Written Answers Nos. 1669-1686
1669. Deputy David Cullinane asked the Minister for Health if there will be a successor to the Healthy Ireland Breastfeeding Action Plan 2016 to 2021; when an evaluation of the action plan will be published; and if he will make a statement on the matter. [18602/21]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
1670. Deputy Neasa Hourigan asked the Minister for Health the progress made to date in respect of implementing the recommendations of the National Policy and Strategy for the Provision of Neuro-Rehabilitation Services in Ireland; and if he will make a statement on the matter. [18604/21]
View answer1671. Deputy Neasa Hourigan asked the Minister for Health his plans to put in place the necessary neuro-rehabilitation community teams within regional centres throughout the State; his plans to address a shortage of inpatient beds within neuro-rehabilitation services; and if he will make a statement on the matter. [18605/21]
View answerI propose to take Questions Nos. 1670 and 1671 together.
The Programme for Government – Our Shared Future’ 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 Neuro-Rehabilitation Strategy Implementation Framework (IF) was launched in February 2019. The overarching aim of the Strategy is the development of neuro-rehabilitation services to improve patient outcomes by providing safe, high quality, person -centred neuro-rehabilitation 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.
These services should be configured into population based managed clinical rehabilitation networks (MCRNs). The MCRN, while an effective model in a number of European countries, is a new concept in Ireland. MCRNs are recognised as having the potential to bring together an appropriate range of primary, secondary and tertiary services to ensure equitable provision of high quality and clinically effective services.
Funding has been sought and approved to support the introduction of a managed clinical rehabilitation network demonstrator project. The focus of the demonstrator project is the development of post-acute and community neuro-rehabilitation services across CHO 6 & 7. In terms of service provision, this is where the gap is most evident in terms of demonstrating a Network model.
Funding became available from Q4 2020, with full year funding of €2.29m available for 2021.The learning from the demonstrator project will inform implementation of the Neuro-rehabilitation Strategy across each CHO and implementation of strategy will roll-out from 2022.
As the issues raised are service matters, I have asked the Health Service Executive (HSE) to reply directly to the Deputy.
1672. Deputy Johnny Guirke asked the Minister for Health if there is a schedule for the approval and implementation of a vaccination program for vulnerable children with underlying conditions under 16 years of age; and if he will make a statement on the matter. [18609/21]
View answerThe National Immunisation Advisory Committee's (NIAC's) 'Updated Recommendations: Priority Groups for Covid-19 Vaccination', dated 29 March 2021, states the following:
"No vaccine has currently been approved for ages younger than 16 years.
Vaccine trials in children are planned or underway for all four authorised Covid-19 vaccine, with results expected in 2021.
There is no evidence to recommend vaccination of children at present. NIAC will keep this under review."
1673. Deputy Bríd Smith asked the Minister for Health if his attention has been drawn to the fact that many trans persons are being forced abroad for surgery due to the lack of public healthcare surgery options in Ireland; his plans to replace the surgeon who provided public surgery for trans persons but who retired in 2020 leaving many with no option but to travel abroad; his plans to improve the poor level of health surgery aftercare; and if he will make a statement on the matter. [18610/21]
View answer1710. Deputy Jennifer Carroll MacNeill asked the Minister for Health when the multidisciplinary team will be in place as per the HSE Final Report of the Steering Committee on the Development of HSE Transgender Identity Services, February 2020; and if he will make a statement on the matter. [18747/21]
View answer1711. Deputy Jennifer Carroll MacNeill asked the Minister for Health the resources that have been made available to ensure that the HSE service development model of care is implemented and accessible to support transgender young persons to include the provision of appropriate mental health services at primary and specialist services in line with objective 13 of the LGBTI+ National Youth Strategy to improve the physical and mental health of transgender young persons; and if he will make a statement on the matter. [18748/21]
View answer1712. Deputy Jennifer Carroll MacNeill asked the Minister for Health if a policy has been developed to ensure all health programmes take account of young persons who have transitioned, for example, immunisation programmes such as HPV in line with WPATH or other appropriate professional transgender health guidelines and with objective 13 of the LGBTI+ National Youth Strategy to improve the physical and mental health of transgender young persons; and if he will make a statement on the matter. [18749/21]
View answer1713. Deputy Jennifer Carroll MacNeill asked the Minister for Health if clear guidelines have been furnished to health practitioners on referral pathways for transgender young persons and their families to specialised service in line with objective 13 of the LGBTI+ National Youth Strategy improve the physical and mental health of transgender young persons; and if he will make a statement on the matter. [18750/21]
View answerI propose to take Questions Nos. 1673 and 1710 to 1713, inclusive, together.
