Written Answers Nos. 190-209
190. Deputy Shay Brennan asked the Minister for Health if her Department has assessed the potential national cost savings associated with weight based dosing of pembrolizumab (keytruda), in light of the Cork University Hospital study indicating a saving of €635,417.50 for 28 patients over two years. [28352/26]
Amharc ar fhreagraBudgets 2021-2025 allocated an additional €158 million for new drugs, which has facilitated the introduction of 263 new medicines, to date. The Year 1 cost of a new drug comes from the allocation for new medicines, but it should be noted that once these medicines are approved for reimbursement the full cost of providing them can reach multiples of this initial cost as their uptake increases.
Budget 2026 allocated €217 million in additional funding for drugs, with €30 million of this allocated for new drugs funding.
A central component of pharmaceutical expenditure is the HSE’s pricing and reimbursement process for medicines.
To commence the pricing and reimbursement process, a pharmaceutical company must submit an application for a new medicine or a new use of an existing medicine, that has been granted European Medicines Agency (EMA) or Health Products Regulatory Authority (HPRA) authorisation, to the HSE’s Corporate Pharmaceutical Unit.
I understand for the HSE that Pembrolizumab is currently licensed by the EMA for a number of cancer indications. The current license is for fixed dosing for adult indications.
Currently, weight-based dosing for adult indications would therefore represent an unlicensed dosing posology for pembrolizumab in Ireland.
The pricing and reimbursement process is for licenced indications of a medicine.
While clinicians may choose to prescribe based on weight, patients should be informed of this and consented to treatment in line with the hospital’s policy on the use of unlicensed medication and unlicensed or “off label” indications. Cost savings from weight-based dosing would likely require cohorting of patients to reduce wastage from part vials (which can result from weight- based dosing).
191. Deputy Naoise Ó Muirí asked the Minister for Health if she will provide an update on the capital expenditure of Beaumont Hospital in north Dublin in 2025; and if she will make a statement on the matter. [28508/26]
Amharc ar fhreagraI have asked the Health Service Executive to respond directly in this circumstance where capital expenditure is centrally managed by the HSE as a function of Strategic Health Infrastructure and Capital Delivery.
192. Deputy Brian Stanley asked the Minister for Health the steps being taken to improve GP numbers in Laois; if her Department and the HSE are considering directly employed GPs as envisaged as part of Sláintecare; and if she will make a statement on the matter. [28404/26]
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 any area.
Under the GMS scheme, the HSE contracts GPs to provide medical services without charge to medical card and GP visit card holders. There are currently 2,611 GPs contracted to provide services under the GMS Scheme. A further 633 GPs do not hold a GMS contract but hold some other contract(s) with the HSE for the delivery of health services.
As per the Programme for Government, the Government is committed to increasing the GP workforce. Work is ongoing in this regard, to increase the number of GPs practicing across the country and thereby improve access to GP services for all patients.
Over €340 million in additional annual investment in general practice has been provided under the 2019 and 2023 GP GMS Agreements. The Agreements provide for, amongst other things, increased GP capitation fees, increased and new supports for practices, as well as new fees for additional services. Specific supports are available for eligible practices in rural areas and in areas of urban social deprivation.
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 this 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. Furthermore, recruitment of GPs from abroad is ongoing under the International Medical Graduate (IMG) Rural GP Programme, with the placement of IMG GPs targeted to rural and underserved areas.
A Strategic Review of General Practice is currently underway, led by my Department and with support from the HSE. The review is examining the issues effecting general practice, including issues related to GP capacity, and will consider further possible mechanisms to attract GPs to rural and underserved areas. When completed the review will set out recommended actions for a more sustainable general practice.
The Strategic Review is also considering the possible role of HSE employed GPs, as part of the wider examination of the GP capacity issue. It should be noted that any proposed model involving salaried GP positions would require careful consideration to ensure the required level of service could be provided for medical card and GP visit card holders as well as private patients.
193. Deputy Paul Murphy asked the Minister for Health if she will meet with striking workers from an organisation (details supplied); her views on their status as section 39 workers; and if she will make a statement on the matter. [28488/26]
Amharc ar fhreagraI would like to acknowledge the very important role that Health Care Assistants play in delivering home care services to older persons and persons with disabilities in our communities. It is disappointing that Health Care Assistants employed by Northside Home Care Services felt that they needed to take industrial action
I understand this dispute relates to terms and conditions which differ from those that staff in section 39, grant funded, organisations are benefitting from because of the WRC agreement reached between ICTU and relevant Government Departments in March last year.
Northside Home Care Services are primarily funded through a separate tender arrangement for home care and, as such, are not encompassed within this agreement. It is important to note that Northside Home Care is not a public body. Terms and conditions are set by the organisations themselves. The terms and conditions of employment of their staff, once in line with employment legislation, is strictly between the employer and the employee.
