Written Answers Nos. 851-869
851. Deputy David Cullinane asked the Minister for Health the arrangements in place or that have been considered for procuring second generation and booster Covid-19 vaccines; and if he will make a statement on the matter. [21162/21]
View answer855. Deputy David Cullinane asked the Minister for Health his plans in the event of a need for annual Covid-19 vaccinations; and if he will make a statement on the matter. [21166/21]
View answerI propose to take Questions Nos. 851 and 855 together.
Ireland is participating in an EU led procurement process, where the Commission has negotiated a range of contractual agreements with various vaccine suppliers and across a range of technologies on behalf of Member States. Ireland has, through its participation in this process, gained access to a broad range of vaccines that it might not otherwise have access to, and at the cost agreed collectively by the EU.
Recently, the Commission has engaged in negotiations with Pfizer / BioNTech with a view to securing a Purchase Agreement for 900m doses of its vaccine on behalf of Member States, with provision for an additional 900m doses, for 2022/2023. Pfizer / BioNTech's vaccine is based upon mRNA technology, providing scope for it to be adjusted to deal with variants of Covid-19. The vaccine could also be used to provide booster shots, where required. The appropriate mix of vaccine technologies to provide boosters and variants is also being considered by the Steering Board, comprised of the Commission and EU Member States, for the EC procurement process.
In conjunction with this, the new European bio-defence preparedness plan against COVID-19 variants called “HERA Incubator” will work with researchers, biotech companies, manufacturers and public authorities in the EU and globally to detect new variants, provide incentives to develop new and adapted vaccines, speed up the approval process for these vaccines, and ensure scaling up of manufacturing capacities.
852. Deputy David Cullinane asked the Minister for Health the staffing compositions of each public health department; the number of approved posts by grade, filled and vacant, respectively; and if he will make a statement on the matter. [21163/21]
View answerIn 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.
853. Deputy David Cullinane asked the Minister for Health the additional staff hired for public health departments in 2020 and to date in 2021; the additional posts approved; the number of posts routinely filled by non-HSE hires in each public health department; and if he will make a statement on the matter. [21164/21]
View answerIn 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.
854. Deputy David Cullinane asked the Minister for Health the additional staff brought into public health departments in 2020 and to date in 2021, in response to the Covid-19 pandemic; the HSE, agency and secondment breakdown of such posts; the number of posts which will be retained; and if he will make a statement on the matter. [21165/21]
View answerIn 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.
856. Deputy David Cullinane asked the Minister for Health if the new consultant public health medicine posts are additional posts in public health; if all existing posts will be retained and filled as consultant posts are filled; and if he will make a statement on the matter. [21167/21]
View answerMy Department, in conjunction with the HSE, recently reached a major agreement with the Irish Medical Organisation (IMO) on a reformed public health model in Ireland. The parties to the agreement have agreed that this new Consultant led Public Health Model will be implemented by December 2023, with the establishment of 34 new consultant posts in the first year, and a total of 84 new consultant posts by end December 2023. The IMO are recommending the agreement to members who are to ballot on it.
Given the intention to move to a public health consultant led service, the parties are agreed that recruitment to the Public Health Specialist Grade will cease and the Agreement provides accordingly. The Agreement recognises that where vacancies at Specialist-level arise during the reform implementation phase, the HSE may need to recruit at Specialist grade to meet service need.
Within the model, consultants in Public Health Medicine will lead appropriately resourced multidisciplinary teams, that include surveillance scientists/epidemiologists, senior medical officers, trained contact tracers, administrative and, crucially, robust operations and management support.
The Government is committed to investment in our public health workforce. Last September, I committed to significant investment in Public Health with the announcement of plans to double the current workforce by recruiting an additional 255 permanent staff, at an annual cost of over €17m. This includes public health doctors, nurses, scientists, and support staff. This is not only a response to the current pandemic but is an investment in the future development of our Public Health function. Recruitment for these posts is ongoing and is a priority for the HSE. To date, 141 permanent positions have been recruited across all areas (medical, nursing, surveillance, and administration) and additional temporary surge capacity has been deployed across all Departments of Public Health (DPH). There are currently 418 WTEs employed across all DPHs which is an increase of 101 since September 2020.
