Written Answers Nos. 426-448
426. Deputy Louise O'Reilly asked the Minister for Health the number of vacant positions being recruited for by the HSE across the health service; the details based on the discipline of the position; the length of time of each vacancy; the stage at which the recruitment process is at; and the location of the position by hospital, CHO, LHO or other [50817/18]
View answerI have asked the HSE to respond directly to the Deputy on this matter.
427. Deputy Bernard J. Durkan asked the Minister for Health when appropriate treatment will be facilitated in the case of a person (details supplied); when this transfer will take place, with particular reference to the stress and worry being experienced in this instance by the person and in view of the severity of the injury; and if he will make a statement on the matter. [50838/18]
View answerUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
The National Waiting List Management Policy, a standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, since January 2014, 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 HSE, sets out the processes that hospitals are to implement to manage waiting lists.
In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
428. Deputy Maureen O'Sullivan asked the Minister for Health the resources being committed to address the shortage of staff in the Mater Misericordiae University Hospital, Dublin 1; and if his attention has been drawn to the pressures surrounding patient-to-nurse ratios, sick leave and staff attending occupational health for stress management due to the staff shortages [50854/18]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to you directly, as soon as possible.
429. Deputy Maureen O'Sullivan asked the Minister for Health if his attention has been drawn to the frustration of patients such as persons with MS regarding approval of new medicines; if he will report on efforts to work in conjunction with other countries to expedite the process; and if he will make a statement on the matter. [50855/18]
View answerThe HSE has statutory responsibility for medicine pricing and reimbursement decisions, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013. The Act specifies the criteria for decisions on the reimbursement of medicines.
In line with the 2013 Act, if a company would like a medicine to be reimbursed by the HSE pursuant to the community drugs schemes, the company must first submit an application to the HSE to have the new medicine added to the reimbursement list.
As outlined in the Framework Agreement on the Supply and Pricing of Medicines, and in line with the 2013 Act, the HSE will decide, within 180 days of receiving the application (or a longer period if further information is sought from the company), to either add the medicine to the reimbursement list or agree to reimburse it as a hospital medicine, or refuse to reimburse the medicine.
HSE decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds, on the advice of the National Centre for Pharmacoeconomics (NCPE). The NCPE conducts health technology assessments (HTAs) for the HSE and makes recommendations on reimbursement to assist HSE decisions. The NCPE uses a decision framework to systematically assess whether a drug is cost-effective as a health intervention.
The HSE strives to reach a decision in as timely a manner as possible. However, because of the significant monies involved, it must ensure that the best price is achieved, as these commitments are often multi-million euro investments on an on-going basis. This can lead to a protracted deliberation process.
Currently, there are three indications for the treatment of multiple sclerosis going through the reimbursement process. All had applications made in 2018.
The NCPE completed a health technology assessment on 29 August 2018 for Ocrelizumab (Ocrevus) for the treatment of adult patients with relapsing forms of multiple sclerosis (RMS). They recommended that Ocrelizumab (Ocrevus) not be considered for reimbursement unless cost-effectiveness can be improved relative to existing treatments.
On 4 October 2018 the NCPE completed their assessment for Ocrelizumab (Ocrevus) indicated for the treatment of adult patients with early primary progressive multiple sclerosis (PPMS). They did not recommend that Ocrelizumab (Ocrevus) be reimbursed for this indication.
The HSE is the statutory decision-making body for medicine reimbursement. It will make the final decision on whether Ocrelizumab (Ocrevus) will be reimbursed for each of these indications, taking into consideration the statutory criteria in the 2013 Act.
The HSE has also commissioned a HTA of Delta-9-tetrahydrocannabinol/Cannabidiol, THC/CBD (Sativex) which is indicated as treatment for symptom improvement in adult patients with moderate to severe spasticity due to multiple sclerosis (MS) who have not responded adequately to other anti-spasticity medication and who demonstrate clinically significant improvement in spasticity related symptoms during an initial trial of therapy. A full pharmacoeconomic assessment is currently underway by the NCPE.
