Written Answers Nos. 71-90
71. Deputy Violet-Anne Wynne asked the Minister for Health the way in which he plans to address the waiting times to obtain an appointment to see a rheumatologist in the mid-western areas of the country in view of the fact that persons with fibromyalgia are left on long-term waiting lists resulting in low quality of life due to pain; and if he will make a statement on the matter. [23696/20]
View answerMaintaining scheduled care access for all patients is a key priority for hospitals. I fully acknowledge the distress and inconvenience for patients and their families when appointments are delayed.
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.
Application of the essential risk mitigating steps set out in the guidance developed under the auspices of the NPHET Expert Advisory group will have operational implications, which will impact on throughput.
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 24 June. 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. Further detail regarding the phases of service resumption are contained in the HSE’s ‘A Safe Return to Health Services’ document, published on their website on 22 July.
As the system continues to deliver Covid-19 and non-Covid 19 care side-by-side over a more prolonged period, my Department and the HSE will continue to work closely together to protect essential non-Covid 19 acute care and progress the provision of more routine non Covid-19 care.
In relation to outpatient waiting lists for Rheumatology in the mid-western area, the National Treatment Purchase Fund (NTPF) has advised my Department that they have approved a number of initiatives to improve waiting times for outpatient appointments in the University of Limerick Hospital Group. This includes 1,150 additional Rheumatology outpatient clinic appointments.
72. Deputy Sorca Clarke asked the Minister for Health the way in which he plans to deal with the mental health crisis, which has worsened since the onset of Covid-19 and the cancellation of services. [23759/20]
View answerAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
73. Deputy Alan Kelly asked the Minister for Health the status of the clearing of the CervicalCheck backlog; and if he will make a statement on the matter. [23653/20]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
74. Deputy Éamon Ó Cuív asked the Minister for Health the number of children with disabilities on the waiting list for assessment for early intervention; and the average waiting time to get an assessment. [22328/20]
View answerThe Programme for Government, Our Shared Future, recognises the need to improve services for both children and adults with disabilities through better implementation and by working together across Government in a better way.
The Government commits to prioritising early diagnosis and access to services for children and ensuring that the most effective interventions are provided for each child, to guarantee the best outcomes.
As this is a service matter, I have asked the Health Service Executive to respond to the deputy directly.
75. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he can ensure access to services such as elective procedures, mental health services, endoscopy and oncology treatments that have been affected by the Covid-19 crisis, including access to services for persons with special needs; if he has in place or in mind a specific action plan to deal with the issues; and if he will make a statement on the matter. [23663/20]
View answerThe COVID-19 pandemic led to an unprecedented interruption to normal health services, both in the community and acute hospitals. While some services were suspended or delivered on a reduced basis, it is important to recognise that many vital services have continued throughout the pandemic, ensuring that priority care needs were addressed and the most vulnerable protected even at the height of this crisis.
Resuming health and social care services and building the health sector capacity and capability for the pressures of Winter 2020 and into 2021 is a priority for the Government.
To ensure that services were restored in a prioritised manner with investments targeted at rebuilding services guided by Sláintecare - shifting service provision from Hospital to community-based care, the HSE published in June 2020, a Strategic Framework for Delivery of Service Continuity in a COVID Environment. This ensures a safer environment for patients and service users.
Over the summer period we have seen a gradual resumption of many of those services that were curtailed, although unfortunately there are still areas where the level of service falls below that which was being delivered up to mid-March. The immediate priority for the HSE is the finalisation of a Winter Plan that would incorporate the enhancement of services to cope with Winter pressures into early 2021 to ensure the capacity and capability of health system is prepared for this challenging period.
Additionally, a more strategic approach to Service resumption is being undertaken, with the development of a longer-term plan to include augmented levels of service to regain a level of provision across community and acute hospitals that had capacity adversely impacted by COVID 19. This would include establishing key community services envisioned in Sláintecare and the 2018 Capacity Review, while building toward the appropriate level of capacity in our acute hospital services.
