Written Answers Nos. 753-777
754. Deputy Norma Foley asked the Minister for Health if an automatic 14-day quarantine for all visitors by air or port will be enforced; and if resources will be made available for the enforcement of same. [6386/20]
View answerNPHET has considered issues in relation to overseas travel, informed by World Health Organisation and European Centre for Disease Prevention and Control guidance, approaches and learning from other countries, and reports of importation of cases in a number of countries following relaxation of restrictions.
As the number of indigenous cases here declines and Ireland eases some restrictions, the relative importance of the risk of importation of cases from overseas increases. The impact of any imported cases on disease spread would be all the greater in the context of easing of domestic restrictions and the resultant increased movement and contact between people. In addition, a significant increase in the number of cases in Ireland as a result of importation could have an impact on public compliance with public health guidance and restrictions. Ultimately, the suppression of community transmission which has been achieved and which should allow for greater resumption of social and economic life in Ireland could be endangered.
To date, Ireland has introduced a range of travel related measures including issuing advice against non-essential international travel on 13th March. As of 24th April, passengers arriving into Ireland from overseas are expected to complete the Public Health Passenger Locator Form and to self-isolate for 14 days. Self-isolation means staying indoors and avoiding contact with other people and is a more stringent measure than the stay at home requirements that apply to the wider public.
Intensive work is underway by my Department, in consultation with other relevant Departments and the Attorney General’s Office, to finalise regulations to come into effect in the coming days that will make it mandatory for passengers arriving to the State from overseas to present a completed Public Health Passenger Locator Form.
My Department, in consultation with other relevant Departments, is also developing proposals to strengthen the 14 days self-isolation arrangements for travellers from overseas. These proposals will include possible enforcement measures. The issue of imposing mandatory quarantine for a 14 day period, to be considered as the situation evolves, was mentioned in the Roadmap for Reopening Society & Business.
It is intended that self-isolation arrangements will continue to apply to passengers arriving from overseas, irrespective of the country from which they are travelling. Passengers transiting to another jurisdiction and who will not be residing in the State, including transiting to Northern Ireland, will be exempt.
755. Deputy Roderic O'Gorman asked the Minister for Health if progress been made on a mid-term review of the National Drug and Alcohol Strategy 2017-2025: Reducing Harm; Supporting Recovery - A health led response to drug and alcohol use in Ireland, and in particular a focus on the partnership approach and implementation structures that include Departments, relevant State agencies, drug and alcohol taskforces, voluntary and community sectors critical to the successful delivery of the strategy; and if he will make a statement on the matter. [6389/20]
View answerThe national drug strategy, Reducing Harm, Supporting Recovery, sets out government policy on drug and alcohol use until 2025. The strategy aims to provide an integrated public health approach to drug and alcohol use, focused on reducing the harms for individuals, families and communities and promoting rehabilitation and recovery.
The strategy contains 50 actions for delivery between 2017 to 2020. The implementation of these actions is monitored though the national oversight structures, supported by the coordinated system of monitoring, research and evaluation set out in the strategy.
The Department is preparing to carry out a mid-term review of the strategy at the end of 2020. This will provide an opportunity to reflect on progress in implementing the strategy, with scope to develop further actions between 2021 and 2025 to address emerging needs. All stakeholders will have an opportunity to contribute to this review through their participation in the oversight structures.
I believe that the national drug strategy is a dynamic process, with the flexibility to adapt to needs that may emerge over the lifetime of the strategy. The mid-term review is an opportunity to reflect on progress and to identify new challenges. The review is timely as it will allow policy to take into account the impact of Covid-19 on people who use drugs and on drugs and alcohol services and to plan accordingly for the remaining five years of the strategy.
756. Deputy Catherine Murphy asked the Minister for Health the domestic laboratory capacity available for Covid-19; the profile of capacity versus use since 20 April 2020 to date in tabular form; and if he will make a statement on the matter. [6390/20]
View answerAs the HSE has responsibility, the Executive has been asked to reply directly to the Deputy.
