Written Answers Nos. 171-190
171. Deputy Richard Boyd Barrett asked the Minister for Health if he will outline what the eligibility criteria will be for publicly funded fertility care, as outlined in the programme for Government, in terms of age, relationship status, sexuality and so on; and if he will make a statement on the matter. [10381/23]
View answerAs the Deputy will be aware, the Model of Care for Fertility was developed by the Department of Health in conjunction with the HSE’s National Women & Infants Health Programme (NWIHP) in order to ensure that fertility-related issues are addressed through the public health system at the lowest level of clinical intervention necessary.
This Model of Care comprises three stages, starting in primary care (i.e., GPs) and extending into secondary care (i.e., Regional Fertility Hubs) and then, where necessary, tertiary care (i.e., IVF (in-vitro fertilisation), ICSI (intra-cytoplasmic sperm injection) and other advanced assisted human reproduction (AHR) treatments), with patients being referred onwards through structured pathways.
Phase One of the roll-out of the Model of Care has involved the establishment, at secondary care level, of Regional Fertility Hubs within maternity networks, in order to facilitate the management of a significant proportion of patients presenting with fertility-related issues at this level of intervention. Patients are referred by their GPs to their local Regional Fertility Hub, which provides a range of treatments and interventions, including: relevant blood tests, semen analysis, assessment of tubal patency, hysteroscopy, laparoscopy, fertility-related surgeries, ovulation induction and follicle tracking.
The completion of Phase One of the roll-out of the Model of Care, envisaged later this year, will result in fully operational Regional Fertility Hubs at six locations across the country.
Phase Two of the roll-out of the Model of Care will see the introduction of tertiary fertility services, including IVF, provided through the public health system. In this regard, funding was secured in Budget 2023 to support access to advanced AHR treatments, including, crucially, to allow the commencement of Phase Two of the roll-out of the Model of Care.
This investment will facilitate the first steps to be taken towards the provision of a complete publicly-provided fertility service, which is the ultimate objective of Government. In particular, it will allow the historic development of the first National Advanced AHR Centre, delivering IVF and ICSI through a wholly public clinic. This is scheduled to open in the early part of 2024 and will provide a nationwide service, with all six Regional Fertility Hubs having equity of access for onward referral to it, via a shared care pathway. Subject to the provision of additional funding in future, it is envisaged that additional National Advanced AHR Centres will be developed and become operational on a phased basis elsewhere in the country.
The 2023 allocation is also being utilised to support the Regional Fertility Hubs in order to expand their scope of services later this year by introducing the provision of IUI (intrauterine insemination), which can, for certain cohorts of patients, be a potentially effective, yet less complex and less intrusive, type of AHR treatment.
Separately, as an interim measure, I have instructed that some funding be made available to support access to advanced AHR treatment via private providers from September 2023.
Substantial planning, development and policy work to establish the scope, design and requirements for Phase Two of the roll-out of the Model of Care is ongoing. My officials, in conjunction with NWIHP, are continuing to actively prepare for the operationalisation of both the publicly- and privately- provided service, including finalising a national eligibility framework and determining how the interim funding for private treatments will be provided to individual eligible patients.
Overall, my Department and the Government is fully committed, through the full implementation of the Model of Care for Fertility, to ensuring that patients always receive care at the appropriate level of clinical intervention and then those requiring, and eligible for, advanced AHR treatment such as IVF will be able to access same through the public health system. The underlying aim of the policy to provide a model of funding for AHR, within the broader new AHR regulatory framework, is to improve accessibility to AHR treatments, while at the same time embedding safe and appropriate clinical practice and ensuring the cost-effective use of public resources.
172. Deputy Róisín Shortall asked the Minister for Health the steps he is taking to improve the speed and efficiency of health technology assessments for new treatments that have already been approved by the European Medicines Agency, in particular preventative treatments for Covid-19 for immunocompromised people; and if he will make a statement on the matter. [10382/23]
View answerHealth technology assessment (HTA) is a multidisciplinary process that summarises information about the medical, social, economic, and ethical issues related to the use of a health technology. Examples of health technologies include medicinal products, medical equipment, diagnostic and treatment methods, rehabilitation, and prevention methods. Its aim is to inform the formulation of safe and effective health policies, investment and reimbursement decisions that are patient focused and seek to achieve best value.
