Written Answers Nos. 701-722
701. Deputy Pádraig O'Sullivan asked the Minister for Health if the HSE will consider the reimbursement of ibrutinib plus venetoclax for patients with chronic lymphocytic leukaemia; and if he will make a statement on the matter. [36428/24]
View answerUnder the Health (Pricing and Supply of Medical Goods) Act 2013, the HSE has statutory responsibility for decisions on the pricing and reimbursement of medicines; therefore, the matter has been referred to the HSE for attention and direct reply to the Deputy.
702. Deputy Pádraig O'Sullivan asked the Minister for Health if the shingles vaccine will be made available to patients with chronic lymphocytic leukaemia via the medical card and drug payment scheme given that currently this cohort of patients can only avail of the vaccine privately; and if he will make a statement on the matter. [36429/24]
View answerThe immunisation programme in Ireland is based on the advice of the National Immunisation Advisory Committee (NIAC). The committee's recommendations are based on the prevalence of the relevant disease in Ireland and international best practice in relation to immunisation.
NIAC continues to revise recommendations to allow for the introduction of new vaccines in Ireland and to keep abreast of changes in the patterns of disease. Therefore, the immunisation schedule will continue to be amended over time.
The shingles vaccine is not available through the medical card or drug payment scheme. Shingles vaccination is not currently provided as part of the national immunisation programme. Further information is available here: www2.hse.ie/conditions/shingles/
It is open to any individual who is aged 50 years and older and who wishes to receive the vaccine to consult with their GP or pharmacist.
The Health Information and Quality Authority (HIQA) recently carried out a Health Technology Assessment (HTA) on the herpes zoster vaccine which protects against shingles. A HTA is a multidisciplinary research process that collects and summarises information about a health technology. The information can cover a range of fields, including clinical effectiveness and safety, cost-effectiveness and budget impact, organisational and social aspects, and ethical and legal issues. The information is collected and presented in a systematic, unbiased and transparent manner.
HIQA published the HTA on 19 July 2024. The HTA found that adding the shingles vaccine to the schedule is not cost effective and is associated with a substantial budget impact. The Department has considered its findings and determined that the introduction of the vaccine can be reconsidered when cost effectiveness is more favourable.
703. Deputy Gino Kenny asked the Minister for Health if the review by his Department of the medical cannabis access programme has commenced; if so, when the review will be concluded; and if he will make a statement on the matter. [36430/24]
View answerThe Department of Health is currently assembling the clinical review group. It is anticipated that the clinical review will be completed early in the new year.
704. Deputy Róisín Shortall asked the Minister for Health the policy for nursing homes support offices in respect of accepting applications for the nursing homes support scheme, also known as fair deal (details supplied); if local offices should accept soft copy applications; and if he will make a statement on the matter. [36437/24]
View answerAs this is an operational matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
705. Deputy Róisín Shortall asked the Minister for Health if he will fund consultant neurology posts in the five regional hospitals that currently have no, or very limited, access to neurology services, in line with the 2016 Model of Care for Neurology Services in Ireland, which stipulates that all model three and four hospitals should have a dedicated neurology service (details supplied); the timeline for same; and if he will make a statement on the matter. [36438/24]
View answer706. Deputy Matt Shanahan asked the Minister for Health further to Parliamentary Question No. 1921 of 9 September 2024, if the response will be reviewed given the matters raised were not fully addressed (details supplied) in relation to stroke-service resourcing at University Hospital Waterford; his position in terms of proposed future additional clinical and capital funding; and if he will make a statement on the matter. [36440/24]
View answerIn developing the National Stroke Strategy 2022-2027 the HSE mapped the existing gap in health and social care staff numbers for all disciplines that existed at the time and what would be needed with the projected growth in stroke numbers at individual sites given the proportional growth in the over 65 population in the catchment area of that site (taken from CSO figures) and the fact that 75% of all strokes occur in that age group. A mix of therapy grades is required to deliver optimum care to the person who has had a stroke, and this includes basic, senior and clinical specialist posts.
The Strategy outlined the recommended staffing for Stroke Units which included physiotherapist and occupational therapists. In regard to University Hospital Waterford the below table outlines the recommended staffing and requirements to reach 100% capacity based on projections described above.
|
University Hospital Waterford |
Physiotherapy |
Occupational Therapy |
|
Recommended Staffing |
1.4 |
1.2 |
|
Current HSCP staffing for stroke service |
0.5 |
0.5 |
|
Gap |
0.9 |
0.9 |
|
WTE required for 100% capacity |
0.4 |
0.3 |
Discussions in relation to the estimates process and Budget 2025 are ongoing, and any final decisions regarding funding allocations will be based on Governmental priorities, and in the context of my Department’s overall financial envelope for 2025.
