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Tuesday, 14 Jul 2020

Written Answers Nos. 1047-1071

Covid-19 Pandemic

Questions (1047, 1075, 1159)

Alan Kelly

Question:

1047. Deputy Alan Kelly asked the Minister for Health when the HSE roadmap for reopening health services will be published. [14878/20]

View answer

Róisín Shortall

Question:

1075. Deputy Róisín Shortall asked the Minister for Health when the service continuity roadmap will be published; and if he will make a statement on the matter. [14975/20]

View answer

David Cullinane

Question:

1159. Deputy David Cullinane asked the Minister for Health when he will publish the roadmap to restore non-Covid-19 healthcare; and if he will make a statement on the matter. [15438/20]

View answer

Written answers

I propose to take Questions Nos. 1047, 1075 and 1159 together.

The Covid-19 pandemic has led to an unprecedented interruption to normal health services both in the community and acute hospitals. While many vital services were maintained or restructured to respond more appropriately to Covid-19 related risks and evolving needs, other services were suspended or delivered on a reduced basis.

To ensure services are re-introduced in a safe, clinically aligned and prioritised way, the HSE have published a Strategic Framework for ‘Service Continuity in a Covid Environment’. This document was published on June 8th and can be found at the following link: https://www.hse.ie/eng/services/news/newsfeatures/covid19-updates/service-continuity-in-a-covid-environment-a-strategic-framework-for-delivery.pdf.

The implementation of the Framework will ensure service resumption is done in an integrated and phased manner. It will consolidate new ways of working and build on international knowledge.

The HSE are currently developing a Service Continuity Roadmap for the resumption of services across the health system.

The aim of the operational delivery system is to reintroduce services in a phased manner over the coming months. This approach is based on the assumptions that the virus transmission levels will remain low and that public health measures will continue to reduce.

It should be noted that not all services will return to pre-Covid activity levels due to infection prevention and control requirements and current social distancing measures to prevent further spikes of Covid infections.

Health Services Provision

Questions (1048)

Alan Kelly

Question:

1048. Deputy Alan Kelly asked the Minister for Health the amount of extra diagnostics he plans to put into acute and non-acute settings in 2020. [14879/20]

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Written answers

The HSE advises that a pilot project commenced in 2016 by the HSE Acute Hospitals Division to progress the collection of national radiology waiting list data. The project has been supported by the Radiology Clinical Care Programme and has involved key stakeholders across the system including the National Integrated Medical Imaging System (NIMIS) Team, Hospital Groups, and the support of the National Treatment Purchase Fund (NTPF) for data collection and data management expertise.

At present, the pilot project collects data relating to CT, MRI and Ultrasound. In Q1 2020, there were a total of 190,373 patients reported on the waiting list from all sites, this represents all outpatients waiting, urgent, semi urgent, routine and planned/surveillance (where diagnostic access is planned at particular time intervals).

The HSE is currently rolling out a diagnostics plan that envisages a range of diagnostic/imaging services being provided across all Community Healthcare Organisations with the support of hospitals and private providers, with a particular focus on improving GP access to ultrasound. The Deputy may wish to note that in 2019, there were 67,000 ultrasound and 79,500 x-rays delivered via GP access to radiology services.

In terms of medium-term planning for additional diagnostic capacity, the National Development Plan states that, new dedicated ambulatory elective only hospital facilities will be introduced in Dublin, Galway and Cork. As per the Development plan, these facilities will provide high volume, low complexity procedures on a day and outpatient basis, together with a range of ambulatory diagnostic services.

As part of the wider Sláintecare implementation, the Elective Hospitals Oversight Group, established by the Department of Health, is currently developing a high-level facilities spatial brief and order of magnitude costs which details the elective clustering of appropriate activities for each of the three facilities in Dublin, Cork and Galway. This will also include an output and facility specification, based on efficient and effective service delivery, which will include diagnostic procedures. This is due to be completed in the Autumn of 2020.

Departmental Functions

Questions (1049)

Alan Kelly

Question:

1049. Deputy Alan Kelly asked the Minister for Health if he has established an office for budgetary responsibility in his Department; if not, when he will establish it; and the resources that will be in the office [14880/20]

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Written answers

Ensuring Ireland’s health system can deliver the best health outcomes and the best value for the citizen through optimising resources is a key part of the remit of the Department of Health.

In the last twelve months the resources assigned to budgetary oversight, expenditure and forecasting within my Department have expanded substantially in recognition of the ongoing challenges in relation to financial management within the health system. This additional resourcing has facilitated greater oversight and accountability in relation to budgetary performance. In addition the Health Budgetary Oversight Group and the Committee on Budgetary Oversight provide an additional layer of budgetary oversight in relation to health expenditure.