757. Deputy Catherine Murphy asked the Minister for Health if the HSE has put together a specific contract for Covid-19 medical and surgical waste; if so, the details of the contract or contracts; if such waste is being exported, the locations to which it is being exported to; the transport and handling arrangements; and if he will make a statement on the matter. [6391/20]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
758. Deputy Catherine Murphy asked the Minister for Health if a specific action plan is being worked on for family carers including those that are caring for children with disabilities (details supplied); if so, the way in which this plan will be progressed; and if he will make a statement on the matter. [6392/20]
View answerThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
As the Deputy's question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
759. Deputy Roderic O'Gorman asked the Minister for Health when section 39 pay alignment with HSE salary scales will be implemented as has been implemented in section 38 organisations; and if he will make a statement on the matter. [6393/20]
View answerThe employees of section 38 organisations are classified as public servants and therefore, the employer is obliged to adhere to the salary scales as set out in the Department of Health consolidated salary scales.
Section 39 organisations, however, are private sector employers and are therefore not required to adhere to these salary scales. It is a matter for the individual employer to determine the terms and conditions of employment, including rates of pay, for its employees.
760. Deputy Stephen Donnelly asked the Minister for Health the position and process for retrospective testing for persons that are of the view they may have had Covid-19 prior to when testing commenced here; if this is being considered; and if he will make a statement on the matter. [6395/20]
View answerAt present real-time reverse transcription polymerase chain reaction (RT-PCR) is the gold standard for diagnosing suspected cases of COVID-19. There is no role for using this test as an indication of past infection. It can only detect whether there is active virus present at the time of the test.
However serological testing can be used to estimate the level of past exposure and immunity in the general population. Estimation of population age-specific immunity or past exposure to SARS-CoV-2 is one of the actions in Ireland’s National Action Plan in response to COVID-19.
Following a request from the National Public Health Emergency Team (NPHET) the HSE and Health Protection Surveillance Centre (HPSC) are proceeding with plans to undertake a population sero-prevalence study. This work is being carried out jointly by HPSC and NVRL, in collaboration with the Central Statistics Office and Department of Health.
I understand that it is intended that an application to the National COVID-19 Research Ethics Committee will be submitted shortly and that subject to ethics approval and completion of clinical validation of a suitable assay (i.e. antibody test) the aim is to start the seroprevalence study in the next 4 weeks.
761. Deputy Donnchadh Ó Laoghaire asked the Minister for Health his views on whether home help workers should be entitled to PPE and adequate sanitisers; if they have such access; and the steps he plans to take to ensure that this happens. [6414/20]
View answerThe value of personal protective equipment (PPE) is recognised as additional protection for home support clients and staff. It should only be used where it is likely to be beneficial as outlined in the HSE’s guidance on PPE. This guidance is continuously monitored and is subject to change as the COVID-19 outbreak evolves.
The HSE is providing enhanced PPE to an expanded range of settings, including to support the care of people in their own homes. Through a twice weekly PPE planning process, the HSE identify current levels of home support through which PPE requirement and supply is determined. Arrangements are being made in each CHO to faciliate access to enhanced PPE for all healthcare workers and service providers. Delivery of PPE for home support services goes centrally to multiple drop points in CHOs who then distribute PPE to all providers.
The provision of standard PPE (i.e. gloves, aprons, sanitising hand gel) to home support staff employed by approved private and not-for-profit providers remains the responsibility of those providers in accordance with service arrangements in place between those providers and the HSE.
762. Deputy Mairéad Farrell asked the Minister for Health the number of patients in dialysis that have tested positive for Covid-19; if there have been deaths in dialysis units of patients that had tested positive for Covid-19; and if he will make a statement on the matter. [6422/20]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
763. Deputy Peter Fitzpatrick asked the Minister for Health his plans to roll out antibody testing for persons that have recovered from Covid-19 with the aim of understanding if some of the population now have natural immunity;; and if he will make a statement on the matter. [6427/20]
View answerThe ECDC has advised that immunoassays detecting specific antibodies against SARS-CoV-2 (COVID-19) will play an important role in the future for epidemiological surveillance, evaluation of immunity and the outcome of future vaccination studies. However, the reliability of serological tests remains a major issue as does the interpretation of what immunity means and how long it might last. These remain active research questions.
