News Ireland daily BLOG by Donie

Tuesday 25th November 2014

People with terminal illnesses will no longer face a medical card review

 

Major medical card changes announced by Leo Varadkar

Minister for Health Leo Varadkar has announced major changes to the medical card system to make the processing of applications more sensitive to the needs of people with serious illnesses.

People with terminal illnesses will no longer have to have their medical card reviewed, Minister for Health has announced as part of a major change to the system.

Leo Varadkar also said the Health Service Executive can provide people with therapies or appliances, even in the absence of a medical card.

Changes in the medical card system will see more account taken of the burden of an illness as part of an “enhanced” assessment process.

The power of a GP to extend a medical card in difficult circumstances is to be extended to four months and to 12 months in sensitive cases.

There will be greater exchange of information between the medical card central assessment office and local health offices when applications are considered.

More than 10,000 people, who had their medical cards removed and later reinstated, have been told they will retain the cards pending implementation of actions to improve the scheme.

“From now on, wider discretion and greater humanity will be exercised as part of an enhanced process that takes into account the burden of an illness or condition,” Mr Varadkar said.

His initiative is the second attempt by the Government to lay to rest the controversy surrounding the award of discretionary medical cards, which was a major issue contributing to electoral difficulties for Fine Gael andLabour earlier this year.

Last May, former Minister for Health James Reilly tried to defuse the controversy over the withdrawal of cards by promising they would henceforth be given out on the basis of medical condition.

Mr Varadkar abandoned this approach after Prof Keane’s group found this was not possible.

Mr Varadkar said the controversy had convinced him more than ever that the only solution was a move to universal healthcare.

Without this, there would always be people above the financial threshold for qualifying for a card.

New legislation may be needed to ensure the burden of an illness was taken account of when awarding cards, he admitted; “We’re already pushing the existing legislation to the boundaries”.

Prof Frank Keane, who chaired a review group on medical card eligibility, said measuring illness burden would be a difficult process.

It had not been done anywhere else in the world but it was not impossible.

Prof Keane’s group, whose report has been published, found it was neither feasible nor desirable to move away from the present system of awarding cards on financial grounds and listing medical conditions in priority order of eligibility.

“The present system works well in 95 per cent of cases but we’re trying to respond to the public demand for greater discretion in the remaining 5 per cent,” Mr Varadkar said.

He admitted he now regretted the Cabinet decision to impose “probity” savings on the HSE in the 2012, which had resulted in cards being taken away from sick people.

Two-thirds of people who applied for cards this year and were over the income limits were given a card on discretionary grounds, Minister of State for Primary Care Kathleen Lynch revealed.

The Irish Medical Organisation and children’s campaign Jonathan Irwin of the Jack & Jill Foundation both gave the measures a “cautious welcome” for the greater exercise of discretion proposed.

The Irish Cancer Society said it would campaign for a complete overhaul of legislation to decisions were made on medical rather than financial grounds.

The controversy over the removal of discretionary medical cards escalated in the run-up to the local elections earlier this spring and was widely blamed within Fine Gael and Labour for the parties’ poor performance.

Shortly after the election, the Government rowed back by re-instating up to 15,000 discretionary cards which had been removed during HSE reviews in the preceding years.

Ryanair partners Booking.com, now to add some 550,000 hotels to its website

   

Ryanair has announced a strategic partnership with Booking.com, offering over half a million hotels for booking on its website.

The new partnership will allow customers to book accommodation directly on Ryanair.com while booking flights, the airline says.

Booking.com is a world leader in online hotel and accommodation booking, and will facilitate the airline in offering competitive prices on “any type of property” in 209 countries.

The partnership is the latest step in Ryanair’s “Always Getting Better” programme, following a new website, an app with mobile boarding passes and a Business Plus service.

“Ryanair will carry 89 million passengers this year at our lowest fares and our partnership with Booking.com guarantees the lowest hotel prices, allowing Ryanair customers to book their flights and accommodation together,” said Ryanair’s Chief Marketing Officer, Kenny Jacobs.

Andre Manning, Booking.com’s Global Head of PR, added:

“We are excited to be the exclusive partner of Ryanair and to see reservations of accommodations grow rapidly in a very short time via their website.”

Over 750,000 room nights are reserved daily on Booking.com.

The company is based in the Netherlands, but  is supported internationally by 150 offices in over 50 countries including Dublin, Ireland. It hosts over 40 million guest reviews.

How genetic screening can reduce the risk of cystic fibrosis

 

Patrick Mullane and Dr John Waterstone with baby Bridget.

Genetic testing of an embryo prior to implantation gives people with genetic diseases the chance to become parents without passing on inherited condition.

All babies are special but baby Bridget Mullane is particularly precious as her parents thought they might never be able to have a family together. They are at high risk of having a baby born with cystic fibrosis (CF), a disease that primarily affects the lungs and the digestive system.

Bridget’s birth this year following a technique used to screen embryos for genetic conditions such as CF was hailed as a major milestone for Irish reproductive medicine.

