Survivors Society and if he will provide an update of the outcomes of those meetings.

Reply

The Minister for Health (James Reilly):

The Programme for Government includes a commitment to reopen discussions with Irish survivors of thalidomide. I met with both representative organisations in July 2011 and have been in correspondence since.

Given the challenges that persist for each individual, this Government’s aim is to address the health and personal social care needs of thalidomide survivors living in Ireland. I have stated that I am willing to enter into discussions about a health care package on a non-statutory basis; an ex-gratia payment having regard to current financial circumstances; and a statement to the Dáil recognising the challenges faced by survivors.

The Irish Thalidomide Association announced publicly in 2012 that it had ceased talks with the Government. The Association’s legal advisor has initiated personal injuries claims against the manufacturer and distributors of the Thalidomide drug and the State.

The Irish Thalidomide Survivors Society is seeking, amongst other things, an independent agency with ring fenced funding to provide for a statutory package to provide for their needs including health and personal services, housing adaptations, heating, transport and clothing. I am not in a position to meet the demands of the Society. I would also point out that each Irish thalidomide survivor has a medical card and it is open to each individual to apply for the numerous public supports available to people with a disability provided by other Departments such as housing adaptation grants, disabled drivers tax concessions and disability allowance. However, I have asked the Society to consider, in good faith, proceeding with a Health Care Protocol which envisaged appointing and training a multi-disciplinary team, arranging a multi-disciplinary health evaluation, identifying and documenting their healthcare needs/issues and developing plans to address those needs. The Society are unwilling to proceed on that basis.

There are currently 32 Irish Thalidomide survivors. Each survivor received lump sum payments from a German Foundation and the Irish Government in the early 1970s. In 1975 the lump-sums paid by the Irish Government ranged from €6,400 to €21,000. In addition, each survivor receives on-going monthly payments from both the German Foundation and the Irish Government. Combining the Irish and German payments, most individuals receive over €2,500 per month, or €575 per week tax free.

The Medical Council’s prerequisites for transfer to the General Division of the Medical Register – 16 April 2013

To ask the Minister for Health the Medical Council’s reason for requiring doctors who have been registered for two years on the Supervised Division of the Medical Register to take the pre registration exam as a prerequisite for transfer to the General Division.

Reply

The Minister for Health (James Reilly):

Responsibility for maintenance of this Medical Register lies with the Medical Council. The Supervised Division was established in 2011 by amendment to the Medical Practitioners Act 2007 to enable the Health Service Executive (HSE) to recruit doctors to practise under supervision for a fixed term in specialty specific non-consultant hospital doctor posts. It was established to address a shortage of doctors in the HSE.

This amendment to the Medical Practitioners Act requires that doctors registered in the Supervised Division only practise medicine in the post to which they have been proposed by the HSE, while under strict supervisory arrangements, for a period of up to two years. These assessment and practice arrangements are designed to protect patients. The amendment was intended to complement and not to replace arrangements already in place for registration of doctors pursuing training in Ireland.

Under the arrangements for registration set out in Part 6 of the Medical Practitioners Act, doctors registered in the Supervised Division, wishing to establish themselves in practice on an ongoing basis outside the supervised, specialty specific posts for which they were initially assessed, may transfer to the General Division or the Trainee Specialist Division.

Once registered in the General Division, practitioners may practise medicine on an ongoing basis in Ireland in any post and without any regulatory limit on scope of practice. The ability to practice medicine in any post was not assessed in the specialty specific assessment, which was designed for registration in the Supervised Division.
The registration process for entry to the General Division involves an assessment to ensure that the practitioner is fit-to-practise in a diverse range of positions. For most doctors currently registered in the Supervised Division, this will involve examination by way of the PRES, which is designed to ensure that the doctor demonstrates competence in a general scope of practice, which is consistent with registration in the General Division of the register. This is a critical and necessary measure to protect the public.

Doctors registered in the Supervised Division may also seek registration in the Trainee Specialist Division provided relevant criteria are met. These criteria include having access to a recognised training post, holding a document which is deemed equivalent to a certificate of experience, and being successful at the PRES, or being exempted from this exam.

The Medical Council is currently working with the HSE to operate an efficient process for doctors seeking transfer from the Supervised Division. Doctors currently registered in the Supervised Division wishing to transfer registration to the General Division must engage in this process.

In-patient and day case waiting lists in St Vincent’s Hospital – 20th March 2013

To ask the Minister for Health the measures that have been taken to tackle in-patient and day case waiting lists in St Vincent’s University Hospital, Elm Park, Dublin 4; the impact of these measures; and if he will make a statement on the matter.

Reply

The Minister for Health (James Reilly):

In 2011, I established the Special Delivery Unit in my Department as set out in the Programme for Government. The aim of the SDU is to unblock access to acute services by improving the flow of patients through the system. The SDU’s Scheduled Care Team focused initially on waiting times for in-patient and daycase elective surgery. For 2012, a target was set that no adult should wait longer than 9 months for inpatient or daycase treatment. By the end of December 2012, the number of adults having to wait more than 9 months for inpatient and day case surgery nationally had fallen to 86. This was down from 3,706 in December 2011, representing a 98% decrease

I am determined that the progress made in 2012 be maintained and improved upon. For 2013, the target is that no adult should be waiting longer than 8 months for inpatient or daycase treatment. It is important to recognise that the progress made in 2012 does not mean the problem is solved, and 2013 will of course be extremely challenging. For example, winter pressures in Emergency Departments have impacted on scheduled care waiting times. However, in the coming months, as winter pressures ease, the SDU will work towards re-balancing scheduled care to maintain the improvements seen in 2012 and to achieve the new 2013 target.

With regard to the specific hospitals referred to, I have asked the HSE to respond directly to the Deputies concerned.

To view the HSE’s response click here

Medical cards for Polio survivors – 26th February 2013

To ask the Minister for Health his plans to allow Polio survivors to qualify for a medical card automatically and if he is considering categorising Polio as an illness under the long term illness scheme.