857. Deputy David Cullinane asked the Minister for Health the role which consultants in public health medicine might play in delivering Sláintecare; and if he will make a statement on the matter. [21168/21]
View answerThe enhanced service delivery model for public health radically changes the governance and operating structure within Public Health, introducing a more fit-for-purpose National and Regional management structure across each of the pillars of Public Health – a consultant led ‘hub-and-spoke’ structure as envisaged by the Crowe Horwath Report. As part of a reform of the organisation of the current public health system, Consultants in Public Health Medicine will be deployed in line with the forthcoming Regional Health Areas.
Public Health Medicine is about improving and protecting the health of the population, as a whole. Consultants in Public Health Medicine have specialist knowledge of health protection, health service development and health improvement. Their expertise and input will be invaluable in progressing these initiatives and ensuring that they are designed to best serve our population's health needs. Consultants in Public Health Medicine will be invited to contribute to the development of these projects including serving on project oversight groups.
The next implementation phase of Sláintecare is currently being finalised. Subject to approval, there will be a focus over the coming three years on Improving Timely Access to Care and Addressing Health Inequalities with a number of proposed projects centring on health system structural reforms, financial management reforms, community health promotion initiatives and capital infrastructure improvements. I expect that the contribution of Consultants in Public Health Medicine will play a vital role in the success of this next phase.
858. Deputy David Cullinane asked the Minister for Health if he has engaged with his counterpart in Northern Ireland on integrating public health on an all-island basis; and if he will make a statement on the matter. [21169/21]
View answerThere has been, and continues to be, significant engagement and cooperation on public health issues with Minister Swann and between the Chief Medical Officers and the Departments of Health in Ireland and Northern Ireland. In relation to the COVID-19 response, both administrations are seeking to adopt similar approaches, where it is appropriate to do so and on the advice of respective Chief Medical Officers. This approach is underpinned by a Memorandum of Understanding agreed by the Chief Medical Officers in April 2020 to strengthen North South co-operation on the public health response to the COVID-19 pandemic. In November 2020, this overarching agreement was supplemented with a further Memorandum of Understanding in relation to a framework for mutual support for the provision of critical care.
Meetings of the North South Ministerial Council are an important pillar in our regular engagement with Northern Ireland counterparts on public health issues and COVID-19. I met with Minister Swann at the North South Ministerial Council Health and Food Safety Sectoral on Friday 26 March. At this meeting we discussed ongoing collaboration and responses to the COVID-19 pandemic; we were briefed by the Chief Medical Officers on the current public health situation. We also noted the potential for further collaboration on other public health issues including alcohol and drug use and developments in relation to obesity prevention policy in both jurisdictions. We were updated on suicide prevention initiatives including joint working on the Self Harm Registry and the continued collaboration between the Public Health Agency and the National Office for Suicide Prevention in working with the GAA/IRFU/Ulster rugby on health and well-being.
859. Deputy David Cullinane asked the Minister for Health if he has engaged with his counterpart in Northern Ireland on developing all-island contingency planning to prepare for future island-wide epidemics; and if he will make a statement on the matter. [21170/21]
View answerThere has been, and continues to be, significant engagement and cooperation between the Ministers for Health, the Chief Medical Officers, and the Departments of Health in Ireland and Northern Ireland throughout this pandemic.
Both administrations are seeking to adopt similar approaches, where it is appropriate to do so and on the advice of respective Chief Medical Officers. This approach is underpinned a Memorandum of Understanding agreed by the Chief Medical Officers of the Department of Health and the Department of Health in Northern Ireland in April 2020 to strengthen North South co-operation on the public health response to the COVID-19 pandemic. In November, this overarching agreement was supplemented with a further Memorandum of Understanding in relation to a framework for mutual support for the provision of critical care.
