Written Answers Nos. 317-339
317. Deputy Cathal Crowe asked the Minister for Health when his Department will pay the increased public sector pay and arrears to Section 38 workers, in line with other public sector employees; and if he will make a statement on the matter. [25886/24]
View answerI am keen that all pay adjustments due under the new Public Service Agreement (PSA) 2024-2026 are paid to HSE and Section 38 staff as soon as possible, with retrospective application to the appropriate date.
As the Deputy is aware, all public servants including HSE staff and Section 38 staff are entitled to pay adjustments due under the PSA. I can confirm that my Department has issued the consolidated salary scales for the first pay adjustment due under the Public Service Agreement 2024-2026, for retrospective application.
Due to the large size of the health sector workforce, the complex nature of adjustments being made, along with complexities with local payroll systems, the HSE have had some difficulties in processing payments to health sector staff. The Department of Health has been assured by the HSE that every attempt will be made to ensure that the outstanding pay rise of 2.25% or €1,125, whichever is greater, due from 1 January 2024, will be paid to all public sector healthcare workers by the end of June 2024. Regardless of when the adjustment is applied, all eligible staff will receive pay retrospection to the original date of the adjustment, which is 1 January 2024.
The circular giving sanction to the payment of the second pay increase due under the PSA will issue from the Department of Health shortly.
318. Deputy Carol Nolan asked the Minister for Health to address concerns about the absence of endometriosis specialists in Ireland; if he is aware that this shortage is causing acute distress to the many thousands of women who suffer from the condition; and if he will make a statement on the matter. [25888/24]
View answerInvestment in National Endometriosis Framework commenced over the course of 2021 and 2022. This enabled the establishment of two supra-regional complex endometriosis services in Tallaght and Cork, along with five endometriosis hubs, made up of interdisciplinary teams to support the holistic treatment of endometriosis in each of the maternity networks. These five hubs are located at the Rotunda, the Coombe, National Maternity Hospital, Limerick and Galway.
Additional funding is being provided this year through the Women’s Health Taskforce, to ensure the National Endometriosis Framework is fully funded. This will provide a further 18.1 WTEs across the two supra regional specialist centres and five endometriosis hubs.
The HSE has advised that all hubs and supra-regional sites are operational and that the 2024 funding will ensure that the Framework is fully funded. As recruitment of endometriosis specialists is an operational matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible regarding the recruitment status.
319. Deputy Sorca Clarke asked the Minister for Health the number of WTE consultant dermatologists based in Mullingar Regional Hospital in the years of 2022, 2023 and to date in 2024, in tabular form. [25902/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
320. Deputy Sorca Clarke asked the Minister for Health how many international qualifications for physiotherapists were recognised by CORU in 2023 and to date in 2024, in tabular form. [25903/24]
View answerOfficials in my Department have been in touch with CORU and have asked that a response to the question raised be communicated directly to the Deputy.
321. Deputy Sorca Clarke asked the Minister for Health the number of WTE child and adolescent psychiatrists employed at CAMHS mental health intellectual disability services within CHO8 in the years of 2023 and to date in 2024, in tabular form. [25904/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
322. Deputy Sorca Clarke asked the Minister for Health the process by which resource allocation group applications in CHO8 are received, assessed and decided by the HSE. [25905/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
323. Deputy Michael Healy-Rae asked the Minister for Health the reason surgery for a person (details supplied) was cancelled; and if he will make a statement on the matter. [25907/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
324. Deputy Paul Kehoe asked the Minister for Health if there is any obligation on a GP to accept the newborn child of a private patient as a patient in their practice; and if he will make a statement on the matter. [25911/24]
View answerGPs are private practitioners, most of whom hold a GMS contract with the HSE for the provision of medical services without charge to medical card and GP visit card holders. All children under 8 years of age and all those aged 70 years and over are eligible for a GP visit card.