Reply

The Minister for Health (James Reilly):

Medical cards are not awarded to any particular group of patients on the basis of a specific medical condition.

Under the provisions of the Health Act 1970, eligibility for health services in Ireland is based primarily on residency and means. There are currently two categories of eligibility for all persons ordinarily resident in Ireland i.e. full eligibility (medical card) and limited eligibility (all others). Full eligibility is determined mainly by reference to income limits and is granted to persons who, in the opinion of the Health Service Executive, are unable to provide general practitioner, medical and surgical services to themselves and their dependents without undue hardship. There is no automatic entitlement to a medical card for persons with any specific illness.

There is a provision for discretion to grant a card in cases of “undue hardship” where the income guidelines are exceeded. The HSE set up a clinical panel to assist in the processing of applications for discretionary medical cards where there are difficult personal circumstances.

There is an emergency process for a person who is terminally ill, or in urgent need of medical attention and cannot afford to pay for it, that provides a card within 24 hours while the normal application process is completed. Once a letter from the patient’s GP or consultant is received stating that the person is terminally ill and the required personal details are provided, an emergency card is issued to that person for a six-month period.

There are no plans to extend the list of conditions covered by the Long Term Illness Scheme.

Graduate programme for speech and language therapists – 26th February 2013

To ask the Minister for Health if a graduate programme for speech and language therapists will be introduced in 2013.

Reply

The Minister for Health (James Reilly):

The Government has decided that the numbers employed across the public service must be reduced in order to meet its fiscal and budgetary targets. The health sector must make its contribution to that reduction.

The Department of Public Expenditure and Reform agreed to a nurse graduate initiative on the basis that it would deliver significant savings through displacement of agency and overtime expenditure.

I have no plans at present for similar graduate programmes for other health professions.

Funding for day care services for elderly people (Cowpercare daycare) – 7th February 2013

To ask the Minister for Health his views on correspondence regarding funding for day care services for elderly people by Cowpercare daycare in Cowper Road, Rathmines.

Reply

The Minister for Health (James Reilly):

To read the response from the HSE, click here.

Agency nurses in the HSE – 6th February 2013

To ask the Minister for Health his views on the use of agency nurses in hospitals here, in particular the cost-effectiveness of using agency nurses in cases of unexpected demand, specialist nursing and to cover Health Service Executive staff sick leave and holidays.

Reply

The Minister for Health (James Reilly):

In the health service, agency staff are used to fill vacancies that arise for a variety of reasons including sick leave, annual leave and maternity leave, to ensure continuity of service and where some flexibility in staffing a service is required.

However such arrangements involve certain additional costs, such as a fee to the agency concerned as well as Value-Added Tax (VAT) at 22%. As such, health service management must tightly control the extent to which agency staff are used, particularly to substitute for staff who have left the health service, given the requirement to reduce employment levels to a net 98,955 wholetime equivalents by the end of 2013.

The HSE’s National Service Plan 2013 notes that considerable savings have to be achieved from changes to the manner in which staff are deployed, with tight control of the use of higher-cost staffing arrangements and in particular the use of agency staffing and overtime. The Plan includes a target saving of €10m set against the recruitment of graduate nurses to directly offset spend on agency and overtime. It also recognises the need for systematic reviews of rosters and a focused approach to addressing staff absenteeism and implementing revised new sick leave arrangements.

Destruction of Heel Prick data – 6th February 2013

To ask the Minister for Health if he is concerned that the destruction of data obtained through the use of the heel prick test will result in a loss of valuable data that could be used to better understand certain diseases and their genetic links; and if he has considered restrictions on the use of such data instead of its destruction.

Reply

The Minister for Health (James Reilly):

Following the receipt of a complaint regarding the retention of Newborn Screening Cards (NSCs), the Data Protection Commissioner found that the retention of the cards without consent constituted a breach of the Data Protection Acts 1998 and 2003. There were a number of meetings between the Deputy Data Protection Commissioner, representatives from my Department, the HSE, and the Children’s University Hospital, Temple Street which resulted in agreement that NSCs older than 10 years would be destroyed. Retention of NSCs for ten years was deemed appropriate for the purposes of checking an initial diagnosis.

I requested the HSE to conduct a review of this decision. This review examined both the legal and ethical basis for the retention of NSCs and the potential use of the existing cards for research purposes. The Review Group report and recommendations were submitted to me in January 2012. Having carefully considered the issue, I accepted the recommendation of the review group that in order to meet our legal and ethical obligations, particularly in relation to the Data Protection Acts, NSCs older than ten years will be destroyed. The review group also explored how the material could be made available to the research community in a way which was compatible with our ethical and legal obligations.

However, I recognise the potential value of the material for research purposes. As deputies are aware, the HSE has begun an information campaign offering members of the public the opportunity to have their NSC returned to them prior to any destruction of the cards taking place. This will ensure that anyone who wishes to donate their or their child’s Newborn Screening Card to research will be afforded the opportunity to do so. The HSE is actively engaging with the research community to facilitate the direct transfer of cards where this may be more convenient for parents. To this end, the HSE has contacted a number of research organisations to inform them of this position and has invited these organisations to provide a plan setting out a governance system for the storage and future use of the card or cards for clinical or research purposes, prior to any agreed transfer.

I consider that the people to whom the NSCs relate, or their parents if they are under 18 years of age, are the people who should choose what happens to their cards. I am confident that the approach adopted by the HSE will ensure that their choices will be respected.

Employment practices in the civil service – 6th February 2013

To ask the Minister for Health if there are any retired public sector workers from his Department, or any other part of the public sector, currently on his Department’s payroll, for example, for sitting on a committee or preparing a report, but not exclusively these two areas; the number on the payroll; the cost to his Department; the services being delivered for this money; and the way that the positions were originally advertised.

