Thursday, 9 Sep 2021

State Bodies

Questions (1331)

Paul Murphy

Question:

1331. Deputy Paul Murphy asked the Minister for Health if he will expand and strengthen HIQA powers in relation to care home facilitates and rotate HIQA inspectors with unannounced inspections only. [42468/21]

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Written answers

Minister of State at the Department of Health

In August 2020, the Nursing Home Expert Panel (NHEP) report was published which contained 86 recommendations, across 15 thematic areas, many of which will require legislative measures to implement. HIQA also submitted a paper to the Department outlining a number of suggested amendments to the legislation governing the operation of designated centres for older people.

Having regard to the NHEP recommendations, learning from the pandemic and HIQA's suggested regulatory enhancements, Minster Donnelly and I approved a two-phased approach to examining the legislation with a view to proposing enhancements to the primary and secondary legislation governing nursing homes.

It is envisaged that phase 1 will bring forward interim enhancements to the primary legislative framework to enhance governance and oversight of nursing homes. The proposals will, amongst other things, provide new and enhanced enforcement powers for the Chief Inspector of Social Services, HIQA; reduce timelines and processes for regulatory actions and introduce a new reporting system for the reporting and publication of key operational data to support national planning in an integrated way and improve the information available. In January 2021 the Government approved the inclusion of a Health (Amendment) Bill 2021 on its legislative agenda. It is expected that, subject to Government approval, a draft General Scheme will be published by the end of the year in line with Sláintecare commitments, with a Bill and secondary legislation being published next year. The Department has commenced preliminary consultation with relevant stakeholders on the high-level thematic proposals.

In addition, secondary legislation will be drafted to enhance the current regulations in relation to a number of areas including infection prevention and control, governance and management and staffing.

A bilateral project group, established in October 2020 and comprising representatives from the Department and HIQA, is supporting the legislative process.

A wider review of the regulatory framework, phase 2, will commence in the second half of 2022, taking into account a programme of longer-term strategic reform considerations arising from inter alia pandemic learning with a view to exploring moving towards a service licensing system.

As the independent regulator of nursing homes, the Chief Inspector determines the appropriate approach and interventions required to monitor and ensure compliance with the regulatory framework. The Chief Inspector adopts a risk-based approach to regulation, prioritising monitoring, inspection and enforcement, based on the assessment of the risk, including the type of inspection undertaken. The approach to inspections typically includes a mix of announced and unannounced, as required.

Covid-19 Pandemic

Questions (1332)

Paul Murphy

Question:

1332. Deputy Paul Murphy asked the Minister for Health his views on whether there needs to be a full public inquiry into nursing home deaths, denial of resident rights and unsafe practices during the Covid-19 pandemic with suggestions of a way forward that will safeguard and protect residents; and his further views on the need for his Department to make the inquiry public for transparency and for a national conversation on the ecology of care to take place. [42469/21]

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Written answers

Minister of State at the Department of Health

The Health Information and Quality Authority, HIQA, is the statutory independent regulator in place for the nursing home sector, whether a HSE managed or a private nursing home. The Authority, established under the Health Act 2007, has significant and wide-ranging powers up to and including withdrawing the registration of a nursing home facility, which means that it can no longer operate as a service provider. This responsibility is underpinned by a comprehensive quality framework comprising of Registration Regulations, Care and Welfare Regulations and National Quality Standards.

HIQA, in discharging its duties, determines through examination of all information available to it, including site inspections, whether a nursing homes meets the regulations in order to achieve and maintain its registration status. Should a nursing home be deemed to be non-compliant with the Regulations and the National Quality Standards, it may either fail to achieve or lose its registration status. In addition, the Chief Inspector has wide discretion in deciding whether to impose conditions of Registration on nursing homes.

The Deputy will be aware that the Nursing Homes Expert Panel was established, on foot of a NPHET recommendation, to examine the complex issues surrounding the management of COVID-19 among this particularly vulnerable cohort. This Expert Panel report has added further to our knowledge and learning. This report clearly outlines the key protective measures that we must ensure are in place across our nursing homes. These actions are based on learning from our own and the international experience of COVID-19 to date. The report also recommends additional analysis and examination of the relevant public health and other data sets in order that further causal and protective factors for COVID-19 clusters are identified. HIQA and the Health Protection Surveillance Centre (HPSC) recently jointly published an “Analysis of factors associated with outbreaks of SARS-CoV-2 in nursing homes in Ireland”, delivering on recommendation 6.7 of the Expert Panel report, to further the learning from the pandemic. Further data analysis work and learning will also continue, in line with other recommendations of the Expert Panel, although these have been affected by the recent cyberattack on the health system.

