Written Answers Nos. 320-339
320. Deputy Conor Sheehan asked the Minister for Health when routine specialist dental services will be reinstated for a school (details supplied); if she will review the long waiting lists for specialist dental procedures for children with special needs, to ensure timely access to care; and if she will make a statement on the matter. [70597/25]
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.
321. Deputy Robert Troy asked the Minister for Health if a hospital appointment will be expedited for a person (details supplied). [70600/25]
Amharc ar fhreagraUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. The Minister for Health is prohibited from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
In relation to the particular query raised, as this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
322. Deputy Pa Daly asked the Minister for Health if she will examine the introduction of a subsidy or exemption for medical card holders and older patients using monitored dose systems, given pharmacies will continue charge privately from January 2026. [70617/25]
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 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 (MDS) 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 or compliance aids.
Monitored Dosing Systems and phased dispensing are two separate processes. Phased dispensing requires the patient to present to the pharmacy on multiple occasions in the month, e.g. each week, for dispensing of medicines. Phased dispensing is in place where it is unsafe for the patient to have the totality of their medication in one supply occasion. Monitored Dosing Systems are ordinarily provided in one visit and packaged to indicate when medication should be taken. 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 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.
The Agreement is designed to support the delivery of safe, equitable, and efficient healthcare, and to ensure that community pharmacists are better equipped to contribute to national health priorities through structured engagement, sustainable funding, and integrated service delivery.
Under the Agreement, a Strategic Collaboration Group will be established from early 2026 which will provide a structured forum for dialogue and joint consideration of strategic issues shaping the future of community pharmacy in Ireland.
The Agreement also includes the establishment of a rolling annual medicines optimisation programme with dedicated annual funding. The Strategic Collaboration Group will be tasked with exploring the best way to utilise this fund.
323. Deputy Ruairí Ó Murchú asked the Minister for Health if consideration will be given to the inclusion of all ostomy products on the long term illness scheme; if she will remove the need for a prescription for these products; and if she will make a statement on the matter. [70636/25]
Amharc ar fhreagraThe Long-Term Illness (LTI) Scheme was established under Section 59(3) of the Health Act 1970 (as amended). Regulations were made in 1971, 1973 and 1975, prescribing 16 conditions to be covered by the Scheme. Further information, including the list of conditions, can be found at: www2.hse.ie/services/schemes-allowances/lti/about/.
Under the LTI Scheme, patients receive drugs, medicines, and medical and surgical appliances directly related to the treatment of their illness, free of charge.
The Health Service Executive (HSE) administers the Scheme. The HSE advise that the drugs, medicines and non-drug items reimbursable under the LTI Scheme are intended for the treatment of the primary condition.
The Core Lists were developed following detailed consultation with Medical Officers, HSE Pharmacists and the HSE Medicines Management Programme (MMP). The HSE is satisfied that all medicines that should be necessary for the treatment of each primary LTI Scheme condition are provided on these Core Lists. Core Lists are reviewed every few years to ensure that they reflect current prescribing practices and treatments of the primary illness.
324. Deputy Grace Boland asked the Minister for Health if she will review the current list of conditions covered under the long-term illness scheme, which has remained unchanged for over 50 years, with a view to including inflammatory bowel disease, given the significant financial burden of ongoing medication and treatment for patients; and if she will make a statement on the matter. [70637/25]
Amharc ar fhreagra325. Deputy Grace Boland asked the Minister for Health the estimated annual cost to the State of extending the long-term illness scheme to include IBD; the cost-benefit analysis undertaken in relation to expanding the scheme to cover additional chronic conditions; and if she will make a statement on the matter. [70638/25]
Amharc ar fhreagra326. Deputy Grace Boland asked the Minister for Health the supports currently available to patients with IBD who do not qualify for the long-term illness scheme, including access to the drugs payment scheme and discretionary medical cards; and if she will make a statement on the matter. [70639/25]
Amharc ar fhreagraI propose to take Questions Nos. 324, 325 and 326 together.
The Long-Term Illness (LTI) Scheme was established under Section 59(3) of the Health Act 1970 (as amended). Regulations were made in 1971, 1973 and 1975, prescribing 16 conditions to be covered by the Scheme. Further information, including the list of conditions, can be found at:
www2.hse.ie/services/schemes-allowances/lti/about/.
