Thursday, 7 Nov 2024

General Practitioner Services

Ceisteanna (523)

Colm Brophy

Ceist:

523. Deputy Colm Brophy asked the Minister for Health the estimated cost of increasing supports to GPs in areas of deprivation by 10%. [45916/24]

Amharc ar fhreagra

Freagraí scríofa

The 2019 GP Agreement provides for an annual support grant for GP practices in urban areas of social deprivation. The grant may be used by practices to provide additional health services to patients based on identified patient needs.

The urban social deprivation grant has an annual budget allocation of €2 million. As per the HSE Primary Care Reimbursement Service (PCRS) annual report for 2023, funding provided under the urban social deprivation grant last year amounted to approximately €3.1 million. Accordingly, based on this figure, increasing the funding amount provided to GP practices under the urban social deprivation grant by 10% would cost approximately an additional €310,000 per annum.

General Practitioner Services

Ceisteanna (524)

Colm Brophy

Ceist:

524. Deputy Colm Brophy asked the Minister for Health the estimated cost of providing two free visits for women experiencing menopause. [45917/24]

Amharc ar fhreagra

Freagraí scríofa

Minister for Health

We have developed six specialist clinics nationwide, one in each maternity network, for women who require complex, specialist care. All six clinics are operational, in the National Maternity Hospital, Nenagh Hospital, the Rotunda, the Coombe, Galway and Cork.

While the majority of women who seek support for their menopause can be effectively supported within primary care by their GP, a proportion of symptomatic women will require specialist medical expertise in menopause. It is intended that these more complex cases can be dealt with, upon referral by their GP, in one of the six specialist menopause clinics.

These specialist menopause clinics are provided in the public health service, free of charge. All six specialist menopause clinics are being provided as a public outpatients service and can be accessed by GP referral only.

General Practitioner Services

Ceisteanna (525)

Colm Brophy

Ceist:

525. Deputy Colm Brophy asked the Minister for Health the cost of providing for 10 HSE-employed GPs. [45918/24]

Amharc ar fhreagra

Freagraí scríofa

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.

General Practitioner Services

Ceisteanna (526)

Colm Brophy

Ceist:

526. Deputy Colm Brophy asked the Minister for Health the cost of increasing funding to the general practitioner access to community diagnostics scheme by 10%. [45919/24]

Amharc ar fhreagra

Freagraí scríofa

Minister for Health

The nationwide GP Access to Community Diagnostics programme (GPACD), which began accepting referrals in January 2021, facilitates direct referral by General Practitioners to diagnostics services for their patients.

Minister for Health (Deputy Stephen Donnelly)

In line with Recommendation 12 of the National Cancer Strategy 2017-2026, the National Cancer Control Programme (NCCP) developed and launched the National Model of Care for Psycho-Oncology Services for Children, Adolescents and Young Adults (CAYA) with Cancer. This model of care focuses on supporting children and young adults, as well as their families, with the psychological impact of a cancer diagnosis and provides for patient pathways to accessing appropriate care at all stages of their cancer diagnosis and treatment.

Implementation of the model of care is ongoing. Funding allocated for the implementation of the National Cancer Strategy in 2022 included €1.5 million for psycho-oncology and CAYA services more generally, enabling the recruitment of an additional 15 staff to these services.

The NCCP is progressing a comprehensive assessment of current resources in the CAYA network. This assessment will ascertain the additional dedicated staff required across disciplines including psychology, neuropsychology, social work, nursing, play and music therapy, occupational therapy, and psychiatry.

In Budget 2025, €23 million has been secured for the National Cancer Strategy, including access to new cancer medicines, expansion of cancer screening, funding for community cancer support centres, and implementation of the National Cancer Strategy. This will mean over €105 million has been invested into the Strategy since 2017.

Funding to date has enabled the recruitment of more than 670 staff to our national cancer services since 2017, including an additional 200 nursing staff, 100 consultants, and 180 health and social care professionals in designated cancer centres. Investment in 2025 will provide an additional 179 staff for national cancer screening and treatment services. This includes funding for CAYA services and will support the continued implementation of the CAYA Psycho-oncology Model of Care and the National Cancer Control Programme’s (NCCP) A Framework for the care and Support of Adolescent and Young Adults (AYA) with cancer in Ireland 2021 to 2026. Under this Framework, three AYA cancer hubs have been established, based at St James’s Hospital, University Hospital Galway, and Cork University Hospital.

These initiatives under the National Cancer Strategy allow us to address the specific needs of children and young adults with cancer and we will continue to improve the services available to them.