The ECDC have reported that over 60 rapid SARS-CoV-2 antibody tests have been CE marked to date, and many more continue to be placed on the market. Prior to the introduction new serological assays [antibody tests] clinical validation studies will be required to confirm that test performance can be replicated in the context in which the test is intended to be used.
Serological testing can be used to estimate the level of immunity in the general population. Estimation of population age-specific immunity or past exposure to SARS-CoV-2 is one of the actions in Ireland’s National Action Plan in response to COVID-19.
Following a request from the National Public Health Emergency Team (NPHET) the HSE and Health Protection Surveillance Centre (HPSC) are proceeding with plans to undertake a population sero-prevalence study. This work is being carried out jointly by HPSC and NVRL, in collaboration with the Central Statistics Office and Department of Health
I understand that it is intended that an application to the National COVID-19 Research Ethics Committee will be submitted shortly and that subject to ethics approval and completion of clinical validation of a suitable assay (i.e. antibody test) the aim is to start the seroprevalence study in the next 4 weeks.
764. Deputy Joe O'Brien asked the Minister for Health if the HSE or the NPHET carried out an assessment or is following a specific WHO advice on the potential of recirculated air in aircraft to spread the Covid-19 virus. [6435/20]
View answerThe matter raised is more appropriate to my colleague the Minister for Transport, Tourism and Sport.
765. Deputy Paul Murphy asked the Minister for Health the breakdown of the expenditure on the agreement with private hospitals to incorporate their capacity into the public system in tabular form. [6471/20]
View answerUnder the agreement with the private hospitals payment to them will be on a cost only Open Book model whereby the hospitals will be reimbursed only for the operating costs properly incurred during the period. The costs that will be covered will be limited to normal costs of operating the hospital. The final cost will be verified by independent firms of accountants appointed by the HSE and the private hospitals and there will be an arbitration mechanism in place in the event of any disagreement. Since the purpose of the arrangement is to provide additional capacity to deal with the impact of the COVID-19 pandemic for which there is no definitive time horizon it is not possible to indicate a precise cost estimate attaching to the arrangement. The cost only open book model is therefore the most effective way of ensuring the arrangement is value for money for the State.
Under the arrangement a participating private hospital is due 80% of its estimated monthly costs in advance from the HSE. Actual costs incurred are subject to verification, as set out above and any difference is subject to a balancing payment or clawback in the subsequent month. The HSE has made advance payments for April totalling €90.2m and €22.2 in the first week in May. This is based on estimates provided by the participating hospitals and will be adjusted based on verified actual costs validly incurred over the period. As the hospitals are private enterprises, the detailed information regarding payments to individual hospitals or hospital groups is commercially sensitive and therefore in line with the Heads of Terms regarding confidentiality these details will not be published. In the interests of transparency, it is intended to publish summary financial information regarding the arrangement in due course.
766. Deputy Joe Flaherty asked the Minister for Health when IVF services will be fully resumed. [6474/20]
View answer775. Deputy Seán Haughey asked the Minister for Health if he will give permission to IVF clinics to resume services following their suspension due to Covid-19; and if he will make a statement on the matter. [6611/20]
View answerI propose to take Questions Nos. 766 and 775 together.
Private fertility clinics operating in Ireland suspended the provision of assisted human reproduction (AHR) treatment during the current Covid-19 emergency on foot of guidance issued by the European Society of Human Reproduction and Embryology (ESHRE) in mid-March.