The challenge of securing affordable access to innovate medicines is not unique to Ireland. Over the past two years, I and officials have been engaging with a number of voluntary EU forums including the Roundtable meetings with EU Health Ministers and the pharmaceutical industry, High Level Pharmaceutical Policy Meetings and the Valletta Technical Committee in an effort to identifying solutions to issues of medicine pricing, sustainability and supply.
On the 22 June 2018, I signed the Beneluxa Initiative on Pharmaceutical Policy to work with Austria, Belgium, the Netherlands and Luxembourg. This Agreement is in line with my objective to work with other European countries to identify workable solutions, in an increasingly challenging environment, to secure timely access for patients to new medicines in an affordable and sustainable way.
The Beneluxa Initiative on Pharmaceutical Policy will have an important role to play in securing faster access to innovative medicines and provide important platforms in which to strengthen the policy mix and deliver on the shared objective of securing access to high cost, innovative treatments at affordable prices. The patient is at the centre of this collaborative international approach.
430. Deputy Maureen O'Sullivan asked the Minister for Health the status and breakdown of services offered at Summerhill primary health facility; and the projected opening date of same [50856/18]
View answerAs the Health Service Executive is responsible for the delivery of healthcare infrastructure projects and healthcare services, I have asked the HSE to respond to you directly in relation to this matter.
431. Deputy Maureen O'Sullivan asked the Minister for Health his plans to address the concerns raised by persons with Lyme disease in terms of diagnosis, patient services and general care; and if he will make a statement on the matter. [50857/18]
View answerLyme disease (also known as Lyme borreliosis) is an infection caused by a spiral-shaped bacterium called Borrelia burgdorferi. The infection is generally mild affecting only the skin but can occasionally be more severe and highly debilitating. Lyme Disease is the commonest cause of tick-borne infection in Europe. Lyme disease was made statutorily notifiable in Ireland by the Infectious Diseases (Amendment) Regulations 2011 (S.I. no 452 of 2011). The notifiable entity is the more severe neurological form of Lyme disease: Lyme neuroborreliosis. The best protection against Lyme disease is to prevent tick bites when walking in grassy, bushy or woodland areas, particularly between May and October.
Lyme disease is diagnosed by medical history and physical examination. The infection is confirmed by a standard two-staged set of blood tests. A 2016 survey reported that all laboratories offering this testing in Ireland are appropriately accredited and are testing in accordance with best international practice. Testing and treatment for Lyme borreliosis is widely available in Ireland in all major hospitals. Lyme borreliosis is diagnosed by medical history and a physical examination which may be carried out by a General Practitioner.
Lyme disease may be treated by infectious disease specialists or by general internal medicine available in all acute hospitals. Medical training programmes at undergraduate or postgraduate level in Ireland provides specialist training in infectious diseases, including Lyme disease. Lyme disease can be very successfully treated using common antibiotics by General Practitioners. These antibiotics are effective at clearing the rash and helping to prevent the development of complications. Antibiotics are generally given for up to three weeks. If complications develop, intravenous antibiotics may be considered.
The Infectious Diseases Society of Ireland (IDSI) has recently expressed concern that the use of tests that are not validated as clinical diagnostic tests to diagnose Lyme infection can result in the over-diagnosis of Lyme disease and often of other infections. IDSI is particularly concerned that vulnerable individuals with non-specific, chronic symptoms are being encouraged to access non-accredited diagnostics related to tick-borne infections offered by commercial laboratories overseas, often at considerable personal expense. Use of such unvalidated, exploratory diagnostics can result in public misinformation, undue anxiety to individuals and their families, and unnecessary personal financial burden. Additionally, in the worst cases, there is the potential for misdirected referral, inappropriate treatment and missed opportunities for formal medical assessment to out-rule significant alternative pathology as explanation for the chronic symptoms. These are concerns that I, as Minister, share.