Although GPs will ordinarily accept new patients who hold a medical or GP visit card on to their GMS panel, a GP may choose not to accept such a patient. Where a GP chooses not to except a new patient who holds a medical or GP visit card, the HSE may request, in confidence, the reason for that decision.
Where a GMS patient, a person that holds a medical card or GP visit card, experiences difficulty in finding a GP to accept them as a patient, the person concerned having unsuccessfully applied to at least three GPs in the area (or fewer if there are fewer GPs in the area) can apply to the HSE National Medical Card Unit which has the power to assign a GMS patient to a GP's GMS patient list, in accordance with the GMS contract. Likewise, a parent on behalf of a child GMS patient who experiences difficulty in finding a GP that will accept their child as a patient can apply to the HSE National Medical Card Unit also.
People who do not hold a medical card or GP visit card access GP services on a private basis and can make enquiries directly to any GP practice they wish to register with. As private practitioners, it is a matter for each individual GP to decide whether to accept additional private patients. Neither my department nor the HSE have any role in assigning patients who do not hold a medical card or a GP visit card to a GP's patient list.
325. Deputy Marc Ó Cathasaigh asked the Minister for Health if his attention has been drawn to the recent ESRI report entitled "Changes and challenges facing the Irish long-term residential care sector since COVID-19"; his plans to address the disparity between funding for public and private nursing home providers; his plans for Budget 2025; if increases to Fair Deal funding are needed to match inflation; and if he will make a statement on the matter. [25915/24]
View answerThe Government is aware of the investment trends in the Irish residential care market, the growing consolidation of the sector, and the complex investment and ownership structures that now exist.
I welcome the recent publication of the ESRI report ‘Long-term Residential Care in Ireland: Developments since the onset of the Covid-19 pandemic’ which brings into focus the challenges facing the long-term residential care sector in Ireland that the Government has been, and continues to, address to provide short-term stability and long-term growth to this sector.
In the context of the ongoing reform of older persons services, including long-term residential care, over the coming years, it is important that all aspects of the nursing home sector continue to be scrutinised. I am committed to ensuring that service delivery and configuration in the sector meets the needs of service users in a sustainable and safe manner.
The Government is conscious of the financial challenges faced by the nursing home sector, especially smaller and voluntary nursing homes that may not have access to the same economies of scale as larger homes or groups.
I have regular meetings with private nursing home provider representative groups where the issues of Government policy and support for the sector are on the agenda. I have committed to continued engagement with the sector.
The Department of Health acknowledges that there are variations in the cost of care across public centres as well as across private nursing homes. HSE operated Community Nursing Units (CNUs) generally having a higher cost of care.
In December 2021, the Department published the independently chaired Value for Money (VFM) review on nursing home costs. The review found that the cost differential is largely driven by variances in staff-to-resident ratios and the skill mix in public and private nursing homes.
The VFM Review made nine recommendations which the Department continues to take forward.
Residents in HSE-run Community Nursing Units (CNUs), which are often staffed at a level that allows the delivering of more complex care where required, represent less than 20% of Fair Deal scheme participants. Last year, 4,500 residents were in these public CNUs.
The Department of Health also published a review of the National Treatment Purchase Fund (NTPF) pricing system in June 2021 and, in cooperation with the NTPF, continues to work on bringing forward the recommendations that emerged from this review.
The NTPF is the body designated, under Section 40 of the Nursing Homes Support Scheme Act 2009, to negotiate with persons carrying on the business of a nursing home, for the purposes of reaching an agreement on the maximum prices to be charged for nursing home care, and are based on the NTPF’s cost criteria. These criteria include costs reasonably incurred by the nursing home, local market prices, historic prices and overall budgetary capacity. This is the only mechanism for funding from the public purse for nursing home residents.
I have regular interaction with the NTPF to discuss ways to support the sector, where necessary and appropriate, to complement the normal process of negotiating rate increases when contracts are renewed.