Cancer Services

Ceisteanna (532)

Colm Brophy

Ceist:

532. Deputy Colm Brophy asked the Minister for Health the estimated cost of providing equitable universal access to hairpieces and post- mastectomy products including prostheses and specialised bras at the highest rates currently available. [45925/24]

Amharc ar fhreagra

Freagraí scríofa

Minister for Health

The Health Service Executive (HSE) provide an extensive range of aids and appliances under the Community Funded Schemes to individuals living with a wide variety of different medical conditions.

An allowance toward the cost of post-mastectomy products and hair loss products following cancer related treatment has been provided in the past, but there has been variation in the provision across the country.

The estimated cost of providing equitable universal access to such products at the highest rates currently available is €2m.

€2m has been allocated in Budget 2025 to ensure that provision is standardised at the highest level currently available, to all women across the country, regardless of eligibility status.

Cancer Services

Ceisteanna (533)

Colm Brophy

Ceist:

533. Deputy Colm Brophy asked the Minister for Health the estimated cost of increasing funding to cancer survivorship programmes by 10%. [45926/24]

Amharc ar fhreagra

Freagraí scríofa

Minister for Health (Deputy Stephen Donnelly)

Maximising the quality of life of those living with and beyond cancer is one of the four pillars of the National Cancer Strategy 2017-2026.

Recommendations in the current Strategy aim to further survivorship supports and services in cancer care in Ireland. This includes the establishment of psycho-oncology services, provision of treatment summary and care plans, and the development of survivorship programmes. In tandem with these developments, in line with recommendation 41 of the Strategy, The National Cancer Survivorship Needs Assessment was carried out and published in 2019. Findings from this assessment have informed the development of survivorship supports.

Survivorship supports are delivered in different settings, such as hospitals, primary care, and in the community, and vary depending on the needs of those availing of these supports. The National Cancer Control Programme (NCCP) has developed and progressed survivorship supports and services. These include the Stratified Self-Managed Follow Up Framework and associated pathways and Treatment Summary & Care Plans for patients, which are presently available to prostate cancer patients work underway to expand this to other tumour types. Survivorship programmes have also been developed by the NCCP for use in Ireland, including Cancer Thriving and Surviving, and the CLIMB programme. These programmes are often delivered in the community in Community Cancer Support Centres.

Community cancer support centres are recognised in the Strategy as a valuable resource, providing access to support to cancer patients and their families outside of the acute care setting. The works closely with a network of Community Cancer Support Centres, particularly in regard to the psycho-oncology model of care and the implementation of survivorship programmes for those living with and beyond cancer.

Community cancer support centres are voluntary and charity organisations delivering services directly to cancer patients and their families that emphasise the importance of quality of life during and after cancer treatment. These services can be availed of free of charge and in local communities. The NCCP Revised Best Practice Guidance for community cancer support centres was published in March 2022. The Alliance of Community Cancer Support Centres was also established in 2022. The Alliance is a HSE initiative which aims to develop a collaborative framework for community-based cancer support centres and services. This programme promotes participation in capacity-building activities and communication and networking forums aimed at ensuring that community-based cancer support services are integrated.

In Budget 2025, I secured €23 million for the National Cancer Strategy, including access to new cancer medicines, expansion of cancer screening, and implementation of the National Cancer Strategy. This will mean over €105 million has been invested into the Strategy since 2017. Funding will support new posts which will in turn expand and deliver on existing survivorship supports.

Within the investment secured for 2025 is €5.5 million which will be allocated to Community Cancer Support Centres. This is on the back of an investment in 2024 of €3 million to the Alliance of Community Cancer Support Centres, which directly supported survivorship programmes for adults and children, lymphoedema therapy, and other important services in communities throughout Ireland.

Health Services

Ceisteanna (534)

Colm Brophy

Ceist:

534. Deputy Colm Brophy asked the Minister for Health the estimated cost of increasing funding to the national strategy for accelerating genetic and genomic medicine in Ireland by 10%. [45927/24]

Amharc ar fhreagra

Freagraí scríofa

Minister for Health

Since 2023 the implementation of the National Strategy for Accelerating Genetic and Genomic Medicine in Ireland has been allocated €2.7 million annually. A 10% costing increase would amount to €270,000.

Health Services

Ceisteanna (535)

Colm Brophy

Ceist:

535. Deputy Colm Brophy asked the Minister for Health the estimated cost of five ‘see and treat’ gynaecology clinics. [45928/24]

Amharc ar fhreagra

Freagraí scríofa

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.

