Written Answers Nos. 1052-1074
1052. Deputy Rose Conway-Walsh asked the Minister for Health the number of consultant neurologists working in the public health service; her plans to expand this number; the international recommended best practice ratio for consultant neurologist to population; and Ireland’s current ratio. [72217/25]
View answerAs this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.
1053. Deputy Rose Conway-Walsh asked the Minister for Health the number of hip replacement surgeries carried out at Mayo University Hospital in the years 2024 and to date in 2025. in tabular form. [72218/25]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1054. Deputy Rose Conway-Walsh asked the Minister for Health the addiction services that are available in Mayo for young people and children aged under 18; the number of patients serviced; and the current waiting list for these services. [72219/25]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
1055. Deputy Pádraig O'Sullivan asked the Minister for Health if her Department carried out an assessment of the financial or clinical impact of introducing a blister pack charge, particularly for older people; and if she will make a statement on the matter. [72225/25]
View answer1079. Deputy Shónagh Ní Raghallaigh asked the Minister for Health if she plans to restore State-subsidised blister packs for older, vulnerable patients; and if she will make a statement on the matter. [72275/25]
View answer1096. Deputy Duncan Smith asked the Minister for Health the reason the HSE will no longer be providing blister packs to patients; and if she will make a statement on the matter. [72322/25]
View answer1113. Deputy Mark Wall asked the Minister for Health if she will consider funding for blister packs, given the cost that these packs will now have for the most vulnerable in our communities; and if she will make a statement on the matter. [72416/25]
View answerI propose to take Questions Nos. 1055, 1079, 1096 and 1113 together.
Monitored Dosage Systems (MDS), known as “blister packs” or compliance aids, are systems that enable the individual medicine doses for any medication to be organised according to the prescribed dose schedule. These are ordinarily provided once a month and packaged to indicate when medication should be taken.
The State has never agreed to fund this and there has never been a fee associated with monitored dosage systems under the Pharmacy contract. This has always been the case and has been repeated in several HSE circulars to pharmacists.
I recognise that for certain patients, or their carers, the use of blister packs to simplify adherence with their dosage schedule can be helpful and they rely heavily on the provision of these products.
However, it is important to recognise that phased dispensing and blister packing are not the same thing. The State funds phased dispensing for medical card holders. It does not, however, fund MDS (blister packs).
The community pharmacy contract has supported phased dispensing since 1996 for patient safety reasons and will continue to do so. Phased dispensing requires the patient to present to the pharmacy on multiple occasions in the month (e.g., each week) when it would be unsafe for the patient to receive the totality of their medication in one supply occasion, or if the shelf life of the medicine requires it. Community pharmacies receive additional fees for this service – which has only ever been in place for medical card holders.
The changes agreed under the Community Pharmacy Agreement – now paused until later in quarter 1 2026 – will introduce improved controls to align phased dispensing to specified high risk drugs, where a patient safety concern may exist. This will ensure that patients on high-risk medicines, such as anti-psychotics or opioids, are appropriately targeted with support.
Psychotropic medications represent a class of medication that are high risk, have a high dependency potential, and carry a significant risk of misuse. They are often prescribed in the management of conditions where cognitive or functional impairments justify closer monitoring through phased supply.
The State has not imposed a new charge on MDS, also known as “blister packs”. This remains a private service provided by pharmacies. It is also understood that different approaches are taken by community pharmacies in respect of funding the use of MDS for medical card holders:
• Some have been blister packing their patient’s medicines for free,
• Some have been charging the patient privately for providing that service, and,
• Some have submitted claims for phased dispensing to the HSE when in reality they were using MDS. The State has never agreed to this last practice, and it is inappropriate claiming to do so.
It remains open to pharmacies to charge patients or not for the use of MDS as a private service, as many currently do. It is important where a pharmacy charges a fee for any professional service, that they provide updated information to patients in line with the new Pricing Transparency Guidelines, which came into effect on 1 December 2025.