With the establishment of new Department portfolios following the formation of the new Government, it is important for a Department to review its resourcing to align it with any revision to the previous portfolio. An Office for Budget Responsibility will be considered as part of this review of resourcing.

National Children's Hospital

Questions (1050)

Alan Kelly

Question:

1050. Deputy Alan Kelly asked the Minister for Health the full status of the new national children's hospital; the amount spent on the project to date; the revised timelines for the completion of the project; and if he is dedicating new resources to monitoring the construction and spend on the hospital [14881/20]

View answer

Written answers

The NPHDB has statutory responsibility for planning, designing, building and equipping the new children's hospital and I have referred your question to the NPHDB for direct reply.

Disability Services Funding

Questions (1051)

Alan Kelly

Question:

1051. Deputy Alan Kelly asked the Minister for Health the extra funding resources that will be put into the disability sector in 2020. [14882/20]

View answer

Written answers

As set out in the National Service Plan 2020, the 2020 disability budget is €2054.5m. This represents an increase of €138.7m or 7.2% on the 2019 budget.

In addition, the Government has agreed to allocate substantial additional funding to the Health Vote to meet the costs associated with the implementation of the measures outlined in the National Action Plan in response to COVID-19.

The HSE, through the Community Healthcare Organisations (CHOs) is actively engaging with any Section 38 and Section 39 disability service providers who are experiencing financial challenges, including access to cash acceleration, where appropriate, to maintain continuity of service provision during the pandemic. Organisations receiving funding from the HSE should raise any concerns in relation to financial issues that may have implications for continuity of service provision with the relevant Community Health Care Organisation (CHO) responsible for the service arrangements.

The HSE has agreed a structured approach to addressing the financial challenges of Section 39 service providers due to COVID-19. The objective of the programme is to provide a structured governance process and modus operandi through which Section 39 partners experiencing financial difficulties due to the COVID-19 Public Health Emergency can engage through the HSE to ensure, where appropriate, continuity of essential services provided by these agencies. The HSE has also developed a methodology to provide a pro forma approach to support decision making in respect of Section 39 Organisations that have made submissions to the HSE for both financial and non-financial supports during the COVID-19 pandemic.

The HSE has advised my Department that it has given Section 38 and Section 39 providers of disability services and supports assurance that budget allocations confirmed to each provider via the relevant CHO, will remain in place to year end, subject to co-operation with the HSE and compliance with the relevant Service Arrangements.

Other supports provided by CHOs to Section 38 and Section 39 organisations providing disability specialist services between March and May 2020 include PPE; Infection Prevention and Control support, advice and training; Public Health advice/support with regard to suspected/positive cases; Isolation facilities allied to testing, funding for emergency residential placements and logistics in the form of transport and accommodation. In addition, COVID response teams were put in place to assist and support residential service providers during the pandemic. These teams will now oversee and support the reshaping of disability services as a result of COVID 19.

A critical focus at this time is the assurance of value for money in delivering on the required patient services and population health needs to effectively manage COVID-19 infection within the Irish context. Accordingly, the financial implications of measures taken to mitigate impacts of the COVID-19 outbreak are matters which the Department of Health will continue to keep under review in conjunction with the Department of Public Expenditure and Reform, as the situation evolves.

The Deputy will be aware of the COVID-19 Stability Fund for Community and Voluntary, Charity and Social Enterprises which is administered by Pobal, on behalf of the Department of Rural and Community Development. Organisations providing disability specialist services were eligible to apply to the Fund, which is now closed for applications. This scheme is intended to be a targeted once-off cash injection for organisations and groups delivering front-line services to the most at need in our society and in danger of imminent closure due to lost fundraised or traded income as a direct result of restrictions to counter the spread of COVID-19. The approval of funding under Tranche One of the Scheme was announced on 26 June. Further tranches will be announced over the coming weeks.

Question No. 1052 answered with Question No. 975.

Covid-19 Tests

Questions (1053)

Alan Kelly

Question:

1053. Deputy Alan Kelly asked the Minister for Health his plans to increase antibody testing for Covid-19; and the timelines there are for doing so. [14885/20]

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Written answers

The 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 an issue as does the interpretation of what immunity means and how long such immunity might last. These remain active research questions.

The ECDC has 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 of new serological assays [antibody tests] clinical validation studies are required to confirm that test performance can be replicated in the context in which the test is intended to be used.