As part of the Winter and Service Planning process, a range of initiatives have also been developed, and as these are rolled out in the coming weeks and months, we will see further service resumption and increased capacity across the community (primary care, mental health, older persons and disability services) and Acute Hospital system.
This will include implementing new initiatives, new ways of working and eHealth solutions to keep people safe and keep people out of the acute hospital system e.g. ePharmacy, ePrescribing and virtual clinics.
For Mental Health Services, this year has been exceptional with the outbreak of Covid-19. The pandemic has been a source of significant stress, anxiety, worry and fear for many people throughout the world. This arises from the disease itself, as well as from impacts such as increased social isolation, disruption to daily life and uncertainty about employment and financial security.
The HSE has continued to provide all community services, in so far as possible, while following Covid-19 guidelines to ensure the protection of patients and staff. To note, acute inpatient and community residential facilities have remained open and patients have been provided with services throughout the pandemic, although numbers have been reduced in some settings.
The advent of Covid-19 has led to a rapid acceleration in the delivery of online mental health services, with the Department of Health launching numerous initiatives to promote mental health and wellbeing. Among these was the launch of the national Crisis Text-Line in June. An additional €2.2m has been provided for a mental health promotion and well-being campaign, through enhanced online supports, and to support the HSE psychosocial strategy. This will enable the Irish healthcare system to implement integrated telehealth solutions and to augment existing online interventions funded to date. An example of this is the free counselling sessions offered by HSE NGO partner MyMind and Turn2me created online peer support groups for frontline workers.
Tele-psychiatry pilot projects have been tested to enable planning for the delivery of this service nationally to support those with complex mental health needs. This service will alignment and augment existing mental health services.
To plan for the ongoing and increasing need for mental health services nationally and the demand for more holistic person-centred responses across the whole community, the refreshed national mental health policy, Sharing the Vision – A Mental Health Policy for Everyone, was published in June 2020. Service users and their families, carers and supporters will have timely access to evidence-informed mental health services. Tailored measures will be put in place to ensure that individuals with complex mental health difficulties can avail of services across the state without discrimination. This builds on the intent of A Vision for Change and Sláintecare and is expected to be implemented as part of a ten year plan.
Regarding access to services for persons with special needs, adult day services as well as children’s disability services were stepped down in March 2020 in line with government recommendations to minimise the spread of COVID 19.
Adult day services have since been reopening over the last month and this will continue throughout September, and information on reopening dates for all 966 services has been available on the HSE’s website since August 4th.
When day services resume, capacity in day service locations will be reduced, however, the HSE and service providers will keep this measure under review and as public health guidance evolves, capacity to provide supports will adapt accordingly. The HSE is committed to maximising the support that can be provided within these restrictions and providers are exploring options such as the use of other community facilities to augment capacity.
For the foreseeable future, remote supports and supports provided from service user homes will become a key feature of day service provision.
Throughout the pandemic, children’s disability services continued to be provided on the phone/online and also, face to face for some children and families with high prioritised needs, taking all of the required IPC precautions into account, and in line with HSE’s Alternative Models of Support.
On July 31st, the HSE issued “Guidance to Support Resumption of Children’s Disability Services” documentation to their individual Community Healthcare Organizations. These guidance documents are intended to support clinicians in decision making regarding disability assessments in the context of Covid-19 and secondly to support the return to more normal levels of service provision for children with disabilities and their families, who have been significantly impacted by measures taken to prevent the spread of Covid-19.
Having received these guidance documents, all Community Healthcare Organizations should be putting appropriate arrangements in place to resume assessment of need and intervention therapy services in line with public health guidance.
