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 Header Item Written Answers Nos 1028-1045
 Header Item Audit Report on Neglect Cases
 Header Item Child Care Reports
 Header Item Exchequer Savings
 Header Item Official Travel
 Header Item Departmental Bodies
 Header Item HSE Staffing
 Header Item Mental Health Services Provision
 Header Item Proposed Legislation
 Header Item Medicinal Products Availability
 Header Item Medical Disclosure Code
 Header Item Medical Card Eligibility
 Header Item Medical Card Eligibility
 Header Item Health Care Abroad
 Header Item Primary Care Strategy
 Header Item Home Help Service Provision

Tuesday, 16 July 2013

Dáil Éireann Debate
Vol. 811 No. 2

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Written Answers Nos 1028-1045

Audit Report on Neglect Cases

 1028. Deputy Denis Naughten Information on Denis Naughten Zoom on Denis Naughten asked the Minister for Children and Youth Affairs Information on Frances Fitzgerald Zoom on Frances Fitzgerald when it is expected that audits of all serious neglect cases will commence; the estimated number of files to be reviewed and the timeline for completion; and if she will make a statement on the matter. [35080/13]

 1029. Deputy Denis Naughten Information on Denis Naughten Zoom on Denis Naughten asked the Minister for Children and Youth Affairs Information on Frances Fitzgerald Zoom on Frances Fitzgerald the discussions she has had with other Departments on foot of the publication of the audit report on neglect cases; and if she will make a statement on the matter. [35081/13]

Minister for Children and Youth Affairs (Deputy Frances Fitzgerald): Information on Frances Fitzgerald Zoom on Frances Fitzgerald I propose to take Questions Nos. 1028 and 1029 together.

An audit of neglect cases in Roscommon, Waterford and Dublin South-East has been completed by the HSE. The HSE published a composite report of the 3 pilots on 20 June 2013. A decision was taken within the HSE to produce this composite report as the best means of disseminating the learning from the three projects. The decision to publish a composite report, along with the time taken by the HSE to ensure that all of the recommendations are being actioned, were factors in determining the publication date of the report.

From the outset, it was the intention of the HSE that the neglect audit would comprise a number of phases and that the initial pilot phase would inform a more significant National Audit of Neglect Cases. Therefore the audit published in June last was not simply a once off exercise but constitutes one element of a wider process to improve practice in relation to such cases across the country. Phase 1 of this process was the initial audits undertaken by Ms Lynne Peyton, Consultant in Children’s Services and Social Care. Phase 2 will comprise a series of workshops for social work staff and managers nationwide. There will be a minimum of two workshops in each region presented by Ms Peyton in conjunction with Ms Helen Buckley, who will be covering the learning emerging from the child death review process. These workshops are scheduled to begin in autumn 2013 and will be followed by the phase 3 national audit of all neglect files which will be informed by the findings of phase 1 and the outcomes of the phase 2 workshops. A definitive timeline for completion of phases 2 and 3 is dependent on completion of phase 2 at regional level and thereafter individual local audits. It follows that different regions will complete their audits at different times. My Department will be liaising with the HSE over the coming months to monitor progress.

As regards consultations, these have been exclusively with officials in the HSE around progressing to the next phases of the audit process. Any issue emerging as the audit process proceeds will be raised through the interdepartmental Children First Implementation Group.

Child Care Reports

 1030. Deputy Brendan Griffin Information on Brendan Griffin Zoom on Brendan Griffin asked the Minister for Children and Youth Affairs Information on Frances Fitzgerald Zoom on Frances Fitzgerald the action her Department has taken since the broadcast in May of the "Prime Time" undercover exposé of issues of serious concern in the child care sector; and if she will make a statement on the matter.  [35478/13]

Minister for Children and Youth Affairs (Deputy Frances Fitzgerald): Information on Frances Fitzgerald Zoom on Frances Fitzgerald As Minister for Children and Youth Affairs, driving the early childhood care and education quality agenda is one of my key objectives. I recently announced a number of measures as part of my response to the distressing events highlighted in the "Prime Time" programme.

  It is my intention to introduce new qualification requirements for the sector starting in September 2014. This will be an important new development as, at present, staff working in child care services, other than under the ECCE programme, are not subject to any requirement in respect of qualifications.

  The Early Childhood Care and Education (ECCE) programme introduced the first-ever requirement for minimum qualifications for staff working in the child care sector. The current requirement under the programme is that the pre-school leader delivering the pre-school provision must hold a qualification in childcare-early education at a minimum of Level 5 on the National Framework of Qualifications of Ireland (NFQ), or an equivalent nationally recognised qualification or a higher award in the child care-early education field.