Following a request from the National Public Health Emergency Team (NPHET) the HSE and the Health Protection Surveillance Centre (HPSC) are now undertaking a national population sero-prevalence study to measure exposure to COVID-19 infection in the population using an antibody blood test. This work is being carried out jointly by HPSC and the National Virus Reference Laboratory (NVRL), in collaboration with the Central Statistics Office and the Department of Health.

On Monday 15th June, the HSE issued letters to more than 5,000 people inviting them to participate in the Study to Investigate COVID-19 Infection in People Living in Ireland.

Participants in the study are representative of the wider population. Dublin and Sligo have been selected as sample locations as they represent areas of the country with higher and lower known levels of infection respectively. Using a representative sample of participants in both locations, it will be possible to provide an overall national estimate of infection in the Irish population.

Serological tests measure the antibody response in an individual. Antibodies to COVID-19 are produced over several weeks after infection with the virus. The presence of antibodies indicates that a person was infected with the COVID-19 virus, irrespective of whether the individual had severe or mild disease or even asymptomatic infection. The assessment of population immunity can help determine the level of antibodies required to achieve herd immunity, identify groups of susceptible individuals and evaluate the persistence and duration of protective antibodies.

The study will add to our knowledge about how long antibodies last and what protection they may provide against new infection of COVID-19.

According to the HSE, initial results are expected in late August and will enable the HPSC to estimate the level or prevalence of infection of COVID-19 in the population across different age groups.

Any decisions with regard to additional antibody testing will take into consideration the outcome of this study and any other relevant studies.

Departmental Bodies

Questions (1054, 1059)

Alan Kelly

Question:

1054. Deputy Alan Kelly asked the Minister for Health the process he has in place for appointments to NPHET or its subgroups; and if he has changed that process since he became Minister. [14890/20]

View answer

Alan Kelly

Question:

1059. Deputy Alan Kelly asked the Minister for Health if he will publish each of the recommendations and submissions that have guided the actions and decisions by the NPHET during the Covid-19 pandemic. [14901/20]

View answer

Written answers

I propose to take Questions Nos. 1054 and 1059 together.

As the Deputy is aware, the National Public Health Emergency Team (NPHET) structure is a long-standing mechanism utilised over many years to steer health service responses to public health emergencies as required by Ireland’s obligations under the World Health Organization’s International Health Regulations.

These Regulations require State parties to establish multidisciplinary/multisectoral teams to respond to events that may constitute a public health emergency of international concern. This necessitates flexibility in the composition of these national teams in order that they can appropriately respond to major public health emergencies.

As the Deputy is no doubt aware, the NPHET for COVID-19 is accountable to me as Minister for Health and is made up of senior public officials of the Department of Health and a number of relevant State Agencies, in addition to highly qualified subject matter experts from disciplines such as virology, infectious diseases, intensive care etc. who are among the leading practitioners in their fields in this country.

The NPHET can add to its membership on the basis of the additional expertise or support it identifies as being required so as to ensure that it is in the best possible position to provide advice and recommendations for consideration by the Minister for Health and the Government. These are the criteria on which the NPHET identifies the requirement for particular expertise. This flexibility in approach to selection is necessary for a group such as this in the context of an international public health crisis of the kind we are currently experiencing due to the pandemic, and gives effect to Ireland’s obligations to the WHO.

Consideration is currently being given to the national response to the emergence of Covid-19 that has been mounted to date with a view to ensuring that as a country we are as well prepared as possible for the coming period and any potential resurgence in the virus, and that will of course include ensuring that the NPHET continues to be in a position to offer evidence based advice and recommendations to me and the Government as the situation evolves.

With regard to the Deputy's question in relation to the publication of recommendations and submissions, a wide range of documentation related to NPHET has been published to date and it is intended to continue this process to ensure transparency. Letters, agendas, and minutes arising from the NPHET are available on the Department of Health website. I might add that papers discussed at the NPHET meetings from 30 January 2020 to 25 February 2020 inclusive are available to view on the DOH website at https://www.gov.ie/en/collection/691330-national-public-health-emergency-team-covid-19-coronavirus/.

Work is continuing to place the papers from further NPHET meetings on the website as quickly as possible, with additional papers to be published regularly going forward.

HSE Board

Questions (1055)

Alan Kelly

Question:

1055. Deputy Alan Kelly asked the Minister for Health the dates and times of the meetings of the HSE board to date in 2020. [14891/20]

View answer

Written answers

The Health Service Executive (Governance) Act 2019 requires the HSE Board to hold such and so many meetings as may be necessary for the due fulfilment of its functions, but in each year shall hold not fewer than one meeting in each of 11 months of that year. In accordance with this legislation the HSE Board has an agreed schedule of monthly meetings and additional meetings are scheduled as required.