76. Deputy David Cullinane asked the Minister for Health his plans to re-evaluate and relax restrictions on pregnant parents being accompanied by their partners in hospitals before, during and after birth on compassionate grounds; and if he will make a statement on the matter. [23644/20]
View answer94. Deputy Violet-Anne Wynne asked the Minister for Health his plans to allow pregnant women to attend hospital appointments with their partners; his plans to allow restrictions on same to be lifted in hospitals (details supplied); and if he will make a statement on the matter. [23695/20]
View answer97. Deputy Sorca Clarke asked the Minister for Health when the restrictions in maternity hospitals will be lifted to allow a doula and-or birthing partner to support a pregnant woman in labour and delivery. [23758/20]
View answer628. Deputy Carol Nolan asked the Minister for Health if he will request the HSE to remove the restrictions that deny fathers and partners the right to be present with a woman at her antenatal scans and appointments and to be able to provide support throughout the entirety of the labour and beyond one hour after the birth of the baby for the duration of the hospital stay; and if he will make a statement on the matter. [23282/20]
View answer687. Deputy Ged Nash asked the Minister for Health if he will provide the policy and public health rationale that warrants the continued exclusion of partners from supporting expectant mothers through labour and the post-birth period in maternity hospitals; if he plans to review this policy in view of the evidence that supports the presence of partners during this process from an emotional and psychological point of view; and if he will make a statement on the matter. [23463/20]
View answer695. Deputy Denis Naughten asked the Minister for Health his plans to review the restrictions on partners attending maternity and labour wards; and if he will make a statement on the matter. [23504/20]
View answer771. Deputy Rose Conway-Walsh asked the Minister for Health his plans to assess the current restrictions on partners being present during the entirety of childbirth; and if he will make a statement on the matter. [23886/20]
View answer782. Deputy Cathal Crowe asked the Minister for Health his plans to lessen the restrictions in maternity hospitals on persons who can be in the birthing room during labour in view of restrictions in other parts of society easing significantly. [23954/20]
View answer853. Deputy Willie O'Dea asked the Minister for Health when restrictions will be eased at maternity hospitals to allow the birth partners of expectant mothers to attend antenatal appointments and early labour; and if he will make a statement on the matter. [24139/20]
View answerI propose to take Questions Nos. 76, 94, 97, 628, 687, 695, 771, 782 and 853 together.
I acknowledge that the current restrictions in maternity hospitals are presenting difficulties and this is hugely regrettable. However, it is necessary to reduce footfall in order to protect women, babies, staff and our maternity service as a whole.
Maternity hospitals have performed well during the pandemic and have continued to keep women, babies and staff safe. The fact that there have been no Covid maternal deaths in this country,and that we have a had a low incidence in pregnant women, suggests that the current approach is working.
However, we must remain vigilant as services resume and higher numbers of people attend hospitals. Maternity hospitals rely on very specialised personnel; should an outbreak of COVID-19 occur in a maternity hospital, the ability to provide safe, quality care would be severely impacted. It should be remembered that maternity hospitals care for fragile infants at the extremes of prematurity.
All maternity hospitals are challenged by the pandemic, but those challenges vary considerably. Decisions on any restrictions are therefore made, implemented and reviewed at hospital level.
Decisions to restrict visitors in our maternity hospitals have not been taken lightly. Management and staff are acutely aware of the very important support provided by partners at the time of birth. I have been assured that maternity hospitals wish to facilitate this support as far as possible. In that context, I can assure the Deputy that any restrictions currently in place have been minimised as much as possible and will be subject to ongoing review.
77. Deputy Rose Conway-Walsh asked the Minister for Health if he will liaise with the HSE to ensure flexibility for the procurement of catheters from a company (details supplied) as a matter of urgency; and if he will make a statement on the matter. [23699/20]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
78. Deputy Mairéad Farrell asked the Minister for Health the new estimated completion date of the national children’s hospital in view of the recent stoppage of work; if the estimated cost is now likely to exceed the figure of €1.73 billion that was provided in the independent review; and if he will make a statement on the matter. [16632/20]
View answerLike many other sectors of the economy, the construction sector was impacted by the Covid-19 pandemic. This resulted in construction related work on the site of the new children’s hospital stopping on 31 March this year due to Covid-19 Restrictions. On 18th May the restrictions in respect of the construction sector were eased. From this date, the National Paediatric Hospital Development Board (NPHDB) engaged with the main contractor to ensure the earliest possible reopening of the sites. I am informed that the main contractor of the New Children’s Hospital project returned to site on the 13th of July. There will be delays associated with Covid-19, however it is too early to fully assess the impact of the pandemic on the new children’s hospital project and the Paediatric Outpatient and Urgent Care Centre at Tallaght. The NPHDB continues to engage with the contractor and is monitoring progress on site in the interests of completing the project as quickly and economically as possible.