In addition, community pharmacies can, and do, use a variety of means to assist their patients including:
• counselling,
• reminder charts,
• the “Know Check Ask system” with the HSE, and
• tools like picture or large-print labels and alarms.
All of these are aimed at improving understanding and adherence to medication. This remains a key part of the service and support that pharmacies provide to patients. There is no change in that regard.
The HSE Health App ‘My medicines list’ provides a secure place for patients to record a list of their medicines, which can be useful for pharmacy or hospital visits. It also allows people to see a list of their medicines received through the Drugs Payment Scheme or Medical Card Scheme. Keeping a list can help patients know their medicines. It can also help when patients are discussing their medicines with a healthcare professional.
These measures can assist older people, people with disabilities, and people with multiple conditions, to ensure that they manage their medicines safely. Patients should talk to their pharmacist directly about the best way to manage their medicines.
The new Community Pharmacy Agreement 2025, which was negotiated by the Department of Health, the Health Service Executive, and the Irish Pharmacy Union, was published in September 2025. The Agreement is supported by a €75 million new investment across 2025 and 2026.
The Agreement reiterated the long-standing position of the State that MDS (“blister packs”), were not reimbursable under the General Medical Services (GMS) Scheme, or any other State scheme.
In addition, funding released by implementation of improved controls around the phased dispensing of high-risk medicines are committed for reinvestment back into community pharmacy and patient services. Phased dispensing is available – under certain criteria – to those with medical card eligibility and this will remain the case.
Under the landmark Agreement, a new Strategic Collaboration Group will be established in early 2026 to provide a structured forum for joint consideration of strategic issues shaping the future of community pharmacy in Ireland. A key pillar of this is a dedicated fund allocated to progressing opportunities to improve or expand community pharmacy services in relation to medicines optimisation. This new structured collaborative process will help to design and deliver evidence-informed high impact medicines optimisation services to patients and support future opportunities for service investment.
1056. Deputy Ken O'Flynn asked the Minister for Health the number of applications for a full medical card from persons aged 70 years and over that were refused in each of the years 2020 to 2025, and the income thresholds applied in each year that formed the basis for refusal. [72240/25]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1057. Deputy Ken O'Flynn asked the Minister for Health the median and upper-quartile income of applicants aged 70 years and over who were refused a Medical Card in each of the years 2020 to 2025, and the proportion whose means exceeded the threshold by fifty euro per week or less. [72241/25]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1059. Deputy Ken O'Flynn asked the Minister for Health if her Department has assessed whether the continued rise in GP Visit Cards issued automatically to applicants aged 70 years and over indicates unmet need for full medical card coverage within this population; and the actions taken in response at policy level. [72243/25]
View answerMedical Card provision is primarily based on financial assessment. In accordance with the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE, which assesses each application on a qualifying financial threshold. This is the amount of money that an individual can earn a week and still qualify for a card. It is specific to the individual’s own financial circumstances.
Persons aged 69 and under are assessed under the general means tested medical card thresholds which are based on an applicant’s household income after tax and the deduction of PRSI and the Universal Social Charge. Certain expenses are also taken into account. Detailed guidelines are available at: www2.hse.ie/services/schemes-allowances/medical-cards/applying/assessment/
Persons aged 70 or older are assessed under medical card income thresholds which are based on gross income. However, it should be noted that those aged over 70 can also be assessed under the general means tested scheme where there are particularly high medical costs.
Medical card holders are eligible for a range of services including general practitioner services from a participating family doctor (GP), approved prescribed drugs and medicines, public in-patient services in public hospitals, public hospital out-patient services, dental, ophthalmic and aural services. Apart from prescribed drugs and medicines, which are subject to a prescription charge, public health services are provided free of charge to medical card holders.
