Thursday, 9 Sep 2021

Written Answers Nos. 1051-1070

General Practitioner Services

Questions (1051, 1052, 1053)

David Cullinane

Question:

1051. Deputy David Cullinane asked the Minister for Health the estimated additional cost of universal general practitioner care; and if he will make a statement on the matter. [41663/21]

David Cullinane

Question:

1052. Deputy David Cullinane asked the Minister for Health the estimated additional cost to introduce universal general practitioner care for each annualised income bracket starting with €0 to €14,999 and building in increments of €5,000 to €100,000 plus, in tabular form, including the population size of each bracket. [41664/21]

David Cullinane

Question:

1053. Deputy David Cullinane asked the Minister for Health the estimated additional cost of providing a general practitioner visit card for each annualised income bracket starting with €0 to €14,999 and building in increments of €5,000 to €100,000 plus, in tabular form, including the population size of each bracket. [41665/21]

Written answers

Minister for Health

I propose to take Questions Nos. 1051 to 1053, inclusive. together.

GMS contractors receive a range of capitation rates, fee per service payments and practice supports. Extending GP care without charges to all citizens who do not currently hold a medical card or GP visit card would encompass a further 2.88 million people approximately. It is not possible to definitively calculate the cost of universal GP care without charges, as a whole or by annualised income brackets, given the wide range of payments and variables that have to be accounted for.

Such a calculation would require a complex and detailed modelling exercise to account for a range of demographic changes, future projections of service demands and variation in the number of GPs and the allowances that could be paid.

Additionally, the fees payable to GPs could only be determined following agreement with the IMO on the scope and content of the general practitioner service to be provided, as well as on the future of the various other supports provided to general practice.

Question No. 1052 answered with Question No. 1051.

Question No. 1052 answered with Question No. 1051.

Question No. 1053 answered with Question No. 1051.

Health Service Executive

Questions (1054, 1145)

Pa Daly

Question:

1054. Deputy Pa Daly asked the Minister for Health if he will report on the temporary shutdown of HSE IT systems with regard to the steps and their associated timeline to restore IT capacity and resume normal services; and if he will make a statement on the matter. [41670/21]

Paul Murphy

Question:

1145. Deputy Paul Murphy asked the Minister for Health the status of the cyberattack on the HSE and his Department; the computer systems that are now fully working; the systems yet to be fixed; and when the systems that are not yet functioning will be fully operational. [41865/21]

Written answers

Minister for Health

I propose to take Questions Nos. 1054 and 1145 together.

The Health Service Executive (HSE) reported to the Joint Committee on Health on 23rd June 2021 with an update on the extent and response to the cyberattack. This can be found on the Oireachtas website at the following link:

https://data.oireachtas.ie/ie/oireachtas/debateRecord/joint_committee_on_health/2021-06-23/debate/mul@/main.pdf

The HSE response contains four steps or stages - the containment phase and the inform phase are complete.

The third phase, which involved the restoration of services and eradication of ransomware, is substantially complete. The cyberattack had the effect of removing access to most patient care systems and central business systems within the HSE. The initial efforts during phase 3 focused on restoring core patient care systems such as hospital radiotherapy, laboratory, imaging, pharmacy, mental health and patient administration systems along with basic email services. The HSE continues to work through the restoration phase and recently advised that over 95% of all servers and devices had been restored. Acute, community and corporate services are almost fully restored.

The majority of HSE staff can now have access email and most HSE Corporate systems have been restored. The Healthlink system that provides essential connectivity between GP systems and the rest of the health system is also fully functional.

Work on phase 4, the remedy phase, is also advancing. The HSE has deployed additional expertise, resources and technology to provide enhanced monitoring of systems and networks whilst it procures a permanent Security Operations Centre that will provide routine security and threat incidence monitoring in future.

Following a similar cyber attack at the Department of Health, all systems were restored to normal operational status within a relatively short period following the incident. Significant work has been completed to upgrade and strengthen the Department's security infrastructure since that time.