To date in 2020 the Board has held 22 meetings comprising 6 regular monthly meetings and 16 additional Special COVID-19 Board Meetings.

Dates and Times of HSE Board Meetings 2020

Date

Time

31st January 2020:

10:00- 15:30

28th February 2020:

10:00- 15:30

27th March 2020:

10:00- 15:30

24th April 2020:

10:00- 14:00

27th May 2020:

11:00- 14:50

26th June 2020:

10:00- 16.45

Dates and Times of Special COVID-19 Board Meetings 2020

6th March 2020:

11:00- 12:30

9th March 2020:

18:30- 20:00

12th March 2020

19:00- 20:15

16th March 2020:

18:00- 20:15

25th March 2020:

17:45- 19:30

1st April 2020:

18:00- 19:40

8th April 2020:

18:00- 20:00

15th April 2020:

18:00- 20:10

22nd April 2020:

18:00- 20:40

29th April 2020:

18:00- 19:45

6th May 2020:

18:00- 19:45

13th May 2020:

18:00- 20.10

20th May 2020:

18:00- 20:30

22nd May 2020:

13:00- 13:42

3rd June 2020:

18:00- 19.45

17th June 2020:

18:00- 20.25

Covid-19 Pandemic

Questions (1056)

Alan Kelly

Question:

1056. Deputy Alan Kelly asked the Minister for Health his views on the reason so many healthcare professionals have been infected with Covid-19; and the details of the investigation he will commence to address this. [14892/20]

View answer

Written answers

Data on cases in healthcare workers is published by the HPSC and is available here: https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/surveillance/covid-19casesinhealthcareworkers/COVID-19_HCW_weekly_report_19062020_v1.0%20for%20website.pdf.

The Irish Epidemiological Modelling Advisory Group has developed a methodology to determine the recovery rate by considering the number of hospitalisations, ICU admissions, deaths and the dates of confirmation for each case. They have advised the Department that as of 3rd June, our recovery rate in healthcare workers is 93%. This is a higher recovery rate than in the general population, because relatively few healthcare workers have been hospitalised and very few admitted to ICU.

It is worth noting that Ireland, in contrast with many other countries, maintains a very wide definition of a healthcare worker for surveillance purposes and hence international comparisons should be interpreted with caution. In Ireland, a healthcare worker is anyone who works in any area of healthcare across community and hospital settings. It includes, for example, administrative staff, catering, maintenance, IT etc whereas in many other countries it is a considerably narrower definition of frontline workers or even just doctors and nurses. Our very broad definition of healthcare worker along with extensive testing contribute to our proportion of all COVID-19 infections that have been in healthcare workers.

There have been several studies worldwide of healthcare worker COVID-19 infection rates which have shown an infection rate of 5 to 10% of HCWs, whereas in Ireland this rate is close to 3-4% of HCWs based on estimates from the CSO Labour Force Survey of between 225,000 and 250,000 people working in Ireland who would identify as healthcare workers or as working in a healthcare setting.

In an article published by Hunter et al in the Lancet, on 2nd of May 2020 referred to a study in Newcastle (UK) on the 10th and 11th of March, where a random sample of hospital healthcare workers were tested and 5% were COVID-19 positive. This random sample testing was repeated on the 30th and 31st of March and 20% of healthcare workers were COVID-19 positive.

In a Dutch study (Eurosurveillance, Reuskin et al,26/03/2020), 400 healthcare were tested between the 27th of February and the 6th of March 2020 and 2.5% were positive for COVID-19. Between the 6th and the 8th of March 2020, 1,100 HCWs were tested and 4.1% were COVID-19 positive.

As such, it would not appear that the rates of infection among Irish healthcare workers are not out of line with the experiences of comparator countries. However, I have asked my officials to examine this issue further so as to ensure that we are doing everything possible in relation to this crucial aspect of the response to Covid-19.

Nursing Staff

Questions (1057)

Alan Kelly

Question:

1057. Deputy Alan Kelly asked the Minister for Health his views on whether the remuneration of nurses in the HSE is fair and comparable to nurses on both a European and global level. [14893/20]

View answer

Written answers

In 2018, the Public Service Pay Commission (PSPC) published a report on the recruitment and retention of staff in the public health service. This report included the findings from external experts on international pay comparisons for each cohort, including nursing. The report concluded that Ireland is competitive relative to other markets in terms of security benefits such as pension, maternity leave, sick leave and long-term disability benefits, though it also found that there was a case for providing additional incentives for qualified nursing and midwifery staff to remain in the public health service.

