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 Header Item Written Answers Nos. 1020 - 1037
 Header Item Health Services Staff
 Header Item General Medical Services Scheme Payments
 Header Item Neuro-Rehabilitation Services Provision
 Header Item Neuro-Rehabilitation Services Provision
 Header Item Medical Card Eligibility
 Header Item Health Services Staff Data
 Header Item Mental Health Services Provision
 Header Item Health Insurance Claims
 Header Item Hospital Waiting Lists
 Header Item Health Insurance Data
 Header Item General Practitioner Services
 Header Item General Practitioner Services
 Header Item Primary Care Services Provision
 Header Item Hospital Services

Tuesday, 25 March 2014

Dáil Éireann Debate
Vol. 835 No. 1

First Page Previous Page Page of 118 Next Page Last Page

Written Answers Nos. 1020 - 1037

  Question No. 1020 answered with Question No. 1012.

Health Services Staff

 1021. Deputy Ann Phelan Information on Ann Phelan Zoom on Ann Phelan asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if he will clarify when it is expected that the Health Service Executive staff who have been working in an acting capacity, will transition into full post, as stipulated as part of the Haddington Road agreement, which was meant to take place in October 2013 with full back payment from July 2013, there are 12 positions that fit this criteria in Kilkenny alone; if he will confirm when this transition is due to take place; and if he will make a statement on the matter.  [13105/14]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly The Haddington Road Agreement makes provision for the regularisation of long-term acting positions. I understand that this regularisation process is currently in progress and have referred the question to the HSE for a direct reply to the Deputy.

    Question No. 1022 answered with Question No. 1011.

General Medical Services Scheme Payments

 1023. Deputy Kevin Humphreys Information on Kevin Humphreys Zoom on Kevin Humphreys asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the reason the drug Fosamax for treating osteoporosis is not covered by the medical card; and if he will make a statement on the matter. [13107/14]

Minister of State at the Department of Health (Deputy Alex White): Information on Alex White Zoom on Alex White Fosamax 70mg is on the list of GMS Reimbursable items and available to all under the GMS and other community drugs schemes.

Neuro-Rehabilitation Services Provision

 1024. Deputy Billy Kelleher Information on Billy Kelleher Zoom on Billy Kelleher asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly his response to the new survey by the Neurological Alliance of Ireland which indicates major reductions in access to vital community services and benefits for persons with neurological conditions; and if he will make a statement on the matter.  [13190/14]

 1027. Deputy Billy Kelleher Information on Billy Kelleher Zoom on Billy Kelleher asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly his views on the findings of survey by the Neurological Alliance of Ireland that found that of those surveyed in 2011, 9% could not access physiotherapy services; in 2014, 14% could not; that in 2011, 4% could not access respite care; in 2014, 25% could not; and if he will make a statement on the matter. [13193/14]

Minister of State at the Department of Health (Deputy Kathleen Lynch): Information on Kathleen Lynch Zoom on Kathleen Lynch I propose to take Questions Nos. 1024 and 1027 together.

The Department has asked the HSE to provide the Deputy directly with details of the services it provides for people with neurological conditions. The HSE has made commitments in the 2014 Operational Plan to the implementation of the Neuro-Rehabilitation Strategy. A Steering Group has been established to guide the implementation of the Strategy and to ensure adequate links with the Clinical Rehabilitation Medicine Programme.

Waiting times, access, treatment and quality of care are a priority for reform for this Government despite budgetary constraints. The Government is determined to create a new health service that can better respond to the needs of the Irish people.

Neuro-Rehabilitation Services Provision

 1025. Deputy Billy Kelleher Information on Billy Kelleher Zoom on Billy Kelleher asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the progress that has been made in implementing the 2011 neuro-rehabilitation strategy; and if he will make a statement on the matter.  [13191/14]

 1145. Deputy Terence Flanagan Information on Terence Flanagan Zoom on Terence Flanagan asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the position in regard to the implementation of the national neuro-rehabilitation strategy; and if he will make a statement on the matter.  [13820/14]

Minister of State at the Department of Health (Deputy Kathleen Lynch): Information on Kathleen Lynch Zoom on Kathleen Lynch I propose to take Questions Nos. 1025 and 1145 together.

