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 Header Item Written Answers Nos. 204-217
 Header Item Drugs Payment Scheme Coverage
 Header Item Legislative Programme
 Header Item Nursing Homes Support Scheme Expenditure
 Header Item Nursing Homes Support Scheme Applications
 Header Item Counselling Services
 Header Item HSE Staffing
 Header Item Cancer Screening Programmes
 Header Item Appointments to State Boards
 Header Item Departmental Offices
 Header Item Hospital Waiting Lists
 Header Item Hospital Waiting Lists

Tuesday, 14 October 2014

Dáil Éireann Debate
Vol. 854 No. 1

First Page Previous Page Page of 81 Next Page Last Page

Written Answers Nos. 204-217

Drugs Payment Scheme Coverage

 204. Deputy Sean Fleming Information on Seán Fleming Zoom on Seán Fleming asked the Minister for Health Information on Leo Varadkar Zoom on Leo Varadkar if he will provide the medication Eculizumab to the six persons who have been diagnosed with paroxysmal nocturnal haemoglobinuria (details supplied); and if he will make a statement on the matter. [39229/14]

Minister of State at the Department of Health (Deputy Kathleen Lynch): Information on Kathleen Lynch Zoom on Kathleen Lynch The decisions made on which medicines are reimbursed by the taxpayer, are not political or ministerial decisions. These are made on objective, scientific and economic grounds by the Health Service Executive (HSE) and often on the advice of the National Centre for Pharmacoeconomics.

With regard to the drug Eculizumab, in 2010 following prolonged discussions and in the absence of sufficient information to make a long term permanent decision around this agent, the HSE entered into an access with evidence development agreement with Alexion Pharma and St James’s Hospital, Dublin whereby the HSE provided a fund (almost €10m, inclusive of VAT) for three years (2010-2012) sufficient to treat 10 patients (the expected number of patients to be identified for treatment over that time period). At the end of this period, Alexion was expected to have developed additional evidence to allow the HSE to make a long term decision in relation to the funding of this incredibly costly agent. The HSE honoured the terms of that agreement.

The agreement lapsed and a formal re-assessment process was triggered as was agreed with Alexion / St James’s in 2010. Pending consideration of the outcome of the assessment, the HSE continued the funding commitments entered into with Alexion on behalf of the original 10 patients identified by the National Centre i.e. St James’s. The HSE has released funding of €1.9m in the first 8 months of 2014 to fund treatment for the 10 existing patients.

Many countries have struggled to accept the pricing point put forward by Alexion. The medicine in question requires €355,000 per annum plus 23% VAT (multi-year commitment) to be found for each additional patient treated.

The HSE continues to try to engage with the pharmaceutical company to arrive at a pricing point that would assist it in its efforts to fund this medicine for as many patients as possible. The HSE has sought to meet the company again in October but Alexion are unavailable to meet this month. The current Irish list price of €4,557.50 per vial substantially exceeds the list price in the UK (£3,150 sterling).

I would like to assure the Deputy that the Department, and the HSE, fully understand the concerns of patients regarding the availability of this drug. While I appreciate that some may take the view that the taxpayer should reimburse every licensed medicine for whatever the price the drug company demands, I hope the Deputy will appreciate that the better interests of the health service require that we reimburse only the most effective medicines and only at a fair price.

In relation to the administration of the Treatment Abroad Scheme, the Health Service Executive has been asked to examine this matter and to reply to the Deputy as soon as possible.

Legislative Programme

 205. Deputy Seán Kyne Information on Seán Kyne Zoom on Seán Kyne asked the Minister for Health Information on Leo Varadkar Zoom on Leo Varadkar the policy proposals in place for the drafting of primary legislation to give effect to a successor to the mobility allowance and motorised grant scheme; and if he will make a statement on the matter. [39233/14]

Minister of State at the Department of Health (Deputy Kathleen Lynch): Information on Kathleen Lynch Zoom on Kathleen Lynch The policy proposals to be brought for Government's consideration of the drafting of primary legislation for a new travel subsidy scheme for people with severe disabilities are currently under consideration in the Department of Health.

Nursing Homes Support Scheme Expenditure

 206. Deputy Michael McCarthy Information on Michael McCarthy Zoom on Michael McCarthy asked the Minister for Health Information on Leo Varadkar Zoom on Leo Varadkar his views on the waiting list for funding approval under the fair deal nursing home scheme which currently stands at approximately four months; if he will allocate further funding under the fair deal scheme across the regions to address the current backlog in the system; the action he will take in his Department’s budget for 2015 to address and reduce this; and if he will make a statement on the matter. [39243/14]

Minister of State at the Department of Health (Deputy Kathleen Lynch): Information on Kathleen Lynch Zoom on Kathleen Lynch The HSE controls the release of funding for the Nursing Homes Support Scheme in order to stay within budget and to balance activity over the full course of the year. All applicants for participation in the Scheme are, when approved, put on a national placement list in strict order of their approval date. The funding issues to applicants in this chronological order so as to ensure equity nationally.