  I have indicated my intention to increase the qualification requirements for all staff working in pre-school services. The minimum requirement of Level 5 for pre-school leaders delivering the pre-school year will be increased to Level 6. In addition, all pre-school assistants, and all other staff caring for children in a pre-school service, will be subject to a minimum requirement of Level 5. This requirement will be effective from September 2014 for new services, and from September 2015 for existing services.

  Pre-school services are governed by the Child Care (Pre-School Services) (No 2) Regulations 2006 as provided in the Child Care Act 1991. Under the Regulations the Health Service Executive has responsibility for the inspection of services and the enforcement of the regulations. Inspection is carried out to monitor compliance with the regulations, thereby ensuring the health, safety and welfare of children and the promotion of their development.   

  As I have outlined in recent weeks, a number of steps are being taken to improve the current inspection system. These include the introduction of National Quality Standards for pre-school services later this year as part of the inspection process. In addition, my Department is working with the Pre-School Inspectorate to develop new protocols on regulatory compliance so that there is greater clarity and consistency of approach as to how inspection reports deal with findings of serious non-compliance vis-a-vis minor breaches and full compliance. My Department is also undertaking a review of the penalties currently in place for breach of the Child Care (Pre-school) Regulations, as provided for under the Child Care Act 1991. The review will look at increasing the range and severity of the existing penalties, including the actions which can be taken by Inspectors without recourse to court prosecution, as is currently the case.

  In relation to the publication of pre-school service inspection reports, the HSE Pre-School Inspectorate is working to put these online. I gave a commitment to have new reports, once completed, put online from 1 July 2013 and to have all reports available online as soon as possible. My Department is supporting the HSE and Pobal in this work, and I understand that the first of these reports has recently been placed online.    

  A new registration system will be introduced in September this year and new services wishing to open will be required to register with the HSE. The HSE will determine whether the child care service is compliant in terms suitability and service design before the service will be permitted to operate. Following commencement of the service, actual care and welfare practices will be inspected.

  My Department is currently developing a new Children and Young People's Policy Framework which will set out high level goals for both my own and other Departments for the next five years. The Policy Framework is expected to be published later this year and will build on Our Children - Their Lives, Ireland's first children's strategy which was published in 2000. This is relevant to the Early Years Strategy as the strategy is one of three, more detailed strategies which will be developed under the framework.

  The Early Years Strategy, which will be Ireland's first ever national strategy for early years, is under development. It is expected that it will cover a range of issues affecting children in their first years of life such as child health and well-being, parenting and family support, learning and development, play and recreation and early childhood care and education.

Exchequer Savings

 1031. Deputy Mary Lou McDonald Information on Mary Lou McDonald Zoom on Mary Lou McDonald asked the Minister for Children and Youth Affairs Information on Frances Fitzgerald Zoom on Frances Fitzgerald the annual saving to the Exchequer if all State agency board fees were reduced by 25% under the aegis of her Department; and if she will make a statement on the matter.  [35795/13]

Minister for Children and Youth Affairs (Deputy Frances Fitzgerald): Information on Frances Fitzgerald Zoom on Frances Fitzgerald I would like to inform the Deputy there are four agencies which are funded by the Exchequer through my Department's Vote. These are the Adoption Authority of Ireland (AAI); the Family Support Agency (FSA); the National Educational Welfare Board (NEWB) and the Ombudsman for Children's Office (OCO). With effect from 1 January 2012, I have taken responsibility for the Children Detention Schools as provided for in Part 10 of the Children Act 2001.

I am responsible for all Board of Management appointments. It should be noted that all current members of the Board of Management for the Children Detention Schools waived their fees when they were appointed in March 2012.

The Ombudsman for Children's Office does not have a Board of Management.

Based on current remuneration for Board membership, I can confirm that the annual saving to the Exchequer if all Board members fees were cut by 25% is €29,171.

Official Travel

 1032. Deputy Derek Nolan Information on Derek Nolan Zoom on Derek Nolan asked the Minister for Children and Youth Affairs Information on Frances Fitzgerald Zoom on Frances Fitzgerald if she is confident that all overseas travel undertaken by staff in State agencies is necessary; if the agencies ensure a robust business case is submitted before travel is sanctioned; if the agencies ensure the objective of the travel cannot be achieved through other means; if, on their return, the staff have to submit a report on the work carried out while they were on agency business overseas; and if she will make a statement on the matter.  [36040/13]

Minister for Children and Youth Affairs (Deputy Frances Fitzgerald): Information on Frances Fitzgerald Zoom on Frances Fitzgerald I would like to inform the Deputy there are four agencies which are funded by the Exchequer through my Department’s Vote. These are the Adoption Authority of Ireland (AAI); the Family Support Agency (FSA); the National Educational Welfare Board (NEWB) and the Ombudsman for Children's Office (OCO). The OCO does not have a Board.