The report recommended increases to certain fixed allowances and an extension of those allowances to other working areas for nurses and midwives. It also recommended accelerated career progression for Staff Nurses, reducing the length of service requirement for Staff Nurses wishing to progress to Senior Staff Nurses. These measures were accepted by Government as part of the overall 2019 Nursing Agreement. That agreement included additional measures that improved pay and allowances for certain nursing grades, including the creation of an Enhanced Nurse Practice scale as well as further extending the application of the location allowance to those nurses working in medical and surgical areas. In addition, it also provided for the setting up of an Expert Review Body on Nursing and Midwifery and this is due to commence its activity on 30 July 2020. I look forward to reviewing the report of the Expert Review Body in due course.

While noting the PSPC's findings on international comparisons, the remuneration measures arising from the Nursing Agreement should further assist in making a career in Nursing in Ireland more attractive.

Covid-19 Pandemic

Questions (1058)

Alan Kelly

Question:

1058. Deputy Alan Kelly asked the Minister for Health his plans to employ new methods to ensure nursing homes nationally have enough staff and PPE. [14900/20]

View answer

Written answers

Covid-19 pandemic has led to an unprecedented challenge across our health services. As the disease has progressed, a range of enhanced measures for nursing homes recommended by NPHET on 31st March and 3rd April are being implemented. The enhanced measures build on actions already adopted for nursing homes, including general and specific infection prevention measures, specific public health and clinical nursing home guidance published March 17th and subsequently updated, social distancing measures, visitor restrictions and cocooning. A number of webinars were delivered in March and April to provide support and advice to nursing homes including in relation to infection prevention and control.

While nursing home providers are ultimately responsible for the safe care of their residents the HSE is providing staffing, PPE, Oxygen, training and other supports to nursing homes where needed. The HSE has an established process in place for access to PPE and this is the appropriate avenue for nursing homes to engage as required. It has also established 23 HSE COVID Response Teams across the CHOs, to provide support and expert guidance to all long-term care residential settings. These teams comprise of a Director of Nursing as well as clinical and public health expertise and links to acute hospitals.

Together with this unprecedented support to the nursing home sector a COVID-19 Temporary Assistance Payment Scheme has been established to support nursing home providers by contributing towards additional COVID-19 costs such as staffing, enhanced cleaning and infection prevention and control. The original scheme was due to end on June 30, after 3 months, however the scheme has now been extended for a further 3 months until the end of September. This extension will give further support and certainty to this sector.

Furthermore on foot of a National Public Health Emergency Team (NPHET) recommendation, on 23 May a COVID-19 Expert Panel on Nursing Homes was established, to examine the complex issues surrounding the management of COVID-19 among this particularly vulnerable cohort.

The purpose of the Panel is to examine the national and international responses to the COVID-19 crisis, and to examine the emerging best practice. Its main objective is to provide immediate real-time learnings and recommendations in light of the expected ongoing impact of COVID-19 over the next 12-18 months. COVID-19 is a new disease, which can present atypically in the frail elderly, and new evidence and best practice in its management are constantly emerging. I expect the Expert Panel to submit their final report to me later this month.

Question No. 1059 answered with Question No. 1054.

Health Services Access

Questions (1060)

Alan Kelly

Question:

1060. Deputy Alan Kelly asked the Minister for Health his views on whether an e-health card or number should be introduced; and if so, the timeline he would envisage for such work. [14907/20]

View answer

Written answers

The Department of Health's eHealth strategy for Ireland examined the international experience of eHealth including the use of health cards, noting the concerns around privacy, security, trust and additionally, the sensitivity requirement for health smart cards. There are no plans to introduce an ‘e-health card’ at present.

In relation to health numbers, work is progressing within the HSE on the deployment of individual health identifiers (IHI) across the health service, in line with the provisions of the Health Identifiers Act 2014. The IHI is a unique number that will be used to safely identify an individual and their health information when using a health service and will ensure patient safety and privacy and drive improvements in patient care and efficiencies in the health service.

Health Services Provision

Questions (1061)

Alan Kelly

Question:

1061. Deputy Alan Kelly asked the Minister for Health his plans to reopen St. Michael's unit, Clonmel, County Tipperary. [14920/20]

View answer

Written answers

As this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.

Hospital Services

Questions (1062, 1081)

Alan Kelly

Question:

1062. Deputy Alan Kelly asked the Minister for Health when St. Brigid's Hospital, Carrick-on-Suir, will reopen as a unit for respite and palliative care. [14921/20]

View answer

Alan Kelly

Question:

1081. Deputy Alan Kelly asked the Minister for Health if and when St. Brigid's Hospital, Carrick-on-Suir, will return to its normal service, that is, a geriatric facility; and if he will make a statement on the matter. [14992/20]

View answer

Written answers

I propose to take Questions Nos. 1062 and 1081 together.