The National Centre for Pharmacoeconomics (NCPE) was established in 1998 and its remit is to advise the HSE and the Department of Health in relation to the cost-effectiveness of medicines, through the carrying out of HTAs. The Health (Pricing and Supply of Medical Goods) Act 2013 gives full statutory powers to the HSE to assess and make decisions on the reimbursement of all medicines. HSE decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds, on the advice of the NCPE. The NCPE conducts HTAs for the HSE and makes recommendations on reimbursement to assist HSE decisions.
Last week, I published a Report prepared by Mazars which examined the governance arrangements of the HSE’s drug reimbursement process. The Report found that the HSE process is operating in line with the legislation and that it is delivering results in keeping with international norms.
I have prioritised progressing the recommendations concerning transparency from the Report. As well as this, an Implementation Working Group is being established between the Department of Health and the HSE. This Group will consider and progress the various recommendations contained in the Report, one of which is an increase in resourcing for the NCPE.
173. Deputy Eoin Ó Broin asked the Minister for Health when the HSE will publish an alcohol non-compliance list in accordance with section 31 of the Public Health (Alcohol) Act 2018. [10407/23]
View answerAs enforcement issues relating to the Public Health (Alcohol) Act 2018 are the responsibility of the Health Service Executive, I have referred this question to the Health Service Executive for attention and direct reply.
174. Deputy Eoin Ó Broin asked the Minister for Health the number of instances of alleged breaches of section 14 of the Public Health (Alcohol) Act 2018 that have been brought to the HSE’s attention; and the number of cases that have been investigated. [10408/23]
View answerAs enforcement issues relating to the Public Health (Alcohol) Act 2018 are the responsibility of the Health Service Executive, I have referred this question to the Health Service Executive for attention and direct reply.
175. Deputy Martin Browne asked the Minister for Health if he intends to develop a model of care for people with the eating condition of avoidant restrictive food intake disorder; if he intends to develop a model of care for people with ARFID and a diagnosis or ASD or other associated condition in what could be referred to as dual diagnosis; if he has any intention of appointing a clinical lead in providing a pathway to care for people with ARFID, with reference to children and adults; and if he will make a statement on the matter. [10419/23]
View answer176. Deputy Martin Browne asked the Minister for Health the number of people in Ireland estimated to have the eating condition ARFID; and if he will make a statement on the matter. [10420/23]
View answer177. Deputy Martin Browne asked the Minister for Health his views on the equality of access to treatment for people in Ireland with ARFID, with reference to geographical location; and if he will make a statement on the matter. [10421/23]
View answer178. Deputy Martin Browne asked the Minister for Health his views on the equality of access to treatment for people in Ireland with ARFID and another associated or complicating condition, such as ASD, with reference to geographical location; and if he will make a statement on the matter. [10422/23]
View answerI propose to take Questions Nos. 175 to 178, inclusive, together.
As this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
179. Deputy Éamon Ó Cuív asked the Minister for Health the current status of telemedicine abortion; if it is intended to revert back to the pre-Covid practice in this regard, now the Covid pandemic restrictions are ended; if so, when this is likely to happen; and if he will make a statement on the matter. [10436/23]
View answerAs part of the Government’s ongoing efforts to protect public health and limit the spread of COVID-19, the Department of Health and the Health Service Executive (HSE) worked together in 2020 to put arrangements in place to allow termination of pregnancy services in early pregnancy to be provided remotely.
For the duration of the COVID-19 public health emergency, where the need for social distancing, reducing personal contacts and reducing the burden on medical practitioners are paramount, it became possible for a woman to access a termination under section 12 of the Health (Regulation of Termination of Pregnancy) Act 2018 (i.e., before 12 weeks) from her medical practitioner by telephone or video conference consultation.
There is ongoing engagement between the Department of Health and the HSE to monitor service provision, facilitate the smooth-running of the service and resolve any issues that may arise. However, as restrictions began to ease, it became timely to revisit the Model of Care to review its operation and consider whether remote consultation as part of a blended approach to termination of pregnancy care should be continued post the COVID-19 public health emergency period.
At the request of the Department, the HSE conducted a review of the Revised Model of Care for Termination of Pregnancy.
The review of the Model of Care for the Termination of Pregnancy Service found that the majority of providers within primary care feel that a blend of remote and in-person care is optimal.
In-person consultations allow provision of personalised care and allow potential problems to be identified and mitigated, while remote provision improves access for many women and addresses geographical and logistical barriers. It also alleviates some of the difficulty associated with the mandatory 3-day waiting period.
The review found that the provision of a remote consultation as part of the termination of pregnancy service is safe, effective and acceptable to both service users and providers.