On that note I want to say that I am acutely aware of how urgently the new Children’s Hospital is needed and I want to see it delivered as quickly as possible on behalf of children, young people and their families.
Under the contract, the new children’s hospital is due to be completed by the end of 2022 and handed over to Children’s Health Ireland to open in 2023 after a period of commissioning. As of March 2020, when the site closed due to Covid-19, I am advised that the NPHDB was of the view that the Main Contractor was behind schedule on the construction works.
The NPHDB is continuing to engage with the Main Contractor to obtain an updated programme of works that is in line with its contractual commitments. Any delivery outside of the timelines agreed under the contract could potentially be a matter for dispute resolution and so I wish to be careful in respect of what I say here, but I will reiterate that it is a priority for me and this Government that the hospital be completed as quickly as possible.
The € 1.73 billion figure raised by the Deputy is the total overall project cost advised to the previous Government in December 2018. That figure comprises €1.43 billion which is the overall cost to complete the capital project, and also includes a broader programme of activity associated with the integration and transfer of the services of the three children’s hospitals to the new sites under development. This includes for example investment in ICT, an Electronic Health Record system and the Children's Hospital Integration Programme - the merging of three paediatric hospitals.
The PwC report makes clear that the Guaranteed Maximum Price established through the two-stage tender process does not provide a contractual ceiling on cost and significant residual risks remain of further cost. The residual risks, for which there cannot be cost certainty, include items such as construction inflation, claims and certain uncontrollable risks, such as potential costs relating to BREXIT. I am advised that the main contractor has submitted a significant number of claims which it alleges are outside of the agreed scope. The NPHDB has a robust process in place for the assessment of claims by the Contractor in accordance with the Construction Contract. This process is a commercially sensitive one between the contractor and the NPHDB.
79. Deputy Ruairí Ó Murchú asked the Minister for Health his views on mental health services including psychiatry services in County Louth; his plans for the services; and the resources that have been allocated to date; and if he will make a statement on the matter. [23697/20]
View answerAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
80. Deputy Catherine Connolly asked the Minister for Health if his Department or the HSE has carried out an analysis into the effects of the ongoing closure of day centres for adults with disabilities; the number of day centres which remain closed since the outbreak of Covid-19 in Ireland; the number of day centres which have reopened to date; and if he will make a statement on the matter. [23687/20]
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.
As this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
81. Deputy David Cullinane asked the Minister for Health his plans to deliver on commitments to persons with scoliosis and reduce wait times for care; and if he will make a statement on the matter. [23646/20]
View answerIn recent years there has been an increased investment in paediatric orthopaedics and scoliosis services, which has improved access to surgery and outpatient appointments. In 2018 Children’s Health Ireland (CHI; previously the Children’s Hospital Group) was provided with an additional €9 million in funding to address paediatric orthopaedic waiting lists, including the provision of scoliosis services. Scoliosis activity accounts for 20% of overall orthopaedic activity across CHI.
This funding supported the recruitment of approximately 60 WTE in 2018 and 2019 to enable the expansion of paediatric orthopaedic services including scoliosis services. The posts relate to the multi-disciplinary team at diagnosis, pre-assessment, during surgery in theatre, and post operatively. The majority of posts were allocated to each hospital in 2018.