The Department of Health and the Health Service Executive have developed and published the National Policy and Strategy for the provision of Neuro-Rehabilitation Services in Ireland. The Report is the overarching policy on neuro-rehabilitation services and includes proposals for a framework for the future of neuro-rehabilitation services in Ireland. The Clinical Strategy and Programmes Directorate of the HSE provides a national, strategic and co-ordinated approach to clinical services. The Directorate operates a Clinical Programme in Rehabilitation Medicine led by a team of experts. The Rehabilitation Medicine Programme is working with the HSE to support the development of an implementation plan based on the recommendations of the Neuro-Rehabilitation Strategy.

A key part of this is the assignment of Regional Rehabilitation Medicine Consultants who will ensure that national best practice is implemented in each regional network, crossing the boundaries between acute and community services. The number of Rehabilitation Medicine consultants nationally has increased by four. Regional leads are being assigned.

The HSE has made commitments in the 2014 Operational Plan to the implementation of the Neuro-Rehabilitation Strategy. A Steering Group has been established to guide the implementation of the Strategy and to ensure adequate links with the Clinical Rehabilitation Medicine Programme.

Medical Card Eligibility

 1026. Deputy Billy Kelleher Information on Billy Kelleher Zoom on Billy Kelleher asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly his response to the new survey by the Neurological Alliance of Ireland which indicates that 42% of respondents with neurological problems have had their medical card withdrawn; and if he will make a statement on the matter. [13192/14]

Minister of State at the Department of Health (Deputy Alex White): Information on Alex White Zoom on Alex White Under the provisions of the Health Act 1970 (as amended), eligibility for health services in Ireland is based primarily on residency and means. The Act provides that persons who are unable, without undue hardship, to arrange GP services for themselves and family can qualify for a medical card. The HSE can only award medical cards in accordance with the Health Act and, therefore, it must assess applicants on the overall financial situation of the applicant and his or her spouse or partner. The HSE gives effect to this legislation through its Medical Card National Assessment Guidelines.

The HSE is obliged to operate within the legal parameters as set out in the Health Act, while also responding to the variety of circumstances and complexities faced by individuals who apply for a medical card. Under the legislation, there is no entitlement to a medical card based on having a particular disease or illness (nor has there been previously). However, if an applicant’s means are above the financial thresholds as set out in the national guidelines, the HSE routinely examines for indications of medical or social circumstances which might result in undue financial hardship in arranging medical services and, exercising discretion, may grant eligibility for a medical card on this basis. Where persons submit an application, as a new applicant or a renewal review, without additional medical documentation and are refused, they will receive a letter giving a calculation of the guideline thresholds and where these have been exceeded. Also, at this stage, they are informed of the option to furnish further medical documentation, to demonstrate medical expenditure related to an illness or disease, in support their application. The HSE has a panel of Community Medical Officers to assist in the processing of applications for medical cards on a discretionary basis, where the income guidelines are exceeded but where there are difficult personal circumstances, such as an illness or physical disability.

Where discretion is exercised with regard to an applicant with an illness or disease, it is the medical costs of that condition on a person's financial situation that is relevant to the assessment for a medical card. In accordance with the legislation, it is not possible to award a medical card by virtue of an illness or a disease or the severity thereof. The HSE does not record, on the GMS database, the medical conditions of an individual and, therefore, it is not possible to state whether persons with a medical condition did not qualify for a medical card.

All medical card and GP visit card holders are subject to a periodic review of eligibility to determine continuing eligibility. This review process is applied across all medical card holders, and is not targeted at condition specific groups.

  Question No. 1027 answered with Question No. 1024.

  Question No. 1028 answered with Question No. 980.

Health Services Staff Data

 1029. Deputy Thomas P. Broughan Information on Thomas P. Broughan Zoom on Thomas P. Broughan asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly further to Parliamentary Question No. 592 of 17 December 2013, if the report referred to in the reply is now to hand. [13230/14]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly As this is an operational matter it has been referred to the Health Service Executive for direct reply.