Meetings of the North South Ministerial Council are also an important pillar in our regular engagements with Northern Ireland counterparts on COVID-19. Recently, I met with Minister Swann at the North South Ministerial Council Health and Food Safety Sectoral. At this meeting the ongoing collaboration and responses to the COVID-19 pandemic were discussed and the potential for further collaboration on public health in both jurisdictions was welcomed.
I am committed to continue this close and productive cooperation with Northern Ireland to foster commonality in approaches, where possible.
860. Deputy David Cullinane asked the Minister for Health the role played by public health departments; the enhanced role he envisages they will play with the additional consultant public health medicine posts; and if he will make a statement on the matter. [21171/21]
View answer861. Deputy David Cullinane asked the Minister for Health the way in which public health departments are structured; if this will change with the additional consultant posts; if so, the way they will change; and if he will make a statement on the matter. [21172/21]
View answerI propose to take Questions Nos. 860 and 861 together.
There are eight Departments of Public Health covering the Republic of Ireland, each providing Public Health expertise and services locally and nationally. Public Health Doctors provide health protection services, advocate and contribute to health improvement and participate in health service development. Each Department is led by a Director of Public Health who is also a regional Medical Officer of Health and has a mandated responsibility and authority to investigate and control notifiable infectious diseases and outbreaks.
Our Public Health Doctors have been to the forefront of our response to the pandemic and the role of the public health doctor has transitioned very rapidly from one of leading small, confined teams, to now leading and directing the activities of a very broad range of organisations and large multidisciplinary teams. They have made an enormous contribution to the protection of everybody living in Ireland.
The past year has highlighted the critical national importance of an appropriately resourced public health workforce, and through the Covid-19 Path Ahead Plan, this Government has committed to investment in, and resourcing of public health and the delivery of a strengthened and reformed consultant-delivered public health model.
The new model will radically change the governance and operating structure within Public Health, introducing a more fit-for-purpose National and Regional management structure across each of the pillars of Public Health.
This will be a Consultant-led model which will enable the recruitment and retention of Public Health Doctors with the capability, autonomy, authority and accountability to lead multidisciplinary teams to deliver an agile, dynamic, intelligence-led public health service to protect the population from health threats, promote health, improve health services and tackle health inequalities.
The introduction of the Consultant role will also bring the status of this specialty in line with other countries, as Ireland has, for many years, been an outlier in not recognising the specialty at consultant status.
862. Deputy Willie O'Dea asked the Minister for Health the reason student nurses have to be fully vaccinated against Covid-19 to take up employment given this does not apply to their senior colleagues; and if he will make a statement on the matter. [21176/21]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
863. Deputy David Cullinane asked the Minister for Health the prerequisites for adding products to the Medical Cannabis Access Programme; if products can only be added to the Programme if previously prescribed in another EU member state; if so, the reason; and if he will make a statement on the matter. [21177/21]
View answerProducts submitted to the Health Products Regulatory Authority (HPRA) for assessment under the Misuse of Drugs (Prescription and Control of Supply of Cannabis for Medical Use) Regulations 2019 must meet the definition of "specified controlled drug" as defined in the regulations for inclusion in the Medical Cannabis Access Programme (MCAP), one of the conditions being that the product is permitted to be sold or supplied for medical purposes by the relevant public or state body of a Member State other than the State. This was a policy decision to enable access to products already available in member states.