The U.S. Centers for Disease Control and Prevention have cautioned physicians of the serious risks associated with inappropriate prolonged intravenous antibiotics for what is described as ‘chronic Lyme disease’, stating:
“Patients given a diagnosis of chronic Lyme disease have been prescribed various treatments for which there is often no evidence of effectiveness, including extended courses of antibiotics (lasting months to years)........ At least five randomized, placebo-controlled studies have shown that prolonged courses of IV antibiotics in particular do not substantially improve long-term outcome for patients with a diagnosis of chronic Lyme disease and can result in serious harm, including death”.
The IDSI endorses the Infectious Diseases Society of America Treatment Guidelines. It has been argued by various parties that there are two sets of US guidelines for the treatment of Lyme and that it is reasonable for a physician to choose either: those of the IDSA or those of ILADS (International Lyme and Associated Diseases Society). However, an independent review of the ILADS guidelines, instigated by the Chief Executive of the Health Protection Agency, UK and chaired by Professor Brian Duerden CBE, Inspector of Microbiology and Infection Control, Department of Health, England found that they are poorly constructed and do not provide a scientifically sound evidence-based approach to the diagnosis and care of patients with Lyme Borreliosis. This independent review also concluded that:
“There is potential for harm from use of ILADS guidelines.
. Patients with other serious conditions who receive a misdiagnosis of Lyme through ILADS guideline risk losing opportunities for diagnosis and treatment of their illness.
. Patients receiving prolonged antibiotic treatment are at risk of organ damage from adverse effects of the drugs as well as risk of secondary infections such as Clostridium difficile enterocolitis, multi-resistant Gram–positive or Gram-negative bacterial infections and fungal infections. Patients receiving prolonged treatment with parenteral antibiotics have additional infection-related and other risks associated with long-term intravascular access devices.
. Other potential harms to patients associated with misdiagnosis include psychological damage through fixation on an unsubstantiated diagnosis of Lyme disease and financial hardship from recommendations and provision of repeated and prolonged courses of oral or parenteral antibiotics”.
Given the risks entailed by the models of diagnosis and treatment outlined, and in the absence of robust scientific testing and evidence to demonstrate their efficacy, it would be inappropriate for either the Government or myself as Minister to endorse such methods. Given that appropriate treatment is available in Ireland, it is unnecessary (and, potentially, unsafe) to seek treatment for Lyme disease abroad.
A Lyme Disease Sub-Committee was established by the Health Protection Surveillance Centre (HPSC). This aims to examine best practice in prevention and surveillance of Lyme Disease and to produce a report which identifies the best strategies for the prevention of this disease in Ireland. The HPSC delayed the publication of its Report in order to incorporate the findings of an extensive systematic review of the evidence on Lyme Disease by the National Institute for Health and Care Excellence (NICE) in the UK. This was published earlier this year and the HPSC’s own report is now due to be published early in the New Year. In considering the NICE report, the Subcommittee focused solely on the evidence and recommendations contained in the report that related to its remit (specifically in relation to awareness-raising - diagnostics and clinical management aspects fell outside the remit of the Subcommittee). I have been advised that the report of the subcommittee will be recommending the formation of a group of clinicians to review evidence regarding the diagnostics and clinical management of Lyme disease in Ireland as part of its report.
432. Deputy John McGuinness asked the Minister for Health the progress of the Farrelly commission of investigation; if staff giving evidence to the commission who are employed by section 38 and 39 organisations will have their jobs protected; if the costs associated with their absences from work are covered by the HSE; if a reply will issue to queries raised in this regard through correspondence he received on 19 November 2018; if his attention has been drawn to the fact that the refusal of the HSE to address this issue will result in key witnesses not being able to attend and give evidence at future hearings; and if he will make a statement on the matter. [50875/18]
View answerThe work of the Farrelly Commission of Investigation is ongoing. On 15 May 2018 I agreed to a twelve month extension to the Farrelly Commission to complete and submit its phase 1 final report. In granting the extension, I requested that two further interim reports be provided in September 2018 and January 2019. These interim reports are to include a report on the Commission's progress to date and a summary of work yet to be undertaken. The Third Interim Report was published on 3 October 2018 and is available on the Department of Health's website.
