Wednesday, 22 Jan 2025

Mental Health Services

Questions (1321)

Alan Kelly

Question:

1321. Deputy Alan Kelly asked the Minister for Health the funding available to CAMHS teams to carry out electrocardiograms, blood tests and other necessary tests for people with eating disorders. [46287/24]

View answer

Written answers

Minister of State at the Department of Health

As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly as soon as possible.

General Practitioner Services

Questions (1322)

Alan Kelly

Question:

1322. Deputy Alan Kelly asked the Minister for Health the estimated cost of increasing the rural practice allowance for GPs by 33%. [46288/24]

View answer

Written answers

Minister for Health

Under the GMS scheme, the Rural Practice Support Framework provides an additional support to eligible GP practices in rural areas.

As per the HSE Primary Care Reimbursement Service (PCRS) annual report for 2023, funding provided through GMS rural practice grants to eligible practices amounted to approximately €4.8 million that year. Accordingly, based on this figure, increasing the GMS rural practice grants by 33% would cost approximately €1.6 million.

In addition, practices in receipt of rural practice grants attract the maximum allowable rates for practice staff support subsidies and locum contributions for leave taking. For the purposes of this reply, it is assumed that only the rural practice grant would be increased.

Departmental Budgets

Questions (1323)

Alan Kelly

Question:

1323. Deputy Alan Kelly asked the Minister for Health how the €2 million additional funding for the National Maternity Strategy in Budget 2025 will be spent. [46289/24]

View answer

Written answers

Minister for Health

Investment of €2 million announced for Budget 2025 (with a Full Year Cost of €4 million in 2026) has been allocated for the continued implementation of the National Maternity Strategy into 2025 and beyond. The priorities covered by this Budget 2025 funding include:

• Additional Specialist Midwives to enhance women’s access to midwife-led care.

• Driving improvements in the safety of our maternity services through research, audit and new clinical guidelines.

• Recruiting more genetic counsellors and supporting staff to expand a new National Perinatal Genomics Service; evaluating, diagnosing, managing and treating anomalies before birth.

• Delivering 4 new Postnatal Hubs, to provide women with access to postnatal care in the community and away from a hospital environment.

Separately, €0.9 million New Development Funding has also been allocated for breastfeeding supports. This funding will enable recruitment of an additional five lactation consultants and purchase of breast pumps for mothers of critically ill and pre-term infants.

Health Services

Questions (1324)

Alan Kelly

Question:

1324. Deputy Alan Kelly asked the Minister for Health the estimated cost of providing three extra menopause clinics. [46290/24]

View answer

Written answers

Minister for Health

There is currently one specialist menopause clinic in each of the six maternity networks.

These comprise a team of 3-4 staff (1.7 WTE) per clinic, made up of Consultants/Specialist GPs, Clinical Nurse Specialist /Clinical Midwife Specialist, and Grade IV Admin.

The average total full-year salary costs per clinic (including 20% non-pay) is €169k

As part of the Women’s Health Action Plan, additional funding of €349k is being provided in 2024/2025 to extend opening hours in four clinics.

Taking this into account, the average cost per clinic will increase to €227k

Assuming all six clinics were to be funded at the same level i.e. with the extended opening hours, then the average cost per clinic would be € 256k ( €349k÷4 clinics with extended hours + €169k)

Therefore, it would cost an estimated €769k (€256k x 3 new clinics) to fund three additional specialist menopause clinics i.e. based on all six clinics operating with extended hours.

Capital investment may also be required for any additional clinics, and this would vary depending on the space available and refurbishment/equipment requirements.

Health Services

Questions (1325)

Paul Donnelly

Question:

1325. Deputy Paul Donnelly asked the Minister for Health the number of paediatric neurosurgeries outsourced abroad in the years of 2023 and 2024, in tabular form. [46302/24]

View answer

Written answers

Minister for Health

As this is an operational matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.

Primary Care Services

Questions (1326)

Paul Donnelly

Question:

1326. Deputy Paul Donnelly asked the Minister for Health the number of vacant optometry and ophthalmology roles in primary care services in CHO7. [46303/24]

View answer

Written answers

Minister for Health

As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.

Hospital Appointments Status

Questions (1327)

Pádraig O'Sullivan

Question:

1327. Deputy Pádraig O'Sullivan asked the Minister for Health when a person (details supplied) will receive an appointment; and if he will make a statement on the matter. [46309/24]

View answer

Written answers

Minister for Health

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.

In 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.

Nursing Homes

Questions (1328)

Carol Nolan

Question:

1328. Deputy Carol Nolan asked the Minister for Health if he will commit to immediate action on the fair deal pricing review, releasing the review within 100 days of Government formation; and if he will make a statement on the matter. [46310/24]

View answer

Written answers

Minister of State at the Department of Health

The Department of Health published a review of the NTPF pricing system in June 2021 and continues to work on bringing forward the recommendations that emerged from this review.

