Written Answers Nos. 319-338
319. Deputy Ken O'Flynn asked the Minister for Health to provide a comparative analysis of staffing levels per 100,000 population across all HSE regions, including the South-West, for medical, nursing, midwifery, Health and Social Care Professionals, and administrative grades, and to confirm whether staffing levels in the South-West are in line with, above, or below national averages. [66537/25]
Amharc ar fhreagraAs this is a service matter I have asked the HSE to respond to the deputy as soon as possible.
320. Deputy Ryan O'Meara asked the Minister for Health the current policy regarding GP charges for ‘routine’ and ‘non-routine’ blood tests for medical card holders; the guidance issued to GP’s in relation to charging procedures for medical card holders for blood tests and other services; her plans to change the current system whereby medical card holders can be charged for ‘routine’ blood tests; the reimbursement options available to a medical card holder who has been charged for ‘routine’ blood tests; and if she will make a statement on the matter. [66541/25]
Amharc ar fhreagraGPs are private practitioners, most of whom hold a GMS contract with the HSE for the provision of GP services without charge to medical card and GP visit card holders.
Under the terms of the GMS contract, GPs are required to provide eligible patients with ''all proper and necessary treatment of a kind usually undertaken by a general practitioner and not requiring special skill or experience of a degree or kind which general practitioners cannot reasonably be expected to possess". Persons who hold a medical card or a GP visit card are not subject to any co-payments or other charges in respect of such services.
The issue of GPs charging GMS patients for phlebotomy services is complex given the numerous reasons and circumstances under which blood tests are taken. Clinical determinations as to whether a blood test should be taken to either assist in the diagnosis of illness or the treatment of a condition are made by the GP concerned. There is no provision under the GMS GP contract for persons who hold a medical card or a GP visit card to be charged for clinically necessary blood tests.
The HSE has previously communicated to GMS GPs on this matter. However the relevant GP representative body, the IMO, does not agree with my Department’s and the HSE’s position regarding the provision of routine blood tests under the GMS contract. The issue of certain GPs charging GMS patients for necessary blood tests has previously been raised with the IMO. It has not yet proven possible to achieve agreement that no charges for clinically necessary blood tests would be applied in any circumstances.
Blood tests undertaken in the context of the GP Chronic Disease Management programme are covered by the fees paid to GPs by the HSE for this care.
Where a patient who holds a medical card or GP visit card believes they have been incorrectly charged for routine phlebotomy services (i.e. a blood test to either assist in the diagnosis of illness or the treatment of a condition) by their GP, or has been charged for a blood test provided under the Chronic Disease Management programme, then that patient should report the matter to their HSE Local Health Office. The local management, upon being notified of potential inappropriate charging of a GMS patient, shall contact the GP concerned and carry out an investigation into the complaint and will, where appropriate, arrange for a refund of charges incorrectly applied by that GP.
Fees charged by GPs outside the terms of the GMS contracts (and other HSE GP held contracts) are a matter of private contract between clinician and patient.
321. Deputy Ryan O'Meara asked the Minister for Health the chronic diseases and diagnoses that are included under the Chronic Disease Management Programme; if routine blood tests are covered under the Chronic Disease Management Programme; and if she will make a statement on the matter. [66542/25]
Amharc ar fhreagraThe GP Chronic Disease Management Programme commenced in 2020 and was been rolled out on a phased basis over 4 years to adults with either a Medical Card or GP Visit Card (GMS patients). The aim of the Programme is to prevent and manage chronic diseases.
The conditions covered by the CDM Treatment Programme are Type 2 Diabetes, Asthma, Chronic Obstructive Pulmonary Disease (COPD) and Cardiovascular disease. A process to further expand the Programme to include chronic kidney disease is currently underway.
The CDM Treatment Programme supports patients in managing their chronic condition. Patients receive two reviews in a 12-month period, with each review consisting of a practice nurse consultation and a GP consultation.
GMS patients over 45 years of age found to be at high risk of cardiovascular disease or diabetes are enrolled into the CDM Prevention Programme. The CDM Prevention Programme was expanded in November 2023 to include adult GMS patients with hypertension and all women who have had a diagnosis of gestational diabetes or pre-eclampsia since 1st January 2023.
Patients enrolled in the CDM Prevention Programme receive one review in a 12-month period, with each review consisting of a practice nurse consultation and a GP consultation.
