Written Answers Nos. 519-540
519. Deputy David Cullinane asked the Minister for Health if a framework is in place regarding contractual and pricing agreements on funding programmes under the Access to Care funds; if she will publish any such frameworks; and if she will make a statement on the matter. [31460/25]
Amharc ar fhreagraIn relation to the particular queries raised, as these are operational service matters I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
520. Deputy David Cullinane asked the Minister for Health the date and the mechanism by which she received a report from CHI into concerns regarding NTPF funding at CHI hospitals; and if she will make a statement on the matter. [31461/25]
Amharc ar fhreagraMy Department received a copy of the internal report (2022) from the HSE on the 26th of May 2025. CHI has advised that the internal report (2022) was conducted in response to the concerns and issues raised and that the majority of actions are complete, and work is ongoing on remaining actions.
The HSE CEO is commissioning an audit of governance and equity in patient access and waiting list management at CHI. There has also been a strengthening of the Service Level Agreement between CHI and the HSE to strengthen operational oversight. There will also be increased involvement and support from the Dublin Midlands Region Regional Executive Officer and senior management.
Following concerns raised over the internal report (2022), the NTPF immediately placed a temporary pause on all insourcing work with CHI. It initiated a comprehensive review of all insourcing work with CHI to gather the necessary assurances regarding compliance, value for money and appropriate use of NTPF funding mechanisms. On the 11th of June, the NTPF confirmed that following a meeting of its Board, it is immediately recommencing insourcing work with CHI after a review of the assurances given by CHI in relation to its ongoing compliance with existing NTPF protocols and procedures.
521. Deputy David Cullinane asked the Minister for Health if she will outline plans to reduce dependency on insourcing and outsourcing care to reduce waiting lists; if a multi-annual plan exists to achieve same; and if she will make a statement on the matter. [31462/25]
Amharc ar fhreagra522. Deputy David Cullinane asked the Minister for Health the steps she has taken to manage conflicts of interest in relation to the insourcing of care at public hospitals; and if she will make a statement on the matter. [31463/25]
Amharc ar fhreagra524. Deputy David Cullinane asked the Minister for Health if she has identified any potential perverse incentives in relation to the insourcing and outsourcing of care to manage waiting lists; and if she will make a statement on the matter. [31465/25]
Amharc ar fhreagraI propose to take Questions Nos. 521, 522 and 524 together.
I acknowledge that many patients are still waiting too long to access hospital care, and I am conscious of the burden that this places on them and their families.
I published the Waiting List Action Plan (WLAP) for 2025 on February 12th, representing the Government’s commitment to reducing waiting times for patients and improving access to hospital care.
With the 2025 plan, we are continuing to build upon the progress delivered to date under the multi annual action plan approach, progressing towards the ultimate vision of a public healthcare service in which everyone has timely access to high-quality scheduled care, where and when they need it.
This Government remains committed to increasing capacity in the public system and until that capacity is in place to meet the increased levels of demand, it’s appropriate that we make use of all available additional capacity in the public and private systems to ensure that patients have access to the care they need.
Accordingly, the Waiting List Action Plan approach includes targeting the delivery of additional capacity for patients in the public and private systems, through a coordinated approach by the HSE and the National Treatment Purchase Fund.
NTPF Insourcing initiatives are governed by a Memorandum of Understanding (MOU) between the NTPF and the relevant public hospital. Under the MOU, the public hospital confirms that any such work is additional work over and above core hospital activity and is specifically carried out to reduce waiting lists. All governance for insourcing remains with the public hospital, based on specific treatment plans where a need is identified and a solution available. All work is approved at the appropriate senior level.
The NTPF also sources treatment and appointments for patients through outsourcing arrangements with Private Hospitals. This is done through a Panel Agreement established following a competitive tender competition. As with insourcing initiatives, while the NTPF identifies patients eligible for treatment the clinical suitability is determined by the public hospital. The payment to the private hospital is based on a tendered price for the relevant procedure, and all payments to Consultants are a matter for the Private Hospitals.
In April, at my request, the HSE CEO initiated a detailed survey of all insourcing activity within the HSE, which will be assisted by Finance, Internal Audit, HR and Access/Integration functions. Insourcing can be funded either directly by the HSE/hospital concerned, or by the NTPF. This nationwide review is underway, and the HSE CEO has taken certain precautionary steps in the interim to further reduce the risks of conflicts of interest and other concerns that might arise.
