Written Answers Nos. 2204-2217
2204. Deputy Conor Sheehan asked the Minister for Health the number of vacant community health posts in UHL hospital group CHO by discipline, by grade and whole time equivalent, in tabular form; and if she will make a statement on the matter. [74605/25]
Amharc ar fhreagraAs this is a service matter I have asked the HSE to respond to the deputy as soon as possible.
2205. Deputy Pearse Doherty asked the Minister for Health if she will ensure that adults have access through the health service to burosumab for treatment for hypophosphataemia; and if she will make a statement on the matter. [74617/25]
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, I have asked the HSE for an update in this matter.
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 robustly assesses 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.
The HSE considers the following criteria prior to making any decision on pricing / reimbursement, in line with the Health (Pricing and Supply of Medical Goods) Act 2013:
(1) The health needs of the public,
(2) The cost effectiveness of meeting health needs by supplying the item concerned rather than providing other health services,
(3) The availability and suitability of items for supply or reimbursement,
(4) The proposed costs, benefits, and risks of the item or listed item relative to therapeutically similar items or listed items provided in other health service settings and the level of certainty in relation to the evidence of those costs, benefits and risks,
(5) The potential or actual budget impact of the item or listed item,
(6) The clinical need for the item or listed item,
(7) The appropriate level of clinical supervision required in relation to the item to ensure patient safety,
(8) The efficacy (performance in trial), effectiveness (performance in real situations) and added therapeutic benefit against existing standards of treatment (how much better it treats a condition than existing therapies) and,
(9) The resources available to the HSE.
In terms of the specific details of the applications for pricing and reimbursement of burosumab (Crysvita®):
Hospital pricing approval is in place for burosumab (Crysvita®) for the treatment of X-linked hypophosphataemia with radiographic evidence of bone disease in children 1 year of age and older and adolescents with growing skeletons from the 1st May 2021.
The HSE received an application for pricing and reimbursement of burosumab (Crysvita®) on the 3rd February 2023 from Kyowa Kirin (the applicant) for the treatment of X-linked hypophosphataemia in adults.
• 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 3rd February 2023.
• The NCPE Rapid Review assessment report was received by the HSE on the 14th March 2023. The NCPE advised the HSE that a full health technology assessment (HTA) was recommended to assess the clinical effectiveness and cost effectiveness of burosumab compared with the current standard of care.
• The HSE commissioned a full HTA on the 28th March 2023 as per agreed processes.
• The NCPE HTA Report was received by the HSE on the 1st August 2024. The NCPE recommended that burosumab (Crysvita®) not be considered for reimbursement, for this indication ([www.ncpe.ie/burosumab-crysvita-2/]).
• 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 Kyowa Kirin regarding their application for burosumab (Crysvita®).
• The HSE 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 HSE Drugs Group considers all of the evidence and makes a recommendation to the HSE Senior Leadership Team. The totality of clinical and economic evidence for burosumab (Crysvita®) for the treatment of X-linked hypophosphataemia in adults was comprehensively and extensively reviewed by the Drugs Group at the June 2025 meeting. The Group were unable to progress a recommendation that was supportive of reimbursement on the basis of the totality of available evidence. As the application was for a medicine for the management of a rare disease, the Group requested its referral to the HSE Rare Diseases Technology Review Committee (RDTRC) for further patient and clinician engagement to assist in their deliberations ([www.hse.ie/eng/about/who/cpu/drugs-group-minutes/hse-drugs-group-minutes-june-2025.pdf]).
• The totality of clinical and economic evidence for burosumab (Crysvita®) for the treatment of X-linked hypophosphataemia in adults, including the statement from the RDTRC, was reviewed by the Drugs Group at the November 2025 meeting. Based on the totality of available evidence, the Drugs Group recommended against hospital pricing approval of burosumab (Crysvita®) for this indication. ([www.hse.ie/eng/about/who/cpu/drugs-group-minutes/hse-drugs-group-minutes-november-2025.pdf]).
• 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. The HSE Senior Leadership Team supported the Drugs Group recommendation against hospital pricing approval of burosumab (Crysvita®) for the treatment of X-linked hypophosphataemia in adults.