A significant change that the NTPF have made to their negotiation process is to offer nursing home providers contracts of a shorter duration, which will aim to ensure that NTPF rate increases stay aligned with any cost pressure increases that occur over the course of the contracted period. This has allowed for more surety in the sector.
As of the end of April, 420 nursing homes have agreements with the NTPF under the Nursing Homes Support Scheme (Fair Deal). The NTPF is expected to negotiate 389 Deeds of Agreement in 2024. For 2023, there were 257 full Deeds renegotiated, with a further number of mid-Deed uplifts in addition to this (this is where Deeds were negotiated with a 2-stage uplift: one at the start and another uplift that comes 6, 12 or 18 months after but still within that Deed of Negotiation). Nursing homes who renegotiated their Deeds of Agreement in 2023 received an average uplift of 6-7%. The average uplift to date in 2024 is 5-6%.
It should be noted that the Nursing Homes Support Scheme (or Fair Deal) was designed to protect and support vulnerable older people, to ensure equal access to nursing home care based on what they could afford. This gives certainty to people and families.
Increases in year-on-year funding for the NHSS continues and will reach €1.5 billion this year. Budget 2023 saw over €40 million in additional funding for the scheme. I am cognisant that the budget must support all participating nursing home residents for the full calendar year.
It is therefore imperative that private and voluntary providers continue to engage in the process as set out in the Nursing Homes Support Scheme Act 2009.
An additional €45.6 million has also been allocated to support nursing homes in Budget 2024, including a new €10 million fund to support private and voluntary nursing homes with HIQA compliance.
The Resident Safety Improvement (RSI) Scheme has been introduced and is designed to target and support structural improvements in nursing homes to assist their meeting HIQA compliance plans in respect of protection against infection and fire precautions. It is active as from 1 January 2024 and can be backdated for eligible works to 1 January 2020.
I recently welcomed the completion of the national rollout of a new community based mobile X-ray service which aims to reduce the number of older patients attending Emergency Departments (EDs). Following a pilot launched in 2022, from 1 March 2024 this free, community-based service is available to all residents in nursing homes and Community Nursing Units nationwide. It should also be noted that a nursing home resident's eligibility for other schemes, such as the medical card scheme or the drugs payment scheme, is unaffected by participation in the NHSS or residence in a nursing home. This means that nursing home residents who also have medical cards have the same access to GMS services regardless of whether they reside in their own homes or in a nursing home.
Furthermore, in late February, it was announced that over €3.2 million in State support will be provided for over 440 registered nurses in private nursing homes to obtain a Postgraduate Diploma in Gerontological Nursing.
All of these measures are intended to find the right balance between delivering value to the taxpayer, affordable access to long-term care for citizens and a sustainable nursing home sector which ensures that people who require care can continue to receive high quality services in the most appropriate settings.
326. Deputy Seán Canney asked the Minister for Health when a power wheelchair will be provided for a person (details supplied); and if he will make a statement on the matter. [25919/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
327. Deputy James Lawless asked the Minister for Health the steps his Department is taking to address the evolving issue regarding the current standards for what illnesses qualify as 'long-term' for those looking to avail of the long-term illness scheme; if it is possible to update the list of illnesses that fall under the remit of being a 'long-term illness' in order to coincide with modern standards, statistics and research; and if he will make a statement on the matter. [25926/24]
View answerThe Long-Term Illness (LTI) scheme was established under Section 59(3) of the Health Act 1970 (as amended) which provides that arrangements may be made for the supply without charge of drugs, medicines or medical and surgical appliances to persons suffering from a prescribed disease or disability of a permanent or long-term nature.
Various regulations were made in the 1970s prescribing 16 conditions covered by the scheme. Further information regarding the conditions covered can be found at:
www2.hse.ie/services/schemes-allowances/lti/about/ .
However, it is also important to remember that the LTI Scheme exists within a wider eligibility framework.
People who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be eligible for a medical card. In accordance with the provisions of the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE. Medical card eligibility is primarily based on an assessment of means and is not granted on the basis of any particular condition.