707. Deputy Michael Healy-Rae asked the Minister for Health the number of palliative care beds and long-stay beds that are available in Valentia Hospital in Kerry; if all of these beds are in use; if not, the number being used; and if he will make a statement on the matter. [36446/24]
View answerAs this is an operational matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
708. Deputy Paul Kehoe asked the Minister for Health the reason an emergency care facility (details supplied) is operating limited hours; the reason bloods are not being taken on site; and if he will make a statement on the matter. [36447/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
709. Deputy Mairéad Farrell asked the Minister for Health the reason Ireland does not have an osteoporosis programme, given it is one of the most prevalent and disabling diseases in Ireland and accounts for almost 10% of the healthcare budget. [36458/24]
View answer710. Deputy Mairéad Farrell asked the Minister for Health the reason private DEXA facilities are being supported by the HSE with taxpayers' money when public DEXA systems are being closed or not used. [36459/24]
View answerThis PQ is more suitable for the HSE to respond.
711. Deputy Mairéad Farrell asked the Minister for Health the reason the HSE claims to be saving €4 million per year using biosimilar teriparatide, when the cost of managing fractures is estimated to be increasing by approximately €100 million per year. [36460/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
712. Deputy Mairéad Farrell asked the Minister for Health the reason Irish patients are being denied access to the most effective medicine for severe osteoporosis (details supplied) when other European Union citizens have access. [36461/24]
View answerUnder the Health (Pricing and Supply of Medical Goods) Act 2013, the HSE has statutory responsibility for decisions on the pricing and reimbursement of medicines. I have asked the HSE to provide an update in relation to the Deputy’s question. The HSE have provided the following update:
The HSE must commit to providing access to as many medicines as possible, in as timely a fashion as possible, from the resources available (provided) to it.
The HSE must also robustly assess applications for pricing and reimbursement to make sure that it can stretch available resources as far as possible and to deliver the best value in relation to each medicine and ultimately more medicines to Irish citizens and patients.
HSE decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds.
There are formal processes which govern applications for the pricing and reimbursement of medicines, and new uses of existing medicines, to be funded and / or reimbursed.
The HSE considers the following criteria prior to making any decision on pricing / reimbursement, in line with the Health (Pricing and Supply of Medical Goods) Act 2013:
(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.
In terms of the specific details of the application for pricing and reimbursement of Romosozumab (Evenity®):
• The HSE received an application for pricing and reimbursement of Romosozumab (Evenity®) on the 20th April 2021 from UCB Pharma (the applicant) indicated for the treatment of severe osteoporosis in postmenopausal women at high risk of fracture.
• The first step in the process is the submission of a Rapid Review dossier (a clinical and economic dossier) to the National Centre for Phamacoeconomics (NCPE) for assessment. The HSE commissioned the Rapid Review process on the 21st April 2021.
• The NCPE Rapid Review assessment report was received by the HSE on the 27th May 2021. A full HTA was recommended to assess the clinical effectiveness and cost effectiveness of Romosozumab (Evenity®) compared with the current standard of care.
• The HSE commissioned a full Health Technology Assessment (HTA) on the 28th June 2021 as per agreed processes.
• The NCPE Health Technology Assessment report (ncpe.ie/wp-content/uploads/2021/05/Technical-summary-romosozumab-Evenity-21016.pdf) was received by the HSE on the 7th of March 2023. The NCPE recommended that Romosozumab (Evenity®), for the treatment of women who are postmenopausal with severe osteoporosis who have experienced a MOF (hip, vertebrae, distal radius, proximal humerus) within the previous 24 months and who are at imminent risk of another fragility fracture, be considered for reimbursement if cost-effectiveness can be improved relative to existing treatments.
• The HSE Corporate Pharmaceutical Unit (CPU) is the interface between the HSE and the Pharmaceutical Industry in relation to medicine pricing and reimbursement applications.
• The Drugs Group is the national committee which the HSE has in place to make recommendations on the pricing and reimbursement of medicines. The membership of the HSE Drugs Group includes public interest members. The Drugs Group met in August 2023 and reviewed the pharmacoeconomic report along with the outputs of commercial negotiations, and patient group submissions. The Drugs Group recommended the reimbursement of Romosozumab (Evenity®) subject to a Managed Access Protocol being implemented.