At present, significant funding pressures exist in the health services generally, and the Nursing Homes Support Scheme must operate within the funding available to it and must manage this in the most effective possible way. The position for 2015 will be considered in the context of the Estimates Process for that year, which is currently underway.

Nursing Homes Support Scheme Applications

 207. Deputy Brendan Griffin Information on Brendan Griffin Zoom on Brendan Griffin asked the Minister for Health Information on Leo Varadkar Zoom on Leo Varadkar his views on a matter (details supplied) regarding the fair deal scheme; and if he will make a statement on the matter. [39256/14]

Minister of State at the Department of Health (Deputy Kathleen Lynch): Information on Kathleen Lynch Zoom on Kathleen Lynch The HSE operates a national placement list for the Nursing Homes Support Scheme to enable it to operate within budget. All applicants who are approved for funding are put on the placement list in chronological order by the date of determination of their application, and funding issues to applicants in this chronological order to ensure equity nationally. Funding is released by the HSE on a weekly basis to balance the position across the full year.

At present significant funding pressures exist in the health services generally, the Nursing Homes Support Scheme must operate within the funding available to it and must manage this in the most effective possible way. The position for 2015 will be considered in the context of the Estimates Process for that year, which is currently underway. A review of the Nursing Homes Support Scheme is currently being undertaken by my Department. This review will consider the long-term sustainability of the Nursing Homes Support Scheme as well as looking at the current operation and management of the Scheme.

Counselling Services

 208. Deputy Caoimhghín Ó Caoláin Information on Caoimhghín Ó Caoláin Zoom on Caoimhghín Ó Caoláin asked the Minister for Health Information on Leo Varadkar Zoom on Leo Varadkar if he will provide an update on the counselling in the primary care service, including any information on numbers referred to date in 2014; the waiting lists to date; and if he will make a statement on the matter. [39257/14]

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 this question has been referred to the HSE for direct reply.

HSE Staffing

 209. Deputy Michael McGrath Information on Michael McGrath Zoom on Michael McGrath asked the Minister for Health Information on Leo Varadkar Zoom on Leo Varadkar the number of specialist health economists employed by the Health Service Executive; and if he will make a statement on the matter. [39258/14]

Minister for Health (Deputy Leo Varadkar): Information on Leo Varadkar Zoom on Leo Varadkar As I have no direct role in the matter, I have asked the HSE to respond to the Deputy directly.

Cancer Screening Programmes

 210. Deputy Peadar Tóibín Information on Peadar Tóibín Zoom on Peadar Tóibín asked the Minister for Health Information on Leo Varadkar Zoom on Leo Varadkar the annual cost of extending the national BreastCheck programme to women aged between 65 and 69. [39261/14]

Minister for Health (Deputy Leo Varadkar): Information on Leo Varadkar Zoom on Leo Varadkar The BreastCheck Programme provides free mammograms to all women aged 50-64. A priority of the BreastCheck Programme at present is to maximise national uptake in the 50-64 year age cohort.   

  It is my intention to extend the upper age range to include the 65-69 age cohort as soon as possible in line with available resources.

Appointments to State Boards

 211. Deputy Terence Flanagan Information on Terence Flanagan Zoom on Terence Flanagan asked the Minister for Health Information on Leo Varadkar Zoom on Leo Varadkar if he will provide a list of all State board appointments since general election 2011; the person who recommended each appointment; the credentials of those appointed; if the vacancy was publicly advertised; and if he will make a statement on the matter. [39283/14]

Minister for Health (Deputy Leo Varadkar): Information on Leo Varadkar Zoom on Leo Varadkar There have been 494 appointments to Boards under the aegis of the Department of Health since March 2011 to date. Of these, 159 appointments have been made on the nomination of bodies specified in legislation. The Minister for Health has no function in these nominations other than the actual appointments.

335 appointments have been made where the Minister for Health has nominating rights, and 116 of these have been appointed following public advertising campaigns.

The competencies and skills required for individual Boards, where the Minister for Health has nominating rights, are agreed between the relevant Line Units in my Department and the Agency itself. These competencies and skills can vary greatly between Boards and within individual Boards. I am confident that the appointments made to agencies under the aegis of this Department have the requisite skills and expertise to contribute in a meaningful way to the important work undertaken by the Agencies.

Information on the individual names of appointments to Boards (where the Minister for Health has nominating rights) and whether they were appointed following an advertising process is being collated and will be sent directly to the Deputy when finalised.

Departmental Offices

 212. Deputy Jim Daly Information on Jim Daly Zoom on Jim Daly asked the Minister for Health Information on Leo Varadkar Zoom on Leo Varadkar if he will confirm the quality authority that monitors the quality and ingredients used in cigarettes that are sold legally on the market here; if new chemicals or substances used in the manufacture of these cigarettes in recent years are cleared by a regulating authority; and if he will make a statement on the matter. [39298/14]

Minister for Health (Deputy Leo Varadkar): Information on Leo Varadkar Zoom on Leo Varadkar The ingredients contained in cigarettes are reported to the Health Service Executive's National Tobacco Control Office on an annual basis in accordance with the obligations set out as follows.