However, on April 23 2020, ESHRE issued a new statement recommending that “once the risk of SARS-CoV-2/COVID-19 infection is decreasing, all ART (assisted reproductive technology) treatments can be restarted for any clinical indication, in line with local regulations”, as well as a comprehensive document, the “ESHRE Guidance on recommencing ART treatments”, which contain a set of detailed recommendations for clinics planning to restart AHR treatment.
My officials inform me that, following the revised ESHRE guidance, the majority of fertility clinics at least have either resumed activities or have indicated that they intend to do so in the near future.
Nevertheless, as emphasised on the websites of the clinics, any decision regarding the resumption of treatment and services will be taken in a measured way in order to ensure the protection of patients and staff, and compliance with the “ESHRE Guidance on recommencing ART treatments”. It is also obviously incumbent on clinics to comply with the measures outlined in the Government’s “Return to Work Safely Protocol”, which apply to all workplaces in this country.
767. Deputy Joe Flaherty asked the Minister for Health when it will be possible to offer a return of respite care for special needs children; and his plans to safeguard such children. [6476/20]
View answerThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
The Programme for Partnership Government states that the Government wishes to provide more accessible respite care to facilitate full support for people with a disability.
As the Deputy's question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
768. Deputy Marc MacSharry asked the Minister for Health when the increased income threshold limits announced in Budget 2020 will be implemented for persons over 70 years of age (details supplied); and if he will make a statement on the matter. [6481/20]
View answerOn December 16, 2019 the Government approved the drafting of legislation which, inter alia, would give effect to the Budget 2020 commitment to increase the medical card income thresholds for persons aged over 70. Substantial work has been undertaken by officials in this regard.
769. Deputy Duncan Smith asked the Minister for Health if an application for the over 70 medical card by a person (details supplied) will be expedited. [6492/20]
View answerAs this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.
770. Deputy Pearse Doherty asked the Minister for Health when a person (details supplied) can expect to have an operation on their back carried out in Letterkenny University Hospital; and if he will make a statement on the matter. [6495/20]
View answerUnder 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. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
The National Waiting List Management Policy, a standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, since January 2014, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the HSE, sets out the processes that hospitals are to implement to manage waiting lists.
In response to the Covid-19 pandemic the HSE had to take measures to defer all non-urgent elective scheduled care activity, including outpatient clinics. This was to ensure patient safety and that all appropriate resources were made available for Covid-19 related activity and time-critical essential work. This decision was in line with the advice issued by the World Health Organisation, and the National Action Plan published on 16 March. The trajectory of the disease means there is now an opportunity for increasing the provision of non-covid care including more routine care. It is envisaged that the private hospitals will play an important role in this regard.
My Department, the HSE and the National Treatment Purchase Fund are currently working together to estimate the impact of Covid 19 on Scheduled Care waiting lists, in order to be prepared to address any backlog or pent up demand. My Department continues to ensure that the resources available throughout our health system are best utilised at this unique and challenging time.
In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
771. Deputy Jack Chambers asked the Minister for Health if he will address a matter (details supplied) regarding the reopening of an outdoor activity business; and if he will make a statement on the matter. [6529/20]
View answerIn the first instance it is the responsibility of individual businesses to determine whether they are in compliance with the requirements of the Roadmap for Reopening Society & Business. If guidance is required in relation to a business activity in a particular sector of the economy that advice should be sought from the Government Department with responsibility for that sector.
772. Deputy Mattie McGrath asked the Minister for Health when the 14 day self-isolating guidelines will be lifted for persons coming here in order to provide guidance to companies and groups which operate educational based tourism activities and had anticipated the arrival of students on exchange from Spain in the summer and for the 2020-2021 school year; and if he will make a statement on the matter. [6597/20]
View answerNPHET has considered issues in relation to overseas travel, informed by World Health Organisation and European Centre for Disease Prevention and Control guidance, approaches and learning from other countries, and reports of importation of cases in a number of countries following relaxation of restrictions.