A steering group has been established to oversee the delivery of the recommendations; this group has met on a regular basis since publication of the review. The group made four recommendations:

• Recommendation 1: formal assessment of using a formulaic approach in the pricing system as set out in Section 4 of the Report.

• Recommendation 2: formal assessment of amending the approach to the assessment of “Local Market Price” to reflect prices within other nursing homes within a certain distance of the nursing home rather than within the same county.

• Recommendation 3: NTPF to engage with nursing homes and their representatives in relation to enhancing the internal NTPF Review process.

• Recommendation 4: amending the process for allowing for high dependency residents when the necessary systems are in place

The delivery of recommendations 1-3 primarily sit with the NTPF. As per the recommendations of the review, the NTPF is reporting periodically to the steering group on progress in implementing the recommendations. It is recognised, however, that recommendation 4 has dependencies going well beyond the scope of the pricing review. This recommendation is therefore being addressed within the broader context of the reform of older persons' services, with appropriate links established between the pricing review steering group (including shared membership) to ensure that appropriate links are made between this recommendation and the others.

The terms of reference for the group include a final report to be submitted to ministers, reporting on delivery of the four recommendations and making any further recommendations as appropriate. It is my understanding that this report is at an advanced stage and will be published in early 2025.

A decision on the next steps and further action will be made following analysis and review of the report findings.

Nursing Homes

Questions (1329)

Carol Nolan

Question:

1329. Deputy Carol Nolan asked the Minister for Health if he will ensure equal access for all nursing home residents, private and public to primary care services; and if he will make a statement on the matter. [46311/24]

View answer

Written answers

Minister for Health

As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible

Mental Health Services

Questions (1330)

Pa Daly

Question:

1330. Deputy Pa Daly asked the Minister for Health the monitoring, support and evaluation efforts that are put in place when a person is released from the National Forensic Mental Health Service. [46324/24]

View answer

Written answers

Minister of State at the Department of Health

As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly as soon as possible.

Departmental Bodies

Questions (1331)

Cian O'Callaghan

Question:

1331. Deputy Cian O'Callaghan asked the Minister for Health the progress that has been made by his Department with regard to the inclusion of certified athletic therapists within the CORU register; and if he will make a statement on the matter. [46358/24]

View answer

Written answers

Minister for Health

A number of representative bodies for unregulated professions have approached the Department seeking to be regulated. It is important in this context to point out the issues to be considered regarding the proportionate degree of regulatory force required to protect the public are complex.

In light of this, and in line with ongoing work in the Department of Health, the Health Research Board was requested to carry out research on behalf of the Department to assist in policy development in this area. The report, “National Approaches to Regulating Health and Social Care Professions”, examines the approaches to the regulation of health and social care professionals internationally and is publicly available on the Department’s website

(www.gov.ie/en/publication/ea62b-national-approaches-to-regulating-health-and-social-care-professions/).

My officials are in the process of drawing from this report and other relevant sources to develop a framework to guide policy on the regulation of health and social care professionals into the future. This framework will also be informed by an evidence and risk-based approach to regulation in line with requirements set out in the EU Proportionality Test Directive, which was transposed into Irish law on 19 August 2022 (S.I. No. 413/2022). Further information on the Proportionality Test Directive can be found here: single-market-economy.ec.europa.eu/news/services-directive-handbookproportionality-test-directive-guidance-2022-12-22_en.

It should be noted that there are no plans in place to progress regulation of individual professions until appropriate risk-assessment and evaluation tools are in place in compliance with best practice, international evidence, and the Proportionality Test Directive.

Hospital Equipment

Questions (1332)

Paul Murphy

Question:

1332. Deputy Paul Murphy asked the Minister for Health if he will instruct his Department to increase funding for urology (details supplied); and if he will make a statement on the matter. [46359/24]

View answer

Written answers

Minister for Health

As this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy, as soon as possible.

Medicinal Products

Questions (1333)

Carol Nolan

Question:

1333. Deputy Carol Nolan asked the Minister for Health if concerns regarding the lack of supply for a certain medicine (details supplied) will be addressed; and if he will make a statement on the matter. [46362/24]

View answer

Written answers

Minister for Health

Evorel 25 micrograms/24 hours transdermal patch does not have a marketing authorisation in Ireland, via the Health Products Regulatory Authority (HPRA), or in Europe, via the European Medicines Agency (EMA), therefore making it an unlicensed medicinal product (ULM), otherwise known as an exempt medicinal product (EMP). An exempt product may not be prescribed or supplied in situations where an authorised equivalent (i.e. same active substance(s), strength and dosage form) is available in Ireland.

This is likely the route by which your constituent received Evorel 25 mcg transdermal patches.

What is an Exempt Medicinal Product:

There is a mechanism in Ireland that allows for the supply of unauthorised medicines: the Exempt Medicinal Product route. EMPs can be supplied in response to a bona fide unsolicited order, formulated in accordance with the specifications of a practitioner for use by their individual patients on their direct personal responsibility to fulfil the special needs of those patients.

