Written Answers Nos. 413-426
413. Deputy Gerry Adams asked the Minister for Health further to Parliamentary Question No. 301 of 20 April 2016 the number of bariatric surgeries that have been performed by the HSE in 2016; and if he will make a statement on the matter. [14399/16]
Amharc ar fhreagraAs this is a service matter, I have asked the HSE to respond to you directly. If you have not received a reply from the HSE within 15 working days please contact my Private Office and my officials will follow the matter up.
414. Deputy Niamh Smyth asked the Minister for Health if the staffing deficits for obstetricians and midwives, identified in the 2015 review of maternity services at Cavan Monaghan Hospital, have been addressed; and if he will make a statement on the matter. [14403/16]
Amharc ar fhreagraAs this is a service matter, I have asked the HSE to respond to you directly. If you have not received a reply from the HSE within 15 working days please contact my Private Office and my officials will follow the matter up.
415. Deputy Niamh Smyth asked the Minister for Health the number of full-time obstetricians employed at Cavan General Hospital; the number of locum obstetricians in place; the number of midwives employed; and the midwife to birth ratio, for each of the years 2011 to 2015 and in 2016 to date, in tabular form. [14404/16]
Amharc ar fhreagraAs this is a service matter, I have asked the HSE to respond to you directly. If you have not received a reply from the HSE within 15 working days please contact my Private Office and my officials will follow the matter up.
416. Deputy Billy Kelleher asked the Minister for Health the specific changes to the misuse of drugs legislation that need to be put in place, to address the illegal sale of prescription drugs. [14405/16]
Amharc ar fhreagraThe supply of prescription medicines, including benzodiazepines, is controlled in a number of ways. Under the Medicinal Products (Prescription and Control of Supply) Regulations, it is prohibited for a person to supply a prescription medicine except in accordance with a prescription, and the supply must be made from a registered pharmacy by or under the personal supervision of a registered pharmacist. A person who contravenes these Regulations is guilty of an offence.
In addition, medicines which have a high potential to be misused are controlled under the Misuse of Drugs Acts. A person who has in his possession a prescription medicine containing a controlled drug under the Misuse of Drugs legislation for the purpose of selling or supplying it, is guilty of an offence under that legislation. A Bill to amend the Misuse of Drugs Act to bring a number of new substances, including certain prescription medicines, under the scope of that legislation is currently being drafted and it is the intention to publish it before the House rises for the summer.
Regulations will also be made to introduce substantial additional controls on certain prescription drugs being traded illicitly, such as benzodiazepines and z-drugs medicines. The planned measures include introducing import and export controls, tighter prescribing and dispensing controls as well as an offence of possession, thereby assisting the law enforcement roles of Customs and An Garda Síochána.
The Health Product Regulatory Authority which is the competent authority in Ireland for human medicines, Revenue’s Customs service and an Garda Síochána work closely to prevent the unauthorised flow of illegal medicinal products into and out of the State. The enforcement of the law relating to the sale of drugs, including prescription drugs, continues to be a priority in the Government’s commitment to tackling the issue of drug misuse in this jurisdiction.
417. Deputy Pearse Doherty asked the Minister for Health in relation to the register of nurses and midwives maintained by the Nursing and Midwifery Board of Ireland, NMBI, the number of applications which were received by the organisation in the past 12 months; the number of these for which the applicant has been successfully added to the register, following the completion of the registration process; the number of applications received during this period, which were later withdrawn by the applicant prior to the application having been formally assessed, as part of the initial stages of the registration process; the average number of weeks typically taken to fully evaluate an application, and to thus complete the registration process; and if he will make a statement on the matter. [14407/16]
Amharc ar fhreagraI wish to thank the Deputy for the matter raised.
Given that this is an operational matter, it is appropriate that it should be dealt with by the NMBI. I have referred the Deputy's question to the NMBI for attention and direct reply.
If you have not received a reply from the NMBI within 15 working days, please contact my Private Office and they will follow up the matter with them.
418. Deputy Michael Healy-Rae asked the Minister for Health the status of an application by a person (details supplied) for a medical card; and if he will make a statement on the matter. [14408/16]
Amharc ar fhreagraThe Health Service Executive has been asked to examine this matter and to reply to the Deputy as soon as possible.
The Health Service Executive operates the General Medical Services scheme, which includes medical cards and GP visit cards, under the Health Act 1970, as amended. It has established a dedicated contact service for members of the Oireachtas specifically for queries relating to medical cards and GP visit cards, which the Deputy may wish to use for an earlier response. Contact information has recently issued to Oireachtas members.
If the Deputy has not received a reply from the HSE within 15 working days, please contact my Private Office who will follow up the matter with them.