Blood tests conducted as part of the reviews for both the CDM Treatment Programme and the CDM Prevention Programme are included.
322. Deputy Claire Kerrane asked the Minister for Health if she will meet with local elected representatives regarding maternity services at Portiuncula Hospital, as per my request to her in writing on 17 September 2025, seven weeks ago; and if she will make a statement on the matter. [66547/25]
Amharc ar fhreagraI and those working on my behalf (including officials and the HSE) are continuing to engage with a range of stakeholders in relation to the issues that the Deputy has raised.
This includes through Parliamentary Questions, Ministerial Representations, and briefings. I have also visited Portiuncula University Hospital in person and met with families involved and staff working at the hospital.
I and the HSE welcome this engagement and will continue to provide updates on this matter.
323. Deputy Cathal Crowe asked the Minister for Health if a person (details supplied) in County Clare can get ozempic on their medical card or on the drugs refund scheme given it costs €160.00 per month; and if she will make a statement on the matter. [66550/25]
Amharc ar fhreagraUnder the Health (Pricing and Supply of Medical Goods) Act 2013, the HSE has statutory responsibility for decisions on the pricing and reimbursement of medicines and medical devices; therefore, the matter has been referred to the HSE for attention and direct reply to the Deputy.
324. Deputy Robert O'Donoghue asked the Minister for Health if her Department holds up-to-date figures on the number of people living with dementia in each county; if so, to provide the most recent breakdown; and if not, to state whether a national dementia register exists or is planned, and the timeline for its establishment; and if she will make a statement on the matter. [66559/25]
Amharc ar fhreagraThe most recent published estimated dementia prevalence figures for 2020, including a breakdown by county and projected figures for 2045, were generated by Health Atlas, HSE based on Central Statistical Office Census data from 2016. Work is currently under way to update the estimates and future projections of the number of people with dementia in Ireland, including a breakdown by county.
The 2025 Programme for Government contains a commitment to "Work with the National Dementia Office and key stakeholders to develop a National Dementia Registry...". On 23 May, I was pleased to announce the commencement of this Irish Dementia Registry (IDR).
The IDR will be developed, implemented, and maintained, by the National Office for Clinical Audit. It will provide a comprehensive framework for the collection of reliable, accurate, valid and timely dementia data. This data will guide service planning and delivery, support research, inform policy development and align with the recommendations of the Model of Care for Dementia in Ireland (2023).
Significant progress in setting up the IDR has already been made including the recruitment of key posts (Clinical Lead, Project Manager, and Data Analyst) and, the establishment of an oversight group to support the advancement of key deliverables.
The development of the IDR is expected to take approximately three years, with full implementation scheduled for Q3 2028.
325. Deputy Ken O'Flynn asked the Minister for Health the current national policy governing the provision of non-medically indicated circumcision procedures in public hospitals, including whether such procedures are authorised, the clinical or administrative basis for any such authorisation, and the responsible decision-making structure within her Department. [66560/25]
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
326. Deputy Ken O'Flynn asked the Minister for Health to confirm whether any HSE hospital or hospital group provides circumcision procedures where no medical indication exists, and to provide a breakdown by hospital of the number of such procedures carried out in each of the past five years. [66561/25]
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.
327. Deputy Ken O'Flynn asked the Minister for Health to state whether non-medically indicated circumcisions carried out in public hospitals are publicly funded, partially funded, or privately funded, and to provide the applicable charging structure and accounting treatment for such procedures. [66562/25]
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.
328. Deputy Ken O'Flynn asked the Minister for Health the criteria, oversight mechanisms, and clinical governance arrangements that apply when theatre time, anaesthetists, and surgical staff are allocated for procedures that are not clinically required, and to state how the use of theatre capacity for such procedures is assessed against the needs of patients on waiting lists for medically necessary surgery. [66563/25]
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.
329. Deputy Ken O'Flynn asked the Minister for Health if her Department has carried out any assessment of the impact of providing non-medical circumcision procedures on surgical waiting lists, day-case capacity, or staffing resources in the public system, and to publish the findings of any such assessments. [66564/25]
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.