Mental Health Services

Ceisteanna (536)

Colm Brophy

Ceist:

536. Deputy Colm Brophy asked the Minister for Health the estimated cost of providing a mother and baby unit for mothers who require inpatient mental health supports. [45929/24]

Amharc ar fhreagra

Freagraí scríofa

Minister of State at the Department of Health

The Model of Care for Specialist Perinatal Mental Health Services (SPMHS) was launched in 2017, adopting a hub and spoke model. Services are now available in all 19 maternity hospitals nationwide. There are 6 consultant-led multidisciplinary hub sites and 13 spoke sites, staffed by Perinatal Mental Health Midwives. Overall funding for this programme to-date is €3.5m.

A key element of the Model of Care is the Mother and Baby Unit, and progressing the Unit is a priority for me, the Department of Health and the HSE. The HSE is currently preparing a feasibility study on the building of a Unit at the Elm Park site at St. Vincent's University Hospital in Dublin. I expect this to be finalised in the near future. This would include all relevant estimated costs and timescales for the Unit.

I can also advise that a Steering Group has been established to refresh the Model of Care, and the Department of Health is currently considering issues raised separately in the National Women’s Council (NWC) report on Perinatal Mental Services. The Department will work closely with the HSE to strengthen the Model of Care where required, and to address gaps highlighted by the report.

As the estimated cost of providing a Mother and Baby Unit would be a matter for the HSE, I have asked the Executive to reply direct to the Deputy on this matter.

Health Services

Ceisteanna (537)

Colm Brophy

Ceist:

537. Deputy Colm Brophy asked the Minister for Health the estimated cost of providing five postnatal hubs. [45930/24]

Amharc ar fhreagra

Freagraí scríofa

Minister for Health

The 2022 Women's Health Action Plan and the National Maternity Strategy 2016-2026 call for a coordinated approach to support postnatal women and new babies in the community. The National Maternity Experience Survey has shown that improving postnatal care is a priority for women. Since 2022, significant investment has been directed into piloting and establishing a national network of Postnatal Hubs. Five Hubs are already operational, with four more currently in development. Budget 2025 will provide four more Hubs, bringing the national network to 13.

These Hubs provide essential care for women in the community and closer to home in the weeks after birth. Women who have attended this service have reported how much they value the additional support, including hotlines, birth reflections, and physiotherapy.

To initiate the first two Postnatal Hubs, in 2022 €0.9 million was allocated through the Women's Health Fund. In the same year, this Government provided unprecedented funding of €8.7 million for the National Maternity Strategy, through which three further Postnatal Hubs were funded. A total of five Postnatal Hubs were open by the end of 2023 in Cork, Kerry, Portiuncula, Sligo and Carlow-Kilkenny. €0.4 million was allocated in 2024 to establish four more Postnatal Hubs, with a full year cost of €1.9 million in 2025. This Government is investing an additional €2.0 million in the National Maternity Strategy in Budget 2025, which includes €0.9 million to open four further Postnatal Hubs.

On this basis, the estimated Full Year Cost to establish five additional Postnatal Hubs would be €2.3 million.

These costs may be subject to inflationary increase. A review is ongoing into the first pilot Postnatal Hubs, which may also have implications for the projected costs in the future.

Health Services

Ceisteanna (538)

Colm Brophy

Ceist:

538. Deputy Colm Brophy asked the Minister for Health the estimated cost of providing five menopause clinics and increase the hours of all such clinics by one additional hour. [45931/24]

Amharc ar fhreagra

Freagraí scríofa

Minister for Health

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

The existing specialist menopause clinics have been operating with 1.7 Whole-Time Equivalents (WTEs) each. These comprise a team of 3-4 staff, made up of Consultants/Specialist GPs, Clinical Nurse Specialist /Clinical Midwife Specialist, and Grade IV Admin.

The total full-year salary costs (including 20% non-pay) that have been funded for the existing clinics, are as follows:

• Coombe: €173,611

• Rotunda: €165,607

• NMH: €175,541

• Cork: €166,409

• Galway: €166,409

• Limerick: €166,409

The estimated cost for each additional clinic is based on the average cost for existing clinics. This works out at €168,998 per clinic and does not include capital investment.

As part of the Women’s Health Action Plan, additional funding for the existing menopause clinics is being provided this year to extend their opening hours. This funding will provide an additional 2.8 WTEs spread across the NMH, Rotunda, Cork and Galway.

The full-year cost for the additional 2.8 WTEs is €349,415. Taking this into account, the average cost per clinic will increase to €227,217. Capital investment may also be required for any additional clinics, and this would vary depending on the space available and refurb/equipment requirements.