As these are service matters I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

General Practitioner Services

Questions (1063)

Michael Lowry

Question:

1063. Deputy Michael Lowry asked the Minister for Health when the general practitioner visit card will be extended to children under eight years of age; and if he will make a statement on the matter. [14927/20]

View answer

Written answers

On 25 June, the Government gave approval for the publication of the Health (General Practitioner Service and Alteration of Criteria for Eligibility) Bill 2020. This Bill provides, amongst other things, for the phased expansion of GP care without fees to all children aged 12 years and under. The Bill was published on July 01, 2020 and it is expected to proceed through the Houses of the Oireachtas in mid-July.

The initial stage of this phased expansion will be the provision of GP care without fees to all children aged between 6 and 8. I am currently reviewing the situation in relation to this expansion to determine how and when this expanded service can be introduced in a way which will meet the ongoing health needs of children and will also be sustainable for General Practice in the current COVID environment.

Hospital Facilities

Questions (1064)

Michael Lowry

Question:

1064. Deputy Michael Lowry asked the Minister for Health if the commitment to the building of a second cath lab at University Hospital Waterford will be reaffirmed; if so, the date on which a build contract will be signed off; and if he will make a statement on the matter. [14928/20]

View answer

Written answers

The Estates unit in the Health Service Executive has been tasked with the delivery of additional capacity (infrastructure and equipment) nationwide in the effort for the containment and prevention of the spread of the Coronavirus - COVID-19. This has resulted in delays to works and schedules.

Funding has been allocated in the Capital Plan for the provision of 2nd Cath Lab at University Hospital Waterford. Planning Permission is in place for this project and applications for fire and disability certification are currently in progress. It is anticipated the project will go to tender in late August/early September – subject to approval. As required by OGP, tender is a 2 stage process for Main and Specialist contractors. This process will take approximately 4 months.

At present the draft Capital Plan 2020 is being reviewed and revised to take account of the impact of Covid-19 which resulted in delays on many projects and the funding of an emergency Covid-19 programme of works. Once the HSE has finalised its Capital Plan for 2020, it will then be submitted to me for consideration.

Motorised Transport Grant

Questions (1065)

Violet-Anne Wynne

Question:

1065. Deputy Violet-Anne Wynne asked the Minister for Health if he will review the 2013 decision to end the motorised transport grant with a view to reinstating same (details supplied); and if he will make a statement on the matter. [14932/20]

View answer

Written answers

Two schemes, the Mobility Allowance and Motorised Transport Grant, were put in place in 1979 and 1968 respectively, for operation by the Health Service Executive (HSE) at a time when there was limited availability of accessible public transport. The Government decided to close these administrative schemes in 2013, on foot of the reports of the Ombudsman in 2011 and 2012 regarding the legal status of both Schemes in the context of the Equal Status Acts. The Review Group on Transport Supports for People with a Disability reported to Government in 2013 and the Report informed the deliberative process for proposals for a new Scheme.

In 2013, the Government also decided to continue payment of the monthly Mobility Allowance on an interim basis, to those who were in receipt of the Mobility Allowance at the time that the Scheme closed. Of the 4,700 individuals in receipt of the Mobility Allowance (€9 million per annum) when the Scheme closed in 2013, there were 3,831 people in receipt of the interim payments at July 2019.

With regard to the Motorised Transport Grant, this scheme operated as a means-tested grant to assist persons with severe disabilities with the purchase or adaptation of a car, where that car was essential to retain employment. The maximum Motorised Transport Grant, which was payable once in any three-year period was €5,020. Following closure of the scheme in February 2013, no further Motorised Transport Grants have been payable.

At the whole of Government level, the National Disability Inclusion Strategy 2017-2021 sets the overall framework for the equal participation of people with disabilities in society. Monitoring of the implementation of the Strategy is being overseen by the National Disability Inclusion Strategy Steering Group which comprises key Government Departments, the National Disability Authority and the Disability Stakeholders Group.

Under the Strategy, the Department of Transport, Tourism and Sport has responsibility for the continued development of accessibility and availability of accessible public transport and is committed to the continued development of accessible public transport in recognition of the importance of such services to the lives of people with disabilities.