Reply

The Minister for Health (James Reilly):

Six retired Public Servants (3.86 wholetime equivalents) are currently re-employed in my Department and are on the payroll.

Four former staff members of my Department, who are now retired, were rehired in line with a Government Decision on the arrangements for dealing with our EU Presidency requirements. These officers have experience and expertise that is essential to a successful Presidency for Ireland in the important area of Health Policy. The fixed term contracts of employment in each of these cases will terminate as soon as our Presidency tasks have been discharged.

In addition to this I appointed Ms Maureen Windle, ex-Chief Executive Officer of the Northern Area Health Board as my Special Adviser on a two-thirds basis and Minister of State Alex White appointed one retired Public Servant as a Civilian Driver.

For ease of reference I have attached the information requested by the Deputy in tabular format.

Grade Current – Annual Salary Rate
1 Principal Officer (50% of full time) – €40,025
2 Assistant Principal (50% of full time) – €30,983
1 Assistant Principal (70% of full time) – €43,376
1 Special Adviser (66% of full time) – €61,784
1 Civilian Driver – €32,965

The pensions of these staff are subject to pension abatement rules.

Working Hours for non-consultant hospital doctors (NCHDs) – 5th February 2013

To ask the Minister for Health if Ireland is complying with the EU Working Time Directive for non-consultant hospital doctors at present; if NCHDs are working more than 48 hours per week and/or working for more than 24 hours consecutively; and if he will make a statement on the matter.

Reply

The Minister for Health (James Reilly):

The Government is committed to achieving compliance with the European Working Time Directive in respect of non-consultant hospital doctors (NCHDs) by 2014. I have emphasised to the HSE the high priority the Government and I attach to this issue.

In January 2012, a detailed plan for the achievement of compliance by NCHDs with the Working Time Directive was submitted to the EU Commission. The plan affirmed Ireland’s commitment to achieving compliance with the Directive over a three-year time period. It committed to implementing the measures necessary, including: the implementation of new work patterns for medical staff, transfer of work undertaken by NCHDs to other grades, and the organisation of hospital services to support compliance.

The Health Service Executive’s Service Plan for 2013 specifically recognises the need to address the issue as a priority, stating that there will be a particular focus in the acute hospital service on the achievement of compliance with the European Working Time Directive amongst the non-consultant hospital doctor workforce, in line with the Implementation Plan submitted to the Commission in 2012. The HSE is currently finalising its National Operational Plan to support the implementation of the National Service Plan 2013. This will specify in greater detail the actions to be taken during the year in relation to EWTD compliance. A key priority for the HSE in 2013 will be a further reduction of average weekly hours worked and also a reduction in the duration of shifts undertaken.

The HSE, as the principal health service employer, engages with the IMO on a regular basis in relation to contractual matters, including EWTD compliance, and will continue to do so.

Reform of the Health System – 5th February 2013

To ask the Minister for Health when the single health insurance fund will be put in place; the persons who will be covered under the new system; the services to be covered by the fund; the amount of the additional cost that is covered; if there is a forum in which private insurers may decide how to modify their plans in line with these services; if additional tax relief is planned for those still maintaining private health insurance; and if he will make a statement on the matter.

Reply

The Minister for Health (James Reilly):

The Government is embarking on a major reform programme for the health system, the aim of which is to deliver a single-tier health service, supported by universal health insurance (UHI), where access is based on need, not on income. Insurance will be provided under a multi-payer insurance model with no distinction between “public” and “private” patients. Under UHI, everyone will be insured and will have equal access to a standard package of primary and acute hospital services, including acute mental health services. A new Insurance Fund will subsidise or pay insurance premiums for those who qualify for a subsidy.

In moving to a system of UHI, there are a number of key stepping stones that are necessary to pave the way for the introduction of universal health insurance. Work is underway on these critical building blocks that will bring benefits and drive efficiencies in advance of implementing UHI. They include:

– the strengthening of primary care services to deliver universal primary care with the removal of cost as a barrier to access for patients;

– the work of the Special Delivery Unit in tackling waiting times and establishing hospital groups;

– the introduction of a more transparent and efficient “Money Follows the Patient” funding mechanism for hospitals, and

– reform of the private health insurance market.

The reform programme is a major undertaking that requires careful planning and sequencing over a number of years. The Programme for Government acknowledges that full implementation of UHI will take some time to achieve. Future Health: A Strategic Framework for Reform of the Health Service 2012-2015 highlights the importance of a step-by-step evidence-based approach to achieving an effective, equitable and efficient system and sets out key actions to systematically deliver on reform. It is anticipated that by 2016 the necessary groundwork will be in place to enable us to phase in implementation of UHI, as promised in the Programme for Government.

The Department is preparing a White Paper on Universal Health Insurance which will provide further detail on the UHI model for Ireland in addition to the estimated costs and financing mechanisms associated with the introduction of universal health insurance. The work involved is both complex and technical, necessitating significant research and financial modelling to support analysis and costing of different design options. This, in turn, demands a wide-range of specialised expertise. The Department is engaged in a process to ensure the provision of this expertise to feed into work on the preparation of the White Paper during 2013. The White Paper will be published as early as possible within the Government’s term of office.

In advance of the White Paper, my Department has produced a Preliminary Paper on UHI, which I intend to publish in the near future.

Finally, the Deputy has asked about a forum in which private health insurers may engage in relation to plans on UHI. Last year, I established the Health Insurance Consultative Forum. The Forum comprises representatives from the country’s main health insurance companies, the Health Insurance Authority and the Department of Health. The Forum provides a platform for identifying ways of addressing costs throughout the industry, whilst always respecting the requirements of competition law. In addition, it also gives a voice to insurers in raising issues relating to the development of the new Universal Health Insurance model.

Proposal for new qualified speech and language therapists – 18th December 2o12,

To ask the Minister for Health if he has considered a proposal regarding graduate speech and language therapists (details supplied).