The "Final Report of the Steering Committee on the Development of HSE Transgender Identity Services" was published by the HSE in December 2020.
There has been ongoing engagement by the National Clinical Advisor and Group Lead for Mental Health with the National Gender Service regarding the development of a seamless interface and integrated service.
I understand that the HSE is working on the further development of multidisciplinary gender care delivery in Ireland (including gender clinics) both in services for Children & Adolescents and for Adults. The National Gender Service (NGS) has submitted business cases for additional staff, with approval already provided for a number of posts (including Clinical and Admin posts) to begin addressing the waiting list and allow the NGS to offer a more diverse range of supports and interventions.
The HSE is also working on the establishment of a Child & Adolescent service, including the recruitment of a Consultant Psychiatrist with a special interest in Gender Identity as part of the model of care. I understand that CHI at Crumlin have advertised for a replacement Consultant Paediatric Endocrinologist who will be part of the Team.
Considerable progress has been made in the establishment of a Clinical Governance Group in the National Gender Service, with membership composed of representatives from the Adult Endocrine and Mental Health Services and from the Children’s Endocrine Service. Further progress is underway to develop a Service User Forum for the NGS, with support provided by the HSE Head of Mental Health Engagement & Recovery in relation to service user involvement and representation.
The Department of Health is committed to the development by the HSE of a well-governed, patient-centred health care service for adults and children in the transgender community, in line with the Programme for Government.
1674. Deputy Bríd Smith asked the Minister for Health if he will introduce a new model of care for trans persons by investing in surgery options here and providing training for general practitioners in order that they can provide an excellent and informed level of aftercare for trans persons; his views on the need to abide by international best practice standards of care as established by the WHO; and if he will make a statement on the matter. [18611/21]
View answerAs this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy as soon as possible.
1675. Deputy Colm Burke asked the Minister for Health if there are grants or supports available to subsidise the cost of purchasing a mobility scooter for those who need it; if there are no supports of this nature currently available, if his Department will consider instituting such a support; and if he will make a statement on the matter. [18617/21]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1676. Deputy Pádraig O'Sullivan asked the Minister for Health further to Parliamentary Question No. 739 of 27 January 2021, the status of the suspension of water birth services; and if he will make a statement on the matter. [18620/21]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
1677. Deputy Brendan Griffin asked the Minister for Health his views on a matter regarding changes to National Vaccination Programme (details supplied); and if he will make a statement on the matter. [18622/21]
View answerThe Covid-19 Vaccine Allocation Strategy sets out a provisional list of groups for vaccination. The Strategy was developed by the National Immunisation Advisory Committee (NIAC) and my Department, endorsed by the National Public Health Emergency Team (NPHET), and approved by Government on 8 December 2020.
On the 23rd of February, I announced an update to Ireland’s Covid-19 Vaccine Allocation Strategy. In comprising the initial Vaccine Allocation Strategy, the NIAC listed several conditions associated with increased risk of severe disease and death. In the intervening period, national and international evidence has become available which has enabled a more detailed analysis of underlying conditions that may increase the risk of developing severe disease or death. The NIAC has now been able to more comprehensively identify those medical conditions and to distinguish between those which place a person at very high or high risk of severe disease if they contract the virus. Medical conditions and the magnitude of the risk they pose will continue to be monitored and periodically reviewed.
On 30 March, the Government approved a further update to the Covid-19 Vaccination Allocation Strategy. Based on clinical, scientific and ethical frameworks produced by the National Immunisation Advisory Committee and my Department, following the vaccination of those most at risk, future groups will be vaccinated by age, in cohorts of 10 years (i.e., 64-55; 54-45, etc.).