Under the LTI Scheme, patients receive drugs, medicines, and medical and surgical appliances directly related to the treatment of their illness, free of charge. While there are currently no plans to extend the list of conditions, it is important to remember that the LTI Scheme exists within a wider eligibility framework.
People who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be eligible for a medical card under the General Medical Services (GMS) Scheme. In accordance with the provisions of the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE.
In certain circumstances the HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income guidelines, where he or she faces difficult financial circumstances, such as extra costs arising from illness. The HSE afford applicants the opportunity to furnish supporting documentation to determine whether undue hardship exists and to fully take account of all relevant circumstances that may benefit them in assessment.
In circumstances where an applicant is still over the income limit for a medical card, they are then assessed for a GP visit card, which entitles the applicant to GP visits without charge.
The issue of granting medical card eligibility based on having a particular disability or illness was previously examined in 2014 by the HSE Expert Panel on Medical Need and Medical Card Eligibility. The Group concluded that it was not feasible, desirable, nor ethically justifiable to list medical conditions in priority order for medical card eligibility. In following the Expert Group’s advice, a person’s means remains the main qualifier for a medical card.
Under the Drugs Payment Scheme (DPS), no individual or family pays more than €80 a month towards the cost of approved prescribed medicines. The DPS is not means tested and is available to anyone ordinarily resident in Ireland. The DPS significantly reduces the cost burden for families and individuals with ongoing expenditure on medicines.
There has been a significant focus on improving access to and the affordability of healthcare services over the last few years. This includes reductions in the DPS threshold, expansion of access to free GP care, and the abolition of all public in-patient hospital charges for children and adults. These measures continue to create a health and social care service that offers affordable access to quality healthcare.
Individuals may also be entitled to claim tax relief on the cost of their medical expenses, including medicines prescribed by a doctor, dentist, or consultant. Relief is at the standard tax rate of 20%.
327. Deputy Robert Troy asked the Minister for Health if an appointment can be offered to a person (details supplied) at a more convenient location. [70643/25]
Amharc ar fhreagraUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. The Minister for Health is prohibited from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
In relation to the particular query raised, as this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
328. Deputy Paul Murphy asked the Minister for Health the exact number of representatives with direct lived experience who are on the working group for the National Clinical Programme for Gender Healthcare. [70648/25]
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.
329. Deputy Paul Murphy asked the Minister for Health to provide a list of all interim care options being considered by the HSE while the HSE's transgender model of care is being developed. [70649/25]
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.
330. Deputy Paul Murphy asked the Minister for Health if she will commit to the trans community being consulted before implementing any interim care options while the HSE's transgender model of care is being developed. [70650/25]
Amharc ar fhreagraAs the Deputy will be aware, set out in the Programme for Government 2025, this Government is committed to ensuring a transgender healthcare service that is based on clinical evidence, respect, inclusiveness and compassion. I have acknowledged previously that the current public gender healthcare services are not meeting people’s full range of needs.
It is in this context that the HSE has established a new National Clinical Programme for Gender Healthcare to develop an updated clinical Model of Care with the aim of designing clinical pathways to deliver safe and effective health and social care for those seeking gender affirming healthcare services. This work will also inform an implementation plan for its delivery. As this work will take some time to complete Minister Mary Butler and I have requested that the HSE examine all avenues to improve interim care options while the Model of Care is being developed.
A key aspect of the development of the new model of care is stakeholder consultation. I am committed to ensuring that all stakeholders are heard and actively involved in this process. This inclusivity is vital for the success of the Model of Care that we aim to create.
Gaining an understanding of the experiences of those in the transgender community will be integral to the development of the model of care. That is why there has been and will continue to be a strong focus on the experience base which will bring in stakeholder perspectives and experience, as well as, the evidence base, which relates to the clinical research on the topic. This collaborative approach will ensure that the needs and perspectives of all stakeholders are considered, leading to a more inclusive and effective care model.
A number of lived experience engagement design sessions, attended by several advocacy groups, have already been held to inform the development of a plan to maximise stakeholder engagement. It is our sincere hope and expectation that this approach not only will strength the relevance and inclusivity of the final model but will also lead to better outcomes by the services truly reflect the experiences and populations they are meant to serve.