• The decision-making authority in the HSE is the HSE Executive Management Team. The HSE Executive Management Team decides on the basis of all the demands it is faced with (across all services) whether it can fund a new medicine, or new use of an existing medicine, from the resources that have been provided to it in line with the Health (Pricing and Supply of Medical Goods) Act 2013.
• Reimbursement of Romosozumab (Evenity®) on the High Tech Arrangement is supported for a sub-group of the licensed population who meet the criteria outlined in a managed access protocol (MAP), i.e. women who are postmenopausal, with severe osteoporosis, who have experienced a major osteoporotic fracture (MOF) within the previous 24 months and who are at imminent risk of another fragility fracture. All criteria must be satisfied in order for reimbursement to be supported.
• Evenity® will be made available under a managed access system operated by the HSE Medicines Management Programme (MMP) in the coming months.
713. Deputy Mairéad Farrell asked the Minister for Health his plans to solve the trolley crisis while ignoring osteoporosis which is one of the most frequent reasons for admission to public hospitals and one of the highest bed occupancy requirements. [36462/24]
View answerAs this is a service matter, I have asked the HSE to respond to the deputy directly.
We are making progress in reducing the number of patients on trolleys nationwide.
There has been a significant reduction in the cumulative daily 8am trolley count over the first eight months of 2024, with numbers down 11% (over 9,000) when compared to the same period in 2023.
The improved performance has been driven by the significant increase in capacity under this government - with an additional 28,346 people working in our health service since the end of 2019 and 1,195 acute hospital beds and hundreds of community beds added since the end of 2019.
This progress is being driven by the ongoing implementation of the Urgent and Emergency Care Operational Plan 24/25 (the UEC Plan), which was presented to Government in July.
The UEC Plan 2024/25 includes targeted actions and reform initiatives such as:
• The operation of 10-bedded Virtual Wards in University Hospital Limerick (UHL) and in St Vincent's University Hospital (SVUH), scaling to 25 virtual beds for each site by year end to deliver 50 virtual beds in total.
• Providing additional and extended hours for senior decision makers and staff integral to supporting 7/7 operations.
• Standardising the opening hours of all Injury Units (IUs) to provide a 7-day service, 8am to 8pm including Bank Holidays.
714. Deputy Mairéad Farrell asked the Minister for Health the reason osteoporosis and arthritis patients have to wait years for a physiotherapy or outpatient appointments when other diseases have access within weeks or months. [36463/24]
View answerIn relation to the particular query raised, as this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
715. Deputy Mairéad Farrell asked the Minister for Health the reason he spent so much on Covid when a similar number of patients fractured or suffered a fracture-related death during the same time period. [36464/24]
View answerAs this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.
716. Deputy Mairéad Farrell asked the Minister for Health if his attention has been drawn to the fact that many severe osteoporosis patients are unable to use a daily injection or take oral therapy correctly. [36465/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
717. Deputy Mairéad Farrell asked the Minister for Health the reason he is not supporting best practice and standards for DEXA in Ireland and osteoporosis care. [36466/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
718. Deputy Mairéad Farrell asked the Minister for Health the reason for waste of funds on unnecessary osteoporosis care, which results in fewer resources for those who need it. [36467/24]
View answerThis PQ has been referred to the HSE to respond.
719. Deputy Mairéad Farrell asked the Minister for Health the criteria to qualify for the fair deal scheme; whether there are any income thresholds for applicants; and if he will make a statement on the matter. [36476/24]
View answerTo qualify for Fair Deal, an applicant must be ordinarily resident in Ireland and be in need of long-term nursing home care. Applicants need to first undergo a care needs assessment to determine their care requirements and, if long-term care is needed, a financial assessment of means to determine their ability to contribute to the cost of their own care.
The Nursing Homes Support Scheme (NHSS), commonly referred to as Fair Deal, is a system of financial support for people who require long-term residential care. Participants contribute to the cost of their care according to their means while the State pays the balance of the cost. The Scheme aims to ensure that long-term residential care is accessible and affordable for everyone and that people are cared for in the most appropriate settings.Participants within the NHSS contribute up to 80% of their income (40% if part of a couple) and 7.5% per annum of the value of their assets (3.75% if part of a couple). Assets include cash assets, such as savings, and non-cash assets, such as the principal residence. The first €36,000 (€72,000 if part of a couple) is excluded from assessment. The value of a person's principal residence is only assessed for contributions for their first three years on the scheme. This is known as the three-year cap, which is intended to protect the value of a principal private residence, along with the other safeguards built into the Financial Assessment which ensure that:• Nobody will pay more than the actual cost of care;• A participant will keep a personal allowance of 20% of their income or 20% of the maximum rate of the State Pension (Non-Contributory), whichever is the greater, and;• If a participant has a spouse or partner remaining at home, they will be left with 50% of the couple’s income or the maximum rate of the State Pension (Non-Contributory), whichever is the greaterIt is important to note that regardless of whether an applicant chooses to reside in a public HSE-run Community Nursing Unit or a private/voluntary nursing home, the contribution to the cost of their own care remains the same as it is based on the financial assessment of means.