864. Deputy David Cullinane asked the Minister for Health if his Department has undertaken an analysis of the overall spending on pharmaceuticals in the health service; if so, the conclusions of same; the recommendations for increasing value for money and for increasing access to innovative treatments or clinical trials; and if he will make a statement on the matter. [21178/21]
View answerThe Irish Government Economic and Evaluation Service (IGEES) within the Department are currently undertaking such an analysis, in the form of an approved Spending Review topic, to examine the growth in High Tech Drug scheme expenditure. This Spending Review is to be published as part of the 2021 Spending Review series in July 2021. It will be subject to both internal and external review before publication and will be made available, along with all other published spending reviews of all Government Departments, at www.gov.ie/en/policy-information/7dc2b1-spending-review/.
The ESRI are also working on long-range analysis of projections of demand for healthcare in Ireland for the period 2015-2030 through the development of the Hippocrates Model. The first report from this can be found here - www.esri.ie/publications/projections-of-demand-for-healthcare-in-ireland-2015-2030-first-report-from-the.
I would also like to inform the Deputy that my Department and the Health Service Executive (HSE) are actively engaged in implementing effective policy levers across a number of domains and under several initiatives to enhance services and generate savings in pharma expenditure.
As the Deputy is aware, the Oireachtas put in place a robust legal framework, in the Health (Pricing and Supply of Medical Goods) Act 2013, to give 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. These include the clinical and cost effectiveness of the product, the opportunity cost, the potential or actual budget impact, and the impact on resources that are available to the HSE. 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 NCPE conducts health technology assessments (HTAs) for the HSE and makes recommendations on reimbursement to assist HSE decisions. The NCPE uses a decision framework to systematically assess whether a drug is cost-effective as a health intervention.
In addition, the prescribing of Best Value Biologic medicines is leading to significant savings for the health service, which is assisting us in facilitating access to new, innovative medicines for patients. In 2019, the HSE introduced the Gainshare Initiative, which provides a financial incentive to public hospitals and clinics to pursue biosimilar treatment switching programmes. By December 2020, almost 12,000 patients have switched to a best-value-biologic (BvB), almost 57% of the claims submitted to PCRS for payment was for the BvB alternative to the originator biologic and associated annual savings in excess of €46 million has been achieved. Despite the impediment of Covid-19, the HSE are progressing well in achieving savings in this area whilst maintaining the engagement of clinicians and the confidence of patients in the safety and efficacy of this technology.
Ireland has also been engaging over the past number of years with a number of voluntary EU forums. In June 2018, Ireland joined the Beneluxa Initiative on Pharmaceutical Policy. This Initiative is in line with the objective of working with other European countries to identify workable collaborative solutions, in an increasingly challenging environment, to secure timely access for patients to new medicines in an affordable and sustainable way. In June 2019, Ireland became a Founding Member of the International Horizon Scanning Initiative which aims to assist member states' planning and allocation of resources with respect to new medicines.
While progress has been positive, the Department of Health and HSE are continuously monitoring and evaluating the effectiveness of current levers to ensure that the State can capitalise on the most efficient policy approach.
865. Deputy David Cullinane asked the Minister for Health if his Department has undertaken an analysis for minimising the delivery of low value care in the context of the entire health service; if so, the conclusions and recommendations of same; and if he will make a statement on the matter. [21179/21]
View answerThe Department continually seeks to ensure that high quality patient outcomes are gained for the investments made in the health service. Ensuring that public monies are spent as effectively as possible is one of the eight Sláintecare Fundamental Principles. In particular, the Health Capacity Review 2018, sought to ensure that capacity would be developed consistent with delivering the right care, in the right place at the right time, moving care out of hospitals into the community as appropriate, and putting an emphasis on both prevention and hospital productivity. My Department has been implementing the Health Capacity Review together with the HSE to ensure that low value care is safely delivered in the appropriate location within community and home settings, and that high value care is appropriately prioritised for delivery within the acute setting.
866. Deputy Kathleen Funchion asked the Minister for Health if certain essential personnel working in pharmaceutical companies will be prioritised for vaccination (details supplied). [21190/21]
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 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/.
