Tuesday, 21 Jul 2020

Written Answers Nos. 671-691

Hospital Staff

Questions (671)

Pádraig MacLochlainn

Question:

671. Deputy Pádraig Mac Lochlainn asked the Minister for Health the number of hospital consultants employed by hospital in each of the years 2016 to 2019 and to date in 2020, in tabular form. [16901/20]

Written answers

Minister for Health

I have asked the HSE to respond directly to the Deputy on this matter.

Medical Aids and Appliances

Questions (672, 674, 711)

Paul McAuliffe

Question:

672. Deputy Paul McAuliffe asked the Minister for Health the status of patients affected by pelvic mesh medical deficiencies in view of the UK Independent Medicines and Medical Devices Safety review published in July 2020; and if he will make a statement on the matter. [16905/20]

Róisín Shortall

Question:

674. Deputy Róisín Shortall asked the Minister for Health if the recommendations from the UK inquiry into the use of pelvic mesh have been examined; his plans to implement the recommendations; and if he will make a statement on the matter. [16908/20]

Jennifer Whitmore

Question:

711. Deputy Jennifer Whitmore asked the Minister for Health if he will establish a review team to hear the testimonies of patients impacted by complications arising from surgeries involving a mesh implant; if his Department has determined whether these procedures should remain on pause; and if he will make a statement on the matter. [17034/20]

Written answers

Minister for Health

I propose to take Questions Nos. 672, 674 and 711 together.

I note the recent publication in England of the report of the Independent Medicines and Medical Devices Safety (IMMDS) review, “First Do No Harm” which was chaired by Baroness Cumberlege.

International evidence and learning play an important role in health policy considerations to promote safe, high quality care for patients. This report may add to that evidence and learning.

Over the past two decades, Uro-Gynaecological (Transvaginal) Mesh has been widely used in the surgical treatment of Stress Urinary Incontinence (SUI) and Pelvic Organ Prolapse (POP) in women. Mesh devices are certified as compliant with relevant EU legislation, and as such, European regulatory competent authorities consider that the benefits outweigh the risks for these devices.

In Ireland, considerable work has been done to date and continues to progress on patient safety in relation to mesh implants; and the patient voice is central to our understanding of these, and similar, issues. As part of the ongoing policy response, my department officials are examining options to establish a process for an independent, compassionate engagement for women affected by mesh to have their voices heard; and will make proposals to me in this regard. Any engagement process will need to take account of the wider context relating to the COVID-19 pandemic.

Concerns were raised in Ireland regarding complications associated with the use of mesh devices in late 2017, including a number of Ministerial representations from the women affected or on their behalf. At that time, the Minister for Health requested the Chief Medical Officer (CMO) to prepare a report on the clinical and technical issues involved in ensuring both:

1. the safe and effective provision of mesh procedures in urogynaecology and

2. an appropriate response to women who suffer complications as a result of undergoing such procedures.

This CMO Report was published in November 2018.

Importantly, the CMO report was informed by the available national and international evidence and the personal experiences of women who have suffered complications following mesh surgery.

Since July 2018, the HSE has paused all mesh procedures where clinically safe to do so. This was at the request of the CMO and undertaken in advance of completion of the final CMO report. The pause was instigated pending confirmation by the HSE of the implementation of initial recommendations relating to (i) professional training requirements, (ii) patient information and consent and (iii) the development and maintenance of a national data set for all mesh procedures carried out in HSE funded hospitals.

The CMO report identifies that for many women, surgical procedures using synthetic mesh devices have provided a more effective and less invasive form of treatment than traditional procedures. However, mesh devices are associated with significant and severe complications in a minority of women, which are of concern given the difficulties of mesh implant removal.

The CMO report made a number of recommendations, the implementation of which will provide significant assurance that both women presenting for treatment and who develop mesh-related complications, receive high quality, multi-disciplinary patient centred care in accordance with the evidence and supported by robust clinical governance mechanisms.

The HSE published a detailed Implementation Plan for the recommendations in the report in April 2019. The HSE’s National Women & Infants Health Programme (NWIHP) is progressing treatment pathways and referral services for women suffering from mesh-related complications.