The Farrelly Commission is an independent statutory Commission of Investigation. I am not in a position to comment on its ongoing work.
Sections 23 and 24 of the Commissions of investigation Act 2004 provide for guidelines concerning the recovery of legal costs necessarily incurred by witnesses (section 23) and requests for the recovery of legal costs necessarily incurred and certain other expenses (section 24). These guidelines and the payment of witnesses' expenses and other costs are set out in the Farrelly Commission's Rules and Procedures (sections 13 to 17 and appendix 2). Determinations on witness payments are a matter for the Commission.
Section 38 and 39 agencies are funded by the HSE under the provisions of the Health Act 2004, where the HSE provides a grant to allow the agency to provide services similar or ancillary to the HSE. The HSE has Service Level Arrangements (SLAs) in place with these voluntary providers which set out the level of service to be provided for the grant to the individual organisation.
Employees of Section 39 organisations are not public servants and are therefore not encompassed by the Public Service Stability Agreements. This differs for employees of Section 38 bodies who are directly bound by the Department of Health's Consolidated Salary Scales. It is a matter for Section 39 organisations to negotiate salaries with their staff as part of their employment relationship and within the overall funding available for the delivery of agreed services. I cannot intervene in employment related matters, including the issues raised by the Deputy.
433. Deputy John McGuinness asked the Minister for Health the reason for the delay in appointing a nurse to administer medication on a daily basis to a person (details supplied) at home; if the delay in making the arrangement is a cause of the person being kept as a patient at St. Luke's General Hospital, Kilkenny; and if a resolution of this issue will be expedited [50877/18]
View answerAs this question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply.
434. Deputy Margaret Murphy O'Mahony asked the Minister for Health the number of residential places for persons with a disability being provided by CHO in tabular form. [50886/18]
View answer437. Deputy Margaret Murphy O'Mahony asked the Minister for Health the number of in-home respite supports for emergency cases by CHO to date in 2018, in tabular form. [50889/18]
View answer449. Deputy Margaret Murphy O'Mahony asked the Minister for Health the status of the provision of 12 dedicated respite houses nationally, announced on 12 December 2017; the specific locations of each; the number of persons that can be accommodated in each at a given time; the estimated number of respite nights each house will provide annually; the capital and acquisition costs of each; the estimated annual running costs of each; the number of whole-time equivalent staff to be employed in each; if each house is now operational; and if not, when each will commence providing services in tabular form [50902/18]
View answerI propose to take Questions Nos. 434, 437 and 449 together.
The Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
The Programme for Partnership Government states that the Government wishes to provide more accessible respite care to facilitate full support for people with a disability.
As the Deputy's questions relate to service matters, I have arranged for the questions to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
435. Deputy Margaret Murphy O'Mahony asked the Minister for Health the number of new emergency places provided to persons with a disability to date in 2018, by CHO in tabular form. [50887/18]
View answerThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
As the Deputy's question relates to a service matter, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
436. Deputy Margaret Murphy O'Mahony asked the Minister for Health the number of new home supports for emergency cases by CHO to date in 2018, in tabular form. [50888/18]
View answerThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
As the Deputy's questions relate to service matters, I have arranged for the questions to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
438. Deputy Margaret Murphy O'Mahony asked the Minister for Health the number of persons who have moved on from a congregated setting to date in 2018, by CHO, in tabular form. [50890/18]
View answerThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs.
The Department of Health is also responsible for the development of policy on, and oversight of, the provisions of specialist health and personal social services for people with disability, including the reform programme for health funded specialist disability services.