The Department of Health worked closely with the HSE and the NTPF to develop the specific actions and targets set out in this year’s WLAP. The WLAP 2025 has further measures beyond insourcing and outsourcing to address waiting list issues and sets out 25 actions under the themes of “Delivering Capacity”, “Enabling Scheduled Care Reform” and “Reforming Scheduled Care”. In this way, we aim to reduce our reliance on insourcing and outsourcing and continue to build a public hospital system in which everyone can receive care in a timely fashion.
523. Deputy David Cullinane asked the Minister for Health the steps the CEO of the HSE has taken to manage conflicts of interest in relation to the insourcing of care at public hospitals; and if she will make a statement on the matter. [31464/25]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
525. Deputy David Cullinane asked the Minister for Health if the head of the HSE has identified any potential perverse incentives in relation to the insourcing and outsourcing of care to manage waiting lists; and if she will make a statement on the matter. [31466/25]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
526. Deputy David Cullinane asked the Minister for Health to outline any meetings she has held with the CEO of the HSE, the CEO of CHI and the Secretary General of her Department on the HIQA report into the use of non-medical grade springs on children attending CHI hospitals, on the audit into osteotomies on children attending CHI and on any reports into the use of NTPF funding at CHI; the dates of the meetings and minutes arising from any such meetings; and if she will make a statement on the matter. [31467/25]
Amharc ar fhreagraI, along with the Secretary General, attended a briefing with HIQA on their review of surgical springs on 4th April in the Department.
I met with the CHI CEO on 7th April following the HIQA briefing.
I attended a meeting of the CHI Board with the HSE CEO on 14th April by video conference.
I met with the CHI Board in person in the Department on 28th April in DOH.
I met with HSE CEO and Secretary General for briefing on Developmental Dysplasia of the Hip (DDH) Audit on 22nd May.
I met with the HSE CEO and Secretary General on Monday 26th May following the DDH briefing.
Other than with meetings, I continue to regularly engage with my officials on these issues.
527. Deputy David Cullinane asked the Minister for Health if her attention has been drawn to any CHI oncology risk assessments carried out at CHI; if she is taking any action following these risk assessments; and if she will make a statement on the matter. [31472/25]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
528. Deputy David Cullinane asked the Minister for Health if her attention has been drawn to of concerns regarding post surgical complications on children in oncology services at CHI; if she was made aware of instances of prolonged recoveries for children following complications; the numbers of children involved; if she is aware if the families of those children were notified of the reasons for the complications and prolonged recoveries; and if she will make a statement on the matter. [31473/25]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
529. Deputy David Cullinane asked the Minister for Health if her attention has been drawn to paediatric oncology patients at CHI having a poor experience or being harmed, due to the inability of CHI to deliver international best practice standards of paediatric surgical oncology provision; if so, the action she has taken; and if she will make a statement on the matter. [31474/25]
Amharc ar fhreagraAs this is an operational matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
530. Deputy David Cullinane asked the Minister for Health if her attention has been drawn to a term called “orphan children” contained in any CHI report she has received; if she was identified the number of children this involves; if they are children with spina bifida; if these children were left without appropriate care; if she has asked CHI to notify the parents of these children; and if she will make a statement on the matter. [31475/25]
Amharc ar fhreagraAs this is an operational matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
531. Deputy David Cullinane asked the Minister for Health if she will confirm whether a report into paediatric urology services in Ireland, with particular reference to spina bifida and neuropathic bladder, commonly known as the Dickson Report exists within CHI; if she has requested a copy; if she received a copy; if families of children referred to in the report have been notified of the contents of the report; if she will ensure families and advocates receive a copy of the report; if she will publish the report in the public interest; and if she will make a statement on the matter. [31476/25]
Amharc ar fhreagraAs this is an operational matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
532. Deputy Aidan Farrelly asked the Minister for Health to provide a schedule of the amount expended by her Department, and bodies under her aegis, on external training, simulations and advice in advance relating to appearances as witnesses at Oireachtas committees, from 2021 to date in 2025; if the supplier of services will also be provided, with a brief outline of services provided, indicating for which Oireachtas committee the services were utilised; and if she will make a statement on the matter. [31497/25]
Amharc ar fhreagraThe document at the link below sets out the requested information in tabular format. According to records held by the Learning and Development unit within my Department, 18 staff have completed training on “Preparing to Appear as a Witness in front of Oireachtas Committees” and “Oireachtas Preparation Training”. This training was delivered by the Communications Clinic. Since 2024, staff can request to attend this training course through the One Learning management system as places become available.“Preparing to Appear as a Witness in front of Oireachtas Committees” is a practical and theoretical course for participants who need to develop their skills and confidence in appearing before Oireachtas Committees. This course goes through the best ways witnesses can prepare in advance of an invitation, where long-term relationships between senior Civil Servants and Committees are as important as outcomes.The other course that offers support to staff is “Preparing Colleagues to Appear at Oireachtas Committees”. This course looks at the best ways to prepare a colleague in advance of appearing before an Oireachtas Committee, in a structured and professional manner. This is particularly important in the Civil Service context, where established rules and legislation need to be understood as part of the preparation process.