A multidisciplinary National Specialist Centre is being developed over 2 sites at Cork University Maternity Hospital (CUMH) and the National Maternity Hospital (NMH) Dublin. In addition, two translabial scanners, were procured by the HSE in late 2019, and are now onsite in both hospitals. However, the first scanning clinic, which was due to take place last March had to be postponed, due to the pandemic.

The HSE has published a dedicated webpage about vaginal mesh implants, including contact information for women suffering complications, which I hope is a useful resource. This can be found on the HSE website.

I would strongly encourage all women affected by mesh to engage with the relevant HSE contact points provided, to ensure that their service needs can be identified and provided for.

Medicinal Products

Questions (673)

Róisín Shortall

Question:

673. Deputy Róisín Shortall asked the Minister for Health if he will engage with an organisation (details supplied) regarding the use of sodium valproate in pregnancy; his plans to hold an inquiry into the use of the drug; the actions he is taking to support families affected by foetal valproate syndrome; and if he will make a statement on the matter. [16907/20]

Written answers

Minister for Health

On 8 July, the Independent Medicines and Medical Devices Safety Review in the UK published its report into sodium valproate and two other medical interventions. I have asked officials in my Department, as well as in the HSE and the Health Products Regulatory Authority, to consider the findings of this report and provide me with comprehensive briefing before I consider the next steps in addressing the issue of sodium valproate use in Ireland. This will include consideration of requests to meet patient organisations and other stakeholders.

Question No. 674 answered with Question No. 672.

Vaccination Programme

Questions (675)

Róisín Shortall

Question:

675. Deputy Róisín Shortall asked the Minister for Health his plans to reinstate universal administering of the BCG vaccine; and if he has received recommendations from the HSE on the matter. [16909/20]

Written answers

Minister for Health

The BCG vaccine is given to protect babies against tuberculosis (TB). It is important to note that the number of cases of TB in Ireland is low. A total of ten cases were reported in the 0-14 age group in 2019.

As of 2015, most European countries did not give the BCG vaccine routinely to all babies (Dierig et al, Vaccine, 2015).

In April 2015, due to a lack of vaccine from the sole EU supplier, the BCG vaccine became unavailable in Ireland. In 2015, the National Immunisation Advisory Committee (NIAC) recommended that the BCG vaccine does not need to be given to all children in Ireland. The Heath Information and Quality Authority (HIQA) published a Health Technology Assessment of BCG vaccine in Ireland in December 2015. This also concluded that BCG vaccination does not need to be given to all children in Ireland.

The HSE were requested, in 2019, to undertake an updated review of the epidemiology of TB in Ireland, considering the public health impact of having no BCG vaccination since April 2015. The intention is that this review will be used to inform an updated recommendation to my Department regarding the future provision of BCG vaccination in Ireland. Once the recommendation to my Department is received and considered, my Department will issue an instruction to the HSE on the future provision of BCG vaccination in Ireland.

Medical Research and Training

Questions (676)

Róisín Shortall

Question:

676. Deputy Róisín Shortall asked the Minister for Health if his consultation with the HSE has considered the introduction of bursaries to support graduate entry medicine students which could require a contribution of clinical years upon completion of studies similar to the bursaries available from the NHS in the UK; and if he will make a statement on the matter. [16911/20]

Written answers

Minister for Health

In my time as Minister for Health I have not had any consultation with HSE regarding the introduction of bursaries to support graduate entry medicine students.

In the past representations have been made to my Department that were forwarded to the Minister for Finance with a positive recommendation, seeking tax relief on the costs/college fees incurred by graduate entry medical students. The level of costs incurred by graduate entry students has also been highlighted in consultations with the NCHDs who have qualified through this route. Unfortunately the Minister for Finance was not in a position at the time to accede to the proposal. Given the manner in which NCHDs undertake their training and often further training abroad post qualification, the proposal that bursaries would be given in return for future clinical years would be challenging to implement.

