Tuesday, 24 Nov 2020

Written Answers Nos. 812-828

Covid-19 Pandemic

Questions (812)

Michael McNamara

Question:

812. Deputy Michael McNamara asked the Minister for Health the specific areas or regions of the State in respect of which Ireland will provide data to the European Centre for Disease Control to give effect to the recommendation on a co-ordinated approach to the restriction of free movement in response to the Covid-19 pandemic, arising from the European Council meeting of 13 October 2020 that member states apply those restrictions to persons coming from specific areas or regions of the State particularly affected rather than to the entire territory of Ireland; and if he will make a statement on the matter. [38055/20]

Written answers

Minister for Health

Ireland provides data to the ECDC based on NUTS regions. For the purpose of mapping in the context of EU Council Recommendation 2020/1475, the ECDC publishes data by NUTS2 regions for Ireland.

There are three NUTS2 regions in Ireland, these being Northern & Western, Southern, Eastern & Midland. The boundaries of NUTS2 regions align with both NUTS3 regions and county boundaries, shown in the attached table in the following link.

Regions

Covid-19 Pandemic

Questions (813)

Gerald Nash

Question:

813. Deputy Ged Nash asked the Minister for Health his view on the concerns of a person (details supplied) relating to the classification of yoga under the plan for living with Covid-19; and if he will make a statement on the matter. [38065/20]

Written answers

Minister for Health

Firstly, I would like to say that I fully understand how important activities such as yoga are for people's physical and mental health, particularly in the winter months.

As you will be aware, Ireland has moved to level 5 of the Government’s medium-term strategy for dealing with COVID-19, Resilience and Recovery 2020-2021: Plan for Living with COVID-19. This Plan sets out Ireland's approach to managing and living with COVID-19 in a range of areas over the next 6 - 9 months.

The Plan sets out five levels of response, each with a number of measures designed to help us all lower COVID-19 transmission and setting out what is permitted at that moment in time. It aims to allow society and businesses to be able to operate as normally as possible, while continuing to suppress the virus. Each level outlines what is permitted for social or family gatherings, work and public transport, bars, hotels and restaurants, exercise activities and religious services.

The Plan reflects a careful consideration of the impact of the introduction of restrictions on employment and livelihoods, keeping as many businesses open as possible at different stages, while acknowledging that some businesses and services are critical.

As I'm sure you can appreciate, COVID-19 spreads when individuals and groups come into close contact with one another, enabling the virus to move from one person to another. COVID-19 is infectious in a person with no symptoms, or for the period of time before they develop symptoms.

At level 5 of the Plan, people are asked to stay at home, with certain exceptions, and must exercise within 5km of home. Exercise and sporting amenities have been closed in order to reduce the person-to-person contacts which allow the virus to spread. No matches or other sporting events may be held with the exception of professional elite sports and senior inter-county gaelic games and horse and greyhound racing, which may continue behind closed doors. All other training activities should be individual only. It is possible to meet with 1 other household in an outdoor setting which is not a home or garden, such as a park, including for the purpose of exercise.

The Government recognises that there are many aspects of normal life that have been altered by the emergence of COVID-19, and the response that has been required. It also recognises that these changes are difficult for many people. However, it is the case at present that many of the things which we have previously taken for granted - such as yoga classes, but also eating out, attending church, travelling abroad freely - are no longer accessible in the same way due to the risks that they pose and the ease with which this virus spreads in particular conditions.

The Government's guidelines for exercise and sporting events at all levels of the Plan are available at: https://www.gov.ie/en/campaigns/resilience-recovery-2020-2021-plan-for-living-with-covid-19/. Level 5 guidance from Sport Ireland is available at: https://www.sportireland.ie/news/return-to-sport-expert-group-issues-guidance-to-sports-sector

Hospital Appointments Status

Questions (814)

Michael McNamara

Question:

814. Deputy Michael McNamara asked the Minister for Health when a person will be facilitated with emergency surgery (details supplied); and if he will make a statement on the matter. [38095/20]

Written answers

Minister for Health

It is recognised that waiting times for scheduled appointments and procedures have been impacted as a direct result of the COVID-19 pandemic.