Some staff may have attended training organised by the Senior Public Service team in DPER; however, the Department of Health does not hold any records of such attendance and there were no costs arising to the Department.
Information in respect of the other bodies under the aegis of the Department, including the Health Service Executive (HSE), is an operational matter for the bodies concerned and the Deputy should contact the relevant Director/CEO/Registrar directly.
533. Deputy Peter 'Chap' Cleere asked the Minister for Health further to Parliamentary Question No. 367 of 28 May 2025, to clarify a matter (details supplied). [31505/25]
Amharc ar fhreagraThe Health Service Executive (HSE) provides optical services free of charge to pre-school children and national school children referred from child health service and school health service examinations who are discovered to have sight problems. These children are referred to the appropriate service for treatment. In such circumstances, these services will continue to be provided until the child has reached the age of 16.
The service includes the provision an eye examination and prescribed optical appliances, such as glasses. There is a mechanism in place for children who may need a second pair of glasses to receive them. However, it is not standard practice to provide a second pair to every child that needs glasses as this would not represent value for money in the operation of the service.
535. Deputy Rose Conway-Walsh asked the Minister for Health is she is aware that at present approximately 20 adults are excluded from access to approved SMA treatments solely because they were over 18 at the time of the original HSE approval; if she will review the criteria for access to these treatments; and if she will make a statement on the matter. [31518/25]
Amharc ar fhreagraThe HSE has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drugs schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013. Therefore, I have asked the HSE to provide an update in relation to treatments for SMA patients over 18 years of age.
The HSE has advised that once a medicine is approved by the European Medicines Agency, the HSE is dependent on a pharmaceutical company making an application to Ireland for its drug or new indication to be assessed for reimbursement. All medicines are considered for pricing of reimbursement in order of application.
While many companies engage proactively with the HSE, Ireland, by virtue of its size and market share, may not always be prioritised by some companies in the first stages of marketing a new medicine. Reports describing timelines for reimbursement from EMA approval to HSE reimbursement approval do not consider this important factor, as statutorily the HSE are not able to add a new medicine to the reimbursement list until an application is received.
The HSE has advised that it is committed 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 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.
In terms of the specific details of the application for pricing and reimbursement of Risdiplam (Evrysdi®):
Reimbursement approval is in place for Risdiplam (Evrysdi®) for the treatment of 5q spinal muscular atrophy (SMA) under the High Tech arrangements from the 1st September 2023. Reimbursement support is for a subgroup of the licensed indication.
As a condition of reimbursement, an individual patient approval system has been put in place by the HSE, to enable reimbursement for patients who meet the pre-defined criteria as per a HSE devised managed access protocol.
If the manufacturer of Risdiplam(Evrysdi®) (Roche) submits a de novo application for adult patients with a clinical diagnosis of SMA Type 1, Type 2 or Type 3, that application will be duly progressed through the formal processes governing the pricing and reimbursement of medicines.
In terms of the specific details of the application for pricing and reimbursement of onasemnogene abeparvovec (Zolgensma®):
In October 2021, onasemnogene abeparvovec (Zolgensma®) was approved for reimbursement in Ireland following joint assessment and negotiations under the Beneluxa initiative for the treatment of patients with spinal muscular atrophy (SMA) with a bi-allelic mutation in the SMN1 gene and a clinical diagnosis of SMA type 1, or pre-symptomatic patients with 5q SMA with a bi-allelic mutation in the SMN1 gene and up to 3 copies of the SMN2 gene.
As a condition of reimbursement, an individual patient approval system has been put in place by the HSE, to enable reimbursement for patients who meet the pre-defined criteria as per a HSE devised managed access protocol.