Transforming Lives is the programme to implement the recommendations of the Value for Money and Policy Review of Disability Services. The Review is a multi-year project which is resulting in very significant changes to the way in which services and supports for people with disabilities are delivered in moving away from institutional models of care and service delivery to community based, person centred, models of service. The implementation of the recommendations in the VFM Review continues to be a priority in the HSE’s National Service Plan for 2018.
The Report “Time to Move on from Congregated Settings – A Strategy for Community Inclusion” proposes a new model of support in the community moving people from Congregated settings to the community in line with Government policy.
The Programme for Partnership Government contains a commitment to continue to move people with disabilities out of congregated settings, to enable them to live independently and to be included in the community. The objective is to reduce this figure by one-third by 2021 and ultimately, to eliminate all congregated settings.
At the end of December 2017, there were less than 2,400 people with a disability living in congregated settings. The HSE has prioritised the transition of 170 people from congregated settings in 2018 under its Service Plan. The HSE has established a subgroup, under the Value for Money Steering Group, which is developing an implementation plan for moving people from institutions that will be rolled out at a regional and local level, in full consultation with residents and their families.
To ensure that the needs of people transitioning from congregated settings are fully taken into account during the process, the model of care for individuals will be based on a person centred plan (PCP). The PCP may change over time in line with an individual’s needs and circumstances and the model of service delivery applicable at a particular time.
As the HSE is responsible for leading out on the recommendations on "Time to Move on from Congregated Settings - A Strategy for Community Inclusion", I have arranged for the specific issues raised in the Deputy's question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
439. Deputy Margaret Murphy O'Mahony asked the Minister for Health the number of persons with a disability in receipt of services (details supplied) by CHO to date in 2018, in tabular form. [50891/18]
View answer440. Deputy Margaret Murphy O'Mahony asked the Minister for Health the number of persons with disabilities in receipt of rehabilitation training by CHO to date in 2018, in tabular form. [50892/18]
View answer441. Deputy Margaret Murphy O'Mahony asked the Minister for Health the number of persons with a disability in receipt of other day services (details supplied) by CHO to date in 2018, in tabular form. [50893/18]
View answerI propose to take Questions Nos. 439 to 441, inclusive, together.
The Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
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.
442. Deputy Margaret Murphy O'Mahony asked the Minister for Health the number of day-only respite sessions accessed by persons with a disability by CHO to date in 2018, in tabular form. [50894/18]
View answer443. Deputy Margaret Murphy O'Mahony asked the Minister for Health the number of overnights with or without day respite accessed by persons with a disability to date in 2018, by CHO area in tabular form [50895/18]
View answer444. Deputy Margaret Murphy O'Mahony asked the Minister for Health the number of persons with a disability (details supplied) in receipt of respite services to date in 2018, by CHO area in tabular form [50896/18]
View answerI propose to take Questions Nos. 442 to 444, inclusive, together.
The Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
The Programme for Partnership Government states that the Government wishes to provide more accessible respite care to facilitate full support for people with a disability.
As the Deputy's questions relate to service matters, I have arranged for the questions to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
445. Deputy Margaret Murphy O'Mahony asked the Minister for Health the number of personal assistant service hours delivered to adults with a physical and-or sensory disability to date in 2018, by CHO area in tabular form. [50897/18]
View answerThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
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.
446. Deputy Margaret Murphy O'Mahony asked the Minister for Health the number of adults with a physical and-or sensory disability in receipt of a personal assistant service to date in 2018, by CHO area in tabular form. [50898/18]
View answerThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
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.
447. Deputy Margaret Murphy O'Mahony asked the Minister for Health the number of home support hours delivered to persons with a disability to date in 2018, by CHO area in tabular form; and if he will make a statement on the matter. [50899/18]
View answer448. Deputy Margaret Murphy O'Mahony asked the Minister for Health the number of persons with a disability (details supplied) in receipt of home support services to date in 2018, by CHO area in tabular form [50900/18]
View answerI propose to take Questions Nos. 447 and 448 together.
The Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
As the Deputy's question relates to a service matter, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
