Written Answers Nos. 1466-1483
1466. Deputy Joe Carey asked the Minister for Health if the HPV vaccination will be made available to teenagers who missed out on receiving the vaccine in first year and now want to be vaccinated; and if he will make a statement on the matter. [63350/21]
View answerThe immunisation programme in Ireland is based on the advice of the National Immunisation Advisory Committee (NIAC). The committee's recommendations are based on the prevalence of the relevant disease in Ireland and international best practice in relation to immunisation. It makes recommendations on vaccination policy to my Department. The NIAC continues to revise recommendations to allow for the introduction of new vaccines in Ireland and to keep abreast of changes in the patterns of disease. Therefore, the immunisation schedule will continue to be amended over time.
In 2009, the NIAC recommended HPV (human papillomavirus) vaccination for all 12 to 13 year old girls to reduce their risk of developing cervical cancer when they are adults. In September 2010, the HPV vaccination programme was introduced for all girls in first year of secondary school.
In June 2017, on foot of the NIAC’s recommendation that the HPV vaccine should also be given to boys, my Department asked the Health Information and Quality Authority (HIQA) to undertake a health technology assessment (HTA) to establish the clinical and cost-effectiveness of extending the immunisation programme to include boys in the first year of secondary school.
The HIQA completed the HTA in December 2018, recommending that the HPV immunisation programme be extended to include boys. A policy decision was made to extend the HPV immunisation programme to include boys, starting in September 2019, with the introduction of a 9-valent HPV vaccine.
The ages at which vaccines are recommended in the immunisation schedule are chosen by the NIAC in order to give each child the best possible protection against vaccine preventable diseases. As the HPV vaccine is preventative it is intended to be administered, if possible, before a person becomes sexually active, that is, before a person is first exposed to HPV infection.
Therefore, the gender-neutral HPV vaccination programme targets all girls and boys in first year of secondary school to provide maximum coverage. All vaccines administered through the School Immunisation Programme are provided free of charge.
My Department will continue to be guided by NIAC's recommendations on any emerging evidence on this issue in the future.
Anyone not in 1st year of secondary school or age equivalent in special schools or home schooled during the 2020/2021 school year who wishes to get the HPV vaccine, must go to their GP or sexual health clinic and pay privately for the vaccine and its administration. This applies to everyone whether or not they have a medical card/GP visit card, as it is outside of the HPV immunisation programme.
My Department has asked the National Immunisation Advisory Committee to consider the clinical effectiveness of providing the HPV vaccine to:
- girls and boys in secondary school who were eligible to receive HPV vaccine in 1st year but who did not receive it; and
- women up to the age of 25 years who have left secondary school and who did not receive the vaccine when eligible.
If the NIAC conclude that there is sufficient evidence to support providing the HPV vaccine to one or both groups, HIQA will undertake a cost-effectiveness assessment on that basis.
1467. Deputy Fergus O'Dowd asked the Minister for Health the status of and position regarding transitional plans to ensure that young persons with a disability who wish to reside outside of nursing home settings and who wish to live independently have sufficient choice and options available to them; and if he will make a statement on the matter. [63351/21]
View answerAs the Deputy's question relates to a service matter, I am referring the question for response to the HSE for direct reply to the Deputy as soon as possible.