867. Deputy Sorca Clarke asked the Minister for Health if the next group for Covid-19 vaccination in line with the amended age-based plan will have a level of priority recognition for those in that group who have medical vulnerabilities and underlying health conditions given that they have been cocooning now for over a year and are experiencing heightened stress for a prolonged period of time. [21194/21]
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 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/.
Vaccination of Group 4 (people aged 16-69 with a medical condition that puts them at very high risk of severe disease and death) began in March. Vaccine registration for Group 5 (people aged 65-69 whose underlying condition puts them at a high risk of severe disease and death) began on the 15th of April.
868. Deputy Charles Flanagan asked the Minister for Health when it is envisaged that the motorised transport grant and similar supports towards the purchase of an automatic or adapted vehicle will be restored; and if he will make a statement on the matter. [21202/21]
View answerBy way of background, two schemes, the Mobility Allowance and Motorised Transport Grant, were put in place in 1979 and 1968 respectively, for operation by the Health Service Executive (HSE) at a time when there was limited availability of accessible public transport. The Government decided to close these administrative schemes in 2013, on foot of the reports of the Ombudsman in 2011 and 2012 regarding the legal status of both Schemes in the context of the Equal Status Acts.
The Disabled Drivers and Disabled Passengers (Tax Concessions) Scheme is underpinned by statute and comes within the remit of the Department of Finance and the Revenue Commissioners. A requirement of the scheme involves Health Service Executive (HSE) Community Medical Doctors making a clinical determination as to whether an individual applicant meets the specified medical criteria for a Primary Medical Certificate.
Following a Supreme Court decision in June 2020, the assessment process for Primary Medical Certificates had to be suspended. While the approval of the Finance Act 2020 paved the way for assessments to recommence this year, the Community Medical Doctors have also played a key role in the National COVID-19 response, including the roll out of the vaccination programme.
I have been working with the HSE to ensure that the outstanding applications for Primary Medical Certificates are processed as a matter of urgency. HSE data indicates that 401 assessments were carried out between January and March 2021.
The HSE is continuing to monitor progress on these assessments in the context of the HSE Service Recovery and Restoration Plan. I intend to keep the matter under review, to ensure that we continue to work our way through outstanding applications.
At the whole of Government level, the National Disability Inclusion Strategy 2017-2021 sets the overall framework for the equal participation of people with disabilities in society. Monitoring of the implementation of the Strategy is being overseen by the National Disability Inclusion Strategy Steering Group which comprises key Government Departments, the National Disability Authority and the Disability Stakeholders Group.
Under the Strategy, the Department of Transport, has responsibility for the continued development of accessibility and availability of accessible public transport and is committed to the continued development of accessible public transport in recognition of the importance of such services to the lives of people with disabilities.
Work is ongoing on the policy proposals for the provision of transport supports for people with disabilities. I intend to revert to Government with proposals in due course. Recent developments which will impact on the policy options include the following:
- The ongoing progress by the Department of Transport in providing accessible public transport nationally and that Department's public consultation, to review active travel and public transport policy, including accessible public transport;
- The Cost of Disability Study currently underway which was commissioned by the Department of Employment Affairs and Social Protection as part of Budget 2019. The research, when complete, will inform policy direction in relation to the provision of adequate supports to meet the needs of people with disabilities, including transport costs;
- The Working Group established under Action 104 of the National Disability Inclusion Strategy by the Department of Justice and Equality which states that:- 'We will lead a review of transport supports encompassing all Government funded transport and mobility schemes for people with disabilities, to enhance the options for transport to work or employment supports for people with disabilities and will develop proposals for development of a coordinated plan for such provision. This plan will have regard to making the most efficient use of available transport resources.” ; and
- The review of the Disabled Drivers and Passengers (Tax Concessions) Scheme by the Department of Finance.
869. Deputy Sean Sherlock asked the Minister for Health the number of outstanding applications for acceptance to residential institution settings by CHO area, broken down in internal areas within each CHO and the length of time per application outstanding in tabular form. [21223/21]
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.