Information provided by the HSE indicates that there have been increases over recent years in the number of medical cards held by persons 70 years old and over, as outlined in the table below.
|
Year |
Number of Medical Cards held by 70-year-olds and over |
|
1 January 2020 |
359,427 |
|
1 January 2021 |
369,216 |
|
1 January 2022 |
375,937 |
|
1 January 2023 |
383,933 |
|
1 January 2024 |
391,239 |
|
1 January 2025 |
396,939 |
Separately, GP visit card holders are eligible for free visits to a participating general practitioner, removing cost as a potential barrier to GP access for many people. Since 2015, every individual aged 70 and over has automatic eligibility for a GP visit card, which has contributed positively towards an increase in the overall numbers of GP visit card holders for this cohort.
Furthermore, under the 2023 GP GMS Agreement, GP visit card eligibility was expanded in 2023 to all children under 8 years of age, and to all those who earn up to the median household income, which has resulted in an increase in the qualifying weekly financial thresholds for a GP visit card. Over 400,000 additional persons, who otherwise would have attended their GP on a private basis, are expected to become eligible for free GP care under this expansion.
It is important to acknowledge that the administration of the medical card exists within a wider eligibility framework, and that a range of other measures have also been implemented over recent years to help increase access to and the affordability of healthcare services, for example:
• under the Long-Term Illness Scheme, patients receive drugs, medicines, and medical and surgical appliances directly related to the treatment of their illness, free of charge.
• under the Drugs Payment Scheme (DPS) no individual pays more than €80 a month towards the cost of approved prescribed medicines. The DPS is not means tested and is available to anyone ordinarily resident in Ireland. The DPS significantly reduces the cost burden for families and individuals with ongoing expenditure on medicines.
• Public in-patient charges in public hospitals have been abolished.
• Individuals may also be entitled to claim tax relief on the cost of qualifying health expenses, including medicines prescribed by a doctor, dentist, or consultant. Relief is at the standard tax rate of 20%.
I can assure the Deputy that my Department keeps medical card issues under review in order to ensure the medical card system is responsive and sensitive to people's needs. There is a programme of work currently underway in my Department which is reviewing the existing eligibility framework, to clearly assess what is working well and to inform future policy proposals regarding the eligibility framework based on robust evidence. This is an important step towards delivering on universal healthcare in Ireland.
1060. Deputy Ken O'Flynn asked the Minister for Health if her Department has reviewed the administrative process required of persons aged 70 years and over when applying for a medical card, and whether any reforms are planned to streamline or reduce the documentation burden for older applicants. [72244/25]
View answerEligibility for a medical card is primarily based on a financial assessment which is conducted by the HSE in accordance with the Health Act 1970. The Act obliges the HSE to assess whether a person is unable, without due hardship, to arrange general practitioner and other medical services for himself or herself and his or her family, having regard to his or her overall financial position and reasonable expenditure.
Persons aged 70 or older are assessed under medical card income thresholds which are based on gross income. However, it should be noted that those aged over 70 can also be assessed under the general means tested scheme where there are particularly high medical costs. Furthermore, the Deputy may be aware that, since 2015, every individual aged 70 and over has automatic eligibility for a GP visit card.
Applications for a medical card and GP visit card can be made online at www.mymedicalcard.ie/. This is the quickest method of applying for a card. All of the required documentation that will assist in an application can also be uploaded along with the online application. Application forms are also available from local health centres or Local Health Offices for different areas.
The HSE strives to have an application process for medical cards which is as streamlined and straightforward as possible for all applicants. Assistance is available to persons completing application forms through the National Medical Card Unit and Local Health Offices if needed. Alternatively, an application form can be downloaded from the HSE’s website.
I can assure the Deputy that, to ensure the medical card system is responsive and sensitive to people's needs, my Department keeps medical card issues under review and any changes are considered in the context of Government policy and other issues which may be relevant.
1061. Deputy Ken O'Flynn asked the Minister for Health the current number of whole-time equivalent vacancies for social workers, social care workers and dietitians in the HSE South/South-West region; the average duration of these vacancies; and the projected contribution of apprenticeship schemes to reducing these vacancies in 2025 and 2026. [72250/25]
View answerAs this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.
1062. Deputy Ken O'Flynn asked the Minister for Health the cost per apprentice for social work, social care work and dietetics; the budget provided to support these apprenticeships in 2025 and 2026; and the assessment used to determine whether current intake levels are sufficient to meet workforce needs. [72251/25]
View answerAs this is an operational matter, this PQ has been referred to the HSE to respond.