The findings of this review are currently being examined as part of a deliberative process. The consideration of appropriate next steps will form part of this process.
180. Deputy Éamon Ó Cuív asked the Minister for Health if nursing homes that are part of the "nursing home subvention scheme" are entitled to charge a general daily "contribution charge" to the resident over and above the amount agreed with the HSE for the resident; if not, the steps the HSE intend taking to ensure that this practice is happening; and if he will make a statement on the matter. [10445/23]
View answer181. Deputy Éamon Ó Cuív asked the Minister for Health if nursing homes that are part of the "nursing homes subvention scheme" are entitled to charge for ancillary services not covered by the scheme as a general charge, even though they are not being availed of by the resident of the home; and if he will make a statement on the matter. [10446/23]
View answer182. Deputy Éamon Ó Cuív asked the Minister for Health if it is intended to send inspectors to nursing homes that are part of the "nursing home subvention scheme" to ensure they are not overcharging residents against the rules of the scheme; and if he will make a statement on the matter. [10447/23]
View answerI propose to take Questions Nos. 180 to 182, inclusive, together.
The Nursing Homes Support Scheme (NHSS), commonly referred to as Fair Deal, is a system of financial support for people who require long-term residential care. Participants contribute to the cost of their care according to their means while the State pays the balance of the cost.
• The NHSS covers the cost of the standard components of long-term residential care which are:
• Nursing and personal care appropriate to the level of care needs of the person;
• Bed and board;
• Basic aids and appliances necessary to assist a person with the activities of daily living; and
• Laundry service.
Data from HSE indicates that, on average, NHSS residents cover around 30% of their cost of care, with the state covering the remaining 70%. This proportion is based on the assessment of residents' assets and income, rather than on the cost of providing their care, and has remained stable over recent years.
Costs not covered by the NHSS include those individually incurred for items like social activities, newspapers and hairdressing. This may also include medical services such as therapies and some medical equipment. A person's eligibility for other schemes, such as the medical card scheme or the drugs payment scheme, is unaffected by participation in the NHSS or residence in a nursing home. In determining the services covered by the NHSS it was considered very important that the care recipient and the taxpayer would be protected and would not end up paying for the same services twice. For this reason, medications and aids that are already prescribed for individuals under an existing scheme are not included in the services covered by the NHSS, as this would involve effectively paying twice for the same service.
It is important to state that residents of nursing homes should enjoy the same levels of support and access to services for which they are eligible as when they lived in their own homes. It is acknowledged that the reason they require 24 hour levels of support is due to their level of dependency, which in turn may require access to clinical services including hospital and other outpatient appointments in the community.
Although the NHSS covers core living expenses, residents can still incur some costs in a nursing home, as set out above. In recognition of this, anyone in receipt of financial support under the NHSS retains at least 20% of their income. The minimum amount that is retained is the equivalent of 20% of the State Pension (Non-Contributory).
The Department of Health does not currently hold data relating to additional charges in private nursing homes; these vary according to each individual nursing home depending on the services offered. It is important to note that it is private nursing homes who hold responsibility for delivering care to their residents in line with their terms of registration and the relevant regulations under the Health Act 2007.
Nevertheless, the Department of Health is currently reviewing the available evidence and considering various policy options with relation to additional nursing home charges.
It is clear that, under the terms of the NHSS Act 2009, private nursing homes should not levy additional charges on NHSS residents for services coming within scope of the Nursing Home Support Scheme.
Part 7 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 stipulates that the registered provider of the nursing home must agree a contract in writing with each resident on their admission to the nursing home. This contract must include details of the services to be provided to that resident and the fees to be charged. Residents should never be charged fees which are not set out in the contract. The Department of Health and the HSE are not a party to such contracts which are concluded between each resident and their nursing home.
Registered providers of nursing home care are obliged to provide an accessible and effective complaints procedure. Concerns about additional charges should in the first instance be taken up with the nursing home provider. Where an individual is not satisfied with the response they receive, they may wish to take their complaint further by seeking a review from the Office of the Ombudsman.
The Office of the Ombudsman can examine complaints about the actions of a range of public bodies and, from 24 August 2015, complaints relating to the administrative actions of private nursing homes. The Office of the Ombudsman normally only deals with a complaint once the individual has already gone through the complaint’s procedure of the private nursing home concerned.