Her father, Patrick Mullane, who is 34, has CF, the most common genetic disease in Ireland, while her mother, Lisa Cooke, who is 24, discovered she was a carrier of the CF gene after being tested. The couple, from Dromahane near Mallow, Co Cork, were facing the possibility that they would never be able to have children together when they heard about Pre-implantation Genetic Diagnosis (PGD) which had just been introduced to Ireland.

PGD is a technology that allows genetic testing of an embryo prior to implantation. Conception takes place through IVF and only the embryos diagnosed as being free of a specific genetic disorder are transferred into a woman.

The treatment is suitable for couples who are at risk of transmitting an inherited genetic disease to their children such as CF, Batten disease, muscular dystrophy, Fragile X or Fanconi Anaemia.

Prior to the development of the PGD technology, the only option for such couples was either to avoid becoming pregnant, or to become pregnant and undergo chorionic villus sampling or CVS (which involves taking a sample of cells from the mother’s placenta) at 11 weeks, or amniocentesis (which involves taking a small amount of amniotic fluid from around the baby) at about 14 weeks. If the foetus was affected by a life-threatening, inherited disease, the couple faced the awful decision of whether to continue with the pregnancy.

After her first round of PGD at Cork Fertility Clinic, Cooke discovered she was pregnant and the couple were thrilled when their little daughter was born weighing a healthy 7lbs 9oz (3.4kg) at Cork University Maternity Hospital on June 27th. Bridget was tested for CF at birth and was found to be a carrier of the gene.

“We realise how lucky we were to get pregnant on the first attempt. I was nervous at the start but the treatment wasn’t as bad as I thought it would be. I was told to do a pregnancy test two weeks after the embryo was transferred into me, and I was actually on a train in London when I found out I was pregnant,” she says.

Genetic counselling: Mullane and Cooke had genetic counselling before the treatment and Cooke was put on medication to stimulate ovulation. The treatment involved removing 28 eggs from her, and fertilising them through IVF. On day five, using laser-assisted biopsy, cells were removed from the embryos and sent to a genetic lab in the UK for analysis. Of the healthy embryos that survived, one was transferred back into Cooke’s uterus and the others were frozen.

The couple are already talking about having a second baby, and they are planning to use some of the other embryos that are in storage at the fertility clinic. Mullane is optimistic about the future.

“I lead a fairly normal life. I go to the gym to keep myself healthy. Staying fit helps to keep my lungs clear. I’m on a mild antibiotic all the time and I take tablets to help with my digestion. There’s a new drug for my mutation of the disease in stage 3 trials so hopefully that will become available some time soon.”

Ireland has the highest incidence of CF in the world with about one in 19 Irish people said to carry one copy of the defective gene that causes it. Many people with the disease in Ireland can now expect to live into their 30s, 40s and beyond; a 76-year-old woman recently became the oldest woman in the country to be diagnosed with CF.

High price? The cost of PGD is very high, at more than €10,000, as it includes genetic counselling and genetic analysis fees on top of IVF treatment. Cystic Fibrosis Ireland provided Mullane and Cooke with a first-time applicant grant of €3,000 through its fertility treatment scheme but Mullane feels strongly that the HSE should fund the procedure for people with CF. He points out that infertility is directly linked to CF and the cost of PGD treatment to ensure a child is born without CF far outweighs the lifetime cost of treating a CF patient.

Alicia May of CF Ireland agrees that the treatment should be funded by the HSE, saying that infertility should be treated like any other secondary complication of CF such as diabetes or osteoporosis. The organisation is currently drafting a policy document to advocate for the State funding of fertility treatment in CF.

“Our fertility grant has been operating for a few years, it is hugely beneficial and hugely valued by people with CF, and we have had quite a few success stories. We have not had to turn anybody down yet, but there is more demand for the scheme with people living longer and wanting to start families, which would not have been possible in the past.

“Unfortunately, PGD is so expensive that it excludes many people with CF who cannot work and are dependent on disability allowance.”

Dr John Waterstone, medical director of the Cork Fertility Centre and a consultant obstetrician at Cork University Maternity Hospital, stresses that PGD is not an easy process and is “not for everybody”.

He says that Cooke was a very favourable candidate for the treatment due to her age and the large quantity of good-quality eggs she produced. “This is not an easy process and we have to be very sensible about who we offer it to. IVF is more successful for younger couples and PGD is a form of IVF. Some of the embryos are not going to be usable because of the genetic condition involved, and in older women, there will be fewer eggs to start with.

“If a woman is older and less likely to produce a lot of eggs, it is less likely that the treatment will take, so unfortunately she would not be a good candidate and we would not offer her this treatment. Obviously, when it does work, it’s fantastic and is the neatest solution to the problem of couples at risk of passing on a genetic condition.”

The Cork centre has a number of couples going through PGD at the moment and one other couple with a rare genetic disorder are expecting a baby. The treatment is also being offered by Beacon Care Fertility in Dublin, part of the Care chain in the UK, where some 23 couples have been through PGD to date but there have been no successful pregnancies yet.