  Under current Irish legislation the yields of tar, nicotine and carbon monoxide in cigarettes are regulated as set out in SI No 425/2003 European Communities (Manufacture, Presentation and Sale of Tobacco Products) Regulations 2003.

  In addition under these regulations manufacturers are obliged as follows:

  “6.       (1) Any person manufacturing tobacco products in the State or importing tobacco products into the State, shall submit the following to the Office -

  (a) a list of all ingredients, and quantities thereof, used in the manufacture of those tobacco products by brand name and type, and

  (b) a statement setting out the reasons for the inclusion of such ingredients in those tobacco products, indicating their function and category, and

  (c) the toxicological data available to such person regarding such ingredients in burnt or unburnt form as appropriate, referring in particular to their effects on health and taking into account, inter alia any addictive effects.
  Under the new EU Tobacco Products Directive adopted this year mandatory reporting on ingredients is foreseen for all tobacco products through a standardised electronic format. Enhanced reporting obligations will be in place for certain frequently used substances found in cigarettes and roll your own tobacco. This will enable regulators to gain more information on the ingredients contained in tobacco products and their effects on health and addiction. Member States have until May 2016 to transpose this Directive.

Hospital Waiting Lists

 213. Deputy James Bannon Information on James Bannon Zoom on James Bannon asked the Minister for Health Information on Leo Varadkar Zoom on Leo Varadkar if he will provide a date for a medical operation in respect of a person (details supplied) in County Westmeath; and if he will make a statement on the matter. [39302/14]

Minister for Health (Deputy Leo Varadkar): Information on Leo Varadkar Zoom on Leo Varadkar In relation to the particular patient query raised by the Deputy, as this is a service matter, I have asked the Health Service Executive to respond to him directly.

Hospital Waiting Lists

 214. Deputy Billy Kelleher Information on Billy Kelleher Zoom on Billy Kelleher asked the Minister for Health Information on Leo Varadkar Zoom on Leo Varadkar the actions being taken regarding the alleged manipulation of waiting list data by Health Service Executive officials; his views on the issue; and if he will make a statement on the matter. [39308/14]

 215. Deputy Billy Kelleher Information on Billy Kelleher Zoom on Billy Kelleher asked the Minister for Health Information on Leo Varadkar Zoom on Leo Varadkar if it is the case that at any stage since March 2011 the Health Service Executive has directed or authorised that surgical patients who need further tests before surgery be removed from waiting lists. [39309/14]

 216. Deputy Billy Kelleher Information on Billy Kelleher Zoom on Billy Kelleher asked the Minister for Health Information on Leo Varadkar Zoom on Leo Varadkar if it is the case that at any stage since March 2011 the Health Service Executive directed or authorised that patients be removed from hospital waiting lists and be sent to private doctors, who sometimes work in different specialties and cannot do the required interventions; and if those patients are then referred back to the public hospital consultant, to the bottom of the queue. [39310/14]

 217. Deputy Billy Kelleher Information on Billy Kelleher Zoom on Billy Kelleher asked the Minister for Health Information on Leo Varadkar Zoom on Leo Varadkar if it is the case that at any stage since March 2011 the Health Service Executive directed or authorised that patients be asked by letter to confirm, within just two weeks, that they still need a hospital outpatient appointment and that if they do not respond, they are removed from the waiting list. [39311/14]

Minister for Health (Deputy Leo Varadkar): Information on Leo Varadkar Zoom on Leo Varadkar I propose to take Questions Nos. 214 to 217, inclusive, together.

My Department has raised these issues with the Health Service Executive. The policy of the HSE on the matter of waiting lists is clear. All hospital managers are expected to efficiently manage waiting lists in chronological order, except where clinical need dictates that a patient needs to be prioritised. The HSE does not condone the manipulation of waiting lists and will take appropriate disciplinary action if this can be proved.

In late 2013, a number of patients waiting for a first outpatient appointment were outsourced to the private sector for assessment and were then referred back to the public system for surgical procedures. The HSE has advised that this practice has now ceased. Patients can be removed from waiting lists as part of the HSE waiting lists validation protocol but GPs and consultants concerned are told if a patient is being removed from the list and if the GP or consultant considers the patient should be reinstated on the list, this is done as part of the protocol.

A recent media article alleged that patients who needed further tests were suspended from waiting lists. In some instances, it is appropriate to defer formally placing a patient on an inpatient or day-case waiting list after they have been seen for the first time as out-patients until all investigations confirm that a surgical procedure is actually necessary. This may require sending the patient for further tests as outpatients.

The HSE continues to implement further measures to tackle waiting lists. These include: increasing the throughput of patients in public outpatient clinic, reducing the number of patients who do not turn up for their appointment, and increasing the number of new patients in the clinic rather than just reviewing previous patients who are often better returned to their GP.

It is important for the Deputy to note that there is no policy to manipulate waiting lists. The only waiting lists that I'm interested in are accurate ones. Accurate waiting lists allow us to plan services. When it comes to negotiating a good budget for health, waiting list figures that make the situation look better than it really is are no benefit to me. I will continue to work with the HSE to ensure that the issues relating to hospital waiting lists are resolved.


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