The application for burosumab (Crysvita®) remains under consideration. In line with the Health (Pricing and Supply of Medical Goods) Act 2013, the next step in the process involves the HSE providing formal written notice of the HSE Senior Leadership Team’s proposed decision, together with the reasons for the relevant decision to the applicant. The applicant will then be afforded the opportunity to make representations on the proposed decision.
The HSE cannot comment on potential outcomes pending the notice of proposal and representation process.
2206. Deputy Naoise Ó Muirí asked the Minister for Health the payroll cost of her Department and of each organisation or agency under its remit individually, in 2015 to 2025, by year, in tabular form. [74629/25]
Amharc ar fhreagraThe payroll costs for the Department of Health and its agencies and aegis bodies from 2015 to 2025 are set out at the link below.
Please be advised that confirmed 2025 payroll costs for many agencies and bodies are not yet finalised. This has been indicated at the link below.
The HSE will issue a separate response directly to you.
2207. Deputy Grace Boland asked the Minister for Health if she will provide an update on the work undertaken by the HSE to recruit a full-time psychologist for the community adult mental health team in Balbriggan; and if she will make a statement on the matter. [74650/25]
Amharc ar fhreagraAs this is a service matter I have asked the HSE to respond to the deputy as soon as possible.
2208. Deputy Grace Boland asked the Minister for Health the plans the HSE has in place to address the backlog of patients waiting to be seen by the community adult mental health team; the measures being implemented to reduce waiting times; and if she will make a statement on the matter. [74651/25]
Amharc ar fhreagraAs this is a service matter I have asked the HSE to respond to the deputy as soon as possible.
2209. Deputy Grace Boland asked the Minister for Health the number of patients currently on the waiting list for psychological services within the community adult mental health team; the average waiting time; and if she will make a statement on the matter. [74652/25]
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.
2212. Deputy Micheál Carrigy asked the Minister for Health the steps being taken to address the absence of effective crisis intervention pathways for adults experiencing severe mental illness who lack insight into their condition and are therefore deemed capable of refusing care, despite being acutely unwell; and if she will make a statement on the matter. [74713/25]
Amharc ar fhreagra2213. Deputy Micheál Carrigy asked the Minister for Health the reason An Garda Síochána continues to be the default point of contact for families experiencing mental health crises involving vulnerable adults; what engagement has taken place between her Department, the HSE and the Department of Justice, Home Affairs and Migration, to develop health-led alternatives; and when families can expect access to dedicated mental health crisis response teams nationwide; and if she will make a statement on the matter. [74714/25]
Amharc ar fhreagra2214. Deputy Micheál Carrigy asked the Minister for Health if she is satisfied that current mental health legislation adequately protects vulnerable adults who refuse care due to impaired insight arising from mental illness; if legislative gaps have been identified by the Department or the Mental Health Commission; if amendments are being actively considered to better protect patients and families in such circumstances; and if she will make a statement on the matter. [74715/25]
Amharc ar fhreagra2215. Deputy Micheál Carrigy asked the Minister for Health the immediate reforms planned to prevent irreversible harm to individuals experiencing acute mental health crises where early intervention is not currently available; and if consideration is being given to expanding crisis admission criteria, mobile crisis teams, or family-initiated assessments outside Garda involvement; and if she will make a statement on the matter. [74716/25]
Amharc ar fhreagra2216. Deputy Micheál Carrigy asked the Minister for Health the number of cases in the past five years have involved families seeking urgent intervention for a mentally unwell adult who was deemed capable of refusing care; and if the Department has assessed the outcomes for those individuals; and if she will make a statement on the matter. [74717/25]
Amharc ar fhreagraI propose to take questions Nos. 2212 to 2216, inclusive, together.
I am satisfied that appropriate safeguards are in place in legislation to adequately protect individuals with mental health difficulties who may lack insight into their condition.