The 2018 investment in paediatric orthopaedics included funding to support transition of adolescents with scoliosis from CHI at Crumlin to the Mater Misericordiae University Hospital (MMUH). CHI and MMUH have developed and agreed the clinical pathways for the transition of adolescents with scoliosis to MMUH. The transition of patients over the age of 16 who were awaiting a first-time outpatient/spinal review appointment at Crumlin commenced in December 2018. Each month, appropriate patients are identified for this pathway via clinical validation.
CHI have advised my Department that the introduction of government restrictions for COVID-19 based on public health advice required CHI at Crumlin and Temple Street to defer all non-emergency spinal operations. CHI at Crumlin and Temple Street have now resumed services on an incremental basis.
Key social distancing measures and Infection Prevention and Control (IPC) requirements have material impact on the available physical space to deliver services, significantly impacting on the overall capacity and operational activity levels for inpatient / outpatient settings. To the end of August 2020, 177 scoliosis procedures had taken place, compared to 251 for the same period last year, marking a decrease in activity of 29%.
At the end of August 2020 there were 218 scoliosis patients waiting for a spinal procedure at Crumlin, Temple Street and Cappagh Hospitals, across active, TCI (to come in) suspended and planned procedure categories. Of this number, 129 were awaiting spinal fusion procedures, while 89 were awaiting other spinal procedures.
Additional initiatives are being explored to increase access to scoliosis treatment - CHI is working with the National Orthopaedic Hospital, Cappagh to transfer additional patients who meet the clinical criteria for treatment at Cappagh and in conjunction with the NTPF, sourcing additional theatre space.
Scoliosis services, waiting lists, and activity levels are specifically monitored by the Scheduled Care Performance Unit in my Department, through weekly performance monitoring meetings which are attended by representatives from CHI, and through continued engagement between Department and HSE officials.
82. Deputy James Lawless asked the Minister for Health if he will ensure more regular publication of localised statistics on Covid-19, especially in view of the significantly differing incidence of the virus within counties. [23431/20]
View answerSince the National Public Health Emergency Team (NPHET) met for the first time, a commitment was given to collect and publish as much relevant data as possible while ensuring individual patient confidentiality is maintained at all times. While the nature and scale of the Covid-19 pandemic has been unprecedented, the collection of timely and comprehensive data has been instrumental in developing the health service response to Covid-19 and to the advice provided by NPHET and the Department of Health to assist Government decision-making in the wider response to the disease in Ireland.
Comprehensive national statistics, information and data about Covid-19, including a timeline of confirmed cases by date, is published on a daily basis on the Department of Health website at https://www.gov.ie/en/organisation/department-of-health/ and on the Covid-19 Data Hub and Dashboards available at https://covid19ireland-geohive.hub.arcgis.com/. The published data are based on official figures provided by the Health Protection Surveillance Centre (HPSC) and the Health Service Executive (HSE).
All datasets, charts and maps are updated on an on-going basis and in line with newly published data. Data in relation to COVID-19 confirmed cases at electoral division level are updated on a regular basis. However, the Deputy should note that care is required to ensure patient confidentiality is preserved and that no potential identification of individual patients arises. As a result, the data relating to confirmed cases by electoral division is not updated on as frequent a basis as the other data on the Data Hub.
The Deputy may also wish to note that a range data on the epidemiology of Covid-19 in Ireland is also published in the daily report by the Health Protection Surveillance Centre (HPSC) available at https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/casesinireland/epidemiologyofcovid-19inireland.
83. Deputy Pádraig O'Sullivan asked the Minister for Health the action being taken to reduce CAMHS waiting lists in the Cork north Lee area; and if he will make a statement on the matter. [23693/20]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
84. Deputy Mark Ward asked the Minister for Health if investment in neurological and neurorehabilitation services will be increased (details supplied); and if he will make a statement on the matter. [23427/20]
View answerThe Programme for Government includes a commitment for advancing neuro-rehabilitation services in the community. The Health Service Executive is leading on the implementation framework in respect of the recommendations of the National Policy and Strategy for the provision of Neuro-Rehabilitation Services in Ireland 2011-2015.