Managed Access Protocol – Onasemnogene abeparvovec (Zolgensma®) for the treatment of 5q Spinal Muscular Atrophy (SMA)(www.hse.ie/eng/about/who/cspd/medicines-management/managed-access-protocols/onasemnogene-abeparvovec-zolgensma/managed-access-protocol-onasemnogene-abeparvovec-zolgensma.pdf)
In terms of the specific details of the application for pricing and reimbursement of nusinersen (Spinraza®) for adult patients (>18 years):
The HSE approved funding of nusinersen (Spinraza®) effective 1st July 2019 for the treatment of 5q Spinal Muscular Atrophy (SMA) Type I, Type II and Type III in children under 18 years.
The first step in the process is the submission of a Rapid Review dossier (a clinical and economic dossier) to the National Centre for Pharmacoeconomics (NCPE) for assessment. The HSE commissioned the Rapid Review process on the 28th September 2020.
The NCPE Rapid Review assessment report was received by the HSE on the 29th October 2020. The NCPE advised the HSE that a full Health Technology Assessment (HTA) was recommended for nusinersen (Spinraza®) to assess the clinical and cost-effectiveness compared to the current standard of care for adult patients (>18 years).
Nusinersen (Spinraza®). HTA ID: 20044 | National Centre for Pharmacoeconomics (www.ncpe.ie/nusinersen-spinraza-hta-id-20044/)
The HSE commissioned a full Health Technology Assessment on the 9th November 2020 as per agreed processes.
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 CPU met with Biogen regarding their application for Nusinersen (Spinraza®).
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 pharmacoeconomic report will be reviewed by the HSE Drugs Group along with the outputs of commercial negotiations, and any patient group submission(s) received. The HSE Drugs Group will consider all of the evidence and make a recommendation to the HSE Senior Leadership Team.
The decision-making authority in the HSE is the HSE Senior Leadership Team. The HSE Senior Leadership 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.
A completed HTA is required from the applicant (Biogen) to progress this application, as per the formal processes governing the pricing and reimbursement of medicines. In the absence of a completed HTA the pricing and reimbursement application cannot progress.
The application remains under consideration with the HSE. The HSE cannot make any comment on possible outcomes from the ongoing assessment processes.
536. Deputy Marie Sherlock asked the Minister for Health the number of GPs operating in the Ballymun area network, Blakestown area network, Blanchardstown area network, Coolock area network, coastal area network, Finglas area network, Kilbarrack area network, and Swords area network. [31531/25]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
537. Deputy Marie Sherlock asked the Minister for Health the number of GPs operating in the community area networks of Cavan, central Meath, east Meath, Monaghan, north Louth, north Meath and Ardee, south Louth, and Bettystown and south-west Meath. [31532/25]
Amharc ar fhreagra538. Deputy Marie Sherlock asked the Minister for Health the number of GPs operating in each community area network (details supplied). [31533/25]
Amharc ar fhreagra539. Deputy Marie Sherlock asked the Minister for Health the number of GPs operating in each community area network (details supplied). [31534/25]
Amharc ar fhreagra540. Deputy Marie Sherlock asked the Minister for Health the number of GPs operating in each community area network (details supplied). [31535/25]
Amharc ar fhreagra543. Deputy Marie Sherlock asked the Minister for Health the number of GPs operating in the community area networks of Ballyfermot and Palmerstown, Clondalkin, Drimnagh, Crumlin, and Harold's Cross, Lucan, Newcastle, Citywest and Saggart, Rathfarnham, Knocklyon and Ballyboden, Rathmines, Terenure and Templeogue, south Dublin inner city, and Tallaght and Firhouse. [31559/25]
Amharc ar fhreagra544. Deputy Marie Sherlock asked the Minister for Health the number of GPs operating in the community area networks of east Kildare and Blessington, east Offaly and north Laois, east Westmeath, north-east Kildare, north-west Kildare, south Kildare and west Wicklow, and south Laois. [31560/25]
Amharc ar fhreagra545. Deputy Marie Sherlock asked the Minister for Health the number of GPs operating in each of the following community area networks; Offaly, West and Central Kildare, West Westmeath and Northwest Offaly and Longford and Central Westmeath [31561/25]
Amharc ar fhreagraI propose to take Questions Nos. 537 to 540, inclusive, and 543 to 545, inclusive, together.
As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
Please note that GPs are private practitioners, most of whom hold at least one contract with the HSE for the provision of medical services on its behalf, such as the GMS contract for the provision of GP services without charge to medical card and GP visit card holders. Accordingly, it may only be possible for the HSE to respond in relation to the number of HSE contracted GPs per Community Healthcare Network.