I understand that the organisation is in receipt of a separate, smaller amount of grant funding under Section 39, in relation to a meals-on-wheels service they provide and workers within this service may be eligible. The HSE have engaged with Northside Home Care Services in recent weeks in relation to the process for claiming an uplift in pay funding in respect of the section 39 funding that they do receive for the meals-on-wheels service they provide.
I appreciate that workers and organisations not encompassed by the WRC Agreement may be disappointed. However, the agreement reached applies only those aforementioned, grant-funded organisations.
The maintenance of industrial peace is vital to safeguarding patient safety and ensuring the uninterrupted delivery of essential services, and I would strongly encourage the employer and its employees to engage with the State’s established industrial relations machinery to work towards a resolution.
194. Deputy Barry Ward asked the Minister for Health to provide an update on the development and implementation of the updated National Breastfeeding Strategy; and if she will make a statement on the matter. [27965/26]
Amharc ar fhreagraEncouraging mothers to breastfeed is a priority, both for the Department of Health and for the HSE. Breastfeeding as a public health measure is protective against Non - Communicable Diseases and is the optimum nutrition for infants.
There has been considerable progress under the HSE Breastfeeding in a Healthy Ireland 2016-2025 Action Plan, resulting in a modest 7% increase in breastfeeding rates. However, further cultural and societal change is required to support breastfeeding in Ireland.
In 2025, the Department of Health formed a breastfeeding steering group to research and design the development of a new whole of government breastfeeding strategy.
Over the last year, the Department of Health has engaged with multiple stakeholders and across government, to inform how the new strategy will be designed.
The Department has engaged an independent reviewer to oversee the consultation process to assist in the development of a new national breastfeeding strategy.
A large multistakeholder event was held in November 2025, followed by specific focus groups in January 2026. A final workshop focusing on stakeholder implementation was hosted by the department in February. The independent reviewer is currently drafting the consultation report, which will be submitted to the department imminently.
The Department intends to build on the positive impact of the HSE Breastfeeding Action Plan up to 2025, by taking a whole of government approach to the new Breastfeeding strategy, which is expected to be published later this year.
195. Deputy Michael Cahill asked the Minister for Health the plans in place to increase the number of healthcare professionals in Kerry; and if she will make a statement on the matter. [28347/26]
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.
196. Deputy Pádraig Rice asked the Minister for Health to provide further details with respect to a review by HIQA into new studies related to the potential secondary benefits of shingles vaccination (details supplied); the status of this work; and if she will make a statement on the matter. [28363/26]
Amharc ar fhreagraThe immunisation programme in Ireland is based on the advice of the National Immunisation Advisory Committee, (NIAC). NIAC considers the prevalence of the relevant disease in Ireland as well as international best practice in relation to immunisation when developing its advice.
The current NIAC guidelines state that the shingles vaccine may be considered for those aged 65 years and older, due to the greater burden and severity of disease in this age group and in those aged 18 years and older at increased risk of shingles.
The Health Information and Quality Authority, (HIQA), has carried out a Health Technology Assessment, (HTA) on the herpes zoster vaccine which protects against shingles. HIQA published this HTA on 19 July 2024. The HTA found that adding the shingles vaccine to the routine immunisation schedule, at the vaccine price at the time, for all adults aged 65 years and over would not be cost effective and would be associated with a substantial budget impact.
While the vaccine is considered safe and effective, its protective effect diminishes over time. HIQA also noted the substantial budget impact associated with vaccination. If made available to everyone aged 65 and older, vaccination would cost €218 million over five years.
Whilst the HTA found that the introduction of the shingles vaccine was not cost effective based on the cost of the vaccine, it found that it could be cost effective for vaccination of those at 75 years and 80 years if the cost of the vaccine was reduced by 80%.
Given that the healthcare budget is finite and decisions regarding increased spending relating to a change in one area could impact the provision of other health technologies and treatments within the healthcare system, the cost-effectiveness must be considered in any decision-making process.
My Department considered the findings of this HTA in 2024 and determined that the introduction of the vaccine could be reconsidered when the cost effectiveness of the vaccine is confirmed as being more favourable.
I can confirm that the introduction of the shingles vaccine to the immunisation schedule in Ireland is again being actively considered for a cohort of immunocompromised individuals, in line with NIAC advice and cognisant of the cost effectiveness of market pricing and available funding.
The recombinant zoster vaccine, (RZV, Shingrix), is licensed in Europe for the prevention of shingles and its most common complication, post-herpetic neuralgia.
HIQA is aware that a number of studies have been published, since the HTA, suggesting a possible association between shingles vaccination and potential indirect benefits, such as a delay in the onset of dementia.