Details Supplied: If graduate Speech & Language Therapists (SLTs) want to go abroad to work due to the lack of jobs in Ireland, they need to have worked in Ireland under supervision (in order to get a letter of good standing from the Irish Association of Speech & Language Therapists). Therefore, if qualified SLTs were placed around Ireland under supervision in the health centres and hospitals (a badly needed service due to the current need in Ireland). This would satisfy the dual requirement of the year’s supervision & offer the services of an SLT to the state and people of Ireland at a reduced cost.

Reply

The Minister for Health (James Reilly):

My Department is not aware of the proposal referred to by the Deputy.

Upon graduation from one of the recommended Irish training programmes speech and language therapy graduates are deemed fully qualified to work in the Irish health service having fulfilled the required hours of practice placements prior to graduation. Students on existing Irish programmes which lead to recognised qualifications in speech and language therapy are facilitated by the Irish health service to undertake clinical placements during the course and as part of their education and training programme. There is no postgraduate supervised practice required as a prerequisite to employment.

Irish graduates seeking work abroad in any of the EEA countries are assessed for qualification equivalence under Directive 2005/36/EC. A letter of good standing from the Irish Association of Speech and Language Therapists is not a requirement under the Directive.

Methadone Clinics – December 13th 2012,

To ask the Minister for Health his views on methadone clinics (details supplied)

Details Supplied: Details: moving methadone clinics out of the city centre, where they cause serious problems with anti-social behaviour, possibly adopting the practice as in Amsterdam. Buses distribute the methadone at relevant, suitable locations. Existing buildings could be sold to cover the costs of the scheme. This dispersal method overcomes some of the current problems being experienced here in the city centre but would also have the added benefit of protecting people attending clinics from drug dealers and other related elements

Reply

The Minister of State at the Department of Health (Alex White):

The HSE provides opioid substitution (mainly methadone) in a number of treatment settings to meet the needs of individual drug users. These settings include:

primary care through GPs and community pharmacies;

satellite clinics that facilitate opioid substitution provision through community pharmacies;

treatment centres where opioid substitution treatment is dispensed on site; and

residential rehabilitation facilities.

The HSE recognises that drug treatment is best provided at the lowest level of complexity, matching the patient’s needs and as close to the patient’s home as possible. There are currently 52 clinics within the four Dublin Local Authority Areas of which only 6 are based in the city centre. The city centre clinics cater for 1,082 people which is less than a quarter of the overall Dublin figure. 85% of those availing of services in the Dublin city centre clinics are from the local area.

The HSE has reviewed waiting lists for opioid substitution treatment over the past few years with a view to maximising the utilisation of existing services and developing new services where required. I support the provision of services in local communities but some concentration of services in Dublin city centre is needed in view of the number of clients from these areas, the fact that some people wish to avail of services outside their local area and the need to provide services for some people who have more complex needs. This approach is in line with that in many EU countries.

HSE clinics, as well as a number of voluntary service providers, have “good neighbour” policies and protocols in place and a strong focus on inter-agency working. Some provide a range of outreach and drop-in services to encourage engagement with a view to moving more people into treatment. C.C.TV is used at some centres to monitor movements and as an aid towards deterring anti-social behaviour. Drug treatment centres also work closely with An Garda Síochána with the aim of minimising any potential problems.

The number of nurse who have emigrated since 2010 – 5th December 2012,

To ask the Minister for Health if his attention has been drawn to the number of nurses who have qualified here and subsequently emigrated since 2010.

Reply

The Minister for Health (James Reilly):

There are no statistics available regarding the number of nurses who graduated in this country and subsequently emigrated in the period 2010 to date. The number of Irish nursing graduates in the period is set out under. The Nursing and Midwifery Board of Ireland hold information on the number of new Irish Graduates who apply for Certificate of Current Professional Status documents (CCPS documents). The CCPS documents establish the graduates qualification for working outside of Ireland. It is important to note that applying for CCPS documents does not necessarily mean that the graduate actually emigrated.

Number of Nurse Graduates Number of New Irish Graduates  who applied for CCPS documents:
2010        1629         320
2011        1701         213
2012        1672         176 (to date)

Is there a shortage of nurses in Ireland? – 5th December 2012,

To ask the Minister for Health his views on a possible shortage of suitably trained nurses in hospitals here.

Reply

The Minister for Health (James Reilly):

At present, some 1650 nurses/midwives graduate per annum from our Universities and other colleges. The Department of Health has recently completed a review of undergraduate nursing and midwifery education programmes. As part of this review an analysis of the number of student places required to ensure sufficient numbers of nurse and midwife graduates was completed. This indicates that the overall numbers of students at undergraduate level meets demand.

The Government has determined that, in line with its commitment to reduce the size of the public service, health sector employment numbers must be reduced substantially in 2013 and 2014. Spending on health services will also have to be very tightly controlled. The cumulative impact of staff reductions from this year and previous years represents a significant challenge for the health system in delivering services. The priority is to reform how health services are delivered in order to ensure a safe, more productive and cost-effective health system.

These changes implemented through the moratorium on recruitment have had an impact on the number of nurses and midwives available. Directors of Nursing/Midwifery will continue to examine closely improvements in flexible working arrangements, changes to rosters, changes to the role of staff and other approaches to minimise impact on patient safety and the quality of care.

The Croke Park Agreement has been crucial to the health service’s ability to manage through the very difficult circumstances of recent years. The flexibility and adaptability shown by staff has meant that even with reducing staff numbers, service levels have largely been maintained and indeed performance in relation to Emergency Departments and hospital waiting lists has markedly improved.

The continued reduction in staffing increases the need for reform, including greater flexibilities in work practices and rosters, as well as redeployment and the HSE is committed to fast-tracking new, innovative and more efficient ways of using reduced resources under the Croke Park Agreement.

 CoAction in West Cork – 5th December 2012,

To ask the Minister for Health if he is planning any cuts in budget or service to CoAction West Cork in 2013.