In response to the Covid-19 pandemic the HSE had to take measures to defer most scheduled care activity in March, April, and May of this year. This was to ensure patient safety and that all appropriate resources were made available for Covid-19 related activity and time-critical essential work. This decision was in line with the advice issued by the National Public Health Emergency Team (NPHET) in accordance with the advice of the World Health Organisation.

Patient safety remains at the centre of all hospital activity and elective care scheduling. To ensure services are provided in a safe, clinically-aligned and prioritised way, hospitals are following HSE clinical guidelines and protocols.

The HSE continues to optimise productivity through alternative work practices such the use of alternative settings including private hospitals, community facilities and alternative outpatient settings.

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 Health Service Executive to respond to the Deputy directly, as soon as possible.

Nursing Home Accommodation

Questions (815, 840)

Holly Cairns

Question:

815. Deputy Holly Cairns asked the Minister for Health if he will review the visiting restrictions in nursing homes; and if he will make a statement on the matter. [38105/20]

Pauline Tully

Question:

840. Deputy Pauline Tully asked the Minister for Health his plans in relation to family visits to care homes over the Christmas period; and if he will make a statement on the matter. [38261/20]

Written answers

Minister of State at the Department of Health

I propose to take Questions Nos. 815 and 840 together.

The importance of continued social interaction of residents and their families cannot be overstated and every effort should be made, in line with public health advice, to ensure that these interactions continue, including through window visits.

Nursing home providers are ultimately responsible for the safe care of their residents. Under Regulation 11 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 it is the legal responsibility of each registered provider to make arrangements for a resident to receive visitors, having regard to any risks that may present for the resident or other residents. Public health guidance has been developed in order to assist and support providers in this regard.

The current guidance aligns with the 5 level framework of restrictive measures as outlined in the Government’s Living with COVID-19 Plan, to support long-term residential care providers in the discharge of their responsibilities and to support in the safe visiting, to the greatest extent possible, having regard for the challenging times in which we are living.

I encourage all nursing homes to remain familiar with the latest public health advice and support, and to make every effort to continue to facilitate visitors in line with public health advice and to communicate with family and friends on an ongoing basis in order to support positive mental health and wellbeing. I have communicated with the sector outlining the need for them to be flexible, innovative and to facilitate to the greatest extent possible alternative arrangements such as window visiting, in line with public health advice.

I understand that the Health Protection Surveillance Centre is currently reviewing the public health guidance on visiting, in consultation with relevant national stakeholders, to consider, in line with the range of public health factors, further potential for safe visiting within nursing homes. Visiting guidance is being considered in the context of the wider COVID-19 situation, as we plan and prepare for exiting level 5 restrictions.

Notwithstanding this, it is also important to be cognisant of the wider epidemiological situation and the risks associated with same. On the 19th November, the European Centre for Disease Control published its latest risk assessment with regard to long-term care facilities. It highlights that the probability of COVID-19 introduction into a long-term care facility depends on the level of COVID-19 circulation in the community, with a higher risk associated with higher incidence rates in the community.

This highlights the importance of suppressing the level of the virus in the community as one of the primary measures for protecting nursing homes. As citizens, we all have a responsibility in this regard and our actions across all of society can directly impact the outcomes for nursing home residents.

Mental Health Services

Questions (816)

Holly Cairns

Question:

816. Deputy Holly Cairns asked the Minister for Health the way in which the implementation of the immediate priority to ensure that short-term additional supports are available for persons who are making the transition from CAMHS to GAMHS at 18 years of age given the issues and vulnerabilities that can prevail as outlined in Sharing the Vision: A Mental Health Policy for Everyone; and if he will make a statement on the matter. [38107/20]

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 to the deputy directly, as soon as possible.

Covid-19 Pandemic

Questions (817, 944)

Bernard Durkan

Question:

817. Deputy Bernard J. Durkan asked the Minister for Health if consideration will be given to replacing county boundaries with radius calculation when considering public health Covid-19 guidelines applicable to sports clubs, with particular reference to guidelines applicable to level 3; and if he will make a statement on the matter. [38142/20]

Seán Canney

Question:

944. Deputy Seán Canney asked the Minister for Health his views on the call by an association (details supplied) to be included in the modifications to restrictions to allow it to commence its activities in a controlled safe manner for the wellbeing of all participants. [38801/20]

Written answers

Minister for Health

I propose to take Questions Nos. 817 and 944 together.

