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 Header Item Written Answers Nos. 528-543
 Header Item Medical Card Applications
 Header Item National Treatment Purchase Fund
 Header Item Long-Term Illness Scheme Eligibility
 Header Item Vaccine Damage Compensation Scheme
 Header Item Nursing Homes Support Scheme
 Header Item HSE Data
 Header Item Occupational Therapy
 Header Item Health Insurance Prices
 Header Item Respite Care Services Provision
 Header Item National Cancer Strategy Implementation
 Header Item Medicinal Products Availability
 Header Item Suicide Incidence
 Header Item HSE Data
 Header Item Medical Aids and Appliances Provision

Tuesday, 11 April 2017

Dáil Éireann Debate
Vol. 946 No. 2

First Page Previous Page Page of 109 Next Page Last Page

Written Answers Nos. 528-543

Medical Card Applications

 528. Deputy Bernard J. Durkan Information on Bernard Durkan Zoom on Bernard Durkan asked the Minister for Health Information on Simon Harris Zoom on Simon Harris when a full medical card will issue in the case of a person (details supplied); and if he will make a statement on the matter. [17726/17]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris Under the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.

The Health Service Executive has been asked to examine this matter and to reply to the Deputy as soon as possible.

The Health Service Executive operates the General Medical Services scheme, which includes medical cards and GP visit cards, under the Health Act 1970, as amended. It has established a dedicated contact service for members of the Oireachtas specifically for queries relating to medical cards and GP visit cards, which the Deputy may wish to use for an earlier response. Contact information was issued to Oireachtas members.

National Treatment Purchase Fund

 529. Deputy Fergus O'Dowd Information on Fergus O'Dowd Zoom on Fergus O'Dowd asked the Minister for Health Information on Simon Harris Zoom on Simon Harris if he will address a query regarding a person and conditions of appointment (details supplied); and if he will make a statement on the matter. [17750/17]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris In 2011 the NTPF's role in arranging the provision of hospital treatment for patients was suspended. Since that time the post of NTPF CEO was filled on an acting part-time basis. Between 2013 and 2017 Mr Jim O' Sullivan held the post of acting CEO of the NTPF on a part-time basis. No conflict of interest arose in respect of Mr. O' Sullivan's appointment as his role as CEO of the NTPF was clearly defined and distinct from his work within the HSE as Programme Director.

Last October, Budget 2017 allocated €20 million to the NTPF, rising to €55 million in 2018. In line with commitments in the Programme for a Partnership Government to reduce waiting times for our longest waiting patients, the NTPF resumed patient treatment commissioning in 2017. As a result of this change in scope of the NTPF's role, the Board of the NTPF decided it would be necessary for the organisation to appoint a full time CEO.

An open recruitment process was carried out by the Public Appointments Service (PAS). Chairman of the Board of the NTPF has advised that Mr. Liam Sloyan will take up the position of CEO in the coming weeks.

In relation to waiting list audits, this one of the key objectives for the NTPF. The NTPF’s Strategy and Action Plan for 2017 – 2019 sets out a detailed programme of work including the development and delivery of an Audit and Quality Assurance Programme for scheduled care.

Long-Term Illness Scheme Eligibility

 530. Deputy Margaret Murphy O'Mahony Information on Margaret Murphy O'Mahony Zoom on Margaret Murphy O'Mahony asked the Minister for Health Information on Simon Harris Zoom on Simon Harris if the condition known as bilateral recurrent serpiginous choroiditis may be added to the long term illness scheme due to its progressive nature and the need for aggressive immunosuppression and careful long term observation; and if he will make a statement on the matter. [17751/17]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris The long term illness scheme, LTI, was established under Section 59(3) of the Health Act 1970 (as amended). The conditions covered by the LTI are: acute leukaemia; mental handicap; cerebral palsy; mental illness (in a person under 16); cystic fibrosis; multiple sclerosis; diabetes insipidus; muscular dystrophies; diabetes mellitus; parkinsonism; epilepsy; phenylketonuria; haemophilia; spina bifida; hydrocephalus; and conditions arising from the use of Thalidomide. Under the LTI Scheme, patients receive drugs, medicines, and medical and surgical appliances directly related to the treatment of their illness, free of charge.

