Stephen Donnelly (Wicklow, Fianna Fail)
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Heart Failure is an important public health issue. The detection and prevention of heart failure is a priority, and the National Clinical Programme for Heart Failure supports many approaches to improving the quality of life for people living with the syndrome. The programme (HSE) is currently engaging with the European Society of Cardiology who have developed a platform to enable registry development on not only heart failure but other cardiovascular conditions. The National Heart Programme are working to initiate the EuroHeart programme cardiovascular database project in Ireland.

There are clear, evidence-based guidelines and excellent Irish case studies of effective models of care in heart failure. Further focus and development will prevent unnecessary hospitalisations and deaths and maximise people’s quality of life.

To understand the remaining challenges, a National Review of our adult Specialist Cardiac Services, which includes heart failure, was commissioned. The Review’s recommendations will inform the future provision of cardiac services nationally including requirements for data to support development. The Report has been presented to my office, which is now under my consideration.

Stephen Donnelly (Wicklow, Fianna Fail)
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Current Cardiovascular Health programmes highlight the importance of cardiac rehabilitation which includes a psychological component. Psychological health and the presence of potential psychosocial risk factors are assessed for every patient as part of the initial assessment in cardiac rehabilitation. There are 36 centres providing cardiac rehabilitation services nationally. Where a clinical need is identified but the cardiac rehabilitation service has no direct access to psychology services, it is best practice to liaise with the patient’s General Practitioner to recommend that a referral to psychology services be made by the GP (HSE Model of Care for Integrated Cardiac Rehabilitation 2023).

Heart Failure is an important public health issue that affects approximately 90,000 in our population, it is a complex condition with increasing prevalence. The National Clinical Programme for heart failure is developed to improve quality of life for people living with the syndrome. The heart failure Model of Care for Ireland identifies the importance of psychological supports for those living with heart failure.

There has been significant investment in Integrated Care Programmes for Chronic Disease which includes heart failure. This investment has enabled the development of structures of care which will significantly improve all aspects of heart failure care, including psychological support. Within community settings, multi-disciplinary heart failure care is provided through each community specialist team, including access to a psychologist (HSE).

Importantly, the Government recognises and supports new initiatives in managing heart failure as a chronic condition. For example, promoting pioneering innovations like HeartCare at Home, a primary care project which is open to all people with heart failure in Ireland. To get heart failure specialist care to a wider cohort of patients ‘Virtual Consultation’ allows online, real-time discussion of heart failure case questions with a family doctor. This consultation results in very effective remote management, avoiding unnecessary referrals and travel for the patient and facilitates the sharing of specialist expertise.

Progress has been made in heart failure care, and to inform the next steps for this important work and to understand the challenges more, a National Review of our adult Specialist Cardiac Services, which includes heart failure, was commissioned. The Report has been presented to my office and is currently under consideration. The Review's recommendations will inform the future provision of cardiac services nationally including guidance on the priority needs for specialist roles such as psychologists.

Stephen Donnelly (Wicklow, Fianna Fail)
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Medical Card provision is primarily based on financial assessment. In accordance with the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE, which assesses each application on a qualifying financial threshold.

The issue of granting medical or GP visit cards based on having a particular disease 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.

However, every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines. The HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income threshold where they face difficult financial circumstances, such as extra costs arising from an illness. Social and medical issues are also considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services.

The HSE also has a compassionate system in place for the efficient provision of medical cards in response to emergency situations i.e., where persons are in need of urgent ongoing medical care or when a patient is receiving end of life treatment. In these cases, a medical card is issued within 24 hours of receipt of the required patient details and completed medical report by a healthcare professional. In addition, since March 2021, persons who have been certified by their treating Consultant as having a prognosis of 24 months or less are now also awarded a medical card on an administrative basis. Medical cards awarded on end-of-life grounds are never re-assessed by the HSE thereby providing reassurance and comfort to patients and their families.

Since 2022, 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. 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%.

Medical card holders under the age of 70 years, are charged a prescription charge of €1.50 for each item. This is up to a maximum of €15 per month, for each person or family. Medical card holders over 70 years of age, are charged a prescription charge of €1.00 for each item. This is up to a maximum of €10 per month, for each person or family.

This Government has put a significant focus on improving access to and the affordability of healthcare services, advancing substantial policy, legislation and investment to deliver expanded eligibility. I can assure the Deputy that, to ensure the medical card system is responsive and sensitive to people's needs, my Department keeps medical card issues, including prescription charges, under review and any changes are considered in the context of Government policy, annual budgetary estimates process and other issues which may be relevant.

Stephen Donnelly (Wicklow, Fianna Fail)
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As the Deputy's question relates to HSE matters, I have arranged for the question to be referred to the HSE: National Clinical Programme for Heart Failure, Enhanced Community Care and Chronic Disease Management for direct reply to the Deputy.

Stephen Donnelly (Wicklow, Fianna Fail)
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The HSE Heart Failure Clinical Programme is focused on improving all stages in the prevention and treatment of heart failure. It is one of several chronic disease management programmes established in the HSE aimed at bringing a systematic approach to changes in how services are delivered to improve outcomes for patients. Economic evidence highlights that heart failure places a major demand on healthcare spending and can account for an estimated 2-4% of the total healthcare budget (HSE National Heart Failure Clinical Care Programme)

Heart failure is high on the health services agenda. Since the establishment of the HSE Heart Failure Clinical Programme in 2012, approaches to heart failure have improved. The National Heart Failure Clinical Programme has carried out a significant amount of important work for patients living with heart failure. Ireland’s wider community of clinical practice in heart failure has provided leading research and innovation that continues to inspire the world. The STOP-HF project for example is a dedicated heart failure prevention strategy. This first-of-type concept has been proven to be successful and has resulted in changes in international guidelines. Ireland is among the world leaders in developing strategies to prevent heart failure.

Ireland is promoting pioneering innovations like the HeartCare at Home, a primary care project, which is open to all people with heart failure in Ireland. To get heart failure specialist care to a wider cohort of patients ‘Virtual Consultation’ allows on-line, real-time discussion of heart failure case questions with a family doctor. This consultation results in very effective remote management, avoiding unnecessary referrals and travel for the patient and facilitates the sharing of specialist expertise. This service was first developed along the East Coast of Ireland and Carlow and is now being rolled out nationally through the Health Service Executive integrated care programme for chronic illness.

While no formal assessment of the economic impact of heart failure has been undertaken, the National Programme clinical leads, in collaboration with the Irish Heart Foundation, among others, undertook a "cost-to-state" analysis in 2015. It sought to help identify problem areas in heart failure prevention and treatment within the community as well as areas where spending can be increased to better serve the patient and healthcare professionals.