In certain circumstances the HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income guidelines, where he or she faces difficult financial circumstances, such as extra costs arising from illness. The HSE afford applicants the opportunity to furnish supporting documentation to determine whether undue hardship exists and to fully take account of all relevant circumstances that may benefit them in assessment, including medical evidence of costs and certain expenses.
The issue of granting medical or GP visit cards based on having a particular disease or illness was previously examined in 2014 by the HSE Expert Panel on Medical Need and Medical Card Eligibility. The Group concluded that it was not feasible, desirable, nor ethically justifiable to list medical conditions in priority order for medical card eligibility. In following the Expert Group’s advice, a person’s means remains the main qualifier for a medical card.
In circumstances where an applicant is still over the income limit for a medical card, they are then assessed for a GP visit card, which entitles the applicant to GP visits without charge.
Under the Drug Payment Scheme, no individual or family pays more than €80 a month towards the cost of approved prescribed medicines. The Scheme significantly reduces the cost burden for families and individuals who are not eligible for a medical card but who have ongoing expenditure on medicines.
Since 2020 there has been a focus by this Government on expanding eligibility and improving the affordability of healthcare. This has delivered a significant expansion in eligibility across a wide range of areas, including:
• The Free Contraception Scheme launched September 2022 for women aged 17–25. This was extended to 26–year-olds in January 2023, then to women aged 27-30 from 1 September 2023, and most recently it was extended to women aged 31 from 1 January 2024. The Scheme will be further extended to women aged 32-35 from July 2024.
• Successive reductions in Drug Payment Scheme thresholds, which now stands at €80 per month.
• The removal of public in-patient charges in all public hospitals: for children under 16 years of age from 21 September 2022, and for adult public patients from 17 April 2023.
• The expansion of free GP care to include children aged 6 and 7 since August 2023.
• The introduction of Free IVF treatment since September 2023.
The Department recognises that notwithstanding this major expansion of eligibility there is a need for a holistic review of eligibility as committed to in the Sláintecare Implementation Strategy and Action Plan 2021-2023.
The Department has commenced a strategic review of the eligibility framework, the overall objective of which is two-fold:
to review the existing framework to clearly assess what is working well and fit-for-purpose, and
to inform policy options and proposals to enhance eligibility and access to services based on robust evidence and focused on improving health outcomes.
328. Deputy Pat Buckley asked the Minister for Health to outline the steps being taken to address the shortage of general practitioners in east Cork; and the targets for new positions to be created in the next five years. [25929/24]
View answerGPs are private practitioners, most of whom hold a GMS contract with the HSE for the provision of GP services without charge to medical card and GP visit card holders. As self-employed practitioners, GPs may establish practices at a place of their own choosing. There is no prescribed ratio of GPs to patients and the State does not regulate the number of GPs that can set up in a town or community.
The Government is working to increase the number of GPs practicing in the State and thereby improve access to GP services across the country.
Under the 2019 GP Agreement additional annual expenditure provided for general practice was increased by €211.6m. This provided for significant increases in capitation fees for participating GMS GPs, and new fees for additional services and increased practice supports. The GP Agreement 2023 further increased GP capitation fees, increased the existing subsidy rates for practice staff, and introduced a grant support for additional staff capacity as well a practice staff maternity leave support. These measures make general practice in Ireland a more attractive career choice for doctors.
The number of doctors entering GP training has been increased significantly in recent years, with 286 new entrants in 2023 and 350 places made available for new entrants for this year. Annual intake to the GP training scheme has been increased by over 80% from 2015 to 2023, and the number of new entrant places to be available this year is a 22% increase on last year's intake.
Furthermore, GP recruitment is ongoing under the joint International Medical Graduate Rural GP Programme between the HSE and the Irish College of General Practitioners (ICGP). 121 non-EU GPs were enrolled under the training programme last year and it is planned to recruit up to 250 more GPs from outside Ireland this year. The placement of GPs under the programme is targeted to rural and underserviced areas.