The HSE’s National Women & Infants Health Programme has advised that clinics typically operate on a 3- or 4-hour basis, with staff on 35-37 hour per week contracts.

Health Services

Ceisteanna (539)

Colm Brophy

Ceist:

539. Deputy Colm Brophy asked the Minister for Health the estimated cost of increasing funding to the HIV PrEP programme by 10%. [45932/24]

Amharc ar fhreagra

Freagraí scríofa

Minister of State at the Department of Health

A national HIV pre-exposure prophylaxis (PrEP) programme commenced in November 2019, following a HIQA HTA, which concluded that its introduction would be safe, effective, and cost saving.

Free PrEP medication is available to individuals who meet clinical eligibility criteria, attending HSE approved PrEP services. These include public PrEP services, delivered through the public network of STI clinics, and some general practice (GP) services and private providers. There are currently 13 approved public PrEP services, located in public STI clinics, and 17 private or general practitioner (GP) PrEP providers. Appointments at the 13 public PrEP services are free of charge, however, the private providers charge for consultations.

The number of people eligible to access PrEP has been expanding since inception, with the number of individuals re-imbursed for PrEP at least once expanding from 1763 in 2020 (the first full year of service delivery), to 3388 in 2022 and 3802 by the end of Q4, 2023.

Clinical criteria for PrEP eligibility have been widened in recent years, increasing the number of people eligible for the programme. While the PrEP service continued to grow in 2023, many PrEP services are reaching (or have reached) capacity and service users are reporting challenges accessing appointments. By the start of Q4, 2024, 6,070 individuals were approved for free PrEP medication. Additional work is required to understand the extent of the unmet need/demand for PrEP, which has been estimated as circa 30%.

In order to expand these services and provide additional supports to our rapidly growing population, we have been allocated additional funding of €600,000, through Budget 2025, to further support delivery of the PrEP scheme, bringing the total allocation to €5.9m. This additional funding is comprised of €0.2m for additional PrEP drug costs, and €0.4m for additional staffing in the public STI clinics from July 2025, increasing capacity for in-person appointments. The additional allocation comprises approximately 11.5% of the 2024 PrEP budget.

Furthermore, the home STI testing scheme is being used to support the PrEP programme; an additional €0.6m has been allocated to support this, given increasing demand for the service. This brings funding for home STI testing to €4.82m in 2025.

In order to increase capacity, a number of additional measures have been deployed and are being developed, including administrative efficiencies, the use of telephone consultations and use of the free home STI testing scheme for routine tests. In order to increase the number of providers, a PrEP competency framework and eLearning platform has been developed; these can be accessed by GPs with an interest in providing PrEP.

It is of vital importance that people at risk of HIV and living with HIV (PLHIV) are promptly linked to care, for prevention of onward transmission and for clinical benefit. It is also vital that those at risk are encouraged to access regular testing and preventive programmes such as PrEP. These measures are key elements towards achieving UN and WHO aims of ending the HIV/AIDS epidemic in Europe by 2030 and supporting wider national and international commitments.

In addition to further funding for both PrEP and for home STI testing in 2024, we are progressing further development of HIV Fast-Track Cities in Dublin, Cork, Limerick and Galway. We are also supporting people living with HIV and countering the stigma they may experience.

Additional capacity for PrEP delivery, through the public system, its partnerships and through primary care, are being considered as part of the wider ongoing work to redraft the National Sexual Health Strategy, which is almost complete. Measures included for consideration will include a Model of Care for sexual health, to examine capacity and delivery, nationwide, in the context of HIV and STI rates that are rising both nationally and internationally.

As PrEP capacity is a service matter, I have also asked the Health Service Executive to respond to the deputy directly, as soon as possible.

Departmental Data

Ceisteanna (540)

Colm Brophy

Ceist:

540. Deputy Colm Brophy asked the Minister for Health the estimated cost of introducing a vaccine damage scheme. [45933/24]

Amharc ar fhreagra

Freagraí scríofa

Minister for Health

As the Deputy will be aware, work is ongoing to design a model for a vaccine damage scheme and officials in my department are working through related policy matters including consideration of the potential costs of such a scheme.

The development of such a model needs detailed consideration to ensure that it is appropriately designed. Once the model is developed, I will bring it to Cabinet for approval.

Care Services

Ceisteanna (541)

Colm Brophy

Ceist:

541. Deputy Colm Brophy asked the Minister for Health the estimated cost of fully resourcing the carer’s guarantee. [45934/24]

Amharc ar fhreagra

Freagraí scríofa

Minister of State at the Department of Health

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