In Ireland, the development of a National Strategic Framework for Health and Social Care Workforce Planning in 2017 marked an important milestone in developing a more robust and systematic workforce planning approach. A range of policies and programmes are being implemented to support the recruitment, retention and development of key parts of the health workforce, including for example the Strategic Review of Medical Training and Career Structures (MacCraith Report) and the draft Policy on Graduate, Specialist and Advanced Nursing and Midwifery Practice.

The HSE People Strategy 2015–2018 has also delivered a comprehensive suite of initiatives designed to engage, develop and support the workforce to deliver the best possible care and services to people who depend on them.

The new Programme for Government Our Shared Future commits to establishing a Workforce Planning Expert Unit to work with the education sectors, regulators, and professional bodies to improve the availability of health professionals and reform their training to support integrated care across the entire health service. This unit is currently being established within my Department and issues pertaining to graduate entry medical students will be considered as part of this cross departmental collaborative process.

Covid-19 Pandemic

Questions (677)

Róisín Shortall

Question:

677. Deputy Róisín Shortall asked the Minister for Health if copies of the NPHET document entitled Risk Register for each month since March 2020 will be made available. [16912/20]

Written answers

Minister for Health

The Deputy may wish to note that a wide range of documentation related to the National Public Health Emergency Team (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 and its subgroups are available on the Department of Health website. The papers that were discussed at the NPHET meetings from 30 January 2020 to 25 February 2020 inclusive are also now 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 enable the publication of the papers from further NPHET meetings on the website as quickly as possible, with additional papers to be published regularly going forward. I have asked for the publication of the documentation mentioned by the Deputy to be expedited and that it be supplied to her when it is released.

Health Services Provision

Questions (678)

Mary Lou McDonald

Question:

678. Deputy Mary Lou McDonald asked the Minister for Health if his attention has been drawn to the appointment of a provisional liquidator to a convalescent centre (details supplied); if the staff whilst not public servants whose salaries have been funded by the HSE will be redeployed; and the way in which he plans to replace the lost convalescent and respite care beds within the health system following the closure of the centre. [16922/20]

Written answers

Minister of State at the Department of Health

The Health Service Executive has been engaged with the Agency referred to by the Deputy for some time in terms of the potential replacement of its core business, which has reduced following the onset of COVID-19. However, the HSE were unexpectedly advised of the Board’s intention to seek to liquidate the company. The HSE has advised the Department that it is acutely conscious of the value of the Centre and is planning to engage imminently with the Liquidator towards exploring opportunities for the potential continued use of the facility and its staff team to support public care needs across the South Dublin area.

Alcohol Treatment Services

Questions (679)

Darren O'Rourke

Question:

679. Deputy Darren O'Rourke asked the Minister for Health if his attention has been drawn to a significant reduction in the number of meetings of a group (details supplied) during the Covid-19 pandemic due to Covid-19 restrictions; the measures and supports in place for recovering alcoholics at this time; and if he will make a statement on the matter. [16926/20]

Written answers

Minister of State at the Department of Health

The Covid-19 pandemic has created a time of uncertainty and anxiety for everyone and particularly for those who are affected by drug and alcohol addiction. The restructuring of services, social distancing measures and requirement for self-isolation can be particularly difficult for those who are trying to remain drug and alcohol free or are in recovery.

Officials in the Department of Health have been working with Drug and Alcohol Task Forces and the HSE Social Inclusion Services to ensure that services and supports continue to be provided for those with problem drug and alcohol use, in line with public health advice. Details of services operating during the coronavirus outbreak can be found at 'drugs.ie'.

The HSE has advised that some support groups may be available online including those relating to alcohol addiction. In addition, the HSE Drug and Alcohol Helpline, 1800 459 459 is available from Monday to Friday 9.30 at am to 5.30 pm.

The Department and the HSE are aware of the challenges facing people with alcohol-related problems during Covid-19. They have disseminated a poster with advice on reducing harm for people dependent on alcohol or in treatment. It contains key messages on reducing the harms associated with alcohol and accessing advice and supports for recovery.

People with alcohol-related problems may also face mental health issues. Mental health services have responded by providing group and family meetings via video links. Drugs.ie contains information about dual diagnosis and advice for looking after your mental health during the COVID-19 outbreak. There is also a drug recovery page on advice for people who are attempting to remain abstinent and with links to relevant support services.