There are no plans to extend the list of conditions covered by the scheme.

Vaccine Damage Compensation Scheme

 531. Deputy Bobby Aylward Information on Bobby Aylward Zoom on Bobby Aylward asked the Minister for Health Information on Simon Harris Zoom on Simon Harris the details of research undertaken by his Department to ensure the safety of the Gardasil vaccine; his plans to engage with the advocacy groups for those that have suffered adverse health effects having received the vaccine; and if he will make a statement on the matter. [17760/17]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris  In 2009 the National Immunisation Advisory Committee (NIAC) recommended HPV vaccination for all 12 year old girls to reduce their risk of cervical cancer and in September 2010 the HPV vaccination programme was introduced for all girls in first year of second level schools.

While no medicine (including vaccines) is entirely without risk, the safety profile of Gardasil has been continuously monitored since it was first authorised both nationally and at EU level. The Health Products Regulatory Authority (HPRA) is responsible for monitoring the safety and quality of all medicines that are licensed in Ireland. The HPRA and the European Medicines Agency (EMA) in Europe continually monitor adverse events to vaccination. The vast majority of reports received by the HPRA have been consistent with the expected pattern of short term adverse side effects for the vaccine, as described in the product information. The most frequently reported side effects are local redness and /or swelling at the point of injection and fever. These are usually mild and temporary reactions to any kind of vaccination. Fainting has occurred after vaccination with Gardasil, especially in adolescents.

The EMA completed a detailed scientific review in November 2015 of the evidence surrounding reports of two conditions: complex regional pain syndrome (CRPS) and postural orthostatic tachycardia syndrome (POTS). The Agency’s Committee for Medicinal Products for Human Use concurred that the available evidence does not support that CRPS and POTS are caused by HPV vaccines. It therefore did not recommend any changes to the terms of licensing or the product information for these medicines. On 12 January 2016 the European Commission endorsed the conclusions of the European Medicines Agency, that there is no change to the way HPV vaccines are used, or to amend the current product information. This final outcome by the Commission is now binding in all members states.

I am aware of claims of an association between HPV vaccination and a number of conditions experienced by a group of young women. An illness that occurs around the time a vaccine is given and is already known to be common in adolescence does not imply the vaccine caused the problem. It appears that some girls first suffered symptoms around the time they received the HPV vaccine, and understandably some parents have connected the vaccine to their daughter’s condition. It is important to reassure people that anyone who is suffering ill health is eligible to seek medical attention, and to access appropriate health and social care services, irrespective of the cause of their symptoms. The diverse nature of these symptoms, which can have both physical and psychological causes, are shared by many conditions which has implications for both diagnostic and treatment services. The individual nature of the needs of some children may require access to specialist services and the HSE are currently working to put in place clinical care pathways appropriate to the differing medical needs of this group. As there is no scientific evidence that the vaccine causes long term illnesses, the HPV vaccine cannot be held responsible for these illnesses.

It is important to counter misinformation in relation to the safety of vaccines, and to increase the uptake rates of all vaccines in the State’s immunisation programmes. The scientific evidence is clear and misinformation is causing real harm to those unvaccinated children and adults who develop vaccine preventable diseases, and to people who seek inappropriate treatments for real conditions that are not caused by vaccines. The benefits of HPV vaccines outweigh the known side effects. The safety of these vaccines, as with all medicines, will continue to be carefully monitored and will take into account any future new evidence of side effects that becomes available.