Reply

The Minister for Health (James Reilly):

The level of funding which the HSE will allocate to specific organisations in 2013 will have to be determined by the Executive in the context of the overall level of resources which will be made available to it next year, and priorities identified in the National Service Plan.

Private in-patients in public hospitals – 20th November 2012,

To ask the Minister for Health if he will clarify his proposal to charge private patients for medical services provided in public hospitals.

Reply

The Minister for Health (James Reilly):

I think the Deputy may be speaking about the VHI’s recent claim that charging private in-patients who occupy public beds in public hospitals the daily maintenance charge, would result in a 45% increase in health insurance premia.

The situation is that a system of bed designation has been in place in public hospitals since the 1990s. Under this system, most beds are either designated as public beds or private beds: there is a small number of non-designated beds, such as those in Intensive Care Units. Under the current framework, private in-patients who occupy public beds in public hospitals are not levied the daily maintenance charge, which ranges from €586 to €1,046 in most public hospitals.

The Comptroller and Auditor General reported in 2010 that 45% of in-patients treated privately by their consultants were not charged for their maintenance costs because they were not occupying designated private beds. As part of Budget 2012, I announced that I intended to bring forward legislation to provide for the charging of all private patients in public hospitals, irrespective of whether they occupied a public or a private bed. In view of the significant potential cost implications for private health insurers, I subsequently indicated that I would be prepared to postpone implementation of the legislation until 2013 provided that the funds targeted for the current year were raised through a system of improved cashflow from the private insurers. Arrangements for this improved cashflow have been agreed in principle with the insurers, and the legal details are being finalised at present.

In relation to charging all private patients in public beds, the issue will be dealt with as part of the budgetary process for 2013 and I will bring legislative proposals to Government on the matter in due course. I am committed to keeping the cost of health insurance premia as low as possible and, to this end, my Department is working closely with the four health insurers, through the Health Insurance Consultative Forum. The objective of the forum is to explore ways to minimise costs, while always respecting competition law.

Standardised did not attend policy – 20th November 2012

To ask the Minister for Health further to Parliamentary Question No. 1000 of 6 November 2012, if he has considered a penalty scheme for persons who do not attend appointments and give no prior notice of non-attendance in view of the high percentage that occur.

Reply

The Minister for Health (James Reilly):

I refer the Deputy to my previous reply of the 6th November this year. It remains the position that, while acute hospitals currently have in place a variety of DNA (did not attend) policies, a standardised approach is now being developed as part of a national Outpatient Performance Improvement Programme. This Programme, developed by the Special Delivery Unit (SDU) will be implemented nationally over the period 2012 to 2015 to improve the provision of outpatient services. The Programme will address the management of DNAs as well as a range of other issues.

If a patient finds they cannot attend the appointment they have been given I would appeal to all such patients to inform the clinic concerned as soon as they know they cannot attend.

Interchangeable medicinal products – 15th November, 2012,

To ask the Minister for Health if he has plans to exempt anti-convulsant medication for epileptics from the Health (Pricing and Supply of Medical Goods) Bill 2012 in view of evidence that epileptics can suffer breakthrough seizures caused by switching medication.

Reply

The Minister of State at the Department of Health (Alex White):

Under the Health (Pricing and Supply of Medical Goods) Bill, the Irish Medicines Board has statutory responsibility for establishing and publishing a List of Interchangeable Medicinal Products.

In deciding whether to add a group of medicinal products to the List of Interchangeable Medicinal Products, the Board must be satisfied that each medicinal product which falls within the group:
(a) has the same qualitative and quantitative composition in each of its active substances as each of the other medicinal products which fall within the group;
(b) is in the same pharmaceutical form as, or in a pharmaceutical form that is appropriate for substitution for, each of the other products in the group ; and
(c) has the same route of administration as each of the other medicinal products which fall within the group.

In addition, the Bill provides that the Board is not permitted to add a group of medicinal products to the List of Interchangeable Medicinal Products where, for example, any of the medicinal products cannot be safely substituted for any one or more of the other medicinal products in the group. To further enhance the patient safety aspect of generic substitution, Section 13 of the Bill allows a prescriber to indicate on a prescription that a branded interchangeable medicinal product should, for clinical reasons, not be substituted.

It is important to point out that generic medicines must meet exactly the same standards of quality and safety and have the same effect as the originator medicine. All of the generic medicines on the Irish market are required to be properly licensed and meet the requirements of the Irish Medicines Board.

HSE policy on drug rehabilitation clinic locations – 15th November 2012,

To ask the Minister for Health if the Health Service Executive has a policy on the location of its drug rehabilitation clinics.

Reply

The Minister of State at the Department of Health (Alex White):

An objective of the National Drugs Strategy 2009-16 is to develop a national treatment and rehabilitation service that provides drug free and harm reduction approaches for problem substance users and to encourage problem substance users to engage with, and avail of, such services.

To this end the HSE provides a variety of drug treatment interventions to meet the needs of individual drug users. These include interventions to reduce drug-related harm such as needle exchange provision, together with evidence-based treatment options such as opioid substitution, counselling and community and residential rehabilitation initiatives.

The treatment settings utilised include:

  • primary care through General Practitioners and community pharmacies;
  • satellite clinics that facilitate opioid substitution through community pharmacies;
  • treatment centres where opioid substitution treatment is dispensed on site; and
  • residential rehabilitation facilities.

The HSE recognises that drug treatment should be provided at the lowest level of complexity, matching the patient’s needs and as close to the patient’s home as possible. In the past few years the HSE has systematically reviewed waiting lists with a view to maximising the utilisation of existing services and developing new services where required. Arising from this additional services have been made available in Waterford, Wexford, Kilkenny, Cork, Tralee, Limerick and Dundalk, greatly enhancing the drug treatment options for people in these areas.

The HSE will continue to review the overall situation with a view maximising the availability of treatment for problem drug users in line with available resources.