HIQA is undertaking a review of these studies and is considering the implications, if any, for the advice provided in relation to the cost effectiveness of shingles vaccination in Ireland. The findings of this review will assist in decision making in relation to the potential for the introduction of a shingles immunisation programme in Ireland.
197. Deputy Brian Stanley asked the Minister for Health the progress that has been made to date in terms of providing occupational therapists for primary care services in Laois; and if she will make a statement on the matter. [28405/26]
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.
198. Deputy Marie Sherlock asked the Minister for Health the steps she has taken to directly address the major shortfall in staffing in the National Ambulance Service; the steps she is taking to avert impending planned strike action by National Ambulance Service workers; and if she will make a statement on the matter. [28375/26]
Amharc ar fhreagraI was disappointed to learn that SIPTU and UNITE notified the HSE of their decision to proceed with industrial action, up to an including potential strike action, in the National Ambulance Service.
This issue has been the subject of extensive engagement over the last two years, through the Workplace Relations Commission and the Labour Court. My Department, the HSE and Department of Public Expenditure (DPER) accepted both the WRC proposals and the subsequent Labour Court Recommendation in full and both unions also recommended acceptance by their members.
My Department, the HSE and DPER all remain fully committed to the dispute-resolution mechanisms under the Public Service Agreement 2024–2026. The clear priority must be the safety of patients and the continuity of emergency services. I therefore, strongly urge all parties to re-engage constructively and to use the established State mechanisms to bring this matter to resolution in the interest of the public.
Government investment in recent years has supported total NAS staff growth of 30% since 2020, representing a significant increase for the service. I remain committed to supporting continued development of NAS to build further capacity, with an allocation for NAS in 2026 to support HSE plans for an additional 263 posts, representing a €20 million investment. The additional posts in 2026, will support further frontline ambulance capacity as well as further development of NAS alternative care pathways, including Community Paramedic services.
199. Deputy Malcolm Byrne asked the Minister for Health for an update on plans to increase the number of dentists in Ireland. [28390/26]
Amharc ar fhreagraIt is heartening to note that there are 3,909 dentists on the Dental Council register as of 16th of April 2026 which is an increase of 86 since this time last year, April 2025. This reflects ongoing upward trends regarding registered dentists in the State, and compares favourably with the numbers in April 2019, when Smile agus Sláinte was published – 3,100, an increase of over 26%. However, it is unknown how that figure translates into capacity in terms of dental appointments and the ranges of treatments available.
In terms of increasing the capacity of dentists in Ireland my Department intends to address workforce capacity by further engaging with the Department of Further and Higher Education, Research, Innovation and Science (DFHERIS) and the Higher Education Authority (HEA).
I welcome the publication of the report from the Joint Committee on Health on Dental Services in the Healthcare service last week. One of the recommendations in the report includes increasing the capacity to train and educate new dental professionals which my Department is currently advancing in collaboration with DFHERIS.
As part of this engagement, I understand that officials from DFHERIS met with University College Cork in February of this year to discuss in detail its proposal to establish a community-based dental outreach centre in North Cork, and to advance this important project.
The proposal, which includes a request for capital investment from my Department will support an increase in undergraduate dental training capacity and provide students with earlier clinical exposure in primary care settings.
My Department has also received a draft proposal to increase to the number dental training places at the Dublin Dental University Hospital at Trinity College Dublin. This will require further discussion to progress this proposal with the aim to maximise both Irish and EU places to enhance workforce capacity in Ireland, as well as increased service provision.
We will continue to collaborate with all stakeholders including both Trinity College Dublin and University College Cork to increase the capacity at both dental schools.
Both these initiatives complement the new Bachelor of Dental Surgery Programme at the Royal College of Surgeons in Ireland (RSCI) which commenced in September 2025. The RCSI has informed us that its intake is 30 students, 21 of whom are Irish/EU students. The RCSI has secured an agreement with the HEA to expand its intake to 35 Irish/EU student places by 2027. Over time, this will expand domestic graduate output by approximately 25% and contribute to workforce sustainability. Overall, the RCSI has indicated that it will produce 75 graduate dentists per annum when fully operational.
We will continue to work with DFHERIS to increase dental training capacity in a sustainable and strategic manner. Ensuring adequate capacity to train future dentists is part of the Government's commitment to workforce planning that supports the health and wellbeing of our population.
200. Deputy Cathy Bennett asked the Minister for Health the timeframe in which she intends to deliver provision of MRI scans at Monaghan Hospital; and if she has considered providing for CT scans at Monaghan Hospital. [28450/26]
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.
201. Deputy Conor Sheehan asked the Minister for Health if she will consider the provision of a sexual assault treatment unit in Limerick; and the reasons survivors of rape and sexual assault in Limerick, Clare and Tipperary are required to make a report to the Gardaí before they can access treatment at a SATU (sexual assault treatment unit); and if she will make a statement on the matter. [28050/26]
Amharc ar fhreagraAs this is an operational matter, this PQ is referred to the HSE for direct response to the deputy.