The move to an age-based model better supports the programme objectives by:
- protecting those at highest risk of severe disease first, which benefits everyone most;
- facilitating planning and execution of the programme across the entire country;
- improving transparency and fairness.
Further details are available here: https://www.gov.ie/en/press-release/93f8f-minister-donnelly-announces-update-to-irelands-vaccination-prioritisation-list/
1680. Deputy Joe Carey asked the Minister for Health the progress made to recruit a speech therapist for St. Joseph’s Hospital, Ennis, County Clare; when this post is expected to be filled; the arrangements that have been put in place to offer speech therapy for patients while this post remains unfilled; and if he will make a statement on the matter. [18630/21]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1681. Deputy John Lahart asked the Minister for Health when CAR T-cell therapy will be available in Ireland in view of the €8.18 million spend on same abroad by the HSE between 2019 and 2020; if he is considering expediting approval for the therapy in order that immunocompromised patients will not be required to go abroad in order to receive lifesaving treatment; and if he will make a statement on the matter. [18631/21]
View answerAs the Deputy will be aware, the Oireachtas put in place a robust legal framework, in the Health (Pricing and Supply of Medical Goods) Act 2013, which gives full statutory powers to the HSE to assess and make decisions on reimbursement of medicines, taking account of a range of objective factors and expert opinion as appropriate. Under the 2013 Act, the Minister for Health has no role in individual reimbursement decisions.
Reimbursement is for licenced indications which have been granted market authorisation by the European Medicines Agency or the Health Products Regulatory Authority.
In line with the 2013 Health Act and the national framework agreed with industry, a company must submit an application to the HSE to have a new medicine added to the reimbursement list.
In making a relevant reimbursement decision on a given medicine, the HSE is required under the Act to have regard to a number of criteria including efficacy, the health needs of the public, cost effectiveness, and its potential or actual budget impact.
HSE decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds, on the advice of the National Centre for Pharmacoeconomics (NCPE).
The HSE has advised that there are currently four pricing/reimbursement applications for CAR T-cell therapies underway.
On 18 September 2018, the HSE received applications for pricing / reimbursement of Tisagenlecleucel (Kymriah) for the following indications:
- For the treatment of paediatric and young adult patients up to 25 years of age with B-cell acute lymphoblastic leukaemia (ALL) that is refractory, in relapse post-transplant or in second or later relapse; and
- For the treatment of adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) after two or more lines of systemic therapy.
Following the rapid review process, the NCPE completed full health technology assessments (HTAs) for both of the above indications in August 2019 and September 2019, respectively. The NCPE recommended in both cases that Tisagenlecleucel not be approved for reimbursement unless cost-effectiveness could be improved relative to existing treatments.
The HSE conducted commercial negotiations with respect to both of these indications in February and June 2020.
At its October 2020 meeting, the HSE Drugs Group considered Tisagenlecleucel for the ALL indication, reviewing the HTA report and the outputs of the commercial negotiations. The Drugs Group concluded that it did not have sufficient information to proceed with a recommendation and requested that further engagements be conducted with the applicant with a view to addressing the uncertainty in both the clinical and cost-effectiveness evidence.
At its November 2020 meeting, the HSE Drugs Group considered Tisagenlecleucel for the DLBCL indication, reviewing the HTA report and the outputs of the commercial negotiations. The Drugs Group was unable to support reimbursement at that time, having considered all of the criteria of which is obliged to take account.
In March 2021, the HSE received final updated information from the applicant. At its April 2021 meeting, the HSE Drugs Group again considered both applications and will now progress recommendations to the HSE Executive Management Team (EMT).
The HSE has advised that, on 6 September 2018, the HSE received a separate pricing/reimbursement application for Axicabtagene ciloleucel (Yescarta) for the treatment of adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) and primary mediastinal large B-cell lymphoma (PMBCL), after two or more lines of systemic therapy.
Having completed a rapid review and a full HTA with respect to this indication, the NCPE recommended in February 2020 that Axicabtagene ciloleucel not be considered for reimbursement unless cost-effectiveness could be improved relative to existing treatments.