Nursing Homes Support Scheme

 532. Deputy Noel Grealish Information on Noel Grealish Zoom on Noel Grealish asked the Minister for Health Information on Simon Harris Zoom on Simon Harris when the interdepartmental group which is currently reviewing the fair deal scheme is expected to conclude its review; when will the findings be brought before Dáil Éireann; if this review will give some relief to farm families; and if he will make a statement on the matter. [17762/17]

Minister of State at the Department of Health (Deputy Helen McEntee): Information on Helen McEntee Zoom on Helen McEntee The Nursing Homes Support Scheme (NHSS) is a system of financial support for those in need of long-term nursing home care. Participants contribute to the cost of their care according to their income and assets while the State pays the balance of the cost. The Scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone and that people are cared for in the most appropriate settings.

When the NHSS commenced in 2009, a commitment was made that it would be reviewed after three years. The Report of the Review was published in July 2015. Arising out of the Review, a number of key issues have been identified for more detailed consideration across Departments and Agencies.

An Interdepartmental/Agency Working Group has been established to progress the recommendations contained in the Review. This Group is chaired by the Department of Health and includes representatives from the Department of the Taoiseach, the Department of Public Expenditure and Reform, the HSE, the Revenue Commissioners, and when required, the National Treatment Purchase Fund (NTPF). These recommendations include examining the treatment of business and farm assets for the purposes of the financial assessment element of the Scheme. This work is currently underway. An initial report on progress was submitted to the Cabinet Committee on Health in September 2016.

Once all of the relevant Review recommendations have been considered, any amendments required to the Scheme will be identified. Changes which require legislative implementation will be addressed collectively; in that regard, it is important to remember that the NHSS is largely underpinned by primary legislation, therefore where such changes are needed they will be brought before the Houses of the Oireachtas.

The Programme for a Partnership Government has also committed to reviewing the NHSS to remove any discrimination against small businesses and family farms. This review is currently underway.

HSE Data

 533. Deputy Brendan Griffin Information on Brendan Griffin Zoom on Brendan Griffin asked the Minister for Health Information on Simon Harris Zoom on Simon Harris his views on a matter (details supplied); and if he will make a statement on the matter. [17817/17]

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

Occupational Therapy

 534. Deputy John Brady Information on John Brady Zoom on John Brady asked the Minister for Health Information on Simon Harris Zoom on Simon Harris the number of persons on waiting lists to see an occupational therapist in health centres in County Wicklow, including Baltinglass and Blessington; the average waiting time in each of the health centres; and if he will make a statement on the matter. [17825/17]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris As this question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply.

Health Insurance Prices

 535. Deputy Mattie McGrath Information on Mattie McGrath Zoom on Mattie McGrath asked the Minister for Health Information on Simon Harris Zoom on Simon Harris the efforts being made to alleviate the spiralling costs of health insurance; the supports available to those under 35 years of age who are of the view that they were pressurised by the Government to take out health insurance or be penalised due to the impact of the lifetime community rating; if he will review this policy; and if he will make a statement on the matter. [17826/17]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris Insurance companies operate as commercial providers and as Minister for Health, I have no legal power to intervene in relation to any insurer’s pricing policies. The overall claims experience is influenced by a number of factors such as the cost of claims, the cost of care, the age profile of those holding private health insurance and ongoing medical innovations. Each of these are contributors to the cost of premiums payable.

A community-rated health insurance market depends on inter-generational solidarity and requires a constant influx of young healthy members to support the older, less healthy members. In 2015 two policy measures were introduced to ensure the ongoing viability of community rating - Lifetime Community Rating and Young Adult rates. Lifetime Community Rating was designed to encourage people to take out health insurance at a younger age and to retain it. Young Adult rates are based on a sliding scale of maximum chargeable rates up to age 26. This approach ensures the phasing-in of full adult rates and eases the effect of the dramatic price increases when student rates no longer apply. Without these measures, there would be a continued deterioration in the age profile of the insured population, which in turn would contribute to claims inflation and result in higher insurance premiums.