The focus of the Neuro-Rehabilitation Strategy is on achieving best outcomes for people, by providing safe, high quality, person-centred care at the lowest appropriate level of complexity. This must be integrated across the care pathway and provided as close to home as possible or in specialist centres, where necessary. The framework will guide the reconfiguration and development of neuro-rehabilitation structures and services at national and local level, through a 10-step Framework. It proposes the formation of Managed Clinical Rehabilitation Networks (MCRNs), with the set-up of one demonstration MCRN suggested as the first step. The ultimate goal of this approach is to put in place a national framework of acute, inpatient and specialist community services.
The Managed Clinical Rehabilitation Network (MCRN) model acknowledges that different service users need different input and different levels of expertise and specialisation at different stages in their rehabilitation journey.
The critical point of this model is that, although service users may need to access different services as they progress, the transition between services should be facilitated by appropriate communication and sharing of information between services so that they progress in a seamless continuum of care through the different stages:
- Acute hospital;
- Complex specialist rehabilitation services;
- Post-acute specialist inpatient rehabilitation services;
- Community based specialist rehabilitation services;
- Primary care; and
- Voluntary organisations.
This National Implementation Framework is evidence-based and informed by population needs. It addresses the continuum of care for those in need of neurological rehabilitation services. It describes the requirement for a whole system approach and provides the blueprint for how we should deliver care and services for those who suffer from neurological conditions who require individualised, goal focused rehabilitation.
The implementation framework covers an initial period from 2019 into 2021. However, it is recognised that continued investment in and development of neuro-rehabilitation services will need to be prioritised beyond the three-year implementation period of this Implementation Framework.
In relation to health needs, HSE Disability Services provide personal and social supports based on the needs of the individual, rather than the provision of services based on a specific diagnosis or condition.
In general services for people with neurological conditions are delivered within the context of Primary Care, with referrals into secondary care for specialist interventions, where appropriate. However, people with neurological conditions may also benefit from Specialist Disability Services such as assisted living services.
The HSE provides a range of assisted living services including Personal Assistant and Home Support Services to support individuals to maximise their capacity to live full and independent lives.
PA and Home Support Services are provided either directly by the HSE or through a range of voluntary service providers. The majority of specialised disability provision (80%) is delivered through non-statutory sector service providers.
Services are accessed through an application process or through referrals from public health nurses or other community based staff. Individual’s needs are evaluated against the criteria for prioritisation for the particular services and then decisions are made in relation to the allocation of resources. Resource allocation is determined by the needs of the individual, compliance with prioritisation criteria, and the level of resources available. As with every service there is not a limitless resource available for the provision of home support services and while the resources available are substantial they are finite. In this context, services are discretionary and the number of hours granted is determined by other support services already provided to the person/family.
As the issues raised are service matters, I have asked the Health Service Executive (HSE) to reply directly to the Deputy.
85. Deputy Sean Sherlock asked the Minister for Health when disability services will resume operation; the additional budget that has been allocated to meet the costs of adhering to public health advice; and the additional allocation to each service provider nationally in tabular form. [22335/20]
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.
As this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
86. Deputy Paul Murphy asked the Minister for Health the steps he will take to ensure the full reopening of paediatric emergency services at Tallaght Hospital as was promised earlier in 2020; and if he will make a statement on the matter. [23675/20]
View answerLast March as part of the response to the COVID-19 pandemic, CHI temporarily relocated paediatric services from Tallaght to its other sites at Crumlin and Temple Street and to the urgent care centre at Connolly. This freed up resources at Tallaght to support the adult service there in responding to the demands of COVID and meant that some CHI staff, on a voluntary basis, worked in the adult services supporting their colleagues, including in ICU, during this very challenging period.
This was a temporary measure, and paediatric services at Tallaght have now resumed. CHI advises this began with the return of outpatients in July. A 24/7 emergency care unit, medical inpatient care and day case surgery, medicine and x-ray resumed on site from 3 September. Tallaght will now take on increased day surgeries instead of resuming in-patient surgeries,creating theatre capacity in Temple St and Crumlin for surgeries that can only be undertaken in those hospitals. Additionally, critically ill and critically injured children will be directed to the CHI Emergency Departments at Crumlin and Temple Street.