419. Deputy Billy Kelleher asked the Minister for Health the number of midwives in each public and voluntary hospital that provide maternity services for the end of 2015 and the latest figures available in 2016 in tabular form [14409/16]
Amharc ar fhreagraI have asked the HSE to respond to the Deputy directly on this matter. If you have not received a reply from the HSE within 15 working days please contact my Private Office and they will follow up the matter with them.
420. Deputy Billy Kelleher asked the Minister for Health the number of obstetricians, whole-time equivalent, employed in each of the 19 maternity units nationwide (details supplied); and the number of locum appointments for the end of 2015 and the latest figures available for 2016 in each hospital in tabular form. [14410/16]
Amharc ar fhreagraI have asked the HSE to respond to the Deputy directly on this matter. If you have not received a reply from the HSE within 15 working days please contact my Private Office and they will follow up the matter with them.
421. Deputy Kevin O'Keeffe asked the Minister for Health the funding available from his Department or the Health Service Executive for specific rehabilitation (details supplied) and the guidelines on same. [14411/16]
Amharc ar fhreagraAs this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.
If the Deputy has not received a reply from the HSE within 15 working days he should contact my Private Office and they will follow up the matter with them.
422. Deputy Billy Kelleher asked the Minister for Health if he is aware of the recommendations contained in the recent UK Government report authored by Lord O’Neill on antimicrobial resistance, AMR; his plans to introduce the key recommendations contained in the report; if he is satisfied that Ireland’s AMR policy is robust enough to meet the huge challenge of AMR and with the situation that Ireland, unlike the UK, does not have set targets for the reduction of usage and or prescribing of antibiotics in health care settings such as hospitals or primary care; and if he will make a statement on the matter. [14416/16]
Amharc ar fhreagraThe Report Chaired by Lord O'Neill which was published on 19 May 2016, is welcomed by Ireland and is a valuable addition to the serious debate on the worldwide threat of antimicrobial resistance (AMR).
Lord O'Neill's concerns about both the human and economic costs of increasing resistance to often life saving treatment in the form of antibiotics is a matter which is being addressed at international, EU and national levels. The Report’s recommendations on reducing demand for antimicrobials, improving global surveillance of drug resistance and antimicrobial consumption in humans and animals are in line with the World Health Organisation’s Global Action Plan on Antimicrobial Resistance, which Ireland supports.
Ireland, through membership of the World Health Organisation, is part of the international effort aimed at tackling the global public health threat of AMR, which requires action across human and animal health sectors, agriculture and the wider environment.
In May 2015, at the WHO 68th World Health Assembly the final WHO Global Action Plan was endorsed. It sets out five strategic objectives:
(1) to improve awareness and understanding of antimicrobial resistance;
(2) to strengthen knowledge through surveillance and research;
(3) to reduce the incidence of infection;
(4) to optimise the use of antimicrobial agents; and
(5) develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.
Through adoption of the Global Action Plan, governments committed to have in place, by May 2017, a national action plan on antimicrobial resistance that is aligned with the global action plan. This national plan needs to cover the use of antimicrobial medicines in animal health and agriculture, as well as for human health. WHO will work with countries to support the development and implementation of their national plans, and will report progress to the World Health Assembly in 2017.
In recognition of the serious and increasing threat of antimicrobial resistance and the requirement for a ‘whole of Government’ approach to health issues, the Department of Health’s Chief Medical Officer (CMO) and the Department of Agriculture, Food and the Marine’s Chief Veterinary Officer (CVO) established, with Ministerial approval, a high level National Interdepartmental AMR Consultative Committee to address this issue. The Committee meets Ireland’s requirements to have an Intersectoral co-ordinating mechanism for addressing AMR at European level.
The Committee has a clear role and mandate across the human and animal health sectors. Committee membership consists of representatives of both Departments and of the relevant HSE and veterinary specialist agencies, including other relevant bodies with a remit across the two sectors; membership is representative of major stakeholders. The Committee meets bi-annually and its most recent meeting took place on 13 April last. The Committee agreed as a key action for 2016 the development of Ireland’s AMR national action plan, aligned to the WHO Global Action Plan.
In addition, the prevention and control of healthcare associated infections (HCAIs) and AMR has been a significant, long-standing patient safety and public health priority for the Department of Health for many years. A wide range of initiatives has been put in place in the Irish health system in response to the rising incidence of AMRs including improved surveillance of infections and prescribing, infection prevention and control processes, antimicrobial stewardship initiatives and public and professional awareness raising, with a significant emphasis on the education and training of healthcare professionals.
Ireland is fully committed to and engaged in addressing resolution of the problem of AMR and will continue to collaborate at international, EU and national levels to this end. Ireland contributes reporting to the European Antimicrobial Resistance Surveillance System.