The positive impact of these initiatives on the market is now evident, as the number of people holding private health insurance has increased to 2.152 million, or 46% of the population (end-December 2016). Critically, these figures include a total of 240,025 insured lives in the age cohort 25-35 years (an increase of 13,785 compared to end-December 2015), which contributes positively to keeping health insurance affordable for those who wish to avail of it.

A review of the Lifetime Community Rating Regulations, after 30 April 2017, is provided for in the legislation. The independent regulator, the Health Insurance Authority (HIA), has already completed its public consultation process as a first phase of its review. Members of the public were invited to submit their views before the deadline of 3 March 2017. The HIA are now in the process of considering all of the submissions received and will submit its report and recommendations to me in due course.

Respite Care Services Provision

 536. Deputy Thomas P. Broughan Information on Thomas P. Broughan Zoom on Thomas P. Broughan asked the Minister for Health Information on Simon Harris Zoom on Simon Harris if his attention has been drawn to the fact that respite beds offered by an organisation (details supplied) have been greatly reduced in the past ten years; and if he will make a statement on the matter. [17869/17]

 537. Deputy Thomas P. Broughan Information on Thomas P. Broughan Zoom on Thomas P. Broughan asked the Minister for Health Information on Simon Harris Zoom on Simon Harris if his attention has been drawn to the lack of respite facilities for children with disabilities on the north side of Dublin (details supplied); and if he will make a statement on the matter. [17870/17]

 538. Deputy Thomas P. Broughan Information on Thomas P. Broughan Zoom on Thomas P. Broughan asked the Minister for Health Information on Simon Harris Zoom on Simon Harris if his attention has been drawn to the fact that an organisation (details supplied) has had to utilise its last remaining respite house as a permanent residential care home; if alternative respite facilities will be made available for those affected families. [17871/17]

Minister of State at the Department of Health (Deputy Finian McGrath): Information on Finian McGrath Zoom on Finian McGrath I propose to take Questions Nos. 536 to 538, inclusive, together.

The Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.

The Programme for Partnership Government states that the Government wishes to provide more accessible respite care to facilitate full support for people with a disability.

As the Deputy's questions relate to service matters, I have arranged for the questions to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.

National Cancer Strategy Implementation

 539. Deputy Dara Calleary Information on Dara Calleary Zoom on Dara Calleary asked the Minister for Health Information on Simon Harris Zoom on Simon Harris when the publication of the national cancer strategy is expected; to his views on the delay in the publication of the strategy; if his attention has been drawn to the fact that in the absence of this strategy, cancer services do not meet best international practice; and if he will make a statement on the matter. [17872/17]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris The development of a new National Cancer Strategy is nearing finalisation and I intend to bring the strategy proposals to Government shortly. Publication of the strategy around the end of May is envisaged.

Significant improvements have been made in cancer care in recent years under the previous cancer strategy. Outcomes for those with a cancer diagnosis have improved and five year cancer survival is now at 61%. The new National Cancer Strategy will aim to build on these successes and will provide the overall strategic direction for cancer control for the next decade.

Medicinal Products Availability

 540. Deputy Dara Calleary Information on Dara Calleary Zoom on Dara Calleary asked the Minister for Health Information on Simon Harris Zoom on Simon Harris his views on the national cancer control programme's opinion on the cancer treating drug nivolumab also known as Opdivo; his views on making this drug available on the reimbursement scheme; the number of persons being treated with this drug; the costs associated with treating each person on an annual basis; and if he will make a statement on the matter. [17874/17]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris The HSE has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drugs schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.

  In reaching its decision, the HSE examines all the evidence which may be relevant in its view for the decision (including the information /dossier submitted by the Company) and will take into account such expert opinions and recommendations which may have been sought by the HSE at its sole discretion (for example, from the National Centre for Pharmacoeconomics and the National Cancer Control Programme).