Patient safety is central to CHI’s decision making, both in the provision and development of services. This approach is designed to ensure that resources across all CHI sites at Tallaght, Crumlin, Temple Street and Connolly are utilised as effectively as possible to maximise the level of service provided and ensure the delivery of safe, high quality services. This is crucial in the context of what is expected to be a challenging winter for paediatric services.
87. Deputy Mark Ward asked the Minister for Health the number of children waiting for an assessment of need in each CHO; the length of time they have been waiting; and if he will make a statement on the matter. [23426/20]
View answerThe Programme for Government, Our Shared Future, recognises the need to improve services for both children and adults with disabilities through better implementation and by working together across Government in a better way.
The Government commits to prioritising early diagnosis and access to services for children and ensuring that the most effective interventions are provided for each child, to guarantee the best outcomes.
As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly.
88. Deputy Niamh Smyth asked the Minister for Health the status of the review being conducted into the midwifery-led unit in Cavan General Hospital; and if he will make a statement on the matter. [23425/20]
View answerFollowing reports of planned changes to midwifery led maternity service provision at Cavan General Hospital, my Department requested a full report from the National Women & Infants Health Programme. I have been advised that the review is currently on-going within the RCSI Hospital Group and it is envisaged that the report will the finalised by the end of September.
In the meantime, the Midwifery Led Unit at Cavan General Hospital is operating as normal and bookings are being accepted from women wishing to avail of the service. Once the full report has been received, my Department will work with the National Women & Infants Health Programme to ensure that any additional supports which are required to secure the future of community midwifery services in Cavan, will be put in place. This will ensure that the choice of the Supported Care pathway remains available to women attending Cavan General Hospital for maternity services and that maternity services will continue to develop in line with the National Maternity Strategy.
89. Deputy David Cullinane asked the Minister for Health his plans to advance an inquiry into mesh implants and sodium valproate; his further plans to gather better data to understand the extent of the impact of same; if an expert panel will review the UK report on the matter; and if he will make a statement on the matter. [23647/20]
View answer626. Deputy David Cullinane asked the Minister for Health his plans to advance an inquiry into mesh implants and sodium valproate; his further plans to gather better data to understand the extent of the impact of same; if an expert panel will review the UK report on the matter; and if he will make a statement on the matter. [23642/20]
View answerI propose to take Questions Nos. 89 and 626 together.
Considerable work has been done and continues to progress in Ireland in relation to the safe use of mesh implants and sodium valproate; and the patient voice is central to our understanding of these, and similar, issues. With regards to the specific details, I will first deal with mesh implants and then consider sodium valproate.
Over the past two decades, Uro-Gynaecological Mesh has been widely used in the surgical treatment of Stress Urinary Incontinence and Pelvic Organ Prolapse 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.
I am aware that in response to concerns raised in Ireland regarding complications associated with the use of mesh devices in late 2017, the then Minister for Health requested the Chief Medical Officer (CMO) to prepare a report on the matter. The report was informed by the available national and international evidence and the personal experiences of women who have suffered complications following mesh surgery.
In July 2018, in advance of publication of the full report, the CMO requested the HSE to pause all mesh procedures where clinically safe to do so. This pause was instigated pending implementation of initial recommendations regarding (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 was published in November 2018. Four of the 19 recommendations relate to data gathering to support the development of information resources to permit long-term research and audit of practice, ensuring the reporting of mesh related complications, and ensuring timely, appropriate arrangements for the management of women with complications.
The HSE published a detailed Implementation Plan for the recommendations in the report in April 2019. The National Women and Infants Health Programme is leading on this work.
The Health Products Regulatory Authority (HPRA) receives adverse incidents reported in Ireland with respect to mesh products. It is working with the National Women and Infants Health Programme on a national reporting guidance document, for adverse incident reporting associated with uro-gynaecological mesh. This new guidance is expected to be finalised and published in the coming weeks. It requests that Healthcare Professionals including consultants, GPs and national mesh administrators report adverse events associated with vaginal mesh implants to the HPRA.