Mental Health Services Provision

 1030. Deputy Thomas P. Broughan Information on Thomas P. Broughan Zoom on Thomas P. Broughan asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if a specific policy exists in relation to the provision of mental health services to children in care of the State; and in particular if there is a national policy on the provision of mental health services to children in care in circumstances where children are placed in a Health Service Executive area outside of their own locality. [13232/14]

Minister of State at the Department of Health (Deputy Kathleen Lynch): Information on Kathleen Lynch Zoom on Kathleen Lynch This Government has prioritised reform of mental health services in line with implementing A Vision for Change, including the delivery of more and better quality mental health care for children in both community and residential settings. This policy is reflected in the significant investment and changes that we have brought to Mental Health since 2012 and covers the provision of Child and Adolescent Mental Health Services (CAMHS). The implementation of that policy includes CAMHS Teams, in-patient care, and development of forensic mental health services for children. 

  A Vision for Change envisages 99 multi-disciplinary teams to provide acute secondary mental health care for children in the community, including hospital liaison and day hospital services. There are now 61 CAMHS teams in place, compared to 54 in 2008. It also recommends the provision of 80 Child and Adolescent psychiatric in-patient beds. In 2008 there were 16 such beds, while now there are 51 beds operational nationally, with more planned. Further capacity will be available with the completion of the CAMHS Forensic Unit as part of developing the National Forensic Mental Health Service, and the National Children’s Hospital. To underpin the new initiatives approved to-date, around 230 new posts were allocated to CAMHS Teams over 2012-13, and recruitment of these is well underway. More CAMHS posts are due to come on-stream over the course of this year.

  A Vision for Change (paragraph 10.12) recognises the needs of children requiring special consideration, including children in care. It recommends that the primary support for these children should be provided by the psychological services in community care or by the local Child and Adolescent Community Mental Health Team, where specialist care is required. The needs of such children would be decided and, where necessary, prioritised following professional assessment. In circumstances where children are placed in a HSE area outside of their own locality, and the criteria governing these cases, I have referred this matter to the Executive for direct reply to the Deputy, as the Executive has operational responsibility in such cases.

Health Insurance Claims

 1031. Deputy Denis Naughten Information on Denis Naughten Zoom on Denis Naughten asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the value and number of outstanding health insurance claims in each acute hospital; the value and number of claims outstanding for 30, 60 and 90 days; the corresponding figures for claims outstanding for six and 12 months; the steps which are being taken to address this problem; and if he will make a statement on the matter. [13180/14]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly This question has been referred to the HSE for direct reply to the Deputy.

Hospital Waiting Lists

 1032. Deputy Gerry Adams Information on Gerry Adams Zoom on Gerry Adams asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if the clinical review of all patients waiting for bariatric operations has been completed as part of the transition from St. Colmcille's to St. Vincent's Hospital; if the position of a person (details supplied) in County Waterford has changed as a result of this review; the number of bariatric surgeries that he expects to take place in St. Vincent's Hospital each month; the number of persons on the list for a gastric bypass; and if he will make a statement on the matter. [13238/14]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly In relation to the particular patient query, and the number of other issues raised by the Deputy, as these are service matters, I have asked the Health Service Executive to respond to him directly.

Health Insurance Data

 1033. Deputy Billy Kelleher Information on Billy Kelleher Zoom on Billy Kelleher asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the total volume of premium income in the private health insurance market in 2011, 2012 and 2013; the way that premium income was split between each insurer in each of the years; and if he will make a statement on the matter. [13240/14]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly The total premium income in the market for 2011 was €2.048 billion and for 2012 was €2.226 billion. (These figures do not include the Hospital Saturday Fund).

  The premium income figures quoted above are "premium income paid" data that have been calculated by the HIA from quarterly levy returns provided by health insurers. The following is a breakdown by the different health insurance businesses in the State (except restricted membership undertakings) of their "earned premium income", which has been extracted from financial accounts information that has been separately provided to the HIA by the health insurers. It should be noted that "premium income paid" and "earned premium income" are related but not identical accounting calculations of premium income in insurance businesses.