I can assure the Deputy that these four agencies are aware of their responsibilities with regard to all travel, including foreign travel, in respect of each official trip undertaken in accordance with Part 17 and Appendix VI of the Revised Code of Practice for the Governance of State Bodies 2009 and that they ensure that appropriate procedures are in place to monitor, report and enforce the relevant rules and requirements regarding overseas travel.

Departmental Bodies

 1033. Deputy Mary Lou McDonald Information on Mary Lou McDonald Zoom on Mary Lou McDonald asked the Minister for Children and Youth Affairs Information on Frances Fitzgerald Zoom on Frances Fitzgerald if she will provide, in tabular form, a list of all non-commercial State-sponsored bodies under the aegis of her Department; and if she will make a statement on the matter.  [36212/13]

Minister for Children and Youth Affairs (Deputy Frances Fitzgerald): Information on Frances Fitzgerald Zoom on Frances Fitzgerald I would like to inform the Deputy there are four agencies which are funded by the Exchequer through my Department's Vote. dThese are the Adoption Authority of Ireland (AAI); the Family Support Agency (FSA); the National Educational Welfare Board (NEWB) and the Ombudsman for Children's Office (OCO). With effect from 1 January 2012, I have taken responsibility for the Children Detention Schools as provided for in Part 10 of the Children Act 2001.

  I have set out in tabular format the non-commercial State-sponsored bodies under the remit of my Department.

Non – commercial State sponsored bodies - Department of Children and Youth Affairs
National Educational Welfare Board
Family Support Agency
Adoption Authority of Ireland
Ombudsman for Children’s Office
Children Detention Schools

HSE Staffing

 1034. Deputy Finian McGrath Information on Finian McGrath Zoom on Finian McGrath asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the position on working hours in respect of a person (details supplied) in Dublin 9.  [34505/13]

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

Mental Health Services Provision

 1035. Deputy Derek Nolan Information on Derek Nolan Zoom on Derek Nolan asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly his views on the adequacy of mental health support services for direct provision residents; and if he will make a statement on the matter.  [35360/13]

 1036. Deputy Derek Nolan Information on Derek Nolan Zoom on Derek Nolan asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if he will provide a yearly breakdown, from 2003 to date in 2013, of the number the persons in direct provision centres who have availed of mental health services and-or support; and if he will make a statement on the matter.  [35361/13]

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. 1035 and 1036 together.

  As this is a service matter which relates to co-operation at local level between the centres in question and the HSE, the Deputy's questions have been referred to the Executive for direct reply in relation to the operational matters raised.

Proposed Legislation

 1037. Deputy Thomas Pringle Information on Thomas Pringle Zoom on Thomas Pringle asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the action he plans to take to prohibit the trafficking of human organs from non-consenting persons; and if he will make a statement on the matter. [35379/13]

 1141. Deputy Maureen O'Sullivan Information on Maureen O'Sullivan Zoom on Maureen O'Sullivan asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if on his visit to China he discussed the issue of forced organ harvesting practised against practitioners of Falun Gong in China; and if he will make a statement on the matter. [35461/13]

 1149. Deputy Patrick Nulty Information on Patrick Nulty Zoom on Patrick Nulty asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly in view of the allegations of forced organ harvesting in China, if he will consider the need for legislation, at national and European Union level, to prohibit the trafficking and use of such organs in the State; and if he will make a statement on the matter. [35524/13]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly I propose to take Questions Nos. 1037, 1141 and 1149 together.

Human trafficking for the purpose of the removal of organs is criminalised under the Criminal Law (Human Trafficking) Act 2008.

In addition, the removal of human organs without consent or for payment is an offence under the European Union (Quality and Safety of Human Organs Intended for Transplantation) Regulations 2012 - S.I. No. 325 of 2012. These Regulations give effect to Directive 2010/53/EU. Under the Regulations, it is an offence to traffic, harbour, import or export organs contrary to the Regulations and the Directive. The Regulations set out a framework encompassing the establishment of competent authorities, the authorisation of transplantation centres and the establishment of conditions of procurement and systems of traceability.

My Department is also preparing legislative proposals for a Human Tissue Bill which will set out a detailed consent framework for the removal, donation and use of organs from deceased and living persons for the purpose of transplantation.