202. Deputy Joe Neville asked the Minister for Health given the current GP shortage, particularly in areas like north Kildare, if she will consider alleviating set up costs on new GP services to ensure new practices are established; and if she will make a statement on the matter. [28454/26]
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.
As committed to in the Programme for Government, work is ongoing to increase the number of GPs practicing across the country, thereby improving access to GP services. Measures taken to increase GP capacity include significant increases in investment in general practice under the 2019 and 2023 GP GMS agreements, increased GP training places, and the recruitment of GPs from abroad under the joint HSE and ICGP International Medical Graduate (IMG) Rural GP Programme.
Most GPs hold a GMS contract for the provision of GP services without charge to medical card and GP visit card holders. General practitioners who hold a GMS contract are reimbursed for the services they provide to medical card and GP visit card holders on behalf of the HSE. GMS GPs are remunerated through capitation payments and fee-per-item payments for certain services, and they also receive a range of practice supports.
Under the GMS scheme, GPs are paid a subsidy towards the cost of employing a practice nurse and/or a practice secretary. The rate payable depends on the GP's GMS panel size and the level of experience of the nurse or secretary. A practice manager subsidy is also available. The GP Agreement 2023 increased the existing subsidy rates for practice staff and introduced a new grant support for additional practice staff capacity as well as a practice staff maternity leave support.
GMS GPs working in rural areas who meet the qualifying criteria qualify for an annual rural support allowance. The 2019 GP Agreement increased the practice support package for rural GP practices by 10% and introduced a €2 million annual support for GP practices in disadvantaged urban areas. Practices in receipt of rural practice supports attract the maximum allowable rates for practice staff support subsidies and locum contributions for leave taking. Contributions are also made under the GMS scheme towards locum costs for various GP leave arrangements.
My Department and the HSE are currently undertaking a Strategic Review of General Practice which is to be completed this year. The review, with input from key stakeholders, is examining the broad range of issues affecting general practice and will set out the measures necessary to deliver a more sustainable general practice into the future. Under this review, consideration is to be given to the development of the support model necessary to underpin the provision of sustainable GP services.
It is worth noting that some GP practices operate from HSE Primary Care Centres (PCCs). PCCs are modern, purpose-designed buildings that provide a single location for a primary care team to work from. As of end 2025, there are 181 PCCs operational.
204. Deputy Liam Quaide asked the Minister for Health the current level of investment in psychiatry of later life services in each HSE health region; the level of investment required in each such area to achieve the staffing and service targets envisaged in the 2019 Specialist Geriatric Services Model of Care, Part 2: Mental Health Service Provision; and to explain the shortfall between current investment and the investment required to meet those targets. [28474/26]
Amharc ar fhreagraMental health policy is guided by Sharing the Vision the national mental health policy , which promotes tailored, community-based services for older adults and better integration between primary care and specialist mental health teams. Over 30 Psychiatry Later Life Teams are currently in operation, and the Model of Care for Specialist Mental Health Services for Older People (2019) is being implemented, with five demonstration sites delivering liaison psychiatry services have established.
Expansion of these services is ongoing, with additional teams planned based on identified needs and staffing gaps. Under Budget 2026, I have funded two additional teams for this Programme.
With reference to the specific information requested, as this relates to a service matter, it has been referred to the HSE for direct reply to you.
205. Deputy Pa Daly asked the Minister for Health her plans to improve services at University Hospital Kerry. [28493/26]
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.
206. Deputy Martin Daly asked the Minister for Health when additional primary care centres or services will be delivered in underserved areas of Roscommon-Galway. [28491/26]
Amharc ar fhreagraAs the Health Service Executive (HSE) holds responsibility for the provision, along with the maintenance and operation of Primary Care Centres, I have asked the HSE to respond to the Deputy directly, as soon as possible.
207. Deputy Micheál Carrigy asked the Minister for Health for an update on the price negotiations regarding Skyclarys; the steps being taken to support those with Friedrich’s ataxia in the time critical interim; and if she will make a statement on the matter. [28226/26]
Amharc ar fhreagra208. Deputy Peter 'Chap' Cleere asked the Minister for Health for an update on capital projects at St. Luke's Hospital, Kilkenny; and if she will make a statement on the matter. [28344/26]
Amharc ar fhreagraAs the Health Service Executive is responsible for the delivery of public healthcare infrastructure projects, I have asked the HSE to respond to you directly in relation to this matter.
209. Deputy Naoise Ó Cearúil asked the Minister for Health the steps being taken to restore staffing to the primary care children's assessment team in CHO7; the interim diagnostic pathways that are available to children who have been informed that no clinicians are currently available to carry out assessments; and if she will make a statement on the matter. [28368/26]
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.