Placements for graduate speech and language therapists – 15th November 2012,

To ask the Minister for Health if he has considered allowing graduate speech and language therapists to conduct their mandatory supervised one year placement with the Health Service to allow graduates receive their qualification and make available more personnel in this area, and at a reduced cost to the State.

Reply

The Minister for Health (James Reilly):

There is no requirement for graduate speech and language therapists to undergo a mandatory supervised one-year placement post qualification.

Students on existing Irish programmes which lead to recognised qualifications in speech and language therapy are facilitated by the Irish health service to undertake clinical placements during the course, and as part, of their education and training programme.

What it costs the HSE to subsidise antidepressants and anxiolytic drugs – 13th November 2012,

To ask the Minister for Health the cost breakdown to the Health Service Executive in the years 2009, 2010 and 2011 to subsidise antidepressants and anxiolytic drugs.

Reply

The Minister for Health (James Reilly):

The cost to the Health Service Executive of antidepressants and anxiolytics for 2009, 2010 and 2011 is set out in the table below:

Mental Health Services – 13th November 2012,

To ask the Minister for Health the capacity, number of patients per year, within the public services to provide mental health services.

To ask the Minister for Health the cost per day of a hospital bed within the mental health services for psychiatric patients.

To ask the Minister for Health the waiting time in terms of access to mental health professionals within the public services.

To ask the Minister for Health the number of days, on average, that a patient stays in, once admitted into a hospital for psychiatric care.

To ask the Minister for Health the number of patients being taken care of every month by psychologists and or psychiatrists in the Health Service Executive.

To ask the Minister for Health the number of patients, as a percentage, that are referred to a psychologist after an emergency appointment at a public hospital.

Reply

The Minister for Health (James Reilly):

As the Deputy’s questions relate to service matters, I have arranged for the questions to be referred to the HSE for direct reply to the Deputy.

Number of A&E admission related to the abuse of alcohol – 8th November 2012

To ask the Minister for Health the percentage of accident and emergency admissions that are drink related or due to the abuse of alcohol and the estimated cost of this to the health system.

Reply

I wish to advise you that this information is not routinely collected by the HSE. On the subject of Emergency Department drink related admissions research was carried out and published in a document called Alcohol and injuries in the accident and emergency department – a national perspective. Dublin: Department of Health and Children by Hope
A, Gill A, Costello G, Sheehan J, Brazil E and Reid V (2005). The link to the publication is http://www.drugsandalcohol.ie/6006/1/DOHC_alcohol__and_injuries.pdf

Number of missed outpatient appointments – 6th November 2012,

To ask the Minister for Health the percentage of outpatients not turning up for scheduled outpatient appointments and not giving any notice; the estimated cost of this to the health service; if penalties financial or otherwise for a person not cancelling an outpatient appointment are being considered by the Government.

Reply

The Minister for Health (James Reilly):

Table 1 sets out a yearly sum of patients who missed scheduled appointments (did not attend) from 2008 to 2010, along with those who attended and total number of appointments booked (supplied by the HSE Business Intelligence Unit). The DNA rate is calculated by taking the number of missed appointments (DNAs) as a percentage of the total number of attendances and missed appointments combined. While hospitals returned activity, including DNA data across 2011, this data was not compiled / processed by BIU due to the roll out of the Outpatient Data Quality Programme.

Table 1. Outpatients – Attendances and DNAs 2008, 2009, 2010

Year No of New Attendances No of Return Attendances No of Appointments Missed (DNA) No of Return Appointments Missed (DNA) All Appointments Booked DNA as a % of all appointments booked

RAW DATA SOURCE: HSE BIU

While acute hospitals currently have in place a variety of DNA (did not attend) policies, a standardised approach is now being developed as part of a national Outpatient Performance Improvement Programme. This Programme, developed by the Special Delivery Unit (SDU) will be implemented nationally over the period 2012 to 2015 to improve the provision of outpatient services. The Programme will address the management of DNAs as well as a range of other issues.

If a patient finds they cannot attend the appointment they have been  given I would appeal to all such patients to inform the clinic concerned as soon as they know they cannot attend.

Public Sector Rostering – 6th November 2012,

To ask the Minister for Health the sectors of the public sector that are currently employed on a roster basis and if there are any plans to remove employees from the rostering system.

Reply

The Minister for Health (James Reilly):

As Minister for Health, I am replying to this question only insofar as it relates to the health sector.

Where it is necessary to provide services on an extended-hours or 24-hour basis, staff are rostered for duty to ensure an appropriate match between the staff available and service required.  Provision is also made, where appropriate, for some staff to be off duty but on-call to meet urgent but unpredictable service needs. Health service managers keep rosters under review to ensure the most cost-effective staffing arrangements having regard to service needs and to achieve optimum patient care.  There are no general plans to cease the rostering of staff, as such arrangements are key to the provision of essential health services to the population.

Shortage of speech and language therapists in the HSE – 18th September 2012,

To ask the Minister for Health in view of the shortage of speech and language therapists in the health service, if he will consider allowing graduate speech and language therapists conduct their mandatory supervised one year placement with the Health Service to allow graduates receive their qualification and make available more personnel in this area, and at a reduced cost to the State.

Reply

The Minister for Health (James Reilly):

I will examine the proposal and will correspond with the Deputy on the matter as soon as possible.

Number of staff in the department who completed PMDS – 10th July 2012,

To ask the Minister for Health the number of health service employees who completed performance management and development system assessments in 2011 by the Health Service Executive area and hospital; if he will provide a breakdown of the scoring categories 5 to 1 in each HSE area and hospital.

Reply

The Minister for Health (James Reilly):

As this is a service matter, it has been referred to the HSE for attention and direct reply to the Deputy.

Public sector staffing numbers – 12th June 2012,

To ask the Minister for Health the percentage of staff working in the health sector, that he deems to fall into the category of frontline staff, administrative, management, elected representative and any other relevant categories; and the way the pay budget is allocated across these categories in percentage and real terms in terms of as a proportion of the health sector spend on salaries.