In relation to people accessing mental health services in the community, it is generally a decision for that person to make decisions about his or her own mental care and treatment. If a person does not wish to engage with a mental health service, or does not want to consent to a particular form of treatment, those wishes must be respected. A person in the community cannot be compelled to accept a form of treatment if he or she makes the capacitous decision to refuse it. Mandating treatment where a person refuses such treatment would very likely be found to be a breach of that person's constitutional and ECHR rights.
If a person in the community has been determined to lack decision-making capacity, due to his or her mental health difficulties or for any other reason, the Assisted Decision-Making (Capacity) Act 2015 is available. This means that a person can appoint a Designated Healthcare Representative to make decisions on his or her behalf regarding healthcare (including mental health) when that person lacks capacity. Furthermore, an order can be made to the Court to appoint a Decision-Making Representative to make decisions about care and treatment on behalf of a person who has been determined as lacking capacity by the Court.
The provisions of the Mental Health Act 2001 are available to mental health professionals in cases where a person is refusing mental health care and treatment and where that person has a ‘mental disorder’ within the meaning of the Act (which means that he or she meets strict admission criteria.) The purpose of the Mental Health Act 2001 is to set out the legal basis for the detention, admission and treatment of people with mental disorders.
Following a person’s admission, the person can be treated where he or she is incapable of consenting and where the treatment is in the best interests of the person. The 2001 Act sets out various safeguards in relation to the administration of treatment. Where an urgent intervention is required, a person may be admitted as an involuntary patient under the 2001 Act following a three-step process to determine that the person has a mental disorder, including examinations by both a GP and a consultant psychiatrist.
An Garda Síochána play a key role under the 2001 Act as its members have the power to take a person into custody that they believe has a mental disorder. When a person has been taken into custody, an application can be made under the 2001 Act for the person’s involuntary admission to an inpatient mental health service, as the first step in the three-part admission process.
As the Deputy will be aware, I am currently progressing the Mental Health Bill 2024 through the legislative process. In due course, this Bill will replace the 2001 Act. The 2024 Bill retains the ability to involuntarily admit a person and provides for a person to be treated without consent where that person has a mental disorder that meets the criteria for involuntary admission, lacks capacity and lacks a substitute decision-making arrangement under the Assisted Decision-Making (Capacity) Act 2015. Involuntary admission will continue to be available in all cases where a person has a mental disorder that meets the admission criteria set out in the Bill.
An Garda Síochána will continue to play an important role under the new Bill and will still retain the ability to bring people they suspect of having a mental disorder into custody. In future, when a person is brought into Garda custody, the HSE will dispatch an authorised officer to assess the person and who will decide whether the involuntary admission process should be initiated for that person. Authorised officers are an existing grade of mental healthcare professionals in the HSE and already operate under the Mental Health Act 2001.
The enhanced role for the Authorised Officer will reduce the making of inappropriate applications, provide a more holistic view of the person, and allow the Authorised Officer to act as a point of information for family members through the process.
The Bill is currently progressing through Committee Stage in the Seanad and I look forward to the enactment of the Bill in the first months of 2026.
I would also like to mention the Final Report of the High Level Taskforce to consider the mental health and addiction challenges of those who come into contact with the Criminal Justice sector, which was published in September 2022.
The Report identified the need to take a holistic approach when considering the mental health and addiction challenges of those who come into contact with the criminal justice sector from initial contact right through to release and support in the community. Many of the recommendations detailed in the Taskforce’s Final Report build on existing infrastructure, creating better connectivity and linkages between services to better support those in the criminal justice system with mental health and/or addiction issues and to make a meaningful difference to their treatment.
In relation to the health sector, good progress has been made overall in progressing key objectives of the Taskforce Report. A focus has been to bring about new and real options around Diversion, including more person-centred and integrated care by all relevant health services for this small but highly vulnerable group. A joint pilot project in Limerick between An Garda Siochana and the HSE over 2025 to help divert those away from the justice system has proved promising. A formal evaluation of this is due to be completed in the next few months, which will help inform the future potential of this approach to care.
With regard to the number of cases with family involvement seeking urgent intervention, pathways for crisis intervention, the expansion of crisis interventions and nationwide roll out of crisis response teams, I have referred these service questions to the HSE for direct reply to the Deputy.