330. Deputy Ken O'Flynn asked the Minister for Health whether any guidance, circulars, or instructions have issued from her Department or the HSE regarding the provision of cultural or religious surgical procedures in public hospitals, and to place all such guidance in the Oireachtas Library. [66565/25]
Amharc ar fhreagraAs this is a service matter I have asked the HSE to respond to the deputy as soon as possible.
331. Deputy Ken O'Flynn asked the Minister for Health the number of theatre slots allocated in each of the past five years to circumcision procedures where there was no medical indication, broken down by hospital group and year. [66566/25]
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.
332. Deputy Ken O'Flynn asked the Minister for Health if she is satisfied that all procedures performed in public hospitals that are not clinically indicated are subject to proper oversight, transparency, and cost controls, and to outline what reforms are planned to ensure that theatre resources are prioritised for patients on clinically necessary waiting lists. [66567/25]
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.
333. Deputy Ken O'Flynn asked the Minister for Health the reason her Department and the HSE do not maintain a record of approved HSE posts that remain unfilled for more than six months; the mechanisms currently used to monitor persistent vacancies of this kind; the way in which her Department assesses the financial effect of these long-term vacancies on the Exchequer and the impact of such vacancies on service delivery and workforce planning; and if she will now direct the HSE to establish a formal audit process for posts that remain unfilled for extended periods. [66568/25]
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.
334. Deputy Ken O'Flynn asked the Minister for Health to specify how her Department calculates the financial implications arising from HSE posts that remain unfilled for more than six months, including the projected savings, additional costs linked to overtime or agency staffing, and the effect on service capacity; and to outline whether a standard methodology is applied across HSE regions. [66569/25]
Amharc ar fhreagraThe HSE does not produce pay or staffing data in sufficiently granular detail to calculate the financial implications of individual posts that remain vacant at different time intervals vacancies for more than three, six, nine or twelve months as the cost would exceed the benefit that could be derived from such an enhanced data capture exercise.
From data supplied by the HSE the Department can view:
• total staffing numbers versus agreed staffing limits by broad staff category such as Medical & Dental, Nursing & Midwifery and Health and Social Care Professional.
• total expenditure on pay for the year to date sorted by core pay, employers PRSI, agency, overtime and staff allowances, which vary significantly between staff categories.
The Department forecasts revised estimates of payroll costs each month, which include an estimate of the cost of any additional staff expected to onboard before year end. Also, as part of the annual budgetary estimates process, officials estimate the cost of filling the balance of vacant posts in current and subsequent years.
The HSE carry out similar exercises, but do not, to the Department's knowledge, produce rolling estimates of the financial implications of posts remaining unfilled for more than six months.
The methodology used by the Department in its estimates is necessarily high level in nature and is dictated by both the scale of the HSE workforce (~141,000 staff in D/Health funded posts in September 2025) and the nature of the data available. It involves the application of time apportioned annual average payroll costs for broad staff categories to vacancy rates for each of these broad categories.
The quantum of payroll data available will naturally improve, when the current IT projects (IFMS and NISRP) are fully implemented across the entire Health service.
335. Deputy Ken O'Flynn asked the Minister for Health how her Department assesses the effect of long-term vacant posts on service delivery, including waiting lists, emergency department pressures and specialist care capacity; and to detail any measures she intends to introduce to ensure persistent vacancies are identified, monitored and addressed as part of the National Service Plan 2026. [66570/25]
Amharc ar fhreagraAs this is a service matter we have the HSE to respond directly to the Deputy.
336. Deputy Ken O'Flynn asked the Minister for Health the policy and operational basis on which the HSE seeks the retrospective recovery of specialist qualification allowances from staff who received the allowance in good faith over an extended period, where the allowance had been approved and paid by management; to confirm whether a formal appeals or waiver process exists for such cases; to outline the legal and HR guidance issued to hospitals on retrospective clawbacks; and to state whether her Department will instruct the HSE to suspend such recovery efforts pending a review of long-standing cases involving administrative error rather than staff fault. [66571/25]
Amharc ar fhreagraAs this is a service matter I have asked the HSE to respond to the deputy as soon as possible.