  The latest data available from the Health Insurance Authority, showing a breakdown of the premium income by insurer, is as follows:

  2011:

€m’sAviva Health

12 months to end Dec 2011

€m
Quinn Healthcare

12 months to end Dec 2011

€m
Vhi Healthcare

12 months to end Dec

2011

€m
Earned premiums before reinsurance and age related tax credit270.5323.61,295.8


  2012:
€m’sAviva Health

12 months to end Dec

2012

€m
* Elips

12 months to end Dec 2012

€m
** Great Lakes

12 months to end Dec 2012

€m
Quinn Healthcare

12 months to end Dec 2012

€m
Vhi Healthcare

12 months to end Dec

2012

€m
Earned premiums before reinsurance and age related tax credit336.381.23.2281.01,412.4


  (* trading as Laya Healthcare, ** trading as Glohealth)

  Figures for 2013 are not yet available.

  It is important to note that the tables show the profitability of insurers' private health insurance business in 2011 and 2012. These figures were provided by insurers to the Authority pursuant to its work in relation to assessing whether overcompensation under the Risk Equalisation Scheme occurred. The accounts above may differ from published accounts, which may have been finalised on a different date and may include business other than private health insurance business, which my Department does not collate as the companies concerned are commercial entities.

General Practitioner Services

 1034. Deputy Arthur Spring Information on Arthur Spring Zoom on Arthur Spring asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if a person (details supplied) in County Limerick will be given an extension to the end of 2014 in order to have sufficient time to gather and provide information to support the review of their dispensing arrangements, including identifying patients for whom they wish to continue dispensing. [13243/14]

Minister of State at the Department of Health (Deputy Alex White): Information on Alex White Zoom on Alex White As this is a service matter, it has been referred to the Health Service Executive for direct reply to the Deputy.

General Practitioner Services

 1035. Deputy Brian Walsh Information on Brian Walsh Zoom on Brian Walsh asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if there is empirical evidence to suggest that access to free primary care, disease surveillance and health promotion for children under six years will improve health outcomes, prevent the development of chronic conditions, or effect savings in the primary and acute sectors in future; and if he will make a statement on the matter. [13246/14]

 1095. Deputy Seán Ó Fearghaíl Information on Seán Ó Fearghaíl Zoom on Seán Ó Fearghaíl asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly pursuant to the draft contract for the provision of services to under six year olds, if he has particular concerns regarding the element of the draft agreement which states that the service provider shall not do anything to prejudice the name or reputation of the Health Service Executive; his views on whether such a curtailment of expression impacts on the ability of doctors to speak out and represent their patients and to act as their advocates; his further views on whether the inclusion of this clause in the draft agreement represents an effective gagging order on general practitioners; and if he will make a statement on the matter. [13558/14]

 1096. Deputy Seán Ó Fearghaíl Information on Seán Ó Fearghaíl Zoom on Seán Ó Fearghaíl asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly pursuant to the draft contract for the provision of services to under six year olds, the regularity with which he expects performance reviews to be carried out on general practices; and if he will make a statement on the matter. [13559/14]

 1099. Deputy Seán Ó Fearghaíl Information on Seán Ó Fearghaíl Zoom on Seán Ó Fearghaíl asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly pursuant to the draft contract for the provision of services to under six year olds, the objective of his Department and the Health Service Executive on the issue of out-of-hours payments to GPs; his views on whether the severe curtailment of such payments, which is envisaged in the draft agreement, will impact, in particular, on out-of-hours doctors' co-operatives and will make the funding of such co-ops far more vulnerable; and if he will make a statement on the matter. [13564/14]

Minister of State at the Department of Health (Deputy Alex White): Information on Alex White Zoom on Alex White I propose to take Questions Nos. 1035, 1095, 1096 and 1099 together.

  The Government is committed to introducing, on a phased basis, a universal GP service without fees within its term of office, as set out in the Programme for Government and the Future Health strategy framework.

