Wednesday, 21 Apr 2021

Written Answers Nos. 1705-1723

Hospital Waiting Lists

Questions (1705)

Michael Healy-Rae

Question:

1705. Deputy Michael Healy-Rae asked the Minister for Health if an operation will be expedited for a person (details supplied); and if he will make a statement on the matter. [18723/21]

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.

Vaccination Programme

Questions (1706)

David Cullinane

Question:

1706. Deputy David Cullinane asked the Minister for Health the status of the various annual vaccination programmes; the level of uptake in each of the past five years; and if he will make a statement on the matter. [18737/21]

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.

Vaccination Programme

Questions (1707)

David Cullinane

Question:

1707. Deputy David Cullinane asked the Minister for Health his plans to catch up on missed standard vaccinations due to staff deployed to Covid-19 efforts; and if he will make a statement on the matter. [18738/21]

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.

Vaccination Programme

Questions (1708)

Joe O'Brien

Question:

1708. Deputy Joe O'Brien asked the Minister for Health if persons with spina bifida hydrocephalus are included in cohort 4 of the vaccine allocation strategy; and if he will make a statement on the matter. [18743/21]

Written answers

Minister for Health

The 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 of Health, 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 the 30th of 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: www.gov.ie/en/press-release/93f8f-minister-donnelly-announces-update-to-irelands-vaccination-prioritisation-list/.

In relation to the categories of very high risk and high risk conditions, this list is not exhaustive. It may also include people who have been classed as at very high risk, based on clinical judgement and an assessment of need. It is recommended that the individuals concerned discuss this with their treating physician who is in the best position to give appropriate advice.

Health Services Provision

Questions (1709, 1714)

Jennifer Carroll MacNeill

Question:

1709. Deputy Jennifer Carroll MacNeill asked the Minister for Health the measures being put in place for the healthcare of transgender young persons in Ireland given the exit of the UK based clinic (details supplied) from Crumlin Children’s hospital; and if he will make a statement on the matter. [18746/21]

Jennifer Carroll MacNeill

Question:

1714. Deputy Jennifer Carroll MacNeill asked the Minister for Health the work that has been undertaken with parents and young person's seeking to access healthcare outside the State under the provisions of the cross-border directive and treatment abroad scheme to ensure the available options for access to care are communicated effectively in line with objective 13 of the LGBTI+ National Youth Strategy improve the physical and mental health of transgender young people; and if he will make a statement on the matter. [18751/21]

Written answers

Minister of State at the Department of Health

I propose to take Questions Nos. 1709 and 1714 together.

The UK service to which the Deputy refers operated under the HSE Treatment Abroad Scheme. The clinic suspended this service and so referrals are no longer continuing to the UK via this service.

The HSE is working on the further development of multidisciplinary gender care delivery in Ireland, both in services for Children & Adolescents and for Adults. The National Gender Service has submitted business cases for additional staff to begin addressing the waiting list and allow the NGS to offer a more diverse range of supports and interventions.

The HSE are also working on the establishment of a Child & Adolescent service in Ireland including the recruitment of a Consultant Psychiatrist with a special interest in Gender Identity as part of the model of care. Children’s Hospital Ireland are progressing the advertisement of the vacant Consultant Paediatric Endocrinologist who will be part of the Team, and it is understood that the process is at interview stage. In addition, the post of CAMHS Consultant with a special interest in gender identity is currently with Public Appointment Service for advertising.

There has been ongoing engagement by the National Clinical Advisor & Group Lead for Mental Health with the National Gender Service regarding the development of a seamless interface and integrated service. The need for clear transition pathways from child to adult services was a consideration in the development of the CAMHS Consultant job specification.

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.

Questions Nos. 1710 to 1713, inclusive, answered with Question No. 1673.

Question No. 1714 answered with Question No. 1709.