Recent developments which will impact on policy options regarding the provision of transport supports for people with a disability include the following:

The ongoing progress by the Department of Transport, Tourism and Sport in providing accessible public transport nationally and that Department's public consultation launched on 14 November last, to review active travel and public transport policy, including accessible public transport;

The Cost of Disability Study currently underway which was commissioned by the Department of Employment Affairs and Social Protection as part of Budget 2019. The research, when complete, will inform policy direction in relation to the provision of adequate supports to meet the needs of people with disabilities, including transport costs, and;

The Working Group established by the Department of Justice and Equality under Action 104 of the National Disability Inclusion Strategy which states that:- 'We will lead a review of transport supports encompassing all Government funded transport and mobility schemes for people with disabilities, to enhance the options for transport to work or employment supports for people with disabilities and will develop proposals for development of a coordinated plan for such provision. This plan will have regard to making the most efficient use of available transport resources."

Hospital Facilities

Questions (1066)

Violet-Anne Wynne

Question:

1066. Deputy Violet-Anne Wynne asked the Minister for Health if he will examine the feasibility of upgrading Ennis general hospital to a grade 3 facility in order that the hospital can again perform elective procedures (details supplied); and if he will make a statement on the matter. [14933/20]

View answer

Written answers

As the query raised by the Deputy relates to an operational matter, I have asked the Health Service Executive to reply to you directly.

Hospital Appointments Status

Questions (1067)

Michael Healy-Rae

Question:

1067. Deputy Michael Healy-Rae asked the Minister for Health the status of an appointment for a person (details supplied); and if he will make a statement on the matter. [14935/20]

View answer

Written answers

In response to the Covid-19 pandemic the HSE had to take measures to pause most elective scheduled care activity with effect from the end March 2020. 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 National Public Health Emergency Team (NPHET) and in accordance with World Health Organisation guidelines, and the National Action Plan.

To ensure services are re-introduced in a safe, clinically-aligned and prioritised way, the HSE launched its Strategic Framework for ‘Service Continuity in a Covid Environment’ on 24th June 2020. Its implementation will ensure service resumption is done in an integrated way. This will involve a phased approach to ensure community services are strengthened. The Framework will also consolidate new ways of working and build on international knowledge. The HSE is currently developing a Service Continuity Roadmap for the resumption of services across the health system. My Department, the HSE and the National Treatment Purchase Fund are currently working together to evaluate the impact of Covid 19 on Scheduled Care waiting lists, in order to be prepared to address pent up demand.

Under 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 is a standardised approach used by the HSE to manage scheduled care treatment for in-patient, day case and planned procedures. It sets out the processes that hospitals are to implement to manage waiting lists and was developed in 2014 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.

In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.

Medical Aids and Appliances

Questions (1068)

Jackie Cahill

Question:

1068. Deputy Jackie Cahill asked the Minister for Health when a chair will be received for a person (details supplied); and if he will make a statement on the matter. [14939/20]

View answer

Written answers

As this is a service matter it has been referred to the HSE for attention and direct reply to the Deputy.

Departmental Budgets

Questions (1069)

David Cullinane

Question:

1069. Deputy David Cullinane asked the Minister for Health the amount his Department sought in its Estimate bid in each of the years 2017 to 2020 in terms of additional funding to maintain existing levels of service taking account of demographics; and the amount allocated to ELS and demographics in each year. [14946/20]

View answer

Written answers

The previous government maintained its commitment to investment in health services during its term. Each year the Health Service Executive sets out in its National Service Plan the allocation of the funding received from government for the delivery of health services for the year.

The amount allocated each year follows an extensive process of engagement between my Department and the Department of Expenditure and Reform, which considered both the funding requirements and the fiscal position. These types of engagements are a normal part of the Budgetary process and happen with Departments across Government. All Departments put forward spending proposals but are required to operate within the amounts proposed by Government and determined by the Dáil.

The issue of health funding is a major policy challenge for both the Irish and international Governments. Despite welcome increases annually, the need for effective financial management remains crucial as the health service deals with a larger and older population, with more acute health and social care requirements, increased demand for new and existing drugs and the rising costs of health technology. The costs associated with these service pressures will increasingly need to be managed not solely through annual increased Exchequer allocations but also through improved efficiencies, productivity and value from within the funding base.

Funding is provided to the HSE for Health services in accordance with the letter of determination which sets out the approved level of overall HSE expenditure for the year in question.

From the table below you can see the majority of the funding for the period 2017 to 2020 has been allocated to pay cost pressures and maintaining existing levels of service, taking account of demographic changes. These allocations are balanced with new developments seeking to continuously improve the Irish health system and the growing costs arising from pensions and the state claims agency.