Lastly, a Strategic Review of General Practice is underway. The review, with input from key stakeholders, is examining the broad range of issues affecting general practice including issues related to GP capacity. When completed, the review will set out the measures necessary to deliver a more sustainable general practice into the future.
329. Deputy Pat Buckley asked the Minister for Health to provide an update for local waiting times for counselling and psychotherapy services for adults, children and adolescents in east Cork, in tabular form, detailing the numbers of people waiting over six months, 12 months, 18 months and 24 months, respectively. [25930/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond Directly to the Deputy as soon as possible.
330. Deputy Michael McNamara asked the Minister for Health if an urgent appointment at UHL can be expedited for a person (details supplied); and if he will make a statement on the matter. [25937/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
331. Deputy Michael Healy-Rae asked the Minister for Health if new hearing aids will be granted to a person (details supplied); and if he will make a statement on the matter. [25939/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
332. Deputy Carol Nolan asked the Minister for Health if he will support the work of an organisation (details supplied) dedicated to improving cardiovascular health and providing support services to people with a cardiovascular condition; if he will commit to engaging with the organisation with a view to increasing its funding requirements; and if he will make a statement on the matter. [25940/24]
View answerThanks to continued investment in Health Services, Ireland has seen a decline in the number of deaths from cardiovascular disease (CVD). Since 2012, the mortality rate from heart disease has been reduced by 38%, mortality from stroke has been reduced by 48%. However, CVD remains a significant challenge claiming 9,000 lives annually.
The Government acknowledges the vital support, education, and advocacy offered by the Irish Heart Foundation and other patient support groups. Partnerships and collaboration are and will continue to be, enablers of our commitment to promoting the cardiovascular health of our nation.
Many patient services are embedded in policy, including the National Stroke Strategy 2022-2027 for which the government has provided over €7m to date.
In 2022 and 2023, the HSE's National Heart Programme, supported through the Enhanced Community Care Programme, sponsored two CVD risk prevention projects with the IHF.
The State, via the HSE, provides funding to the IHF, and other cardiovascular support agencies of approximately €530,000 through Service Level Agreements and Grant Aid Agreements of which €380,000 was allocated to IHF in 2024.
In 2024, the HSE advise that an additional once-off sum of €400,000 has been allocated to the Irish Heart Foundation's for a High-Risk CVD Prevention Programme which has demonstrated its effectiveness by enhancing healthcare provision, clinical outcomes, and health behaviours in patients living in deprived communities.
333. Deputy Michael Lowry asked the Minister for Health if he is aware of the urgent need for a dementia care nurse and services team in north Tipperary (details supplied); if he will seek further clarification from the HSE on this matter as regards when a dedicated dementia care nurse and services team will be established in north Tipperary; and if he will make a statement on the matter. [25947/24]
View answerAs this is an operational matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
334. Deputy Niamh Smyth asked the Minister for Health to review a case (details supplied); the reason this application was refused; and if he will make a statement on the matter. [25954/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
335. Deputy James Lawless asked the Minister for Health to examine an issue (details supplied); and if he will make a statement on the matter. [25963/24]
View answer336. Deputy Bernard J. Durkan asked the Minister for Health if dental services will be for persons (details supplied); and if he will make a statement on the matter. [25965/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly.
337. Deputy Marian Harkin asked the Minister for Health for an update/timeline on the re-opening of day hospital services at a facility (details supplied); and if he will make a statement on the matter. [25966/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
338. Deputy Brendan Smith asked the Minister for Health if medical card holders are entitled to have the costs of blood tests covered under the GMS; and if he will make a statement on the matter. [25969/24]
View answerUnder the terms of the current GMS contract, GPs are required to provide eligible patients with ''all proper and necessary treatment of a kind usually undertaken by a general practitioner and not requiring special skill or experience of a degree or kind which general practitioners cannot reasonably be expected to possess". Persons who hold a medical card or a GP visit card are not subject to any co-payments or other charges in respect of such services including GP consultations.