Covid-19 Pandemic

Questions (1055)

Pa Daly

Question:

1055. Deputy Pa Daly asked the Minister for Health if his attention has been drawn to the fact that many expectant parents are still being refused access to their partner for pre-natal appointments, delivery and hospital visits; and if he will make a statement on the matter. [41672/21]

Written answers

Minister for Health

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

Covid-19 Pandemic

Questions (1056)

Pa Daly

Question:

1056. Deputy Pa Daly asked the Minister for Health if he will make available the public health data underpinning the continued closure of large indoor activity, leisure and exercise centres in excess of 500 sq. m; and if he will make a statement on the matter. [41680/21]

Written answers

Minister for Health

As the Deputy will be aware, gyms, swimming pools and leisure centres reopened on 7 June for individual training. Swimming lessons and classes were also permitted to take place.As outlined in COVID-19: Reframing the Challenge, Continuing Our Recovery and Reconnecting, which was published by Government on 31 August, organised indoor group activities including sports and dance classes can take place from 20 September with capacity limits of 100 people where all patrons are immune (vaccinated or recovered) or accompanied minors. Where patrons have mixed immunity status, pods of up to 6 participants will be permitted with multiple pods permitted subject to appropriate social distancing being maintained. These arrangements are also applicable to leisure facilities (including bowling, snooker halls, indoor play centres amusement arcades) where patrons have defined areas which are pre-booked.Based on the criteria of at or close to 90% of people 16 or over being fully vaccinated in the coming weeks and having regard to the incidence and behaviour of the disease at that time, from 22 October onwards, remaining restrictions on indoor sports activities and other indoor leisure/community activities will be lifted. Since the onset of the pandemic, we have saved lives and limited the impact of the disease on society in Ireland due to the huge effort of people across the country. Thanks to the hard work of the Irish people and the progress of our vaccination programme, we are now entering a new phase in the management of the pandemic. As our approach to the management of COVID-19 transitions from population wide restrictions to guidance we must continue to practice basic preventative behaviours, including in relation to self-isolation and restricting movements when advised, observing good respiratory and hand hygiene, physical distancing and mask wearing when appropriate.

COVID-19: Reframing the Challenge, Continuing Our Recovery and Reconnecting can be found online: www.gov.ie/en/press-release/f5291-post-cabinet-statement-covid-19-reframing-the-challenge-continuing-our-recovery-and-reconnecting/

Covid-19 Pandemic

Questions (1057)

Paul Murphy

Question:

1057. Deputy Paul Murphy asked the Minister for Health if his attention has been drawn to the Department of Education instructions which advise pregnant teachers that they are to return to work in September whether they are vaccinated or not; the way in which sending pregnant women into an environment in which they face possible Covid-19 infection for them and their unborn child can be justified given the presence of new and more infections strains in Ireland. [41693/21]

Written answers

Minister for Health

The National Immunisation Advisory Committee (NIAC) has recently updated its recommendations regarding vaccination for pregnant women. In April of this year, NIAC advised that pregnant women should be offered an mRNA COVID-19 vaccination between 14-36 weeks’ gestation following an individual benefit/risk discussion with their obstetric care giver.

Following a review of the most recent evidence and in the context of the Delta variant, NIAC has recommended that the previous term limits for receiving a vaccine by a pregnant woman should be removed and pregnant women and adolescents from 12 years and above should be offered an mRNA COVID-19 vaccine at any stage of pregnancy, following an individual benefit/risk discussion with their obstetric care giver. NIAC also point to a growing accumulation of evidence on the safety and effectiveness of COVID-19 vaccination in this cohort, which indicate that the benefits of vaccination outweigh any known or potential risks of COVID-19 vaccination during pregnancy.

NIAC have also recommended that there should be enhanced efforts to increase vaccine uptake in pregnant women, their partners and eligible household contacts, in order to protect both mother and baby from serious harm as a result of COVID-19.

