Tuesday, 26 Nov 2013

Written Answers Nos. 595 - 615

Primary Care Centre Provision

Questions (595)

Michael McNamara

Question:

595. Deputy Michael McNamara asked the Minister for Health the reason Ennis was not selected as a location for a primary health centre; and if he will make a statement on the matter. [50265/13]

Written answers

Minister of State at the Department of Health

Delivery of healthcare infrastructure is a service matter. Therefore your question has been referred to the Health Service Executive for direct reply.

Hospital Waiting Lists

Questions (596)

Bernard Durkan

Question:

596. Deputy Bernard J. Durkan asked the Minister for Health if and when a knee replacement operation will be facilitated in the case of a person (details supplied) in County Kildare; and if he will make a statement on the matter. [50268/13]

Written answers

Minister for Health

The National Waiting List Management Policy, A standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, January 2013, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the Health Service Executive, sets out the processes that hospitals are to implement to manage waiting lists.

Medical Card Applications

Questions (597)

Finian McGrath

Question:

597. Deputy Finian McGrath asked the Minister for Health the position regarding a medical card application in respect of a person (details supplied) in County Donegal. [50271/13]

Written answers

Minister of State at the Department of Health

The Health Service Executive has been asked to examine this matter and to reply to the Deputy as soon as possible. The Health Service Executive operates the General Medical Services scheme, which includes medical cards and GP visit cards, under the Health Act 1970, as amended. It has established a dedicated contact service for members of the Oireachtas specifically for queries relating to medical cards and GP visit cards, which the Deputy may wish to use for an earlier response. Contact information has issued to Oireachtas members.

Care of the Elderly Provision

Questions (598)

Sean Fleming

Question:

598. Deputy Sean Fleming asked the Minister for Health if he will consider establishing a forum on long-term residential care bringing all of the relevant stake holders involved in the provision of such care for older persons together, in view of the fact that the voluntary and private sector deliver almost 80% of the elderly residential care beds, as it is important in the interest of our elderly citizens and the taxpayer that there should be a proper forum between the Department and the providers in this area; and if he will make a statement on the matter. [50283/13]

Written answers

Minister of State at the Department of Health

My Ministerial colleagues and I, as well as Departmental officials, are always amenable to meeting with providers of residential care services, whether private, voluntary or public, and the representatives of providers in this area will always be facilitated to meet both my Department and the HSE. There are already advance consultations held across a range of issues. I will be glad to hear the position of the sector on future planning, and these views will be carefully considered and taken account of.

However, if I understand it correctly, what is being proposed here is a form of joint decision making on future arrangements, which might well include pricing, regulatory and perhaps even budgetary matters. That is a more problematic proposal given that providers have a very clear vested and commercial interest in decisions that may be made. While those interests are entirely legitimate, the Deputy will understand the need to maintain the independence and impartiality of the decision-making process, and a Forum of the type proposed is not therefore something that would be appropriate. However, as I have already stated above, my door and the doors of my Department are always open, and I will be happy for my officials to sit down with representatives of the sector to discuss structured consultation arrangements on a range of issues that are of common concern.

Medical Card Applications

Questions (599)

Finian McGrath

Question:

599. Deputy Finian McGrath asked the Minister for Health the position regarding a medical card in respect of a person (details supplied). [50311/13]

Written answers

Minister of State at the Department of Health

The Health Service Executive has been asked to examine this matter and to reply to the Deputy as soon as possible. The Health Service Executive operates the General Medical Services scheme, which includes medical cards and GP visit cards, under the Health Act 1970, as amended. It has established a dedicated contact service for members of the Oireachtas specifically for queries relating to medical cards and GP visit cards, which the Deputy may wish to use for an earlier response. Contact information has issued to Oireachtas members.