Firstly, I would like to assure you that the Government is committed to ensuring a balanced and proportionate response to COVID-19 by finding ways to implement public health measures in response to the pandemic in a way that is fair, reasonable and proportionate.

As the Deputies will be aware, in response to the rapidly deteriorating epidemiological situation across the country, Ireland has moved to level 5 of the Government’s medium-term strategy for dealing with COVID-19, Resilience and Recovery 2020-2021: Plan for Living with COVID-1

9

This 5 level Framework reflects a careful consideration of the impact of the introduction of restrictions on employment and livelihoods, keeping as many businesses open as possible at different stages, while acknowledging that some businesses and services are critical.

Any measures introduced at any level of the Plan are aimed at limiting the spread and damage of COVID-19, and are necessary to protect our key priorities of supporting and maintaining health and social care services, keeping education and childcare services open and protecting the most vulnerable members of our communities.

As I'm sure the Deputies can appreciate, COVID-19 spreads when individuals and groups come into close contact with one another, enabling the virus to move from one person to another. COVID-19 is infectious in a person with no symptoms, or for the period of time before they develop symptoms. The number of people allowed to gather in different scenarios in the Government's Framework are based on a review of international practice and the judgment of public health experts. It seeks to balance the risks of different types of gatherings against the desire to allow normal activities to proceed in so far as possible.

With regard to domestic travel, restrictions apply at Levels 3, 4 and 5 of the Plan and these restrictions are set out in the Plan.

The public health advice relating to Covid-19 is kept under continuing review by the National Public Health Emergency Team (NPHET), and it provides advice to Government in line with the current epidemiological position.

Hospital Services

Questions (818)

Michael McNamara

Question:

818. Deputy Michael McNamara asked the Minister for Health when a person (details supplied) in County Clare will get an urgent transfer to the dean clinic at St. Patrick’s University Hospital Dublin, in view of the fact there is a bed available for this person at present, who would be transferring from Limerick University Hospital; and that it be noted that this person is Covid-19 free and the protocol provincial team is happy and willing to facilitate this transfer immediately; and if he will make a statement on the matter. [38143/20]

Written answers

Minister for Health

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

General Practitioner Services

Questions (819)

Bernard Durkan

Question:

819. Deputy Bernard J. Durkan asked the Minister for Health the extent to which outstanding matters remain to be resolved in the context of negotiations with general practitioners, such as the award of consultancy status, the filling of vacant posts, the number yet to be filled and timescale for such, the position in regard to Government-only contracts, the availability of training positions and any further issues still outstanding or arising from FEMPI; and if he will make a statement on the matter. [38146/20]

Written answers

Minister for Health

The GP Agreement on Contractual Reform and Service Development between the Department of Health, the HSE and the Irish Medical Organisation was concluded in April 2019. Implementation of the Agreement continues in consultation with the HSE and the IMO. In return for cooperation with the service developments and reforms under the Agreement, the Government will increase investment in general practice by approximately 40% (€210 million) between 2019 and 2023, providing for significant increases in capitation fees for participating GPs.

GPs are self-employed private practitioners, most of whom have contracts with the HSE to provide services under various public health schemes. As private contractors, the question of consultant status does not arise.

Where a vacancy arises in a practice with a GMS contract, the HSE becomes actively involved in the recruitment process to find a replacement GP. As at 1st November 2020, there are 19 GMS vacancies, less than 1% of total number GMS panels. In each case a locum or other appropriate arrangement has been put in place to maintain GP services to the communities in question. It is not possible to provide a timescale for the filling of GMS vacancies.

Finally, regarding the availability of GP training, the number of GPs entering training has been increased steadily over recent years, rising from 120 in 2009 to 214 in 2020, with a further increase foreseen in 2021.The planned transfer of responsibility for training GPs from the HSE to the Irish College of General Practitioners, pending the resolution of certain outstanding issues, will allow for further increases in the number of training places in future years.

General Practitioner Services

Questions (820)

Bernard Durkan

Question:

820. Deputy Bernard J. Durkan asked the Minister for Health the progress to date in the recognition of public health general practitioners as consultants; and if he will make a statement on the matter. [38147/20]

Written answers

Minister for Health

Consultant status for public health specialists under a new public health framework was recommended in the Crowe Horwath Report on the Specialty published in December 2018. It is also consistent with the role envisaged for the specialists in Slaintecare and Professor Scally’s Report on the National Screening Service ('CervicalCheck').