A cross-speciality Clinical Advisory Group has been established with the Royal College of Physicians of Ireland and convened in June 2025 to support the Model of Care design and development. In addition, a working group, which has a number of representatives with direct lived experience has also been established and the first meeting took place recently.
In terms of progressing the model of care, the HSE commenced the systematic review on the evidence base with respect to co-existing clinical needs in gender diverse people with support from the HSE Library Service. Interim results of this review were made available for public consultation during August of this year and the HSE are now reviewing the submissions and completing the evidence review.
Developing a model of care for Gender Healthcare Services is expected to be a complex process and the HSE and my department will work closely together to support the process, ensure transparency and keep the patient at the centre of the process.
It is important that the HSE is given time to develop a model of care that is based on the best clinical evidence and that will deliver the best outcomes for persons with gender incongruence or dysphoria.
331. Deputy Paul Murphy asked the Minister for Health if she will confirm that the clinician in the recording mentioned during the trans healthcare Dáil debate on 3 December 2025 (details supplied) has no involvement in the National Clinical Programme for Gender Healthcare, including as a member of the working group or clinical advisory group. [70651/25]
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 Grace Boland asked the Minister for Health whether her Department or the HSE holds data on the number of patients currently on waiting lists to register with a general practitioner in Skerries, Balbriggan, Rush and Lusk, in tabular form, by town; the national average for comparison; and if she will make a statement on the matter. [70668/25]
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.
333. Deputy Grace Boland asked the Minister for Health if her Department has data as to the number of general practices in north County Dublin currently accepting new patients; the measures being taken to expand GP capacity in the area; and if she will make a statement on the matter. [70669/25]
Amharc ar fhreagraGPs are self-employed practitioners and therefore may establish practices at a place of their own choosing. There is no prescribed ratio of GPs to patients and the State does not regulate the number of GPs that can set up in a town or community.
It is acknowledged that there is limited access to GP services in certain areas. Work is ongoing to increase the number of GPs practicing in the State and to thereby improve access to GP services for all patients across the country.
Significant increases in investment in general practice have been provided under the 2019 and 2023 GP Agreements. Under the 2019 GP Agreement additional annual expenditure provided for general practice was increased by €211.6m. This provided for increases in capitation fees for participating GMS GPs, and new fees for additional services and increased practice supports, including the introduction of a support for practices in urban areas of social deprivation.
The GP Agreement 2023 further increased GP capitation fees, increased the existing subsidy rates for practice staff, and introduced a grant support for additional staff capacity as well a practice staff maternity leave support.
The annual intake of doctors into the GP training programme has been increased by approximately 80% from 2019 to 2024, with 350 new entrant training places made available in 2024 and again in 2025. The number of new entrant training places is to increase again next year by 50 places to 400. As a result, the number of GP graduates has increased in recent years and will continue to increase in the coming years.
In addition, recruitment of GPs from abroad is ongoing under the International Medical Graduate (IMG) Rural GP Programme. As of end of Q3, there are 115 IMG GPs within the programme currently placed in general practice and a further 39 have completed the 2-year programme. The placement of IMG GPs is targeted to rural and underserved areas.
I have asked the HSE to reply to the Deputy directly in relation to the number of general practices in north County Dublin currently accepting new patients. Please note that as GPs are private practitioners, it will only be possible for the HSE to respond in relation to HSE contracted GPs.
334. Deputy Grace Boland asked the Minister for Health the incentives currently available to attract general practitioners to underserved areas such as Skerries, Balbriggan, Rush and Lusk; whether additional supports are being considered to address the shortage of primary care access; and if she will make a statement on the matter. [70670/25]
Amharc ar fhreagraGPs are self-employed practitioners, most of whom hold a GMS contract with the HSE to provide medical services to medical card and GP visit card holders on its behalf. GPs who hold a GMS contract are reimbursed for the services they provide through capitation payments and fee-per-item payments for certain services, they also receive a range of financial supports.
Under the GMS scheme, the financial supports available to eligible GPs/GP practices include practice staff supports, locum contributions for leave taking, rural practice supports, and a support for practices in urban areas of deprivation. A contribution to GMS GPs medical indemnity insurance is also paid.