Health Services Staff

Questions (1715, 1716)

Jennifer Carroll MacNeill

Question:

1715. Deputy Jennifer Carroll MacNeill asked the Minister for Health the additional specialised staff that have been recruited in the area of transgender healthcare including endocrinologists, social workers, speech and language therapists, senior psychologists, clinical nurse specialists and administrative support officers in line with action 19.1 of the National LGBTI+ Inclusion Strategy; and if he will make a statement on the matter. [18752/21]

Jennifer Carroll MacNeill

Question:

1716. Deputy Jennifer Carroll MacNeill asked the Minister for Health the steps that have been taken to develop transgender health services for children and adults in Ireland with a clear transition pathway from child to adult services in line with action 19.2 of the National LGBTI+ Inclusion Strategy; and if he will make a statement on the matter. [18753/21]

Written answers

Minister of State at the Department of Health

I propose to take Questions Nos. 1715 and 1716 together.

Government policy in relation to LGBTI+ citizens is set out in the National LGBTI+ Inclusion Strategy and the LGBTI+ National Youth Strategy, which fall under the responsibility of the Minister for Children, Disability, Equality, Integration and Youth. The National LGBTI+ Inclusion Strategy aims to improve the lives of the LGBTI+ citizens of Ireland through the promotion of inclusion, protection of rights and the improvement of the quality of life and wellbeing for LGBTI+ people. The LGBTI+ National Youth Strategy is an action-oriented mission to ensure all LGBTI+ young people are visible, valued and included, and arose from the National Youth Strategy which identified LGBT young people as a specific group to be considered in the context of focused provision for marginalised/disadvantaged young people.

Together these strategies play an important part in achieving the Government's broader commitment to continue to strive for the full inclusion of LGBTI+ people in Irish society. Actions relating to the health of LGBTI+ citizens fall to the Department of Health and the HSE.

A proposed model of care for transgender children, adolescents and adults has been developed by the HSE Quality Improvement Division. The model provides the framework for the development of National Gender Clinics and MDTs for children and adults. The emerging evidence on good outcomes following medical and/or surgical transitioning is based on use of multi-disciplinary psychosocial assessment, fulfilment of criteria for hormones and on-going psychological support throughout the process. Local and international evidence increasingly suggests that this multidisciplinary approach should be led by a child psychiatrist with an interest in child and adolescent gender identity.

Currently 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.

New posts for the service include:

one consultant endocrinologist (adult services),

one consultant endocrinologist (paediatric services),

one social worker (adult services),

one speech and language therapist (adult services),

one senior psychologist (adult services),

one senior psychologist (paediatric services),

one clinical nurse specialist (Paediatric services),

two administrative support officers (adult and paediatric services).

This investment is a concerted measure by the HSE to address the waiting times and immediate service needs of children, adolescents and adults in transition.

The Department of Health is committed to the development by the HSE of a well-governed and patient-centred health care service for adults and children in the transgender community, in line with the Programme for Government.

Hospital Waiting Lists

Questions (1717, 2051)

David Cullinane

Question:

1717. Deputy David Cullinane asked the Minister for Health the mean, median and maximum waiting time for surgeries across each discipline, speciality and hospital; the change for each in each of the years 2018 to 2020, in tabular form; and if he will make a statement on the matter. [18764/21]

David Cullinane

Question:

2051. Deputy David Cullinane asked the Minister for Health the mean, median and maximum wait time for surgeries by specialty; and if he will make a statement on the matter. [19691/21]

Written answers

Minister for Health

I propose to take Questions Nos. 1717 and 2051 together.

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

Elective hospital care was curtailed for the first quarter of 2021, in line with the rapid increase in Covid-19 hospital admissions, with only critical time dependent elective procedures undertaken.

On 23 March the HSE published the “Safe Return to Health Services Plan”. This plan outlines a three phased approach for the proposed restoration of services across Community Services, Acute Hospital Operations, Cancer Services and Screening Services. It sets target times for their safe return and details the conditions and challenges that will have to be met. Every phase of the plan has been informed by clinical guidance and putting patient and staff safety first. Decisions in relation to the type and volume of activity will be made at site level based on local COVID-19 numbers, available capacity and guidance from national clinical leads.