I, my Department and the HSE are committed to the early introduction of a new framework for public healthcare, as provided for in the Programme for Government. This will involve the establishment of a consultant-led public health model in line with the Crowe Horwath Report on the Specialty. My Department in conjunction with the HSE have completed a substantial amount of work on a detailed framework for the future public health model that includes consultant level roles. A related business case seeking consultant status has now been submitted to the Department of Public Expenditure and Reform for early consideration.

Legislative Programme

Questions (821)

Bernard Durkan

Question:

821. Deputy Bernard J. Durkan asked the Minister for Health when a commencement order will be signed facilitating the operation of the Health (General Practitioner Service and Alteration of Criteria for Eligibility) Act 2020; and if he will make a statement on the matter. [38148/20]

Written answers

Minister for Health

Section 2 of the Health (General Practitioner Service and Alteration of Criteria for Eligibility) Act 2020, which provides for increases to the gross income limits for medical card eligibility for persons aged 70 or older, came into operation on 1st November 2020.

Sections 4, 5 and 6 of the same act, which provide for the phased expansion of GP care without fees to all children aged 12 years and under, remain subject to commencement. Provided under section 4 of the act, the initial stage of this phased expansion will be the provision of GP care without fees to all children aged between 6 and 8.

The appropriate date for commencing the expansion remains under consideration in light of COVID-19 and the additional pressures the expansion might place on general practice in that context and in anticipation of the usual increase in demand for healthcare services over the winter period. This date will be determined in consultation with the IMO. It is important to ensure that any additional pressures placed on general practice will not limit its capacity to meet the needs of all patients in the community.

Legislative Reviews

Questions (822)

David Cullinane

Question:

822. Deputy David Cullinane asked the Minister for Health the timeline for, and details of, the scheduled review of the Health (Regulation of Termination of Pregnancy) Act 2018 as required under the Act; and if he will make a statement on the matter. [38149/20]

Written answers

Minister for Health

As the Deputy will be aware, section 7 of the Health (Regulation of Termination of Pregnancy) Act 2018 states that

“The Minister shall, not later than 3 years after the commencement of this section, carry out a review of the operation of this Act.”

The review clause was included in the Health (Regulation of Termination of Pregnancy) Act 2018 in order to facilitate monitoring of the operation of the legislation in practice, as well as of the delivery of services in the area.

As set out in the Programme for Government Our Shared Future, the Department of Health intends to conduct the review in 2021.

Cannabis for Medicinal Use

Questions (823)

Gino Kenny

Question:

823. Deputy Gino Kenny asked the Minister for Health the number of ministerial medical cannabis licences that have been issued; the number of licence holders currently being reimbursed under the licensing system; and if he will make a statement on the matter. [38150/20]

Written answers

Minister for Health

Under the Misuse of Drugs Acts 1977 – 2016, it is open to the Minister for Health to consider granting a licence for access to medical cannabis-based preparations for named patients, where this course of treatment has been endorsed by the consultant who is responsible for the management of the patient and who is prepared to monitor the effects of the treatment over time.

To date, one hundred and twenty-six licences have been issued for the treatment of fifty-one separate individual patients via the Ministerial licence application route.

Medical practitioners and patients are encouraged to consult the Department of Health website which contains information on medical cannabis, including clinical guidance on the use of medical cannabis and details on how a medical practitioner may apply for a Ministerial licence for medical cannabis. This information can be found on the Department of Health's website.

It is important to note that the decision to prescribe or not prescribe any treatment, including cannabis treatment, for an individual patient is strictly a decision for the treating clinician, in consultation with their patient. The Minister for Health has no role in this clinical decision-making process.

In relation to the number of licence holders currently being reimbursed under the licencing system, as this is an operational matter for the HSE I have asked the HSE to respond to you directly on this matter.

Cannabis for Medicinal Use

Questions (824)

Gino Kenny

Question:

824. Deputy Gino Kenny asked the Minister for Health the timeframe for the commencement of the medical cannabis access programme; the details of same; and if he will make a statement on the matter. [38151/20]

Written answers

Minister for Health

In June 2019, the Minister for Health signed legislation to underpin the operation of the Medical Cannabis Access Programme (MCAP). This is a 5-year pilot programme, restricted to prescribing of cannabis-based products by medical consultants, for patients with certain medical conditions who have exhausted all other available medical treatment options. Those conditions are:

- Spasticity associated with multiple sclerosis

- Intractable nausea and vomiting associated with chemotherapy

- Severe, refractory (treatment-resistant) epilepsy.