Reply

The Minister for Health (James Reilly):

As this is a service matter, it has been referred to the HSE for attention and direct reply to the Deputy.

Potential sites for the children’s hospital – 12th June 2012,

To ask the Minister for Health further to his statement in Dáil Éireann that the National Assets Management Agency had written to him identifying 11 potential sites for the new children’s hospital, some of which he thought might have use for hospitals of a different nature, the location of those sites; which of the sites have other potential; if the Irish Glass Bottle site or the Elm Park site are included in either list; and the possible future uses that have been identified.

Reply

The Minister for Health (James Reilly):

As you will be aware, I established an independent Review Group to consider the implications of the decision of An Bórd Pleanála, received on 23 February 2012, to reject the planning application for the proposed construction of a national paediatric hospital on the site of the Mater Misericordiae Hospital. The aim of the Review was to consider all the possible options for the earliest possible delivery of a new children’s hospital . During the course of its deliberations, the Group received submissions from many different Groups.

The Group has now presented its report, which I intend to consider carefully before bringing to Government.

As I have previously stated, a number of potential sites were identified by NAMA, details of which cannot be provided for reasons of debtor confidentiality. NAMA advises that it is at all times open to proposals which can contribute to the achievement of broader social and economic objectives and has committed to giving first option to public bodies on the purchase of property which may be suitable for their purposes.

Sections of the Liquor Act 2008 – 23rd February 2012,

To ask the Minister for Health in relation to the recommendations made by the Steering Group Report on the National Substance Misuse Strategy, if he will clarify where the report states the commence Section 9 (structural separation) of the intoxicating Liquor Act 2008, if this refers to sub section 1a or 1b.

Reply

The Minister for Health (James Reilly):

At the end of paragraph 35 on page 18 of chapter 2, the Steering Group of the National Substance Misuse Strategy recommended as follows:

Commence Section 9 (Structural Separation) of the Intoxicating Liquor Act 2008.

At paragraph 32 of the same chapter, the Steering Group wrote that ‘Section 9 of the Intoxicating Liquor Act 2008 provides for the structural separation of alcohol from other products in mixed trading outlets’; and hence what was mainly contemplated by the Steering Group were the substantial provisions on structural separation in Section 9 (1A) of the Intoxicating Liquor Act 2008 – though the powers of commencement of these provisions are vested in the Minister for Justice, Equality and Defence.

The selling of alcohol at below cost price – 23rd February 2012,

To ask the Minister for Health if he has considered banning the retailing of alcohol at below invoice cost price to ensure that retailers cannot reclaim 23% of the cost of the loss leader in their VAT return, thus saving the State an average of €21 million each year.

Reply

The Minister for Health (James Reilly):

In its report on alcohol, the National Substance Misuse Strategy Steering Group recommended – among other things – the introduction of a legislative basis for minimum pricing per gram of alcohol. As minimum pricing is a mechanism of imposing a statutory floor in price levels for alcohol products that must be legally observed by retailers, its primary function would be thus to discourage at risk levels of alcohol consumption. This recommendation is being actively considered as part of the development of an Action Plan in advance of proposals being drafted for Government.

The palliative care budget – 12th January 2012

To ask the Minister for Health his views on the possibility of whether or not cuts to palliative care were contained in the health budget.

Reply

The Minister of State at the Department of Health (Kathleen Lynch):

The HSE has statutory responsibility for the delivery of health and personal social services, and the question of funding specific care programmes, or individual non statutory care providers, can only be addressed in the context of finalising the HSE Service Plan 2012. The allocation of funding across care groups, including Palliative Care,  has yet to be agreed.  As was the case in previous years, the Executive will engage with voluntary providers to discuss services levels for 2012, in line with resources available.    A focus of such discussions will be to identify savings designed to have minimum effects on the provision of services to patients.

Medical card case – 16th of February 2011,

To ask the Minister for Health if he will consider the following case regarding a person’s (details supplied) in Dublin 6 difficulty in receiving a medical card.

The Minister of State at the Department of Health (Roisin Shortall)

Reply

As this is a service matter it has been referred to the Health Service Executive for direct reply to the Deputy.

The possibility of a director of mental health – 12th February 2012

To ask the Minister for Health if he will consider the possibility of putting in place a director for mental health with budgetary authority and accountability.

Reply

The Minister of State at the Department of Health (Kathleen Lynch):

Deputies will be aware that the Government has already approved the drafting of legislation to give effect to changes in the governance of the HSE.   This involves radical reform of the health service generally which will see the introduction of Universal Health Insurance (UHI).  Significantly the new system of governance will involve seven Directorates, including a separate Directorate for Mental Health which will have full responsibility and accountability in that area.  In this context, my colleague Minister Reilly intends to bring forward detailed proposals at a later date for the re-organisation of the HSE at directorate, regional and local levels in a manner which facilitates a smooth transition from the current governance arrangements to the proposed new structures.

When the appointment of the expert group is due to happen – 1st February 2012

To ask the Minister for Health when he will be appointing an expert group to consider the implications of last years ECHR ruling in the ACB v Ireland case on Ireland’s abortion law; the number that will be in this group; and the way it’s members will be selected.

Reply

The Minister for Health (James Reilly):

I am pleased to inform the Deputy that the Expert Group on the ABC v Ireland judgment of the European Court of Human Rights was established on 13th January 2012.  The Group consists of fourteen members who have all been selected based on their medical, legal, and policy expertise.

24th November 2011,

To ask the Minister for Health if any decision has been made in Budget 2012 in relation to funding for St Michael’s House, Ballymun Road, Dublin 9, which provides services to those with intellectual disabilities in the community.