The schedule outlined in the plan for resumption of services will be regularly monitored by the HSE and updated as appropriate, dependant on public health advice and healthcare capacity.

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 work of the HSE to improve access to elective care and reduce waiting times for patients is supported by the National Treatment Purchase Fund (NTPF). This includes increased use of private hospitals, funding weekend and evening work in public hospitals, funding “see and treat” services where minor procedures are provided at the same time as outpatient consultations, funding hybrid services where public and private hospitals contribute to the treatment of patients, virtual clinics and clinical validation.

€240 million has been provided in Budget 2021 for an access to care fund, €210m of which has been allocated to the HSE and a further €30m to the National Treatment Purchase Fund. This will be used to fund additional capacity to address the shortfall arising as a result of measures taken in the context of COVID-19, as well as to address waiting lists.

With regard to the particular query raised by the Deputy, the National Treatment Purchase Fund (NTPF) has advised my Department that in relation to median/mean figures, the health system does not collect the data necessary to calculate average wait times. In particular, the time to treatment of patients who have already received their care is not collected. The NTPF collects data on patients currently on the waiting list and the average time that these patients have been waiting is provided in the attached table.

In relation to the maximum waiting time for surgeries, the NTPF has further advised that in order to protect patient confidentiality, the data in the table provided shows the 5th longest waiting time in each hospital for each speciality. This means that there are 5 people waiting at least the quoted time per speciality per hospital. In situations where there are less than 5 people waiting, that data has been excluded.

Waiting List

Vaccination Programme

Questions (1718)

Mark Ward

Question:

1718. Deputy Mark Ward asked the Minister for Health the HbA1c threshold for a diabetic to be included in the vulnerable at risk priority for the Covid-19 vaccine. [18765/21]

Written answers

Minister for Health

People aged 16-69 with diabetes and with a HbA1C 58mmol/mol in the last 12 months are classed as very high risk of severe disease and death, in the Vaccine Allocation Strategy. Other people with diabetes are classed as high risk of severe disease and death.

The clinical definitions of sub-groups of people in allocation Group 4 are set out in detail in the National Immunisation Advisory Committee’s (NIAC) guidance at the following link: www.hse.ie/eng/health/immunisation/hcpinfo/guidelines/covid19.pdf.

Vaccination Programme

Questions (1719)

Brendan Griffin

Question:

1719. Deputy Brendan Griffin asked the Minister for Health the number and type of Covid-19 vaccines received in January, February and March 2021; the number and type of Covid-19 vaccines due to arrive in April, May, June and July 2021, in tabular form; and if he will make a statement on the matter. [18768/21]

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.

Hospital Car Parks

Questions (1720)

Neasa Hourigan

Question:

1720. Deputy Neasa Hourigan asked the Minister for Health the value to each hospital in the State of the car parking charges system in each of the years 2018 and 2019, in tabular form; and if the system is under the control of the hospitals or run by a private operator. [18771/21]

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.

Health Services Provision

Questions (1721)

Michael Moynihan

Question:

1721. Deputy Michael Moynihan asked the Minister for Health when adult day centres will be permitted to safely reopen given the vital role they play in supporting older persons to access social and health services in their own communities; and if he will make a statement on the matter. [18776/21]

Written answers

Minister of State at the Department of Health

It has been a key priority for the HSE to ensure that the focus on resuming Day Care Services for Older People can occur as soon as it is safe to do so. It is acknowledged that the Day Care Services provided across the country are a fundamental support structure for older people. Day Care Services have been closed since March 2020. The HSE has advised the Department that additional supports including home support, meals on wheels, telephone support, additional public health nursing, virtual activities etc. have been provided for most vulnerable clients during this period. In addition, the Alzheimer’s Association of Ireland have been providing ‘Day Care in the Home’ across the country for clients with Dementia.