GMS GPs working in rural areas who meet the qualifying criteria receive an annual rural practice support allowance under the Rural Practice Support Framework. The 2019 GP Agreement increased this practice support package for rural GP practices by 10%. Practices in receipt of rural practice supports attract the maximum allowable rates for practice staff support subsidies and locum contributions for leave taking.
The 2019 GP Agreement also introduced a support for GP practices in disadvantaged urban areas. The funding may be used for additional health personnel costs or for the provision of additional services.
In addition, a new locum support initiative commenced in May, providing GPs in receipt of rural practice supports with access to a streamlined locum sourcing service. While the GPs themselves will cover the cost of the locum, the HSE will bear the cost of securing the locum.
Further potential measures to support GP practices are being considered under the Strategic Review of General Practice. The review, currently underway, is examining the broad range of issues affecting general practice including issues related to GP capacity and will consider possible mechanisms to attract more GPs to rural and underserved areas. Following its completion, a final report will be presented to me outlining the findings of the review and setting out recommended actions for a more sustainable general practice.
With regard to access to other primary care services, improving timely access to healthcare for all by reducing waiting lists, including Primary Care waiting lists, is a key focus of the Path to Universal Healthcare: Sláintecare & Programme for Government 2025+.
In September, the Minister approved a proposal to address the long waiting lists for three Primary Care therapies, Physiotherapy, Speech and Language Therapy and Occupational Therapy, in order to reduce the waiting times for these three therapies to less than 10 months.
335. Deputy Grace Boland asked the Minister for Health the plans in place to expand primary care services in Skerries, Balbriggan, Rush and Lusk, including any proposals for the expansion of GP care provided through HSE clinics, additional GP contracts or service partnerships; and if she will make a statement on the matter. [70671/25]
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.
336. Deputy Grace Boland asked the Minister for Health if the Department of Health or the HSE holds data on the number of patients currently on waiting lists to register with a GP in north County Dublin; and if she will make a statement on the matter. [70672/25]
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.
337. Deputy Grace Boland asked the Minister for Health if her Department has assessed the impact of the expansion of pharmacist prescribing on GP workload in north County Dublin; if data is available on how this reform will improve access to GP-led healthcare in communities; and if she will make a statement on the matter. [70682/25]
Amharc ar fhreagraOn foot of a recommendation from the Expert Taskforce to Support the Expansion of the Role of Pharmacy (the Taskforce) the development of a national Common Conditions Service is being progressed via the Community Pharmacy Expansion Implementation Oversight Group (IOG). The Common Conditions Service (CCS) will enable community pharmacists to provide advice and prescribe for common and often self-limiting conditions in community pharmacies. The key enablers for this service are in place and it is expected that pharmacists will begin to deliver this service within community pharmacies over the coming weeks and months.
Within its final report, the Taskforce also recommended that the Department of Health should oversee a review of these recommendations, at an appropriate interval once the service has been implemented. The evaluation seeks to determine whether the goals of the service are being achieved and that the service is carried out in accordance with good governance policies and procedures. The outcomes of the evaluation will inform next steps for the expansion of pharmacy services, and will provide information on patient experience and access to care in the community.
As a part of this evaluation, pharmacists will be required to keep certain records for each consultation as agreed by the IOG. Under the recently agreed Community Pharmacy Agreement, it was agreed that 150 Community Pharmacy Contractors will collect and return data for the purposes of the evaluation of the Common Conditions Service. This will begin in March of 2026, and every six months, each pharmacy will generate a report from their pharmacy systems. These Contractors will also be required to complete a survey and make themselves available to participate in a focus group to allow qualitative data to be included within the evaluation. The first evaluation report of the Common Conditions Service will be available in early 2027.
338. Deputy Pádraig Rice asked the Minister for Health the steps she is taking to address staff shortages in University Hospital Galway; and if she will make a statement on the matter. [70701/25]
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.
339. Deputy Pádraig Rice asked the Minister for Health the number of unfilled posts in University Hospital Galway, by grade, in tabular form; and the number that are funded posts from 2024 and 2025 that remain unfilled. [70702/25]
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.