  In considering an application, the HSE will also have regard to Part 1 and Part 3 of Schedule 3 of the 2013 Act. Part 3 requires the HSE to have regard to the following criteria:

  1. the health needs of the public;

  2. the cost-effectiveness of meeting health needs by supplying the item concerned rather than providing other health services;

  3. the availability and suitability of items for supply or reimbursement;

  4. the proposed costs, benefits and risks of the item or listed item relative to therapeutically similar items or listed items provided in other health service settings and the level of certainty in relation to the evidence of those costs, benefits and risks;

  5. the potential or actual budget impact of the item or listed item;

  6. the clinical need for the item or listed item;

  7. the appropriate level of clinical supervision required in relation to the item to ensure patient safety;

  8. the efficacy (performance in trial), effectiveness (performance in real situations) and added therapeutic benefit against existing standards of treatment (how much better it treats a condition than existing therapies); and

  9. the resources available to the HSE.

  An application has been made by a manufacturer for Nivolumab for a number of different indications and as a combination therapy with Ipilimumab for cancer. This statutory assessment process is ongoing for each indication.

  As part of the HSE assessment process the National Centre for Pharmacoeconomics conducts health technology assessments of pharmaceutical products and can make recommendations on reimbursement to assist the HSE in its decision-making process.

  The health technology assessments completed to date by the National Centre for Pharmacoeconomics on advanced renal cell carcinoma, classical Hodgkin Lymphoma, melanoma, non-squamous Non-Small-Cell-Lung-Carcinoma, NSCLC and Nivolumab plus ipilimumab have not recommended reimbursement.

  A summary of the NCPE Pharmacoeconomic evaluations can be found at the following links:

  Renal Cell Carcinoma

  http://www.ncpe.ie/drugs/nivolumab-opdivo-for-advanced-renal-cell-carcinoma/

  Classical Hodgkin Lymphoma

  http://www.ncpe.ie/drugs/nivolumab-opdivo-for-classical-hodgkin-lymphoma/

  Melanoma

  http://www.ncpe.ie/drugs/nivolumab-opdivio-for-melanoma/

  Non-squamous NSCLC

  http://www.ncpe.ie/drugs/nivolumab-opdivio-for-non-squamous-nsclc/

  NSCLC

  http://www.ncpe.ie/drugs/nivolumab-opdivio-for-nsclc/

  Nivolumab plus ipilimumab

  http://www.ncpe.ie/drugs/nivolumab-plus-ipilimumab-opdivio-plus-yervoy/

  These summaries include details on the cost of treatments, budget impact and the NCPE assessment on the data.

  With regard to the number of people currently being treated, as the drug has not been approved for reimbursement, no patients are receiving treatment under the community drug schemes at present.

  With regard to any access schemes that may be in place, the operation of such schemes is at the discretion of the manufacturers and the HSE does not collect data on the number of patients participating in these schemes.

Suicide Incidence

 541. Deputy Pat Buckley Information on Pat Buckley Zoom on Pat Buckley asked the Minister for Health Information on Simon Harris Zoom on Simon Harris the number of suicides that have been recorded on the grounds of public hospitals following a presentation to accident and emergency departments in the past five years by hospital, in tabular form [17877/17]

Minister of State at the Department of Health (Deputy Helen McEntee): Information on Helen McEntee Zoom on Helen McEntee As this is a service issue, this question has been referred to the HSE for direct reply.

HSE Data

 542. Deputy Robert Troy Information on Robert Troy Zoom on Robert Troy asked the Minister for Health Information on Simon Harris Zoom on Simon Harris his views on a matter (details supplied). [17878/17]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris I have asked the HSE to respond directly to the Deputy.

Medical Aids and Appliances Provision

 543. Deputy Paul Kehoe Information on Paul Kehoe Zoom on Paul Kehoe asked the Minister for Health Information on Simon Harris Zoom on Simon Harris if his attention and the attention of the HSE has been drawn to the benefits of medical equipment (details supplied); and his plans to roll this out in surgeries in HSE general practitioner facilities. [17880/17]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris As this question relates to a service matter, I have arranged for the question to be referred to the Health Service Executive for direct reply.


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