2017 saw the commencement of the unwinding of the savings delivered under the Financial Emergency Measures in the Public Interest Act 2009; this combined with other national pay agreements since 2016 has had a significant impact on the funding required to address pay cost pressures annually.

Significant funding is also allocated towards maintaining existing levels of service.

Description

Increase in 2016

Increase in 2017

Increase in 2018

Increase in 2019

Increase in 2020

HSE

€m

€m

€m

€m

€m

Pay Cost Pressures

59

174

278

287

276

ELS/Demographics

401

244

491

254

430

New Developments

137

81

196

199

168

State Claims and Pensions

139

154

96

107

133

HSE Total

736

653

1,061

847

1,007*

* An additional €50m for new developments was included in the original Revised Estimate for 2020 in addition to the allocation provided in the Budget 2020 Expenditure Report. Provision was also made in relation to preparation for the impact of Brexit.

Departmental Budgets

Questions (1070)

David Cullinane

Question:

1070. Deputy David Cullinane asked the Minister for Health the amount his Department is seeking in terms of additional funding to maintain existing levels of service taking account of demographics for 2021. [14947/20]

View answer

Written answers

My Department will shortly be engaging in dialogue with the Department of Public Expenditure and Reform and the Health Service Executive in relation to the 2021 Estimates, and this process will include an analysis of the potential impact of demographic change.

Until these discussions are concluded it would not be appropriate for me to comment on this matter.

Medicinal Products

Questions (1071, 1096, 1154, 1223)

Joan Collins

Question:

1071. Deputy Joan Collins asked the Minister for Health if the Spinraza treatment has been stopped for persons (details supplied); and when the treatment will commence [14951/20]

View answer

Gerald Nash

Question:

1096. Deputy Ged Nash asked the Minister for Health the reason 12 children with SMA are still waiting to be treated with Spinraza one year after the drug was approved; the reason for the delay; when the matter will finally be addressed by the HSE; and if he will make a statement on the matter. [15076/20]

View answer

Gino Kenny

Question:

1154. Deputy Gino Kenny asked the Minister for Health if his attention has been drawn to the number of children with spinal muscular atrophy eligible for treatment with the approved drug Spinraza; the number of those receiving the treatment; the reason for the delay in treatment for some of these children such as a child (details supplied); the way in which and when these issues will be addressed in order that all children can receive this vital treatment; and if he will make a statement on the matter. [15427/20]

View answer

Patricia Ryan

Question:

1223. Deputy Patricia Ryan asked the Minister for Health when Spinraza will be made available for children with spinal muscular atrophy; and if he will make a statement on the matter. [15570/20]

View answer

Written answers

I propose to take Questions Nos. 1071, 1096, 1154 and 1223 together.

The HSE has statutory responsibility for medicine pricing and reimbursement decisions, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.

On 11 June 2019, the HSE Leadership Team approved access to the drug Nusinersen (Spinraza) for children with Spinal Muscular Atrophy (SMA) Type I, II or III on an exceptional and individualised basis.

The HSE decision process in relation to Spinraza involved a full Health Technology Assessment followed by detailed consideration by the HSE expert groups on new drug therapies, including the Technology Review Group for Rare Diseases and the Drugs Committee. Evidence of the clinical effectiveness of this new drug therapy was also reviewed.

The recommendation is to approve access for children with genetically confirmed SMA Type I, II or III, in accordance with the controlled access criteria recommended by the Rare Diseases Technology Review Committee. The rare diseases committee recommendation was clearly targeted at the youngest and most severely affected SMA patients, and this group is the clear priority for the HSE. The actual patient assessment and approval process will be the means for determining access on an individual case by case basis.

The actual delivery of this medicine to approved patients in a safe and sustainable way requires very specific and quite complex service arrangements to be put in place by Children’s Health Ireland (CHI) across all sites.

It is estimated that 1-3 new children will be diagnosed with SMA Type 2 in Ireland each year. CHI has confirmed that there are currently 34 patients with SMA aged 18 years or under who are deemed clinically eligible for treatment with Spinraza by the Paediatric Neurologist in CHI. CHI has further confirmed that 18 patients are currently receiving Spinraza.

However, other patients who were waiting to start treatment have been put on hold due to COVID-19. CHI has confirmed that a Clinical Nurse Manager is commencing at the end of July, and that they are currently working through the remaining patients and how they can be accommodated in the midst of COVID-19 restrictions around social distancing. Individual treatment plans are being worked up for each of the remaining patients.

CHI has confirmed that it is in a continuous engagement process with families regarding their child's individual plan for the administration of Spinraza, as well as representatives of SMA Executive and Advocacy Group.

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