For more information relating to the MCAP, including FAQs, please see the Department of Health’s website at the following link.

https://www.gov.ie/en/publication/90ece9-medical-cannabis-access-programme/

Commercial suppliers whose cannabis products have been reviewed and are considered to have met the specified requirements set out in the legislation and are in line with the clinical guidance for the MCAP, will have their products added to Schedule 1 of the Misuse of Drugs (Prescription and Control of Supply of Cannabis for Medical Use) Regulations 2019. Once the products are listed in Schedule 1 of these Regulations the suppliers will be permitted to supply these products to the Irish market, in line with legal and regulatory requirements. Cannabis products will only be listed in Schedule 1 of the Regulations once they have been assessed as suitable for medical use under the MCAP.

To date four products have been added to Schedule 1 of the Misuse of Drugs (Prescription and Control of Supply of Cannabis for Medical Use) Regulations 2019. The four products are:

1. Aurora High CBD Oil Drops

2. CannEpil ™

3. Tilray Oral Solution THC10:CBD10 25ml

4. Aurora Sedamen Softgels.

The HSE has engaged in discussions with the suppliers of these products, regarding pricing and supply information. The HSE will consider such information, in line with the Health (Pricing and Supply of Medical Goods) Act 2013. The programme will not become fully operational until pricing and supply matters are agreed.

Once the Medical Cannabis Access Programme commences the HSE will establish and maintain a Register to facilitate the enrolment and recording of certain data including patient identifiers (in anonymised format), prescribers enrolled in the Programme, as well as prescribed / supplied medical cannabis products. The Department can advise that while the MCAP register is not currently operational, engagement is ongoing with the HSE in regard to progressing same.

Ministerial Licence under Section 14 of the Misuse of Drugs Acts 1977-2016

Pending full operation of the MCAP and for medical indications not included in the MCAP, doctors may continue to utilise the Ministerial licencing route to prescribe medical cannabis for their patients, should they wish to do so. In line with the Chief Medical Officer's advice, the granting of a licence for cannabis for medical purposes must be premised on an appropriate application being submitted to the Department of Health, which is endorsed by a consultant who is responsible for the management of the patient and who is prepared to monitor the effects of the treatment over time. This information can be found at the following links:

https://www.gov.ie/en/publication/1a5c4e-applying-to-the-minister-for-health-for-a-medical-cannabis-licence/

https://www.gov.ie/en/publication/e35cb4-ministerial-licence-application-process/

It is important to note that the medical decision to prescribe or not prescribe any treatment, including cannabis treatment, for an individual patient is strictly a decision for the treating clinician, in consultation with their patient. The Minister for Health has no role in this clinical decision-making process.

Hospital Services

Questions (825)

Sorca Clarke

Question:

825. Deputy Sorca Clarke asked the Minister for Health if there is a proposal agreed or being examined to move outpatient services from the Midland Regional Hospital, Mullingar to a private hospital in Mullingar, County Westmeath. [38178/20]

Written answers

Minister for Health

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

Care Services

Questions (826)

Sorca Clarke

Question:

826. Deputy Sorca Clarke asked the Minister for Health the number of staff redeployed from the Phoenix Centre in County Longford to other duties due to Covid-19. [38179/20]

Written answers

Minister for Health

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

Care Services

Questions (827)

Sorca Clarke

Question:

827. Deputy Sorca Clarke asked the Minister for Health the number of therapy hours not provided to date in 2020 due to Covid-19 redeployment of staff at the Phoenix Centre in County Longford. [38180/20]

Written answers

Minister of State at the Department of Health

The 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, as soon as possible.

Care Services

Questions (828)

Sorca Clarke

Question:

828. Deputy Sorca Clarke asked the Minister for Health the additional staff and resources that will be provided to the Phoenix Centre in County Longford to address the backlog of missed therapy sessions due to staff redeployment. [38157/20]

Written answers

Minister of State at the Department of Health

The 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, as soon as possible.