The HSE conducted commercial negotiations with the applicant company in July 2020.
The HSE Drugs Group included this application on its meeting agendas in October and November 2020. Following extensive deliberations, the Drugs Group recommended that further commercial discussions be held with the applicant.
Following receipt in February 2021 of additional information and a revised commercial offer from the applicant, the HSE Drugs Group again considered Axicabtagene ciloleucel at its April 2021 meeting. The Drugs Group requested that further commercial engagements be held with the applicant company before the submission of any recommendation to the HSE EMT.
The HSE has also advised that, on 2 March 2021, it received a pricing/reimbursement application for Autologous anti-CD19-transduced CD3+ cells (Tecartus). On 22 March, the NCPE completed a rapid review with respect to this application and recommended that a full HTA was required. The HSE commissioned a full HTA on 31 March, as per agreed processes.
All of the four above applications remain under consideration with the HSE. The HSE EMT is the decision-making body for the reimbursement of medicines under the Health Act 2013 and it will, following receipt of the outcome of the Drugs Group's respective deliberations, make decisions on whether each of the above applications will be approved for reimbursement.
1682. Deputy John Lahart asked the Minister for Health the status of the reimbursement of CAR T-cell therapy by the HSE; the reason for the delay regarding a decision on the reimbursement of same; if he is considering plans for the development of facilities to allow for the availability of CAR T-cell therapy in Ireland; and if he will make a statement on the matter. [18632/21]
View answerUnder 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.
1683. Deputy Peadar Tóibín asked the Minister for Health when pres level 3 medical exams will recommence; and the reason qualified medical doctors that have moved to Ireland but have not completed the pres exams due to the suspension of same are unable to obtain jobs as vaccinators or contact tracers. [18658/21]
View answerThe Pre-Registration Examination System (PRES) is an assessment of a doctor's clinical skills and is required by doctors seeking registration by the Medical Council on its general or trainee specialist division unless they are otherwise exempt. The PRES is conducted by medical schools on behalf of the Medical Council. Unfortunately, due to the onset of Covid-19, medical schools were unable to hold the PRES 3 exams last year. The Medical Council has advised that it has been in contact with the medical schools throughout the year with a view to holding the exams but the continuing restrictions associated with the third wave have impacted the ability to hold these exams given the high number of people involved, including candidates, examiners, patient actors and administration support. As these are clinical examinations, the doctors and patients/actors being in close proximity is unavoidable and would be contrary to social distancing guidelines.The Medical Council has advised that it has remained in contact with the medical schools and the hosting of these exams is seen as a priority, with all parties agreeing that these exams must go ahead with the necessary arrangements and safety procedures in place. I have been advised that the Council and medical schools are exploring all options and hope to provide an update to candidates in the coming weeks.The Medical Council understands the frustration felt by many of the doctors who have applied to take this exam, particularly those who are already living in Ireland. However, the Council’s priority is the safety of patients and it important that only doctors who meet the appropriate standards are able to practise medicine unsupervised. The President of the Council has written directly to the doctors waiting to take the exam to update them and to reassure them that all parties are working to find a safe solution.The workforce requirements associated with rolling out the Covid-19 vaccine programme and contact tracing are a matter for the HSE. Accordingly, I have requested that the HSE respond to the Deputy directly in this regard.
1684. Deputy Peadar Tóibín asked the Minister for Health the number of persons that have signed up to the Be on Call for Ireland database in each county; and the number that signed up that have been recruited to work in the health service in each county. [18659/21]
View answerAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy, as soon as possible.
1685. Deputy Thomas Pringle asked the Minister for Health the number of persons aged 16 to 69 years of age at very high risk of severe Covid-19 identified as part of group four of the Covid-19 vaccine roll-out to date; and the number of first and second vaccines given to this cohort by medical condition in tabular form. [18667/21]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1686. Deputy Thomas Pringle asked the Minister for Health the number of persons invited to take part in BowelScreen in 2019, 2020 and to date in 2021; and the number of persons screened through BowelScreen in each of the same years in tabular form. [18668/21]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