Work to progress the recommendations of the Expert Panel report, particularly those recommendations requiring a priority focus in the response to COVID-19, is ongoing across all of the health agencies and stakeholders. Continued learning and understanding of progression of the disease in Ireland is an integral part of those recommendations. Many of the short and medium-term recommendations have already been implemented.

At a broader level, there has been significant and ongoing consideration of this impact since the start of the pandemic, with various examinations and development of reports with a focus on COVID-19, its impact on nursing homes and the pandemic learnings that can inform future policy, regulation and the model of care for older persons. There has been a very clear national commitment to continue to learn from the pandemic as the national and international understanding of the virus evolves, and where necessary to ensure that the public health-led approach evolves, as evidence and learning materialises. Findings of these reports confirm that the very infectious nature of COVID-19 makes it difficult to prevent and control in residential care settings. The reports produced nationally identify findings consistent with international evidence, which have highlighted that the probability of COVID-19 introduction into nursing home depends on the levels of the disease circulating in the community, with a higher risk associated with higher incidence rates in the community.

While significant progress is being made in relation to the roll-out of the vaccination programme, and the current situation in nursing homes is broadly stable, the prevalence of the more transmissible Delta variant has rapidly increased in Ireland and this poses a significant risk, in particular to those who are not yet fully protected though vaccination. It must be recognised that the pandemic has not concluded and at this time a priority focus of Government remains on the ongoing management of the COVID-19 response, to ensure that the positive gains now been experienced are preserved, and that those most vulnerable to the virus continue to be safeguarded, having regard to the residual risk.

The Government is continuing to look at options which may be available to the State in relation to listening to the voices of those who have lost a loved one.

Covid-19 Pandemic

Questions (1333)

Paul Murphy

Question:

1333. Deputy Paul Murphy asked the Minister for Health if he will provide a non-electronic alternative to the electronic passenger locator form to facilitate those who do not have access or an understanding of the technology involved; and if he will make a statement on the matter. [42471/21]

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Written answers

Minister for Health

All passengers arriving into the state are required to complete an online COVID-19 Passenger Locator Form (PLF) in accordance with SI 45 of 2021. There are limited exemptions from this requirement, as set out in the regulations, such as for international transport workers or for diplomats.

The PLF is used to support a system of engagements with arriving passengers including the targeting of public health messaging by SMS and may be used for contact tracing.

The electronic PLF is the most effective way of capturing the data required under the regulations. The electronic version represents a more sustainable and efficient method of capturing data to assist in public health efforts.

Health Services

Questions (1334)

Thomas Gould

Question:

1334. Deputy Thomas Gould asked the Minister for Health the number of episodes purchased in 2020 and to date in 2021, respectively and the average length of an episode by addiction rehabilitation and detox facility in tabular form. [42473/21]

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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.

Health Services

Questions (1335)

Thomas Gould

Question:

1335. Deputy Thomas Gould asked the Minister for Health the number of beds available by addiction rehabilitation and detox facility. [42474/21]

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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.

Departmental Funding

Questions (1336)

Thomas Gould

Question:

1336. Deputy Thomas Gould asked the Minister for Health the reason his Department has still not sent funding for projects funded under the National Drugs Strategy allocation in Budget 2021 to the HSE. [42475/21]

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Written answers

Minister of State at the Department of Health

In Budget 2021, the Department of Health provided funding of €10 million for new measures under the National Drugs Strategy. The details of these measures were subsequently outlined in the HSE National Service Plan 2021. In line with existing practice, an element of this funding was held back in the Department of Health. The level of funding released during the year for delivery of the new measures is subject to the submission, review, approval and commencement of these measures. To date, the HSE has requested €6.93m of this funding, which has been approved.

In cases where the entire amount of expenditure is not expected by year end, this is largely due once off time related savings, which can be attributed to the following:

- Recruitment into designated roles, including notice period requirements resulting in actual start dates later than estimated.

- Facilities opening later than the timing assumed when planning the operational funding levels in the Budget due to delays construction timetable.