Since November 2020, a Day Care Focus Group Office has been in place with representation from across the HSE and voluntary organisations to put in place a plan for the reopening of Day Care Services for Older People in line with the COVID roadmap. The Group has met on 6 occasions with the focus on putting in place guidance and plans for the resumption of Day Care Services, as soon as possible. The group was originally concentrating on what services could be delivered under current guidance and in line with the current COVID Roadmap and have now extended their approach based on the COVID vaccination programme and the impact this can provide on how services can re-open.

As a result of the vaccination programme currently being rolled out to persons over 70 years of age, further guidance has been sought from Public Health in relation to the provision of Day Care Services and how these can be operated safely and in line with the measures in place to ease restrictions over the next few months.

Day Care Service been also been asked to assess what can currently be delivered and requirements to reopen. A sub-group has also been established to develop an individualised Risk Assessment that can be carried out in respect of clients returning to the services. It will not be feasible at present under Level 5 restrictions and current guidance in place to deliver a service in a congregated setting but plans will be put in place in conjunction with Public Health advice by each service in relation to the resumption of services so that Day Care Services can resume as soon as it is considered safe to provide the service.

Areas to be focused on will include:

- Safe transport

- Protection of carers who have not been vaccinated and the impact of this.

- Identification of clients who are safe to return to Day Care Services.

- Supports for clients who will not be in a position to return to Day Care Services.

The HSE has reassured the Department that it will continue to focus on the re-opening of Day Care Services as a priority and the Focus Group in place will continue to drive a plan to resume these services as soon as possible. The Focus Group are due to meet again on 28th April 2021 and the HSE work will continue to work with services to ensure that as many services as possible can re-open as soon as it is safe to operate within a congregated setting.

It is a priority for me as Minister with special responsibility for older people for day services to resume as soon as possible and I continue to engage with senior officials within the Department and HSE on this very important matter.

Vaccination Programme

Questions (1722)

Thomas Pringle

Question:

1722. Deputy Thomas Pringle asked the Minister for Health the number of Covid-19 vaccinations administered to staff working in Tusla residential care and special care units; the number of Covid-19 vaccinations administered to staff working in Oberstown Children Detention Campus; the reason for any difference in approach; the timeline for the vaccination of Oberstown staff; and if he will make a statement on the matter. [18780/21]

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.

Health Insurance

Questions (1723)

Alan Dillon

Question:

1723. Deputy Alan Dillon asked the Minister for Health his plans to address an issue with private health insurance policies (details supplied); and if he will make a statement on the matter. [18785/21]

Written answers

Minister for Health

The inclusion of maternity benefit in all health insurance products is a statutory requirement, as part of a legal obligation on health insurers to provide a specific minimum level of benefit in all health insurance products sold. Minimum benefit is one of the key principles on which the Irish private health insurance regulatory system is based. Minimum Benefit Regulations, made under the Health Insurance Acts, require insurers to offer a minimum benefit to every insured person. The key purpose of the Regulations is to ensure the continued availability of the type of broad hospital cover traditionally held as a minimum by the insured population and to ensure that individuals do not significantly under-insure. Minimum Benefit Regulations were introduced in 1996, under Section 10 of the Health Insurance Act, 1994 and cover in-patient, out-patient and day-patient services provided by publicly funded hospitals, private hospitals, registered nursing homes and hospital consultants. The Minimum Benefit Regulations ensure that all consumers obtain an appropriate minimum level of health insurance cover regardless of what plan they purchase and that every plan available is inclusive of a minimum suite of benefits/procedures, some of which are available to the market as a whole and some of which will be applicable specifically to either men or women. By way of example, the Regulations include provision for such medical treatments as a prostatectomy or testicular biopsy (in the case of men) and cervical biopsy or maternity services (in the case of women).

Importantly, under community rating everybody is charged the same premium for a particular health insurance plan which includes this minimum suite of benefits, irrespective of age, gender and the current or likely future state of their health. Thus, the broad base line of procedures provided by minimum benefit should not be looked at in gender specific terms, but rather as a cohort of procedures that are important to the community of the insured population and thus should be protected and provided as a minimum base to all.