The NHSS covers the cost of the standard components of long-term residential care which are:• Nursing and personal care appropriate to the level of care needs of the person;• Bed and board;• Basic aids and appliances necessary to assist a person with the activities of daily living; and• Laundry service.For the purposes of financial assessment, income includes:• Earnings, including income from farming or business activities• Pension income• Social welfare benefits/allowances• Rental income• Income from holding an office or directorship• Income from fees, commissions, dividends or interest• Any income which you have deprived yourself of in the five years prior to applicationTransferred assets and income, defined as assets or income transferred to another person up to five years before a person's application to the scheme, are also assessed.It should also be noted that although the NHSS covers core living expenses, residents can still incur some costs in a nursing home, such as social programmes, newspapers or hairdressing. In recognition of this, anyone in receipt of financial support under the NHSS retains at least 20% of their income. Under the terms of the NHSS Act 2009, private nursing homes should not levy additional charges on NHSS residents for services coming within scope of the Nursing Home Support Scheme.A person'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.The NHSS currently supports about 23,000 people. Around 80% of those are supported in private nursing homes, with the remainder in public HSE-run facilities (both systems are funded through the NHSS). An application form can be downloaded directly from the HSE at: www2.hse.ie/documents/2265/HSE_Nursing_Homes_Support_Scheme_Application_form_and_support_information.pdf or can be obtained from the local Nursing Home Support Office. Contact details for local Nursing Home Support Offices can be found at: www2.hse.ie/services/schemes-allowances/fair-deal-scheme/contact/ .
720. Deputy Niamh Smyth asked the Minister for Health the process by which a person (details supplied) can claim back moneys spent on medication while awaiting medical card approval. [36477/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
721. Deputy Brendan Griffin asked the Minister for Health if an appeal will be accepted on behalf of a group (details supplied); and if he will make a statement on the matter. [36480/24]
View answerAs this is an operational matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
722. Deputy Darren O'Rourke asked the Minister for Health the increased staffing investment he plans to make to address the waiting list crisis in primary care child and adolescent psychology services in CHO8; and when he intends a recruitment drive for same to begin. [36501/24]
View answerPrimary Care Psychology is a large provider of psychological services at primary care and community level in Ireland. It provides a range of services of varying intensity, encompassing education, prevention, early intervention, and a range of treatments. It also plays a key role in signposting and escalation to secondary and tertiary services, both within psychology and across other disciplines.
The HSE reports that 10,143 referrals have been received by the Primary Care Psychology service nationally this year to the end of June, an increase of 8.7% on the 9,329 referrals received by the service in the same period last year.
I recognise the central role that Primary Care therapy services play in offering the opportunity for early and cost-effective interventions for children and young people. I also acknowledge that the increasing waiting lists for the Primary Care services, and particularly those waiting for a long time to access services, is a source of real concern for clients and their families.
To this end, a programme of work is currently underway between the Department and the HSE to address access to Primary Care therapy services and to develop a standardised infrastructure and protocols to support systematic responses to Primary Care waiting lists. This programmatic approach is aimed at ensuring consistency at a national level to waiting list management in Primary Care, to improve access to services regardless of location, as well as a greater understanding of the scale of demand, the drivers of demand and to allow for improved planning, interventions, investment considerations, enhanced productivity, and the most efficient use of capacity.
The national waiting list initiative in Primary Care Child Psychology Services, which targets those under the age of 18 years waiting over 52 weeks to access the service, removed 3,507 clients from the waitlist in 2022, and 3,521 clients in 2023.
Continued Waiting List Action Plan funding of €5m this year is targeting removals of 3,088 clients from the waitlist. This funding has proven very effective with the removals year to date (YTD) to end August having already exceeded the target for the year of 3,088 removals, with 3,237 clients having been removed to date.
Discussions in relation to the estimates process and Budget 2025 are ongoing, and any final decisions regarding funding allocations will be based on Governmental priorities, and in the context of my Department’s overall financial envelope for 2025.