Health Services Staff Remuneration

Questions (600, 608, 609, 610, 611, 612, 624, 669)

Maureen O'Sullivan

Question:

600. Deputy Maureen O'Sullivan asked the Minister for Health when the Health Service Executive will publish the first progress report on the audit of 46 agencies, including hospitals and organisations, granting unauthorised payment of allowances; if disciplinary proceedings will exist for those organisations granting these unauthorised payments; and if he will make a statement on the matter. [50330/13]

Terence Flanagan

Question:

608. Deputy Terence Flanagan asked the Minister for Health the steps being taken to ensure that the remaining agencies that have not replied to the Health Service Executive to confirm compliance with the rule that non-Exchequer sources of funding may not be used to supplement approved rates of remuneration reply to the HSE in full; and if he will make a statement on the matter. [50386/13]

Terence Flanagan

Question:

609. Deputy Terence Flanagan asked the Minister for Health the allowances which are being paid to Health Service Executive officials out of taxpayers' funds but which have yet to be officially approved; if he will provide details to whom the funds are being paid to and at which hospital; the amount paid to each person; the action being taken by his Department to address this matter; and if he will make a statement on the matter. [50387/13]

Terence Flanagan

Question:

610. Deputy Terence Flanagan asked the Minister for Health the reason senior Health Service Executive executives are being paid top-up allowances from private funds (details supplied) in addition to their salaries; and if he will make a statement on the matter. [50388/13]

Terence Flanagan

Question:

611. Deputy Terence Flanagan asked the Minister for Health his plans to cut the salaries of senior Health Service Executive staff; and if he will make a statement on the matter. [50389/13]

Terence Flanagan

Question:

612. Deputy Terence Flanagan asked the Minister for Health if income generated from hospital shops and car parks is being used to supplement the salaries of senior Health Service Executive executives; and if he will make a statement on the matter. [50390/13]

Joan Collins

Question:

624. Deputy Joan Collins asked the Minister for Health the date on which the present CEO or past CEOs of Crumlin children's hospital first received the top-up package; if the board makes the decision; if the decision is minuted and voted on; and if he will provide the minute of the vote. [50516/13]

Róisín Shortall

Question:

669. Deputy Róisín Shortall asked the Minister for Health further to the Health Service Executive internal audit report regarding section 38 agencies’ remuneration, the actions his Department has taken regarding same since it first became aware of the practice in 2008. [50866/13]

Written answers

Minister for Health

I propose to take Questions Nos. 600, 608 to 612, inclusive, 624 and 669 together.

Arising from the HIQA report on Tallaght Hospital in 2012 which noted that a number of senior staff had been in receipt of remuneration in addition to the approved rates for their posts, my Department requested the HSE to take steps to ensure that similar payments were not being made in other agencies funded under Section 38 of the 2004 Health Act. The HSE’s Internal Audit Directorate undertook a detailed review of remuneration in these agencies. These are voluntary hospitals and disability organisations and the audit does not relate to employees of the HSE. This review was concluded in March 2013 and identified a significant number of cases in which senior personnel were in receipt of additional payments outside the terms of the approved pay scales.

Arising from a number of individual cases in which it was found that staff of Section 38-funded organisations were in receipt of salaries above approved rates, the Department of Health had, on a number of occasions between 2008 and 2011, drawn the attention of the HSE to the need to ensure compliance in this regard. While the HSE took the matter up with the organisations concerned, it is clear from the results of the more recent and intensive HSE Internal Audit exercise that a range of practices remained in force which were at variance with approved salary scales.

On 27 September 2013 my Department issued a pay policy, prepared following consultation with the Department of Public Expenditure and Reform, to the HSE. This policy, which reflects Government policy on senior public service pay generally, makes it clear that bodies funded under Section 38 of the Health Act 2004 may not supplement approved rates of remuneration with either Exchequer funding or non-Exchequer sources of funding. The pay policy makes clear that if an organisation wishes to make a business case for the continuation of an unapproved allowance, it is open to it to do so and that any such cases will be considered by the HSE (with the involvement of my Department and the Department of Public Expenditure and Reform, as necessary). A business case must also be made for the continued payment of allowances which are not encompassed by or in line with the Department of Health Consolidated Salary Scales but which may have been sanctioned in the past.