I wish to advise the Deputy that the issue of forced organ harvesting practised against practitioners of Falun Gong in China was not discussed during my visit in August 2012.

Medicinal Products Availability

 1038. Deputy Caoimhghín Ó Caoláin Information on Caoimhghín Ó Caoláin Zoom on Caoimhghín Ó Caoláin asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly his plans to make Selincro-Nalmefene available here; and if he will make a statement on the matter.  [34183/13]

Minister of State at the Department of Health (Deputy Alex White): Information on Alex White Zoom on Alex White The Health (Pricing and Supply of Medical Goods) Act 2013 was commenced on the 24 June 2013. The HSE is required to assess all new medicines in accordance with the Act and in line with the procedures and timescales agreed last year by the Department of Health and the HSE with the Irish Pharmaceutical Healthcare Association (IPHA).

The market authorisation holder for Nalmefeme (Selincro) made an application for pricing and reimbursement in June 2013. The HSE has commenced the process of assessment of that application. The HSE has 180 days (with stop clocks) to complete that assessment. A health technology assessment by the National Centre for Pharmacoeconomics will form one of the important inputs into decision making.

It would not be appropriate to comment any further on an ongoing assessment.

Medical Disclosure Code

 1039. Deputy Jerry Buttimer Information on Jerry Buttimer Zoom on Jerry Buttimer asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if he will furnish details on national and European initiative to develop a disclosure code regarding incentives paid to doctors by pharmaceutical companies; and if he will make a statement on the matter.  [34193/13]

 1040. Deputy Jerry Buttimer Information on Jerry Buttimer Zoom on Jerry Buttimer asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if there is any research available that links incentives paid to doctors by pharmaceutical companies to prescribing patterns; and if he will make a statement on the matter. [34194/13]

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. 1039 and 1040 together.

  The European Federation of Pharmaceutical Industries and Associations (EFPIA) has created a "disclosure code of transfers of value to healthcare professionals and organisations", which means that, from 2016, EU drug manufacturers are required to disclose payments to doctors. The code of practice was developed to improve transparency in the industry. Every member company will have to disclose or document the names of the health care professionals or associations who have received payments or something else of value on their websites. The disclosed information will also include the payment amount, as well as the type of financial relationship which will affect consultancy and congress fees and travel payments. EFPIA members must adhere to this code in order to remain in this trade body.

  Section 59.8 of the Medical Council's Guide to Professional Conduct and Ethics for Registered Medical Practitioners advises Medical Practitioners that "You must keep up to date with developments in medication safety. You should not rely solely or excessively on promotional literature distributed by pharmaceutical companies for information about particular drugs. You should seek independent evidence-based sources of information on the benefits and risks associated with medicines before prescribing".

  The HSE has been working with GPs over many years to encourage better quality prescribing of drugs in Ireland. In 2012, the HSE’s Medicines Management Programme was established and one of its key tasks is to communicate with prescribers regarding best practice.

  The Programme has identified "preferred drugs" for prescribers when prescribing Proton Pump Inhibitors (PPIs) or statin medication for patients. This is the first time that the State has introduced a preferred drug initiative. PPIs are prescribed for patients with peptic ulcer disease and-or reflux and statin medication is for high cholesterol. The preferred PPI is Lansoprazole and the preferred statin is Simvastatin. The HSE is asking doctors to prescribe these preferred drugs in order to save money, both for patients who pay for their medication and to deliver savings of an estimated €15 million for the taxpayer.

  A further initiative under way to assist with GP prescribing is the launch of the HSE’s Prescribing Guidance System (PGS). This system supports prescribers with integrated "point of prescribing" information making it easier for GPs to make decisions in line with MMP prescribing guidance. In turn, the system also gives assurance regarding the effectiveness of prescribing guidance interventions.

  It is anticipated that this prescribing guidance system will be a critical assistance to the GP community and significantly important to the wider health system.

  Furthermore, the ESRI report, Pharmaceutical Prices, Prescribing Practices and Usage of Generics in a Comparative Context, which was published on 27 June recommended that "...financial incentives to reduce pharmaceutical expenditure should not be introduced for medical practitioners in Ireland". The Department of Health and the HSE agree with this recommendation and no such incentives are in place.