423. Deputy Billy Kelleher asked the Minister for Health the number of persons or incidents, if any, where antimicrobial resistance has occurred within the health care services over the past ten years; the hospitals which treated these patients and the measures being undertaken to address this issue; and if he will make a statement on the matter. [14417/16]
Amharc ar fhreagraThe rise in antimicrobial resistance (AMR) is recognised at global, European and national levels, including Ireland, as one of the greatest potential threats to human and animal health with possible serious consequences for public health, animal welfare and the agriculture and food sectors.
The emergence of resistance is a normal biological phenomenon but is increased through the overuse and misuse of antimicrobials in human and animal medicine. While most bacteria are effectively killed by antibiotics, certain types of bacteria possess the capacity to develop resistance to certain antibiotics whereby they are less effective and in the worst case scenario, no longer work against bacterial infections. The spread of these resistant strains is further increased, however, through poor hygiene practices and increased global travel and trade. There are also increasing concerns about the potential for spread of antimicrobial resistance in food and environmental pollution with antimicrobials e.g. through water contamination and agricultural run-off.
In Ireland AMR in key clinically important bacteria known to cause potentially serious infections, such as bloodstream infection, (BSI) has been systematically monitored over the past decade by Irish microbiology laboratories serving all acute hospitals. There has been almost complete reporting of AMR data on BSI to the Health Service Executive's Health Protection Surveillance Centre (HPSC) where data is analysed and reported back directly to participating laboratories and hospitals on a quarterly basis. HPSC also published reports on the latest available national BSI AMR surveillance data and hospital level AMR surveillance data on its website at:
htp://www.hpsc.ie/A-Z/MicrobiologyAntimicrobialResistance/InfectionControlandHAI/Surveillance/HPSCSurveillance/ andhttp://www.hpsc.ie/A-Z/MicrobiologyAntimicrobialResistance/EuropeanAntimicrobialResistanceSurveillanceSystemEARRS/ReferenceandEducationalResourcematerial/SaureusMRSA/LatestSaureusMRSAdata/.
The prevention and control of healthcare associated infections (HCAIs) and AMR continues to be a significant, long-standing patient safety and public health priority for the Department of Health. A wide range of initiatives has been put in place in the Irish health system over several years in response to the rising incidence of AMRs. These include:
- improved surveillance of infections and prescribing;
- infection prevention and control processes;
- antimicrobial stewardship initiatives;
- public and professional awareness raising, with a significant emphasis on the education and training of healthcare professionals;
- currently reviewing and updating of National Clinical Effectiveness Committee (NCEC) national Guidelines on MRSA (2013) and Clostridium difficile (2014) for healthcare professionals;
- currently reviewing and updating of HIQA's National Standards for the Prevention and Control of Healthcare Associated Infections (HCAIs) (2009).
Ireland also fully supports the World Health Organisation (WHO) Global Action Plan on Antimicrobial Resistance and through the Interdepartmental AMR Consultative Committee, established and co-chaired by the Chief Medical Officer of this Department and the Chief Veterinary Officer of the Department of Agriculture, Food and the Marine and endorsed by both respective Ministers, is addressing the WHO's requirement for all countries to have in place an Intersectoral co-ordinating Mechanism to develop a national action plan against AMR to encompass both the human and animal sectors, agriculture and the wider environment. The Committee was launched on European Antibiotic Awareness Day in November 2014 and has a clear role and mandate across the human and animal health sectors. Committee membership consists of representatives of both Departments and of the relevant HSE and veterinary specialist agencies, including other relevant bodies with a remit across the two sectors; membership is representative of major stakeholders. The Committee meets bi-annually and its most recent meeting took place on 13 April 2016.
A key action for the Committee's work during 2016 is the development of Ireland's AMR national action plan in order to have in place, by May 2017, a national action plan on AMR that is aligned with the WHO's Global Action Plan. This plan will cover the use of antimicrobial medicines in animal health and agriculture, as well as for human health. The WHO is working with countries to support the development and implementation of their national plans, and will report progress to the World Health Assembly in 2017.
Ireland is fully committed to and engaged in addressing resolution of the problem of AMR and will continue to collaborate at international, EU and national levels to this end. Ireland also supports and has actively engaged on the European Commission's Draft Council Conclusions on AMR which will be presented for adoption to the Ministerial meeting of EPSCO (Employment, Social Policy, Health and Consumer Affairs) on 17th June 2016; this document will call on Member States and the European Commission to develop a new and comprehensive EU Action Plan on AMR.
424. Deputy Billy Kelleher asked the Minister for Health when he expects legislation on health insurance, specifically to provide insurers with legal clarity to facilitate insurers when withdrawing products from the market and protection to consumers where benefits are continuously changed; and if he will make a statement on the matter. [14418/16]
Amharc ar fhreagraOur system of community-rated private health insurance is underpinned by a Risk Equalisation Scheme (RES). Under the RES, insurers receive risk equalisation credits to compensate for the additional cost of insuring older and less healthy members, which are funded by stamp duty levies payable by open market insurers in respect of each insured life covered. Legislation is required each year to revise the applicable risk equalisation credits and the corresponding stamp duty levies necessary to fund them.