The HSE has written to each of the service providers concerned, providing them with the pay policy and seeking confirmation that remuneration arrangements are in full compliance with it. The vast majority of organisations have now responded to the HSE. The HSE will examine in detail the responses received and address any issue arising with the organisations concerned. The HSE’s approach will involve a robust process of verification and, as necessary, clarification of the position in each Section 38 organisation. In these circumstances I do not consider it appropriate that I should comment on the position in any individual organisation at this time.

Speech and Language Therapy

Questions (601)

Willie O'Dea

Question:

601. Deputy Willie O'Dea asked the Minister for Health with reference to his correspondence of 10 October 2013, if there has been any progress on the matter of a speech and language therapist for provision of services to a person (details supplied) in County Limerick; and if he will make a statement on the matter. [50331/13]

Written answers

Minister for Health

The particular issue to which the Deputy refers is a service matter for the Health Service Executive. Officials from my Department sought and received a report from the HSE on this case and a letter has now issued directly to the Deputy with an update on the current position.

Health Services Staff Data

Questions (602)

Clare Daly

Question:

602. Deputy Clare Daly asked the Minister for Health the total number of general practitioners, GMS and non-GMS, currently working here; the number of GPs who qualified from the training schemes in the past five years still working here; the number of GPs that will be needed to provide universal health care to the population by 2016; and the plans in place to meet the shortfall. [50341/13]

Written answers

Minister of State at the Department of Health

On 20 November 2013, 2,828 medical practitioners held registration as trained Specialists in the specialty of General Practice on the Specialist Division of the Medical Council's Register of Medical Practitioners. Holding registration does not necessarily mean that the medical practitioner is in active practice in General Practice at this time. On 20 November 2013, 2,408 general practitioners (GPs) held a General Medical Services (GMS) contract.

The HSE is currently engaged in a medical workforce planning project, which will include a workforce plan for GPs. When this work has been completed, it will assist in identifying GP requirements. I have asked the HSE to reply directly to the Deputy regarding the number of GPs who qualified from training schemes in the past five years and are still working in general practice in Ireland.

Health Services Staff Recruitment

Questions (603)

Clare Daly

Question:

603. Deputy Clare Daly asked the Minister for Health his views on the progress of the working group headed by Professor Brian MacCraith, President of DCU, to look at general practitioner recruitment issues; if representations have been sought from the IMO, ICGP and NEG; and if he will make a statement on the matter. [50342/13]

Written answers

Minister for Health

In July of this year I established a Working Group, chaired by Professor Brian MacCraith, President of DCU, to carry out a Strategic Review of Medical Training and Career Structure. The Working Group will examine and make high-level recommendations relating to training and career pathways for doctors with a view to improving graduate retention in the public health system, planning for future service needs, and realising maximum benefit from investment in medical education and training.

In the course of its work, the Group will examine a range of issues including the pathway for training at every level from Intern to Specialist, and the potential for reducing the length of specialist training. It will also consider mentoring and career planning supports for medical graduates, as well as measures to improve the quality of the training experience. In examining these issues, the Working Group will take account of:

- the need to ensure quality, safe, patient-centred healthcare;

- developments in the clinical programmes and recent reports and recommendations relevant to patient safety;

- opportunities arising from the Health Reform Programme (for example, the development of hospital groups and the expansion of primary care services);

- the achievement of value for money for the State's investment in medical education and training;

- international good practice in regard to medical training and developments, including EU requirements.

I have requested an initial report from the Working Group by the end of November 2013, and a final report by the end of June 2014. In this context, I understand that the Working Group has had initial engagement with stakeholders including trainee doctors, the IMO, the Forum of Irish Postgraduate Medical Training Bodies, the Medical Council and the HSE. Engagement with stakeholders will continue throughout the process to prepare the final report.