The Competition and Consumer Protection Commission (CCPC) has published consumer protection guidelines for contracts of care in long-term residential care services for older people. The guidelines set out the obligations and responsibilities that providers must adhere to under consumer protection law and are aimed at providing greater transparency, clarity and certainty for consumers
183. Deputy Michael Healy-Rae asked the Minister for Health if a hospital appointment will be expedited for a person (details supplied); and if he will make a statement on the matter. [10449/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
184. Deputy Noel Grealish asked the Minister for Health the reason priority is given to CEO entry applicants within the HSE Internship placement programme in addition to or instead of percentile marking; the reason applicants for internship posts who accepted a place in Irish medical school through a CAO officer will be allocated posts ahead of applicants who accepted an Irish medical school place directly from the medical school; his views on whether this practice is discriminatory given that all students registered in a college course should be treated fairly and equitably; and if he will make a statement on the matter. [10452/23]
View answerApplicants for a medical internship are applying for an employment position in the HSE. They are recruited directly by the HSE, as their employer. An offer of Internship is dependent on passing final medical exams and submission of centile by relevant medical school.
The HSE applies the Employment Permits legislation in the recruitment for intern posts. In compliance with the Employment Permits Act an order of merit based on work permit status is applied whereby all eligible CAO entrants to Irish medical schools who are work permit exempt are guaranteed an intern post. Remaining posts are allocated to all remaining eligible EEA applicants, followed by all remaining eligible non-EEA applicants.
The policy regarding the allocation of medical intern posts was put in place in 2016 to ensure that CAO entry medical graduates are guaranteed an internship following completion of their medical degree. It is a priority that CAO graduates have access to an internship in order that they may qualify as a doctor, obtain full registration with the Medical Council of Ireland, with a view to going on to seek permanent employment in our Irish health services. This protects the State investment in the undergraduate education of CAO medical students. It supports Ireland’s commitment under the World Health Organization’s Global Code on the Recruitment of International Health Personnel to strive for self-sufficiency in the domestic training of doctors.
Under this application model all eligible CAO and EEA work permit exempt applicants have been allocated an intern post since 2016. There were 854 medical Intern posts available for the 2022/23 training year. In relation to the July 2022/23 intern year intake all eligible candidates, who applied for an intern post, were offered an intern post.
185. Deputy Patricia Ryan asked the Minister for Health the number of HSE home help carers in County Kildare; and if he will make a statement on the matter. [10477/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
186. Deputy Patricia Ryan asked the Minister for Health the reason it has taken so long to fill a social worker post for a hospice (details supplied) in the Curragh, County Kildare; and if he will make a statement on the matter. [10478/23]
View answerAs this is an operational matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
187. Deputy Patricia Ryan asked the Minister for Health if the social worker position for recruitment in a hospice (details supplied) in the Curragh, County Kildare will be filled by a basic or senior grade social worker; and if he will make a statement on the matter. [10479/23]
View answerAs this is an operational matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
188. Deputy Cian O'Callaghan asked the Minister for Health if the Public Health (Alcohol) Act 2018 will see the introduction of warning signs on alcohol being provided in English and Irish; and if he will make a statement on the matter. [10492/23]
View answerSection 12 of the Public Health (Alcohol) Act requires that health warnings and information relating to a HSE website on alcohol, must also be displayed on notices in licensed premises, on websites which sell alcohol products and on the labels of alcohol products with information on the grams of alcohol and calories of the product.
In the case of the notices to be displayed in licensed premises and the notices on websites which sell alcohol, the information must be in both the Irish and the English language. In the case of labels on alcohol products, the information is required in the English language only. The decision to restrict the labelling to the English language only was taken in order that the obligations on businesses would be as proportionate as possible. Draft regulations under section 12 of the Act are currently with the World Trade Organisation for consultation.
189. Deputy Paul McAuliffe asked the Minister for Health if the figures for all elements in relation to the construction of the national children’s hospital, both mechanical and electrical, that is, lighting, ductwork and ventilation, are completely measured and agreed by the cost consultants. [10493/23]
View answerThe National Paediatric Hospital Development Board (NPHDB) has statutory responsibility for planning, designing, building, and equipping the new children's hospital. I have therefore referred your question to the NPHDB for direct reply.
190. Deputy Paul McAuliffe asked the Minister for Health if the percentage of building work completed in relation to the construction of the national children’s hospital is validated; and how it is validated on a monthly basis. [10494/23]
View answerThe National Paediatric Hospital Development Board (NPHDB) has statutory responsibility for planning, designing, building, and equipping the new children's hospital. I have therefore referred your question to the NPHDB for direct reply.