  As announced in the Budget, it has been decided to commence the roll-out of a universal GP service by providing all children under six years with access to a GP service without fees. The implementation of this measure will require primary legislation, which I expect to be published shortly.

  I am satisfied that there is ample evidence to suggest that access to primary care services helps to improve health outcomes, to prevent the development of chronic conditions and to effect savings in the acute hospital sector.

  The Report of the Expert Advisory Group on the Early Years Strategy recommended that all children under the age of six years should be given access to free GP care. The Trinity College Centre for Health Policy and Management and the Adelaide Hospital Society report entitled Social Health Insurance: Further Options for Ireland, noted that internationally there are strong grounds for providing free health care for children, particularly given their burden of ill health.   

  A draft contract for the provision of free GP care to children under six years, is currently the subject of a consultation process. I would wish to emphasise that the document is a draft and I have no doubt that there will be changes to the text following the consultation process. I have offered to meet with the GP organisations in the coming weeks for more detailed discussions on the scope and content of the draft contract. This will afford them the fullest opportunity to raise any and all issues which they may have regarding the draft contract. Furthermore, I wrote to the Irish Medical Organisation (IMO) on 27th   February 2014, stating that the Department and the HSE are fully prepared to engage meaningfully with them and are prepared to negotiate with them on all aspects of the scope and content of the proposed contract. However, the ultimate setting of fees must remain a matter for the Minister for Health, though there will be an opportunity for their input on the fee structure, which it is proposed to address by means of a separate consultation process. The IMO has been formally invited to meet with the Department and the HSE to commence this process.

  With reference to the question which infers that the draft contract is placing a “gagging order” on GPs, the specific clause in the draft contract relating to this (Clause 28.4.4) is intended to reflect and be protective of the HSE's interests given that the primary statutory obligations to provide general practitioner medical and surgical services will rest with the HSE. It is not in any sense intended to impose unwarranted or inappropriate restrictions on individual GP contractors in advocating on behalf of their patients. A similar clause can be found in the form of agreement with Clinical Dental Technicians, which was introduced in 2011. The clause in question should be viewed in the context of the entire draft document, where the intent is to balance the duties, obligations and rights of both parties, while at the same time, having due regard to the overriding statutory obligations that will rest with the HSE.

  Under the existing contract, GPs contracted under the General Medical Services Scheme must make suitable arrangements to enable contact to be made with them (or a locum/deputy) for emergencies outside normal practice hours. Co-operatives provide an ideal facility to enable GPs to discharge this obligation. The draft under six contract also makes provision for GP out-of-hours services, the details of which I expect will be the subject of further discussions with the GPs. I would wish to state again that no decision has been taken on the rates of fees payable to GPs for services included in the draft under six contract, including out-of-hours payments. These will be addressed through the fee setting process outlined above.

  The Deputies' questions raise a number of other specific issues, including disease surveillance and health promotion. Such activities will ensure that the proposed scope of service under the contract is not limited to “diagnosis and treatment” but will include participation in active health promotion, disease surveillance, prevention and appropriate management of chronic conditions. I expect that issues such as these and the regularity of performance reviews will be the subject of further discussions with the GPs.

Primary Care Services Provision

 1036. Deputy Robert Dowds Information on Robert Dowds Zoom on Robert Dowds asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly his plans to renovate and expand the local health centre at a location (details supplied) in Dublin 22.  [13254/14]

Minister of State at the Department of Health (Deputy Alex White): Information on Alex White Zoom on Alex White The Health Service Executive (HSE) has responsibility for the provision of Primary Care Centres, the maintenance and refurbishment of existing health centres and the provision of services at such centres. Therefore, this matter has been referred to the HSE for attention and direct reply to the Deputy.

Hospital Services

 1037. Deputy Billy Kelleher Information on Billy Kelleher Zoom on Billy Kelleher asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if any wards or beds at Waterford Regional Hospital are currently only available for use by private patients; and if he will make a statement on the matter. [13255/14]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly As this is a service matter, I have asked the HSE to respond directly to the Deputy.


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