337. Deputy David Cullinane asked the Minister for Health if she will urgently review the decision to remove State reimbursement for blister pack medication services; if she is aware that this change will allow pharmacies to introduce private fees of up to €50 per person per month; if she will outline the measures the Department is taking to prevent adverse impacts on patients who rely on blister packs for medication safety, adherence, and accuracy, particularly people with disabilities, older people and those with complex medication regimes; if she has considered the fact that the proposed change could result in increased risk of medication errors due to loss of structured packaging supports, reduced medication adherence arising from unaffordable private fees, additional financial burden on service users already facing high healthcare costs, and increased pressure on community care, residential, and clinical support teams to ensure safe medication administration; if she will address the steps she is taking to address each of these consequences; if she will confirm whether this policy was subject to a risk assessment, and if not, whether she will suspend implementation of this particular policy change pending a full impact review; and if she will make a statement on the matter. [66620/25]
Amharc ar fhreagraThe Community Pharmacy Agreement 2025 was published on the 18th of September 2025, following the successful conclusion of negotiations with the Irish Pharmacy Union (IPU). The Agreement is supported by a €75 million new investment across 2025 and 2026.
The Agreement marks a significant milestone in the strategic collaboration between the Department of Health, the Health Service Executive (HSE), and the IPU. It sets out a comprehensive and ongoing pathway to modernise and expand the role of community pharmacy in Ireland’s healthcare system.
The Agreement is available on the Department of Health’s website at the following link: www.gov.ie/en/department-of-health/publications/community-pharmacy-agreement-2025/.
It is important to note that the Community Pharmacy Agreement 2025 does not remove phased dispensing.
Phased dispensing was introduced in 1996 for patient safety reasons. The supply of medication in instalments can support patients prescribed certain high-risk medications who are at risk of medication misadventure if these medications were to be supplied monthly, as is the norm under the community drug schemes. Where a phased dispensing claim is submitted, the current requirement is that an item must be dispensed in the pharmacy across multiple supply occasions. Community pharmacies receive additional payments in respect of phased dispensing.
Monitored Dosing Systems are systems that enable the individual medicine doses to be organised according to the prescribed dose schedule. These are sometimes referred to as blister packs. The State has never agreed to fund Monitored Dosing Systems.
However, a practice has built up whereby the use of Monitored Dosing Systems are charged as if for phased dispensing. The State has never agreed to this. Phased claiming was never intended to be used to submit claims in lieu of the provision of Monitored Dosing Systems.
Whilst Monitored Dosing Systems may have a role for some patients there is significant uncertainty around the robustness of the evidence supporting its use. The National Centre for Pharmacoeconomics carried out an evidence assessment which indicated that the evidence was, at best, equivocal to support such a programme.
Significant expenditure is therefore being incurred where it was never intended by the State. It has been agreed to introduce improved controls in this regard and to limit the use of phased dispensing to specified high risk drugs, where a patient safety concern may exist.
Phased dispensing support is currently available for medical card holders under the General Medical Services (GMS) Scheme for the following reasons:
Reason 1 - at the request of a patient's physician.
Reason 2 - due to the inherent nature of a medicinal product i.e. product stability and shelf life.
Reason 3 - where a patient is commencing new drug therapy with a view to establishing patient tolerance and acceptability before continuing on a full treatment regime.
Reason 4 - in exceptional circumstances where the patient is incapable of safely and effectively managing the medication regimen.
Under the Community Pharmacy Agreement 2025, from January 2026, phased dispensing under reason 1 and 4 will be limited to a defined set of high-risk medication classes. These are:
• Psychotropics;
• Opioids;
• Codeine; and
• Pregabalin and gabapentin.
The approved list of medications under these classes will be provided by the HSE in due course.
For reasons 1 and 4, by focusing phased dispensing reimbursement on the medication categories on the approved list, phased dispensing payments can be targeted to medications with the highest risk or potential for misuse.
Phased dispensing fees will remain payable as per current arrangements under reasons 2 and 3 and will not be subject to the approved list.
The salient point here is that appropriate phased dispensing is not being removed in this Agreement.
The introduction of improved controls around phased dispensing is being done in a way which puts patient safety first and allows the State to repurpose €20m of funding to be used to implement new patient-centred services.
It remains open to pharmacies to charge patients for the use of Monitored Dosing Systems as a private service.
As the Deputy has also raised service matters, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
338. Deputy Pádraig Rice asked the Minister for Health the reason the National Ambulance Service is utilising private ambulance providers for patient transfers instead of offering staff within the intermediate care service overtime; and if she will make a statement on the matter. [66621/25]
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.