Work is underway to prepare for the restoration of drug and alcohol services in a planned and appropriate manner in line with public health recommendations. This includes guidance on one-to-one and group supports.

I am very much aware of the difficulties for people with drug and alcohol dependency at this time. I would advise people to keep in touch with addiction services and support groups to find out the services that are currently available.

Drugs Payment Scheme

Questions (680)

Darren O'Rourke

Question:

680. Deputy Darren O'Rourke asked the Minister for Health the reason a person (details supplied) is no longer provided access the drug subutex in tablet form on the hardship scheme; and if he will make a statement on the matter. [16928/20]

Written answers

Minister for Health

Under the Health (Pricing and Supply of Medical Goods) Act 2013, the HSE has statutory responsibility for the administration of the community drug schemes; therefore, the matter has been referred to the HSE for attention and direct reply to the Deputy.

HSE Expenditure

Questions (681)

Mairéad Farrell

Question:

681. Deputy Mairéad Farrell asked the Minister for Health the amount a company (details supplied) has been paid by the HSE in University Hospital Galway over the past five years by the payment showing wage costs, management fee and the fee paid by the HSE to the company per patient per meal per day in tabular form; and if he will make a statement on the matter. [16929/20]

Written answers

Minister for Health

As this is a operational matter, I have referred it to the HSE for direct reply to the Deputy.

Question No. 682 answered with Question No. 616.

Care of the Elderly

Questions (683)

Patricia Ryan

Question:

683. Deputy Patricia Ryan asked the Minister for Health the status of the refurbishment of Monasterevin day care centre; and if he will make a statement on the matter. [16950/20]

Written answers

Minister of State at the Department of Health

As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Nursing Home Accommodation

Questions (684)

Patricia Ryan

Question:

684. Deputy Patricia Ryan asked the Minister for Health if he will provide clear guidelines to nursing homes in relation to family visits; and if he will make a statement on the matter. [16951/20]

Written answers

Minister of State at the Department of Health

In line with the Government's Roadmap for the re-opening of Society and Business, the National Public Health Emergency Team has agreed that a phased approach to the recommencement of visiting to long term residential centres would be appropriate at this time. The advice is that a co-ordinated and standard national approach to the recommencement of visiting is taken.

In light of the above , and on the basis that the COVID-19 disease status in the country remains in its current stable condition, the NPHET recommended that from 15th of June, the phased resumption of indoor visiting of residents in residential care facilities may commence in accordance with guidance issued by the Health Protection Surveillance Centre (HPSC). The guidance which is published and available on the HSPC's website advises that indoor visiting in residential care facilities where there is no ongoing COVID-19 outbreak will be permissible from 15th of June in circumstances where certain criteria are followed. During an ongoing outbreak of COVID-19 within a residential care facility, the guidance advises that all but essential visiting is suspended in the interests of protecting residents, visitors and staff.

I am aware of how difficult the restrictions on visiting have been for both nursing home residents and their families. Therefore, this phased approach is much welcomed as it will both facilitate visits to loved ones across the country, whilst also keeping some of our most vulnerable members of society protected during this challenging time.

Home Care Packages

Questions (685)

Patricia Ryan

Question:

685. Deputy Patricia Ryan asked the Minister for Health the number of persons on the waiting list for homecare support; his plans to deal with same; and if he will make a statement on the matter. [16954/20]

Written answers

Minister of State at the Department of Health

As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

General Practitioner Services

Questions (686)

Patricia Ryan

Question:

686. Deputy Patricia Ryan asked the Minister for Health if he will review the need for an extra full-time general practitioner service for Monasterevin, County Kildare; and if he will make a statement on the matter. [16958/20]

Written answers

Minister for Health

As this question relates to a service matter, I have arranged for the question to be referred to the Health Service Executive for direct reply to the Deputy.

Covid-19 Pandemic

Questions (687)

David Cullinane

Question:

687. Deputy David Cullinane asked the Minister for Health if each capital project already committed to is under review due to Covid-19; and if he will make a statement on the matter. [16961/20]

Written answers

Minister for Health

The Health Service Executive has developed a draft Capital Plan for 2020 having regard to the available funding, the number of large national capital projects currently underway, and the cashflow requirements and priorities attaching to each project. All projects are considered as part of this process.