Medical Card Eligibility

 1041. Deputy Jerry Buttimer Information on Jerry Buttimer Zoom on Jerry Buttimer asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly whether dental treatments are covered by a medical card and, in particular, if dental surgery can be provided free of charge for persons with medical cards; and if he will make a statement on the matter.  [34216/13]

Minister of State at the Department of Health (Deputy Alex White): Information on Alex White Zoom on Alex White The Dental Treatment Services Scheme (DTSS) provides access to dental treatment for adult medical card holders. The service is provided by contracted dentists. The HSE prioritises for treatment patients with special needs, high risk patients and those who have greater clinical needs. A free oral examination every calendar year and free emergency dental treatment with a focus on relief of pain and sepsis are available to all eligible patients, regardless of their medical condition. This includes 2 fillings, all extractions, including surgical extractions, and a number of complex treatments.

Medical Card Eligibility

 1042. Deputy Jerry Buttimer Information on Jerry Buttimer Zoom on Jerry Buttimer asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if persons who have medical cards are entitled to have Department of Social Protection forms, such as those for adult dietary supplement and exceptional heating needs supplement, completed by their general practitioners without charge; and if he will make a statement on the matter.  [34218/13]

Minister of State at the Department of Health (Deputy Alex White): Information on Alex White Zoom on Alex White Under the General Medical Services (GMS) contract, a general practitioner (GP) is expected to provide his or her patients who hold medical cards or GP visit cards with all proper and necessary treatment of a kind generally undertaken by a GP.

The contract between the HSE and GPs under the GMS Scheme stipulates that fees are not paid to GPs by the HSE in respect of certain medical certificates which may be required, for example, "under the Social Welfare Acts or for the purposes of insurance or assurance policies or for the issue of driving licences".

Consultation fees charged by general practitioners to private patients and to GMS patients outside the terms of the GMS contract are a matter of private contract between the clinicians and the patients. While I have no role in relation to such fees, I would expect clinicians to have regard to the overall economic situation in setting their fees. I should add that General Practitioners who hold GMS contracts with the HSE must not seek or accept money from medical card or GP visit card holders in respect of routine treatment.

Health Care Abroad

 1043. Deputy Michael McGrath Information on Michael McGrath Zoom on Michael McGrath asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the arrangements in place between Ireland and the United Kingdom to ensure that Irish citizens living in the UK receive healthcare there and that UK citizens living here receive healthcare services here; the amount paid in 2011 and 2012 by each jurisdiction to the other in respect of these services; and if he will make a statement on the matter. [34228/13]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly Ireland operates a bilateral healthcare reimbursement agreement with the United Kingdom, in respect of health services provided under EU Regulations, covering such persons as temporary visitors between the two countries, pensioners of one country and their dependants residing in the other country, and the dependent families of persons employed in the other country. Under the terms of the agreement net liability between the two countries is calculated on a lump sum basis rather than an individual basis. The amount payable is the net difference between the costs to the Irish health services of providing care to those with only UK entitlements and the cost to the UK health services of providing services to those with only Irish entitlements. The payment made in any one year is based on an estimate of the number of persons falling within categories eligible for reimbursement and for whom each country is liable and an estimate of the average cost of providing health care treatment. The amount payable is agreed following compilation of the necessary data and discussions between the two administrations. Payments are made in advance and are subject to final settlement once all necessary statistical and financial information is complete. Total payments in any one year can relate to both final settlements in respect of previous years' liabilities and advance payments in respect of the current year.

By far the largest part of the net payment received from the UK authorities on an annual basis relates to the provision of health care to UK pensioners and their dependants residing in Ireland. The estimated number of pensioners for whom each country is liable was based on a survey by both administrations undertaken every three years, the most recent of which was completed in 2008. Recently both administrations agreed in principle to work towards a form of pensioner registration which will form the basis for calculating pensioner reimbursement costs in the future and agreed interim arrangements, based on previous survey results trends, for determining pensioner liability pending the implementation of same.

The amounts are received by the Health Service Executive as Appropriations-in-Aid and are offset against the gross funding requirements of the Executive at national level thus reducing the net liability to the Exchequer.

The amounts received by Ireland from the UK in respect of reimbursement of healthcare costs provided under Regulation (EC) No 883/2004, for the years in question are

2011 - €270,000,000.

2012 - €220,000,000.

Primary Care Strategy

 1044. 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 further to Parliamentary Questions Nos. 344 of 8 November and 239 of 25 October 2012, if he will provide the figures for the period September to December and the 2012 outturn at PCCC level along with the service plan target for 2012; if he has finalised a national definition for the role; and if he will make a statement on the matter. [34277/13]

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

Home Help Service Provision

 1045. Deputy Pearse Doherty Information on Pearse Doherty Zoom on Pearse Doherty asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the cost of increasing home help hours to the 2011 provision; and the additional hours this would entail.  [34309/13]

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


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