Health Services Staff Data

Questions (604)

Clare Daly

Question:

604. Deputy Clare Daly asked the Minister for Health in relation to the 217 general practitioners who have taken up GMS lists since the opening of the scheme, the number already working as assistants in a practice; and the number of GPs that have applied for the GMS lists that were advertised in the last year. [50343/13]

Written answers

Minister of State at the Department of Health

At the end of September 2013, 246 General Practitioners (GPs) had obtained a General Medical Services (GMS) contract under the Health (Provision of General Practitioner Services) Act 2012. Details about the other aspects of the Deputy's question are not routinely collected by my Department. Therefore, I have asked the HSE to reply directly to the Deputy in these matters.

Hospital Waiting Lists

Questions (605)

Charles Flanagan

Question:

605. Deputy Charles Flanagan asked the Minister for Health when a person (details supplied) in County Laois will be given an appointment for an arthroscopy procedure following a consultation in Cappagh Hospital, Dublin; and if he will make a statement on the matter. [50364/13]

Written answers

Minister for Health

The National Waiting List Management Policy, A standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, January 2013, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the Health Service Executive, sets out the processes that hospitals are to implement to manage waiting lists. In relation to this particular query raised by the Deputy, I have asked the HSE to respond directly to the Deputy in this matter.

Hospital Transfers

Questions (606)

James Bannon

Question:

606. Deputy James Bannon asked the Minister for Health the position regarding a transfer for surgery-scan from Midland Regional Hospital, Mullingar, County Westmeath, to Beaumont Hospital, Dublin, in respect of a person (details supplied) in County Longford. [50375/13]

Written answers

Minister for Health

As this is a service matter, I have asked the HSE to respond directly to the Deputy.

Health Services Provision

Questions (607)

Bernard Durkan

Question:

607. Deputy Bernard J. Durkan asked the Minister for Health if and when psychological assessment will be offered in the case of a person (details supplied) in County Kildare; and if he will make a statement on the matter. [50379/13]

Written answers

Minister for Health

As the particular issue raised by the Deputy relates to an individual case, this is a service matter for the Health Service Executive. Accordingly, I have arranged for the question to be referred to the HSE for direct reply to the Deputy.

Questions Nos. 608 to 612, inclusive, answered with Question No. 600.

Hospital Waiting Lists

Questions (613)

Billy Kelleher

Question:

613. Deputy Billy Kelleher asked the Minister for Health if he will provide an update on the €18 million intervention fund announced last May to tackle waiting lists; if any of the €18 million has been used to provide private treatment for those on waiting lists; if so, the amount; the number of procedures this funding achieved; and if he will make a statement on the matter. [50391/13]

Written answers

Minister for Health

As this is a service matter, I have asked the HSE to respond directly to the Deputy.

Health Services Staff Remuneration

Questions (614)

Joe Higgins

Question:

614. Deputy Joe Higgins asked the Minister for Health further to Parliamentary Question No. 580 of 1 October 2013 the reason medical students on placement in the hospitals for the years 2009 to 2011, inclusive, were not paid; the reason this payment has still not been received, for example, by third level biomedical students in DIT; and the action he or the Health Service Executive is taking to ensure that the payments are passed on to students. [50396/13]

Written answers

Minister for Health

My Department has indicated to the HSE that a monthly training allowance, as set out in my Department's consolidated salary scales, is payable to Student Medical Scientists on work placement. This allowance was approved for continued award to new beneficiaries, following the review of public sector allowances conducted in 2012. The current rate payable is €813.58 per month. The HSE issued a memo to hospitals in February, confirming that this allowance should be paid to all Student Medical Scientists on work placement. As the payment of this allowance is a matter for the HSE in the first instance, the Deputy's specific enquiry has been referred to the Executive for direct reply.