HSE ups number of executives by 10% despite cuts

  

Increase in numbers took place as figures for nurses and support staff fell.

The number of senior mangers in HSE hospitals has increased by more than 10 per cent over the past 3½ years despite significant retrenchment in budgets over the period. The increase in numbers took place at the same time as nursing and support staff levels fell, according to an internal HSE report.

The report, obtained by The Irish Times under Freedom of Information legislation, indicates that overall the numbers of senior mangement staff (grade VIII level and above) in acute hospitals have increased from 273 in 2011 to 303 in 2014, a rise of 10.9 per cent.

The number of directly employed middle management personnel in the acute hospital sector also rose in the same period but there was a fall of about 4 per cent in the number of lower-level administrative personnel.

Officials: The figures were set out by the HSE in an internal report to the Government’s joint monitoring committee for the health service.

The committee comprises officials of the Department of Health, the Department of Public Expenditure and Reform, and the Department of the Taoiseach.

It said the numbers in staff nurse core grades had fallen by 744 since 2011 although there had been an increase of 121 in the number of staff midwives.

The number of general support staff such as cleaners, caterers and porters fell by 468 between 2011 and 2014, according to the HSE figures.

Numbers of health-care assistants/nurse aides fell by 2.9 per cent (the equivalent of more than 100 staff) in the same period.

The HSE told the monitoring committee that the increase in the number of senior managers was due mainly to a “regularisation process” set out in the Haddington Road agreement on public service pay and productivity which came into effect in mid-2013. It said the vast bulk of the increase in numbers at senior mangement level had taken place last year and this year.

It stated there had been an overall reduction of 8.4 per cent in the number of senior managers in acute hospitals since a peak was reached in 2007.

The HSE also said the increase in the numbers at middle mangement level (grades V, VI and VII) in acute hospitals was due to the Haddington Road deal and “general progression of staff from lower grades”.

It said the middle management cohort had fallen since the Government’s recruitment moratorium was introduced in 2009.

The HSE argued that the number of managers was not excessive when it was considered that in terms of budgets and staffing levels the hospital sector was equivalent to about 250 medium-sized enterprises. The hospital sector employs 48,000 personnel and has a pay bill of over €3 billion.

Paying for sex to be made illegal under new laws

  

The legislation is being brought forward by Justice Minister Frances Fitzgerald

PAYING for sex will be made illegal under draft laws coming before the Cabinet today.

But the proposed legislation will not criminalise the prostitute.

The Criminal Purchase of Sexual Services legislation is expected to be approved by ministers and will be finalised over the coming months.

The proposed legislation will specifically penalise the ‘buyer’, but not the ‘seller’.

The legislation is being brought forward by Justice Minister Frances Fitzgerald, who is also proposing that sex offenders be electronically tagged in exceptional circumstances. The Sexual Offences Bill, drafted by the Department of Justice, will result in a major expansion of the Irish Prison Service’s capacity to roll out electronic tagging.

Under the proposals, probation officers attached to the prison service will make an application in court for a prisoner to be tagged.

Antarctic sea ice could be thicker than thought,

A robot submarine finds

  

Political situation has made submersible surveys tricky

The floating sea ice surrounding the South Pole may be thicker than previous estimates have suggested, according to a study based on a submersible robot that has mapped the sea ice in three key regions of the Antarctic.

Past estimates of Antarctic sea ice were based on satellite measurements from space, which can measure its overall surface area, and ice cores drilled through the sea ice from ice-breaking ships to measure its thickness, which have tended to concentrate on thinner ice regions.

However, unlike the Arctic sea ice, there are no military submarines allowed under the Antarctic Treaty, which means that large regions of thicker sea ice have effectively remained unexplored from below, scientists said.

With the help of a 2m twin-hulled autonomous underwater vehicle, scientists from the United States, Australia and the British Antarctic Survey have drawn up the first detailed, high-resolution 3D map of Antarctic sea-ice in areas that were in the past considered too difficult to study.

Stunning images of Antarctica

“The AUV missions have given us a real insight into the nature of Antarctic sea ice, like looking through a microscope. We can now measure ice in far greater detail and were excited to measure ice up to 17m thick,” said Jeremy Wilkinson of the BAS.

“It gave us a really good basis for what the ice thickness is at present. Over time we hope to make repeat measurements and build up a time series to see how it is changing,” Dr Wilkinson said.

The robotic submersible used upward-looking sonar to map the thickness of the sea ice over an area of 500,000 square miles equivalent to about 100 football pitches, in three locations – the Weddell, Bellinghausen and Wilkes Land sectors of Antarctica.

While the sea ice in the Artic has decreased in surface area by about 40 per cent over the past 40 years, the sea ice in the Antarctic has increased for reasons that are still under debate. Dr Wilkinson said that one cause could be a change in wind patterns that is blowing sea ice further out to sea.

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