As part of the development of the Health Insurance (Amendment) Bill 2016, the main purpose of which is to provide for revised RE credits and stamp duties payable, it is proposed that the legal basis to facilitate the formal withdrawal of health insurance products will be clarified. Subject to government approval, the Health Insurance (Amendment) Bill 2016 will be drafted with a view to enactment by end of 2016.
425. Deputy Billy Kelleher asked the Minister for Health his plans to publish the Health Insurance Authority report on reform of minimum benefits provided for as part of health insurance cover; if not, why not; if he will outline the timeline for the introduction of this legislation; and if he will make a statement on the matter. [14419/16]
Amharc ar fhreagraUnder the Minimum Benefit Regulations, 1996, all health insurance products that provide cover for in-patient hospital treatment must provide a certain minimum level of benefits. The key purpose of the Regulations is to ensure the continued availability of the type of broad hospital cover traditionally held as a minimum by the insured population and to ensure that individuals do not significantly under-insure.
In June 2010, the Minister for Health asked the Health Insurance Authority (HIA) to consult with stakeholders in relation to minimum benefits to be provided by insurers. In July 2010, the Authority published its Consultation Paper and interested parties were invited to make submissions. The Authority subsequently submitted a report to the Minister which considered the costs, benefits and impacts of various different options for Minimum Benefits, having regard to the submissions received.
Earlier this year my Department requested the HIA to review the 2010 report, taking account of the current health insurance market and significant developments which have taken place in recent years. The HIA has recently provided my Department with a short analysis paper to inform the Department’s decision making. This paper is under consideration in my Department, in the context of broader health policy of the Government.
426. Deputy Billy Kelleher asked the Minister for Health if he is committed to the introduction of a system of diagnostic-related group data as a measure of health status for health insurance; if so, the measures he has undertaken to progress this initiative; if he has engaged with insurers on this issue; when was the last time this issue was discussed between his Department and insurers; the reasons for the delay in introducing this system which is commonplace in many countries; if he will commit to a timeline for its introduction; and if he will make a statement on the matter. [14420/16]
Amharc ar fhreagraOur system of community rated private health insurance is underpinned by a Risk Equalisation Scheme. Under the scheme, insurers receive risk equalisation and hospital utilisation credits to compensate for the additional cost of insuring older and less healthy members, which are funded by stamp duty levies payable by insurers in respect of each insured life covered.
Risk equalisation credits are paid on the basis of age, gender and type of cover. Since 1 March 2016 the hospital utilisation credits paid to insurers have been expanded to include all day case admissions to hospital, in addition to the existing utilisation credit payable for all overnight stays. This enhancement to the scheme increases the support provided for less healthy people of all ages. It also supports the provision of clinically appropriate treatment on a day case basis.
I support in principle the introduction of a refined health status measure for risk equalisation based on diagnosis-related groups (DRGs). The introduction of a DRG-based health status measure will target support more accurately in respect of less healthy insured members of all ages and will facilitate a better understanding of the extent to which differences in claims costs between insurers are driven by differences in the underlying risk profile of their members. Both consumers and efficient insurers will benefit from a more robust system of risk equalisation. In 2014 the Health Insurance Authority prepared a report which set out the necessary steps, time frames and additional resource requirements for incorporating DRGs into the Risk Equalisation Scheme. My Department will publish a redacted version of the report on its website this week.
A key requirement is collection of and access to the necessary data from both public and private hospitals. A DRG system has been operational in Irish public hospitals for over 20 years which groups all inpatient and daycase activity for each hospital into DRGs which are clinically similar and require similar health resources. Using DRG data for risk equalisation will require the collection and coding of all hospital activity data for both public and private hospitals under the Hospital Inpatient Enquiry (HIPE) system overseen by the Healthcare Pricing Office (HPO) of the HSE. In April 2015 my Department asked insurers to submit proposals on how best to progress this matter and to encourage private hospitals to begin collecting this data.
As part of the Government’s Health Reform Program one of the priorities for my Department and the HSE (including the HPO) is the roll out of Activity Based Funding (ABF) in line with the Government’s policy and the ABF Implementation Plan 2015-2017. This entails switching to ABF funding for inpatients and daycases for public patients in public hospitals and the development of a classification system for outpatients. As indicated in the Plan, the roll out of ABF will take a number of years to implement. The use of HIPE in relation to other policy developments will have to be considered in light of resources available and the priorities I have outlined in relation to the ABF Program.