As the number of indigenous cases here declines and Ireland eases some restrictions, the relative importance of the risk of importation of cases from overseas increases. The impact of any imported cases on disease spread would be all the greater in the context of easing of domestic restrictions and the resultant increased movement and contact between people. In addition, a significant increase in the number of cases in Ireland as a result of importation could have an impact on public compliance with public health guidance and restrictions. Ultimately, the suppression of community transmission which has been achieved and which should allow for greater resumption of social and economic life in Ireland could be endangered.
To date, Ireland has introduced a range of travel related measures including issuing advice against non-essential international travel on 13th March. As of 24th April, passengers arriving into Ireland from overseas are expected to complete the Public Health Passenger Locator Form and to self-isolate for 14 days. Self-isolation means staying indoors and avoiding contact with other people and is a more stringent measure than the stay at home requirements that apply to the wider public.
Intensive work is underway by my Department, in consultation with other relevant Departments and the Attorney General’s Office, to finalise regulations to come into effect in the coming days that will make it mandatory for passengers arriving to the State from overseas to present a completed Public Health Passenger Locator Form.
My Department, in consultation with other relevant Departments, is also developing proposals to strengthen the 14 days self-isolation arrangements for travellers from overseas. These proposals will include possible enforcement measures. The issue of imposing mandatory quarantine for a 14 day period, to be considered as the situation evolves, was mentioned in the Roadmap for Reopening Society & Business.
It is intended that self-isolation arrangements will continue to apply to passengers arriving from overseas, irrespective of the country from which they are travelling. Passengers transiting to another jurisdiction and who will not be residing in the State, including transiting to Northern Ireland, will be exempt.
773. Deputy Mattie McGrath asked the Minister for Health his views on the claim by the NPHET that following the introduction of guidelines, patients are not discharged from hospitals into nursing homes unless they test negative twice for Covid-19 before being moved; and if he will make a statement on the matter. [6598/20]
View answerThe National Public Health Emergency Team (NPHET) for COVID-19 oversees and provides national direction, guidance, support and expert advice on the development and implementation of a strategy to contain COVID-19 in Ireland.
The NPHET is the mechanism for coordinating the health sector response to significant public health emergencies. It facilitates the sharing of information between the Department of Health and its agencies, including the HSE. It provides a forum for agreement on strategic approaches to public health emergencies. This approach is in line with the advice of the World Health Organization.
HSE guidelines aim to assist staff in residential care facilities, including nursing homes, in their management of COVID-19 cases, including in relation to decisions on transfer of residents, to hospitals, where appropriate.
The HSE through the Health Protection Surveillance Centre has developed an extensive body of guidance and support tools to assist staff in residential care facilities, including nursing homes, in their management of COVID-19 cases, including in relation to decisions on transfer of residents, to hospitals, where appropriate. The current relevant guidelines are the “Interim Public Health and Infection Prevention Control Guidelines on the Prevention and Management of COVID-19 Cases and Outbreaks in Residential Care Facilities and Similar Units" (version 4.1 dated 4 May 2020).
The advice states that “People with confirmed COVID-19 should not be transferred to a residential care facility [RCF] until 14 days after onset of symptoms with the last 5 days free of fever. In addition, they should have two nasopharyngeal samples taken at least 24 hours apart reported as not detected. Residents who fulfil the above criteria are not infectious and do not need any special considerations in terms of placement within the RCF.”
The advice notes that: “For those hospitalised patients with a persistent positive PCR test for COVID-19, IPC precautions should be kept in place for another 7 days (i.e. for a total of 21 days) and then removed, provided the patient has no symptoms consistent with ongoing COVID-19 infection at this point. No further retesting is required, as the risk of transmission is extremely low at this point. After 21 days, they can then be discharged from hospital to residential settings, if well enough for discharge.”