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.

Hospital Facilities

Questions (688)

David Cullinane

Question:

688. Deputy David Cullinane asked the Minister for Health if the delivery of a second cath lab at University Hospital Waterford as previously committed to will proceed and is not a project currently under review in the context of revising the capital plan; and if he will make a statement on the matter. [16962/20]

Written answers

Minister for Health

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.

Ministerial Meetings

Questions (689)

David Cullinane

Question:

689. Deputy David Cullinane asked the Minister for Health the organisations and representative groups he has met since he became Minister; and if he will make a statement on the matter. [16963/20]

Written answers

Minister for Health (Deputy Stephen Donnelly)

Since my appointment as Minister for Health on 27 June, I have met with groups that are external from my Department and its agencies, including Nursing Homes Ireland; the Services, Industrial, Professional and Technical Union (SIPTU); the Irish Nurses & Midwives Association (INMO); the Psychiatric Nurses Association (PNA); the Employment, Social Policy, Health and Consumer Affairs Council of the EU (EPSCO); and officials from the World Health Organisation.

Pharmacy Services

Questions (690, 766)

David Cullinane

Question:

690. Deputy David Cullinane asked the Minister for Health when he will commence talks with pharmacists on a new contract; and if he will make a statement on the matter. [16964/20]

Michael Ring

Question:

766. Deputy Michael Ring asked the Minister for Health when negotiations on a new contract for pharmacists will commence; when the last meeting between his Department and pharmacists took place; when the next meeting between his Department and pharmacists will take place; and if he will make a statement on the matter. [17389/20]

Written answers

Minister for Health

I propose to take Questions Nos. 690 and 766 together.

Community pharmacy is recognised as the most accessible element of our health service with an unequalled reach in terms of patient contact and access. Therefore community pharmacists play a vital role in the Irish Health Service in the delivery of holistic patient care. I also fully acknowledge that community pharmacy has played a pivotal role in responding to the health needs of the public during the COVID-19 crisis. It is recognised that community pharmacists have ensured the continued availability of a professional, accessible service for the public and have successfully managed to alleviate the worries and concerns of the population around continuity of medicine supply in the face of great uncertainty.

This has been a period of unprecedented difficulty for the country and pharmacists have been at the forefront of the response. Accordingly, commitment has been given to commence a strategic review of the role of community pharmacists and to engage with the Irish Pharmaceutical Union to develop revised contractual terms. On 5 December 2019, my predecessor met with the Irish Pharmacy Union and communicated this intention.

The existing GMS pharmacy contract dates from 1996 and it is accepted that it is substantially outdated. It has not kept pace with developments that have taken place over the course of recent years including the increasing emphasis on maximising the proportion of people’s healthcare needs met in primary care, interdisciplinary collaboration and the skillset that pharmacists have by virtue of their education and training.

The comprehensive review of the pharmacy contract will address the role to be played by community pharmacy in the context of Sláintecare. It will consider all aspects of pharmacy service provision including delivery of a multi-disciplinary model of service delivery for patients, ensuring clarity of roles and achieving optimum value for money. However, any publicly funded pharmacy service expansion should address unmet public healthcare needs, improve access to existing public health services or provide better value for money or patient outcomes.

There has continued to be regular engagement with the IPU throughout the past number of months and a significant number of contingency measures have been put in place under the Medicinal Products (Prescription and Control of Supply) Amendment Regulations, 2020, intended to relieve the pressures on community pharmacies and General Practitioners during the COVID-19 crisis.

Ophthalmology Services

Questions (691)

David Cullinane

Question:

691. Deputy David Cullinane asked the Minister for Health his plans to update the National Eye Care Plan; and if he will make a statement on the matter. [16965/20]

Written answers

Minister for Health

In 2017, the HSE published the Primary Care Eye Services Review Group Report which sets out the way forward for a significant amount of eye services to be delivered in a Primary Care setting, on a phased basis.

I have referred the Deputy’s question to the HSE for direct reply.