General Practitioner Services

Questions (1058)

Martin Browne

Question:

1058. Deputy Martin Browne asked the Minister for Health if his attention has been drawn to the fact that Templemore, County Tipperary is set to lose one of its two general practitioners; and his plans to address the situation given that there is already a lack of general practitioner services. [41698/21]

Written answers

Minister for Health

GPs are self-employed private practitioners and therefore may establish practices at a place of their own choosing. Under the GMS scheme, the HSE contracts GPs to provide medical services without charge to medical card and GP visit card holders. Where a vacancy arises in a practice with a GMS contract, the HSE becomes actively involved in the selection process to find a replacement GP.

The Government is aware of the workforce issues currently facing general practice, including the limited access to GP services in certain areas, and has implemented a number of measures to improve recruitment and retention in general practice.

These measures include an increase in investment in general practice by approximately 40% (€210 million) between 2019 and 2023 under the terms of the 2019 GMS GP Agreement GP. The Agreement provides for increased support for GPs working in rural practices and for those in disadvantaged urban areas, and for improvements to maternity and paternity leave arrangements. In addition, the number of GPs entering training has been increased steadily over the past number of years, rising from 120 in 2009 to 233 in 2021.

These measures will see an increase in the number of GPs working in the State, improving access to GP services for patients throughout the country.

Social Welfare Benefits

Questions (1059)

Mark Ward

Question:

1059. Deputy Mark Ward asked the Minister for Health if persons on invalidity pensions who reach retirement age can retain the use of medical cards regardless of income (details supplied); and if this will be reviewed for budget 2022 in October as was stated by the Tánaiste in June 2021. [41699/21]

Written answers

Minister for Health

As the Deputy is aware, medical card eligibility is primarily based on financial assessment. In accordance with the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE. The HSE assesses each application on a qualifying financial threshold. This is the amount of income that an individual can earn per week and still qualify for a card. It is specific to the individual’s own financial circumstances.  

Persons aged 69 and under are assessed under the general means tested medical card income thresholds which are based on an applicant’s household income after tax, PRSI and the Universal Social Charge (USC) have been deducted. Certain expenses are also taken into account, for example mortgage payments, which helps to increase the amount a person can earn and still qualify for a medical card. 

It is important to note that most social welfare payments (including Invalidity Pension) are means assessed as part of a medical card application once the applicant or spouse/partner has another source of income.  However, where an applicant’s household income is made up solely of social welfare payments, they will be eligible for a medical card.   

Furthermore, income thresholds for a medical card (and GP visit cards) increase for those aged 66 to 69. Given that persons aged 66 will usually transfer to a State Pension at this point, if an applicant or married/co-habiting couple's household income remains comprised of social welfare payments solely they would continue to hold eligibility for a medical card.  Therefore, transferring from an Invalidity Pension to the State Pension does not of itself result in a person losing eligibility for a medical card.  In certain circumstances, an applicant or married/co-habiting couple may transfer to the State Pension but may then also be in receipt of additional income such as a private or occupational pension. This can result in such persons having to undergo a financial assessment to be reassessed to determine their eligibility for a medical card. 

Finally, it should also be noted that the current eligibility framework is kept under regular review throughout the year. In relation to this particular issue as an anomaly does not arise further review of the matter is not considered necessary.

Vaccination Programme

Questions (1060)

David Cullinane

Question:

1060. Deputy David Cullinane asked the Minister for Health if certification of ineligibility for vaccination where advised by a medical professional will be provided as part of the digital Covid certificate or other means; if a provision will be made for those unable to be vaccinated in the certification system relating to travel and domestic restrictions; and if he will make a statement on the matter. [41702/21]

Written answers

Minister for Health

The EU Digital COVID Certificate is proof that a person has either been vaccinated against COVID-19 or received a negative COVID-19 test result or recovered from COVID-19 in the last 6 months.

While the EU Digital COVID Certificate initiative can support safe travel within the EU during the COVID-19 pandemic it is not a precondition for travel.