The HPRA is also involved other related areas of work. It is leading work in Europe to create a device specific vigilance guidance with respect to mesh products to standardise reporting with respect to these products. It is conducting a market surveillance review into transvaginal mesh products used for stress urinary incontinence or pelvic organ prolapse, in addition to supporting a European taskforce relating to mesh products.
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.
With regard to the medicine, sodium valproate, I am aware of historical and current issues surrounding the use of sodium valproate by women during pregnancy. I am also aware of the significant work carried out by the HSE and the HPRA over the last two years to implement European Medicines Agency (EMA) recommendations from 2018 and to provide support to families who may have concerns about previous exposure to sodium valproate and the possible impact on their children.
As I understand it, the HSE has improved the structures in place to support families affected by foetal valproate syndrome (FVS), including the establishment of a dedicated genetics clinic in Our Lady’s Hospital, Crumlin. This means that families now have access to a clear diagnostic pathway if they feel their child may be affected by FVS.
As regards the UK report referred to by the Deputy, any relevant learnings from that review will be taken into account as my Department continues to work with the HSE, the HPRA, and other stakeholders to support successful implementation of the current regulatory framework and risk mitigation measures for valproate and implementation of the recommendations of the CMO’s report on the use of use of Uro-Gynaecological Mesh in Surgical Procedures.
90. Deputy Neale Richmond asked the Minister for Health the status of publicly funded fertility care as promised in the programme for Government; the form of supports that will be available; and if he will make a statement on the matter. [23278/20]
View answerAs the Deputy is aware, a commitment to introduce a model of care for infertility, details of which had been announced in December last year, is included in the Programme for Government. This model of care will ensure that infertility issues will be addressed through the public health system at the lowest level of clinical intervention necessary. It will comprise three stages, starting in primary care (i.e., GPs) and extending into secondary care (i.e., Regional Fertility Hubs) and then, where necessary, tertiary care (i.e., IVF and other advanced assisted human reproduction (AHR) treatments). Structured referral pathways will be put in place and patients will be referred onwards for further investigations or treatment as required and as clinically appropriate. It is intended that, in line with available resources, this model of care for infertility will be rolled out on a phased basis over the course of the coming years.
Phase One of the roll-out of the model of care involves the development of Regional Fertility Hubs at secondary care level. Funding of €2m was provided to develop these Hubs in maternity networks which will facilitate the management of a significant proportion of patients presenting with infertility issue.
Phase Two will see the introduction of tertiary infertility services, including IVF, in the public health system. Phase Two will not commence until such time as infertility services at secondary level have been developed across the country and the AHR legislation is commenced. Drafting of the AHR legislation is ongoing in conjunction with the Office of the Attorney General.
Substantial progress has been made in respect of the development of the Regional Fertility Hubs, and specifically the development of the first four of these Hubs. This is despite the work having to be slowed due to the management of the Covid-19 pandemic by the health service broadly and its impact upon the provision of elective health services, including fertility services.
It should be noted that while AHR treatment is not currently funded by the Irish Public Health Service, a defined list of fertility medicines needed for fertility treatment is covered under the High Tech Arrangements administered by the HSE. Medicines covered by the High Tech Arrangements must be prescribed by a consultant/specialist and authorised for supply to the client’s nominated community pharmacy by the High Tech Hub managed by the Primary Care Reimbursement Service. The cost of the medicines is then covered, as appropriate, under the client’s eligibility, i.e., Medical Card or Drugs Payment Scheme. Given the costs associated with certain fertility medicines, I am aware that these schemes can have a material impact on the total cost of AHR treatment for individuals who avail of them.
Overall, the implementation of the model of care will help to ensure the provision of safe, effective and accessible infertility services at all levels of the public health system as part of the full range of services available in obstetrics and gynaecology.