Clinical determinations as to whether a blood test should be taken to either assist in the diagnosis of illness or the treatment of a condition are made by the GP concerned. There is no provision under the GMS GP contract for persons who hold a medical card or a GP visit card to be charged for clinically necessary blood tests.
In addition, blood tests undertaken in the context of the GP Chronic Disease Management programme are covered by the fees paid to GPs by the HSE for this care.
Where a patient who holds a medical card or GP visit card believes he or she has been incorrectly charged for routine phlebotomy services (i.e. a blood test to either assist in the diagnosis of illness or the treatment of a condition) by his or her GP, or has been charged for a blood test provided under the Chronic Disease Management programme, then that patient should report the matter to their HSE Local Health Office. The local management, upon being notified of potential inappropriate charging of a GMS patient, shall contact the GP concerned and carry out an investigation into the complaint and will, where appropriate, arrange for a refund of charges incorrectly applied by that GP.
Fees charged by GPs outside the terms of the GMS contracts are a matter of private contract between the clinicians and their patients. The HSE does not have any role in relation to such fees.
339. Deputy Brendan Smith asked the Minister for Health if the costs of blood pressure/cardiac monitoring are covered for medical card holders; and if he will make a statement on the matter. [25970/24]
View answerUnder 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 their family can qualify for a medical card, while those for whom arranging GP services would be unduly burdensome can qualify for a GP visit card.
Medical card holders can currently access a range of services including general practitioner services, prescribed drugs and medicines, public in-patient hospital services, public out-patient hospital services, dental, ophthalmic and aural services. The GP visit card provides for GP services without charge. Certain groups, including all those under 8 years of age and those over 70 years of age, are automatically entitled to a GP visit card.
GP services to medical card and GP visit card holders are provided through the General Medical Services (GMS) scheme. Under the terms of the current GMS contract, GPs who hold a GMS contract are required to provide eligible patients with ''all proper and necessary treatment of a kind usually undertaken by a general practitioner and not requiring special skill or experience of a degree or kind which general practitioners cannot reasonably be expected to possess". Persons who hold a medical card or a GP visit card are not subject to any co-payments or other charges in respect of such services including GP consultations.
The GP Chronic Disease Management (CDM) Programme commenced in 2020 and is available to adult GMS patients, medical card and GP visit card holders. The specified chronic conditions included in the CDM Treatment Programme are Type 2 Diabetes; Asthma; Chronic Obstructive Pulmonary Disease (COPD) and Cardiovascular Disease (including Heart Failure, Ischaemic Heart Disease, Cerebrovascular Disease (Stroke/Transient Ischemic Attack (TIA), Atrial Fibrillation). In addition, the Opportunistic Case Finding Programme identifies those at high risk of cardiovascular disease or diabetes for entry to the Preventive Programme and those with undiagnosed chronic disease(s) are enrolled under the Treatment Programme. Clinically appropriate examinations, including blood pressure monitoring, are included as part of the care reviews provided under the CDM programme. The CDM Preventative Programme was expanded to include hypertension from the 30th of November last year.
Furthermore, a special item of service fee is payable to GPs under the GMS contract for the provision of 24-hour Ambulatory Blood Pressure Monitoring for diagnosis and treatment of hypertension.
The Health (Amendment) Act 2023 removes the acute public in-patient charge for people accessing care as a public patient in public hospitals. This measure came into effect from 17 April 2023.
In addition, the Health (Out-Patient Charges) Regulations 2019 provides that, subject to certain exemptions, a charge shall be made for out-patient services provided at designated centres including an emergency department (€100) and a minor injury unit (€75). These exemptions include a person with a medical card, a person who has a letter of referral from a registered medical practitioner and a person whose attendance results in admission as an in-patient. Where care is provided in the public hospital system in an outpatient setting (other than services provided in certain designated centres including an Emergency Department or Minor Injury Unit) no charge is liable for persons attending as a public patient.