Departmental Correspondence

Questions (1061)

Bernard Durkan

Question:

1061. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he has received submissions from a group (details supplied) with particular reference to the efforts of such carers throughout the Covid-19 outbreak; if any particular issues have been raised with reference to staffing levels in public or private nursing homes or other settings in which patients were deemed to be at high-risk during the Covid-19 pandemic; his views on whether particular attention needs to be paid to specific areas in the aftermath of the pandemic with a view to optimising the level of protection for staff and patients throughout the public and private sectors; and if he will make a statement on the matter. [41710/21]

Written answers

Minister of State at the Department of Health

During the last year, both Minister Donnelly and I, and officials from my Department, have met with a number of groups that advocate for the interests of older people and residents of nursing homes and long-term residential care facilities. I met with representatives from the group referred to by the Deputy on 12 July this year, with members of bereaved families in attendance, and have subsequently corresponded with the Group.

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. The Expert Panel report, which was published in August 2020, 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. 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.

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 health agencies and stakeholders. The recommendations of the report are varied and complex, are short, medium,and longer-term in nature, and require a mix of ongoing operational response to COVID-19 and a longer-term strategic reform. Those strategic reforms are, by their nature, complex and relate to whole of system issues. 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. The significant examination undertaken by the Expert Panel provides important learning and a framework for enhancing older persons services both in the short and long-term and this work is progressing.

The progression of the safe staffing framework in nursing homes is included in the recommendations of the Expert Panel report. Phase 3 of the Safe Staffing and Skill Mix Framework commenced in August 2020. This includes three distinct stages, the first of which will focus on nursing homes. This is a unique stage of the framework development as it is the first time it will span across public, private, and voluntary care settings. A National Taskforce, with representation from key stakeholders and agencies, has been established to develop a Framework for safe staffing and skill mix in long-term residential care settings for older persons. This important programme of work is progressing very well and it is anticipated that pilot testing of a model of staffing will commence with a baseline data collection in each of the pilot sites in the coming month.

Covid-19 Pandemic

Questions (1062)

Bernard Durkan

Question:

1062. Deputy Bernard J. Durkan asked the Minister for Health the extent to which it was possible to ensure the availability of the highest possible standards of care and attention for older patients throughout the Covid-19 pandemic; if specific deficiencies were identified with a view to resolution; and if he will make a statement on the matter. [41711/21]

Written answers

Minister of State at the Department of Health

From the onset of the COVID-19 pandemic, HIQA has maintained regulatory oversight of the health and social care services under its legal remit, monitoring information about services, carrying out inspections and supporting health and social care services.

HIQA has also endeavoured to ensure that the voices of residents and families continue to be heard.

HIQA's regulatory oversight from the onset of pandemic has included:

- contacting nursing homes by telephone every two weeks as part of its quality assurance programme;

- preparing and publishing guidance and self-assessments for providers to assess how prepared they were for COVID-19;

- assessments of nursing homes on contingency planning and preparedness for an outbreak of COVID-19;

- operating an Infection Prevention and Control Hub to give providers information on managing COVID-19;

- processing applications by nursing home providers to renew their registration or register new centres;

- carrying out risk inspections of nursing homes; and,

- providing the HSE and the Department of Health with sector information necessary to support nursing homes, addresses of nursing homes, staffing numbers and assessments of the prevailing risks.

HIQA’s continuing support for the sector has included:

- publishing regulatory information notices to keep providers up to date on how it is regulating services;

- focusing the work of its Information Handing Centre on engaging with people who contacted HIQA with concerns; and,

- daily escalations of the numbers of residents and staff impacted by COVID-19 and liaison between nursing homes and the HSE COVID Response Teams (CRTs).

In addition, HIQA has used the information it holds about centres to support the Department of Health, the National Public Health Emergency Team (NPHET) and the HSE in terms of timely exchange of relevant information on regulated residential centres.

Where available information suggested that a small number of registered providers were not taking all necessary and expected action to ensure that residents received the best possible care the Chief Inspector engaged directly with the provider in the first place and if necessary utilised the legal enforcement framework available to her.

Covid-19 Pandemic

Questions (1063)

Bernard Durkan

Question:

1063. Deputy Bernard J. Durkan asked the Minister for Health the extent to which families of patients and staff have had access to social workers throughout the Covid-19 pandemic with a view to the identification of possible challenges; and if he will make a statement on the matter. [41712/21]

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.