The legislation underpinning EMPs is set out in Schedule 1 of the Medicinal Products (Control of Placing on the Market) Regulations, 2007, as amended, and also in the Medicinal Products (Control of Wholesale Distribution) Regulations, 2007, as amended. If a valid prescription is issued for an EMP in line with the above Regulations, an appropriately authorised wholesaler can source that product from another market for supply to the patient via their pharmacy in line with that prescription. Paragraph 2 of Schedule 1 of the Control of Placing on the Market regulations refers to a personal responsibility undertaken by the prescriber when prescribing an EMP.

As EMPs have not been granted a marketing authorisation in Ireland by the HPRA, they would not be assessed by the HPRA for quality, safety or efficacy. If sourced in response to a bona fide unsolicited order as a licensed product from another market these medicines will have undergone an evaluation of their safety, quality, and efficacy for the granting of their marketing authorisation in that country, carried out by the respective competent authority for medicines in that state.

Reimbursement of Exempt Medicinal Products:

Your constituent also raised queries as to why they were charged for Evorel 25mcg separately to the Drugs Payment Scheme.

The Health Service Executive (HSE) has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drug schemes, in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013.

Reimbursement is for indications which have been granted market authorisation by the EMA or the HPRA. In line with the 2013 Act and the national framework agreed with industry, a company must submit an application to the HSE to have a new medicine added to the reimbursement list.

In making a relevant reimbursement decision, the HSE is required under the Act to have regard to a number of criteria including efficacy, the health needs of the public, cost effectiveness and potential or actual budget impact. HSE decisions on which medicines are reimbursed are made on objective, scientific and economic grounds, on the advice of the National Centre for Pharmacoeconomics (NCPE). I, as Minister for Health, have no role in these decisions.

Decision making power will remain with the HSE for HRT items on the reimbursement list in accordance with the 2013 Act for the HRT initiative.

The HSE further advise that an application for 25mcg estradiol patches can be made on an exceptional basis under Discretionary Hardship Arrangements for medical card holders and via DPS exceptional arrangements. All applications under these arrangements are reviewed on an individual patient basis. The HSE must be satisfied that the patient requires the item for clinical reasons, and that there is no item on the reimbursement list which is a suitable alternative for that patient. Patients can discuss this option with their healthcare professional.

Shortage of Evorel 50mcg:

As our medicines regulator, the HPRA, does not licence Evorel 25mcg, they do not have visibility of expected future supplies. However, the HPRA is aware of a shortage of Evorel 50 micrograms per 24 hours transdermal patches, which is a licensed product in Ireland (by the HPRA).

This shortage is reported as due to an unexpected increase in demand in Ireland, from information provided by Theramex Ireland Limited, the company responsible for supplying Evorel 50mcg. This shortage is expected to be resolved on 15th February 2025.

Ireland has a multi-stakeholder Medicines Shortages Framework in place, operated by the HPRA on behalf of the Department of Health. The framework aims to help prevent potential shortages from occurring and to reduce the impact of shortages on patients by coordinating the management of potential or actual shortages as they arise. Stakeholders in this framework include the HPRA, the Department, the HSE, healthcare professionals, manufacturers, wholesalers, patient representative groups and marketing authorisation holders.

Hospital Staff

Hospital Services

Questions (1340)

Darren O'Rourke

Question:

1340. Deputy Darren O'Rourke asked the Minister for Health the estimated cost of three additional "see and treat" gynaecology clinics. [46410/24]

View answer

Written answers

Minister for Health

The roll out of the Ambulatory Gynaecology Model of Care commenced in 2020. There are currently 16 ambulatory gynaecology clinics in operation nationwide, and five more in development.

The staffing model for ambulatory gynaecology clinics comprises consultant gynaecologists, advanced nurse practitioners, clinical specialist physiotherapists, nurses, administrators, and healthcare assistants. The exact model will depend on whether the clinic is Level 1 or Level 2.

Funding this year from the Women’s Health Taskforce will enable the establishment of a 21st ambulatory gynaecological clinic in Connolly Hospital. This will be a Level 2 clinic with five Whole-Time Equivalent (WTE) staff, comprising the following:

* 1 x Advanced Nurse Practitioner

* 1 x Clinical Specialist Physiotherapist

* 1 x Staff Nurse

* 1 x Health Care Assistant

* 1 x Grade V Administrator

The associated full-year cost for this staffing cohort is €401,478, including non-pay costs.

Nenagh’s ambulatory gynaecology clinic, established in 2022, is an example of a Level 1 clinic, with nine WTEs, comprising the following:

* 1 x Advance Nurse Practitioner

* 2 x Clinical Specialist Physiotherapist

* 1 x Clinical Nurse Specialist

* 1 x Enhanced Nurse (General)

* 3 x Health Care Assistant

* 1 x Grade V Administrator

The associated full-year cost for this staffing cohort is €589,455, including non-pay costs.

The development of any new ambulatory gynaecology clinic requires the financial support of once-off set-up costs. The exact capital figure investment required per clinic is site specific. Set up costs have ranged from €50K for Waterford to €870K for Drogheda. Total Capital investment has been €6.598m to date.