Reply

The Minister of State at the Department of Health (Kathleen Lynch):

The Health Service Executive has advised me that expenditure on health services for people with a disability in 2011 will be approximately €1.5 billion.  Special consideration was given to disability and mental health in Budget 2011 through a maximum reduction of just 1.8% in the allocation for the two sectors.  The relatively lower reduction of 1.8%, compared to other areas of the health budget that saw reductions of up to 5%, recognises that these services are provided to vulnerable groups and should help to ensure that existing services are maintained and that priority is given to the delivery of frontline services.

I recognise and appreciate the valuable contribution that St. Michael’s House makes to the provision of services to individuals with intellectual disabilities in Dublin and Navan through a range of community-based day, respite, and residential services on behalf of the Health Service Executive.  The HSE has advised that St. Michael’s House will receive approximately €72 million in funding from them in 2011.  Taking the reduction in the overall HSE disability budget for 2011 into account, the HSE was asked to manage the additional resources and engage with service providers including St. Michael’s House, to ensure that existing support needs, and demands for additional places and supports, are managed effectively within the overall allocation.

Budget 2012
With regard to the level of funding for the Disability sector next year, this is being considered as part of the Comprehensive Review of Expenditure and Estimates process for 2012 which is currently underway. Deliberations on the expenditure allocations for 2012 are likely to continue up until Budget time and it would not be appropriate for me to comment further at this stage pending the outcome of those deliberations.  As you are aware, the very difficult financial position facing the Exchequer will obviously require very careful management across all areas of expenditure.

Value for Money & Policy Review of Disability Services
A major priority for the Government in the coming months will be to finalise the current Value for Money and Policy Review of Disability Services to ensure that existing funding for people with disabilities is spent to best effect. It is now more important than ever that large scale spending programmes of this nature are subject to detailed periodic review. The VFM Efficiency and Effectiveness Review will make recommendations that will ensure that the very substantial funding of €1.5 billion provided to the specialist disability health sector is used to maximum benefit for persons with disability, having regard to overall resource constraints which affect all sectors at this time.

The funding of the National office for Suicide Prevention – 25th of October 2011

To ask the Minister for Health the steps being made to increase the funding of the National office of Suicide Prevention.

Reply

The Minister of State at the Department of Health (Kathleen Lynch):

The Government has prioritised the reform of our mental health services in line with A Vision for Change – the Report of the Expert Group on Mental Health Policy (2006) and Reach Out -the National Strategy for Action on Suicide Prevention 2005 – 2014.  This commitment was clearly shown in the Programme for Government which provides for the ring-fencing of €35 million annually from within the overall health budget to develop community mental health services and to implement Reach Out. This is currently being considered as part of the Estimates process for 2012 and future years.  Any increases in funding for the National Office for Suicide Prevention (NOSP) will be decided in this context.

The amount to be spent by the department on consultancy fees – 6th October 2011,

To ask the Minister for Health the amount he intends to spend on consultancy fees in 2011, in particular those contracted to identify value for money in his Department.

Reply

The Minister for Health (James Reilly):

The Department has significantly reduced its spend on consultancy in recent years and all projects which involve the engagement of external consultants are approved by the Minister prior to the issuing of public tenders.  Once initiated, the spend profile of each project is monitored by the Department on a monthly basis.  It is expected that the total expenditure on consultancy fees for 2011 will be approximately €760,000, none of which relates to value for money initiatives.

The Department has put in place its own dedicated resources to undertake reviews under the auspices of the Value for Money & Policy Review Initiative 2009-2011.  Last year, the Department completed a value for money review of private and semi-private treatment services in public hospitals.  It is expected that implementation of the report’s recommendations will result in increased revenues to the health service of approximately €75m in 2011 and approximately €18m in 2012.  In addition to participating in the Comprehensive Review of Expenditure as part of the overall pre-Budget deliberations of the Government, the Department is also currently engaged in two further value for money reviews in the areas of disability services and immunisation programmes, both of which will further help to drive efficiency and effectivenesss in the health sector.

Arrangement for those affected by thalidomide – 21st July 2011,

To ask the Minister for Health his views regarding the arrangement made between the parents of children affected by thalidomide and the Government in 1975.

Reply

The Minister of State at the Department of Health (Kathleen Lynch):

Irish survivors of thalidomide receive a monthly payment of up to €1,116 and an annual lump sum of up to €3,680 from the German Foundation for Thalidomide (The drug sold in Ireland in the 1950s and 1960s was manufactured by a German company). In addition the Irish Government provides a monthly payment of up to €1,109. The majority are in receipt of the maximum payments from both Germany and Ireland. All of these payments are tax free. Each individual automatically receives a medical card.

Combining the German and the Irish payments Irish survivors of thalidomide receive on average a tax free payment of €26,000 per annum or €2,166 each month.

In accordance with the Programme for Government I met with both representative bodies of Irish survivors of thalidomide last Friday 15th July. I listened to their proposals for additional health care supports and financial assistance. I undertook to consider their proposals and have further discussion with them.

A medical card case – 21st July 2011,

To ask the Minister for Health if those in receipt of a state and work pension are entitled to a medical card once they reach 70 years as the case of a person (details supplied) in Dublin 14.

Reply

The Minister of State at the Department of Health (Roisin Shorthall):

Under the Health Act 2008, a simplified system of assessment for eligibility was introduced in respect of persons aged 70 or over, based on significantly higher gross income thresholds rather than the standard net income limits.  The gross income thresholds are €700 per week for a single person and €1,400 for a couple, as against net income limits of €210.50 for a single person and €298 for a couple.

The regulation of the cosmetic surgery industry – 19th of July 2011,

To ask the Minister for Health his plans to implement the legislation developed under the previous Government to regulate the cosmetic surgery industry.

Reply

The Minister for Health (James Reilly):

My Department is  developing legislative proposals  for the licensing  of public and private healthcare providers and cosmetic surgery will be considered in this context.  However, in regard to current regulation, the Deputy will also wish to be aware that the Medical Practitioners Act 2007 provides for a clear compulsory requirement for registration for all medical practitioners, including cosmetic surgeons, who practice medicine in Ireland.  Under the Act, the Medical Council.