Tobacco Control Measures

Questions (1064, 1065)

Bernard Durkan

Question:

1064. Deputy Bernard J. Durkan asked the Minister for Health the extent to which his Department continues to monitor the effects of alternatives to tobacco smoking with particular reference to the need to ensure that alternatives do not lead to a return to tobacco smoking; if there have been any indications of an increase in this regard; and if he will make a statement on the matter. [41713/21]

Bernard Durkan

Question:

1065. Deputy Bernard J. Durkan asked the Minister for Health the extent to which his Department continues to monitor smoking trends with particular reference to any return to tobacco smoking which may or may not be attributable to alternatives; and if he will make a statement on the matter. [41714/21]

Written answers

Minister for Health

I propose to take Questions Nos. 1064 and 1065 together.

Adult smoking trends are monitored via the Healthy Ireland Survey each year in order to measure success against the objective of Tobacco Free Ireland (the national tobacco control policy) to achieve a smokefree Ireland by 2025. Overall smoking prevalence has declined by 6% between 2015 and 2019 indicating that increasing numbers of people are successfully quitting long-term.

In relation to relapse rates, the 2019 Survey identified that 46% of those who smoked in that year made an attempt to quit with 25% successfully quitting. The 2019 survey found that 52% of successful quitters did not use any quitting aids, with 38% using e-cigarettes and 10% using nicotine replacement therapies.

Trends regarding e-cigarette use are also monitored in the Healthy Ireland Survey. E-cigarette prevalence remains relatively low at 5% of the population and primarily consists of current and former smokers.

Question No. 1065 answered with Question No. 1064.

Covid-19 Pandemic

Questions (1066)

David Cullinane

Question:

1066. Deputy David Cullinane asked the Minister for Health his plans to review the ongoing attendance and visiting restrictions in hospitals; if the current HSE guidance will be reviewed to allow families and friends to visit their loved ones in hospitals; his position on the use of antigen testing to facilitate same; and if he will make a statement on the matter. [41716/21]

Written answers

Minister for Health

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

Vaccination Programme

Questions (1067)

David Cullinane

Question:

1067. Deputy David Cullinane asked the Minister for Health if he will review a matter raised in correspondence (details supplied) relating to the vaccination of persons aged 16 and older; and if he will make a statement on the matter. [41718/21]

Written answers

Minister for Health

Consent for vaccination is a process of communication between a healthcare worker and the person to whom the vaccine has been offered. A person should be provided with sufficient information on COVID-19 vaccination including the risks and benefits associated with the vaccine and in a format that they can understand. Some people may need additional support and time to consider the information and ask questions to enable them to come to a decision regarding vaccination.

The HSE has developed guidance to support healthcare staff providing care for young people (aged 16 and 17 years of age) as part of the national vaccination programme against COVID-19.

You can read this guidance at:

www.hse.ie/eng/health/immunisation/hcpinfo/covid19vaccineinfo4hps/guidance-on-consent-for-vaccination-16-17-years.pdf

Hospital Facilities

Questions (1068)

Michael Healy-Rae

Question:

1068. Deputy Michael Healy-Rae asked the Minister for Health if his attention has been drawn to the situation relating to the helipad at a hospital (details supplied); and if he will make a statement on the matter. [41722/21]

Written answers

Minister for Health

As the Health Service Executive is responsible for the delivery of public healthcare infrastructure projects, I have asked the HSE to respond to you directly in relation to this matter.

Hospital Staff

Questions (1069)

Rose Conway-Walsh

Question:

1069. Deputy Rose Conway-Walsh asked the Minister for Health the total number of doctors in Mayo University Hospital currently and in 2020 including intern doctors; and if he will make a statement on the matter. [41728/21]

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 Appointments Status

Questions (1070)

Barry Cowen

Question:

1070. Deputy Barry Cowen asked the Minister for Health the status of a hospital appointment for a person (details supplied). [41730/21]

Written answers

Minister for Health

Under the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.

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