- Procurement/negotiation timelines extending longer than originally planned for when setting funding levels.

I acknowledge the work of the HSE in operationalising the business cases for the new measures announced in Budget 2021, especially taking into account the resources required to manage the public health response to Covid-19. I expect that all the new measures will have commenced by Quarter 4 this year.

Nursing Homes

Questions (1337)

Thomas Gould

Question:

1337. Deputy Thomas Gould asked the Minister for Health if changes to the fair deal scheme introducing three year caps apply to cash assets. [42476/21]

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Written answers

Minister of State at the Department of Health

The Nursing Home Support Scheme (NHSS), commonly referred to as 'Fair Deal', is a system of financial support for people who require long-term residential care. The primary legislation underpinning the NHSS is the Nursing Home Support Scheme Act 2009. Participants in the NHSS contribute to the cost of their care according to their means while the State pays the balance of the cost. The Scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone, and that people are cared for in the most appropriate settings.

The Nursing Homes Support Scheme (Amendment), which was signed into law on 22 July, introduced further safeguards in the NHSS to further protect the viability and sustainability of family farms and businesses. It also includes an amendment in relation to applying the 3-year cap to the proceeds of sale of a house while a resident is in long-term care.

Within the NHSS, the asset value of a principal residence is assessed for 3 years, with 7.5% of its value going towards the cost of care. After 3 years on the scheme, the value of the property is no longer assessed. However, under previous rules, if the property was sold, the resulting cash asset was assessable in full for the entire length of stay in care. This could act as a disincentive for those who might otherwise consider selling their homes. The 2021 Act now extends the 3-year cap to cover the proceeds of sale, so that a person who sells their home will not see an increase in their contributions. Extension of the 3-year cap to the proceeds of sale is fair, is in line with the purpose of the Act, and will remove a disincentive to selling a vacant home.

Cash assets that are not the proceeds of the sale of a primary residence are not covered by the 3 year cap and these assets continue to be included in the NHSS financial assessment regardless of the amount of time an individual has spent in care.

Covid-19 Pandemic

Questions (1338)

Denis Naughten

Question:

1338. Deputy Denis Naughten asked the Minister for Health if persons in quarantine who were fully vaccinated with a vaccine (details supplied) were released on appeal; if any discretion on the quarantine period is provided to those fully vaccinated with this World Health Organisation approved vaccine; and if he will make a statement on the matter. [42477/21]

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Written answers

Minister for Health

Mandatory hotel quarantine has been introduced as one element of Ireland’s public health measures to combat the transmission of COVID-19. Currently passengers travelling into Ireland who have valid proof of being vaccinated with an authorised vaccination are not required to complete mandatory hotel quarantine. Dependents, including children, will also be exempted from the requirement to complete mandatory hotel quarantine in this instance.

There are 4 European Medicines Agency (EMA)-approved vaccines currently accepted in Ireland, each of which have specific definitions for when a person is considered fully vaccinated. The following table outlines the definition of ‘fully vaccinated’ in order to qualify for an exemption from mandatory hotel quarantine.

A full course of any one of the following vaccines	Regarded as fully vaccinated after
2 doses of Pfizer-BioNtech Vaccine: BNT162b2 (Comirnaty®)	7 days
2 doses of Moderna Vaccine: CX-024414 (Moderna®)	14 days
2 doses of Oxford-AstraZeneca Vaccine: ChAdOx1-SARS-COV-2 (Vaxzevria® or Covishield)	15 days
1 dose of Johnson & Johnson/Janssen Vaccine: Ad26.COV2-S [recombinant] (Janssen®)	14 days

Minister for Health

The Portiuncula cardiac outreach service project has a cardiac investigation piece (diagnostic tests) and a nursing service piece. The number of patients who attended a Primary Care Centre (PCC) for cardiac investigations for either an echo or a holter monitor is as follows (a small number of patients would have attended for both tests):

PCC	No. of pts
Ballinasloe	212
Portumna	42
Mountbellew	196
Monksland	185
Total	635

The integrated nursing service saw a total of 331 patients across all primary care centres. The location of each patient’s ‘local’ PCC is noted below, but some patients may have attended more than one PCC, depending on the urgency of need to be seen and the availability of a clinic in an individual PCC:

PCC	No. of pts
Ballinasloe	113
Portumna	29
Mountbellew	68
Monksland	121
Total	331

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.