Medicinal Products Expenditure

Questions (615)

Sean Fleming

Question:

615. Deputy Sean Fleming asked the Minister for Health if he will consider asking the National Procurement Office to take responsibility for purchases of drugs and medicine on the State's behalf; and if he will make a statement on the matter. [49580/13]

Written answers

Minister of State at the Department of Health

Most drugs and medicines which are paid for by the HSE are supplied to patients through their local pharmacist who, in turn, purchases them from wholesalers or, to a lesser extent, directly from drug manufacturers. There are no plans to alter these arrangements.

The State has introduced a series of reforms in recent years to reduce pharmaceutical prices and expenditure. These have resulted in reductions in the price of thousands of medicines. Price reductions of the order of 30% per item reimbursed have been achieved between 2009 and 2013; the average cost per items reimbursed is now running at 2001/2002 levels. A major new deal on the cost of drugs in the State was concluded with the Irish Pharmaceutical Healthcare Association (IPHA) in October 2012. It will deliver a number of important benefits, including:

- significant reductions for patients in the cost of drugs;

- a lowering of the drugs bill to the State;

- timely access for patients to new cutting-edge drugs for certain conditions; and

- reducing the cost base of the health system into the future.

The IPHA agreement provides that prices are referenced to the currency adjusted average price to wholesaler in the nine EU member states. The prices of a range of medicines were reduced on 1 January 2013 in accordance with the agreement. The gross savings arising from this deal will be in excess of €400 million over 3 years. €210 million from the gross savings will be available to fund new drugs.

A new agreement was also reached with the Association of Pharmaceutical Manufacturers in Ireland (APMI), which represents the generic drugs industry. Since 1 November 2012, the HSE only reimburses generic products which are priced at 50% or less of the initial price of an originator medicine. This represents a significant structural change in generic drug pricing and should lead to an increase in the generic prescribing rate. It is estimated that the combined gross savings from the IPHA and APMI deals will be in excess of €120 million in 2013 with an additional €28 million saved in 2014.

The Health (Pricing and Supply of Medical Goods) Act 2013, which came into operation on the 24th of June, introduces a system of generic substitution and reference pricing. This legislation will promote price competition among suppliers and ensure that lower prices are paid for these medicines resulting in further savings for both taxpayers and patients. It is estimated that this system will yield €50 million in savings in 2014. Under the Act, the Irish Medicines Board (IMB) is responsible for the assessment for interchangeability of medicines. Generic substitution will be introduced incrementally with the IMB prioritising those medicines which will achieve the greatest savings for patients and the State. The Board is in the process of reviewing an initial 20 active substances, which equates to approximately 1,500 individual medicines. They include statins, proton pump inhibitors, angiotensin-converting-enzyme (ACE) inhibitors and angiotensin II receptor blockers.

The first List of Interchangeable Medicines, containing groups of atorvastatin products, was published by the IMB on the 7th August. The IMB is updating the List of Interchangeable Medicines on an ongoing basis and it expects to complete the assessment of the top 20 priority medicines by mid- 2014. The process will then continue until all relevant medicinal products on the reimbursable list have been assessed.

Once a List of Interchangeable Medicines is published by the IMB a two stage price reduction process gets underway. First, under the terms of the 2012 APMI Agreement, the price of all relevant products fall by 20%, e.g. atorvastatin prices were reduced from 1st September. Secondly, the legislation provides that the HSE may set a reference price for groups of interchangeable products published on the List of Interchangeable Products with a view to introducing further significant price cuts. Taking both price reductions into account, atorvastatin prices are down 70% since the introduction of generic substitution.

Reference pricing involves the setting of a common reimbursement price, or reference price, for a group of interchangeable medicines. It means that one reference price is set for each group or list of interchangeable medicines, and this is the price that the HSE will reimburse to pharmacies for all medicines in the group, regardless of the individual medicine’s prices. The first reference price for atorvastatin products was implemented on 1 November 2013. Reference prices will ensure that generic prices in Ireland will fall towards European norms.