774. Deputy Seán Haughey asked the Minister for Health if he will allow places of worship to open again for individual visits and private prayer; and if he will make a statement on the matter. [6610/20]
View answerThe Government’s Roadmap for Reopening Society & Business, published on 1 May 2020, sets out an indicative path to the easing of COVID 19 restrictions and other actions in order to facilitate the reopening Ireland’s society and economy in a phased manner. The Roadmap specifies that decisions in relation to which actions will be taken and which public health measures might be lifted will be made in accordance with the Framework for Future Decision-Making which is as follows:
1. Before each Government consideration of the easing of restrictions, the Department of Health will provide a report to the Government regarding the following on/off trigger criteria:
a. The latest data regarding the progression of the disease,
b. The capacity and resilience of the health service in terms of hospital and ICU occupancy,
c. The capacity of the programme of sampling, testing and contact tracing,
d. The ability to shield and care for at risk groups,
e. An assessment of the risk of secondary morbidity and mortality as a consequence of the restrictions.
2. It will also provide risk-based public health advice on what measures could be modified in the next period.
3. The Government would then consider what restrictions could be lifted, having regard to the advice of the Department of Health as well as other social and economic considerations, e.g. the potential for increased employment, relative benefits for citizens and businesses, improving national morale and wellbeing etc.
4. It is acknowledged that there is also an ongoing possibility that restrictions could be re-imposed and this process will be carried out on an ongoing basis once every 3 weeks.
As is clear from the framework, it is the Government rather than I or my Department that will decide on any modifications to the current public health measures in place and those decisions will be informed by the status of the on/off trigger criteria and the public health advice received at the time that a decision is being made.
776. Deputy Seán Haughey asked the Minister for Health if Article 2 of the European Convention of Human Rights dealing with the right to life will be taken into account when preparing guidelines in respect of ethical decision making by health professionals during the Covid-19 pandemic; and if he will make a statement on the matter. [6612/20]
View answerArticle 2 is one of the European Convention on Human Rights (ECHR’s) most fundamental Articles and is non-derogable. Article 2(1) places an obligation on the State not only to refrain from the intentional and unlawful taking of life but also to take appropriate steps to safeguard the lives of those within its jurisdiction.
The Ethical Framework for Decision Making in a Pandemic published by the Department of Health on 27th March seeks to ensure that public health measures in response to a pandemic are implemented in a manner that is equitable, reasonable, proportionate, in compliance with national and international law (including the ECHR) and which does not discriminate against particular groups or individuals. The ethical framework sets out clear ethical principles that will guide people in acting so as to produce the greatest good, to ensure the best use of resources and to ensure fairness. It also sets out the values or principles governing how decisions are going to be made.
The positive obligation of Article 2 finds its expression in particular in the ethical principles of minimising harm, duty to provide care and reciprocity contained in the Framework. Building on the Framework, on April 7th the Department published the “Ethical Considerations Relating to Critical Care in the context of COVID-19”. In line with the principle of minimising harm, the document discusses the duty to use limited resources prudently and fairly to minimise the loss of life and suffering and produce the maximal benefit possible for individuals served by those interventions. The document makes clear that everyone is morally equally; that every life matters and that everyone should receive care. As per the procedural values outlines in the framework, any allocation procedure must be fair, clinically justified, transparent and documented. In recognition of the duty of care that State has regarding healthcare workers, the Department issued a paper entitled “Ethical Considerations for PPE Use by Health Care Workers in a Pandemic” on 21 April 21st which considers to what extent health care workers have an obligation to provide, or participate in the provision of, a medical intervention where there are constraints on supplies of PPE.
777. Deputy Róisín Shortall asked the Minister for Health if his Department has considered the recommendations made to it by an association (details supplied) in relation to the restructuring of the public eye care system in view of the probable accumulation of a backlog of patients due to the Covid-19 crisis; and if he will make a statement on the matter. [6641/20]
View answerI am pleased to inform the Deputy that I had a very constructive meeting with the Association of Optometrists in Ireland (AOI) earlier this week at which these recommendations were among the issues discussed. I will continue to engage with the AOI and other stakeholders as we progress with a new model of eye care in line with the HSE Primary Care Eye Services Review Group Report.