1063. Deputy Ken O'Flynn asked the Minister for Health if her Department has set performance indicators or workforce targets for apprenticeships within the South/South-West region; and if so, the targets and the reporting schedule for monitoring progress. [72252/25]
View answerWe have asked the HSE to respond directly to the Deputy on this matter.
1064. Deputy Ken O'Flynn asked the Minister for Health if an evaluation has been carried out on the effectiveness of apprenticeships in retaining qualified staff in the region; and to provide the findings of any such evaluation. [72253/25]
View answerWe have asked the HSE to respond directly to the Deputy on this matter.
1065. Deputy Ken O'Flynn asked the Minister for Health the timeline for approval of the proposed social care worker apprenticeship; the planned intake numbers once approved; and how this aligns with projected shortages in disability services in the South/South-West. [72254/25]
View answerAs this is a service matter I have asked the HSE to respond to the deputy as soon as possible.
1066. Deputy Pádraig O'Sullivan asked the Minister for Health the number and grades of additional clinical staff identified as necessary to increase patient access to orthodontic services; when recruitment for these posts will commence; the projected impact this staffing increase is expected to have on current waiting lists; and whether funding for these additional posts has been ring-fenced; and if she will make a statement on the matter. [72257/25]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1067. Deputy Pádraig O'Sullivan asked the Minister for Health the details of the proposed once-off orthodontic grant of €3,000 for eligible patients; the criteria that will be used to determine eligibility; the way in which the allocation of the grant will operate in practice; whether this measure is intended to permanently supplement public capacity or serve as a temporary intervention to address waiting list pressures; and if she will make a statement on the matter. [72258/25]
View answer1068. Deputy Pádraig O'Sullivan asked the Minister for Health the way in which the proposed orthodontic grant will interact with the existing 20% tax relief on orthodontic treatment; if her Department has estimated the total net out-of-pocket cost remaining for families after both supports; whether measures are being considered for families who cannot claim tax relief due to low income or non-taxpayer status; and if she will make a statement on the matter. [72259/25]
View answer1069. Deputy Pádraig O'Sullivan asked the Minister for Health the reason 890 clients in Cork were awaiting home support at the end of October 2025, representing 3,130 hours of unmet need, including 543 awaiting a new home support service and 347 awaiting additional hours; the actions being taken by the HSE South West to address these delays; and if she will make a statement on the matter. [72260/25]
View answerAs this is an operational matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
1070. Deputy Pádraig O'Sullivan asked the Minister for Health the steps her Department is taking to address the recruitment and retention challenges for Health Care Assistant staff in Cork and Kerry, given the acknowledged impact on service delivery and waiting times; and if she will make a statement on the matter. [72261/25]
View answerAs this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.
1071. Deputy Pádraig O'Sullivan asked the Minister for Health the number of Health Care Assistants (Home Support) in Cork and Kerry in 2025; the number of candidates screened and appointed; the extent to which these campaigns will address the staffing shortages reported by the HSE Southwest; and if she will make a statement on the matter. [72262/25]
View answerAs this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.
1072. Deputy Pádraig O'Sullivan asked the Minister for Health the reason no autism diagnostic assessments are being conducted directly within primary care in the HSE Southwest; the reason a primary care autism team has not been established to provide this service; and if she will make a statement on the matter. [72263/25]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1073. Deputy Pádraig O'Sullivan asked the Minister for Health the cost of outsourcing autism diagnostic assessments in the HSE Southwest; the number of assessments delivered through private providers in each of the past three years; whether direct provision through a primary care team will reduce these costs; and if she will make a statement on the matter. [72264/25]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1074. Deputy Pádraig O'Sullivan asked the Minister for Health the staffing levels required to provide an in-house autism diagnostic service within primary care in the Southwest; whether recruitment for these posts has begun or is planned; and if she will make a statement on the matter. [72265/25]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