1468. Deputy Fergus O'Dowd asked the Minister for Health the current status of the proposed east Meath primary care centre which is to be located in Bettystown town centre; when he expects works to commence; if other relevant details in this regard will be provided; and if he will make a statement on the matter. [63352/21]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1469. Deputy Fergus O'Dowd asked the Minister for Health the current status of the proposed Dundalk primary care centre; and if he will make a statement on the matter. [63353/21]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1470. Deputy Denise Mitchell asked the Minister for Health the number of psychiatrists in CHO9 available to treat persons with ADHD; and if he will make a statement on the matter. [63354/21]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
1471. Deputy Rose Conway-Walsh asked the Minister for Health the number of whole-time equivalent home help staff in CHO2 in counties Mayo, Galway and Roscommon in each year since 2016, in tabular form; and if he will make a statement on the matter. [63357/21]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
1472. Deputy Rose Conway-Walsh asked the Minister for Health the number of whole-time equivalent management and administrative staff working in the area of mental health care in CHO2 in counties Mayo, Galway and Roscommon in each year since 2016, in tabular form; and if he will make a statement on the matter. [63359/21]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
1473. Deputy Rose Conway-Walsh asked the Minister for Health the number of whole-time equivalent nursing staff working with persons with disability in CHO2 in counties Mayo, Galway and Roscommon in each year since 2016, in tabular form; and if he will make a statement on the matter. [63360/21]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
1474. Deputy Rose Conway-Walsh asked the Minister for Health the number of whole-time equivalent HSE staff working with older persons in CHO2 in counties Mayo, Galway and Roscommon in each year since 2016, in tabular form; and if he will make a statement on the matter. [63361/21]
View answerAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy, as soon as possible.
1475. Deputy Sean Sherlock asked the Minister for Health when a person (details supplied) will be fitted with a prosthetic leg. [63362/21]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
1476. Deputy Sean Sherlock asked the Minister for Health if an update will be provided in relation to a dental service provision query by a person (details supplied). [63363/21]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1477. Deputy Mick Barry asked the Minister for Health if he will be renewing the contract with private hospitals to access up to 30% of their bed capacity; the costings of the existing contract; and if he will make a statement on the matter. [63367/21]
View answerThe HSE and the main representatives of the Private Hospitals Association have agreed an amended and extended Safety Net agreement, Safety Net 4, building on the lessons learnt from the operation of Safety Net agreements 2 and 3. The agreement will be submitted to Government shortly for its approval and if Government agrees to it, the details will be made available at then.
The revised agreement will be in place until June 2022, subject to Government approval.
1478. Deputy Fergus O'Dowd asked the Minister for Health the actions taken to date to ensure that nursing homes have effective ventilation systems in place in both private and public nursing homes to reduce Covid-19 risks; and if he will make a statement on the matter. [63368/21]
View answerRegulation 17 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 requires a nursing home to have “ventilation, heating and lighting suitable for residents in all parts of the designated centre which are used by residents”. Regulation 27 states that the “registered provider shall ensure that procedures, consistent with the standards for the prevention and control of healthcare associated infections published by the Authority are implemented by staff”. Furthermore, both the National Standards for Residential Care Settings for Older People in Ireland and the National Standards for Infection Prevention and Control in Community Services set out requirements in relation to adequate ventilation. The Chief Inspector, in discharging their duties, determines through examination of all information available to them, including site inspections, whether a nursing home meets the requirements set out by the Regulations and the National Standards.
The registered providers of nursing homes are responsible for ensuring that bedroom accommodation, communal and dining spaces are well ventilated and not overcrowded, while balancing this requirement against the comfort needs of residents.
Public Health and Infection Prevention & Control guidelines, published by the Health Protection Surveillance Centre, provide comprehensive and detailed guidance on the prevention and management of respiratory infections in residential care settings. This guidance outlines the need for practical measures to increase ventilation to be taken, with consideration of the comfort of residents and weather. While the guidance notes that some healthcare settings have found it helpful to use carbon dioxide (CO2) monitors to identify areas of poor ventilation and or to monitor ventilation, it remains critical, in line with public health advice, that adherence to the established infection prevention and control (IPC) practices, including basic IPC measures, is maintained, as the key measures to mitigate the spread COVID-19. Further, the guidance notes that when appropriately selected certain air cleaning devices can be effective in reducing/lowering concentrations of infectious aerosols in a single space however they have not been shown to reduce the risk of patients acquiring infection with COVID-19 in a healthcare setting.
This guidance is kept under continuing review as new evidence and data emerges with the latest guidance coming into effect on 17 January 2022.
1479. Deputy Fergus O'Dowd asked the Minister for Health if he has progressed discussion on the provision of a public inquiry into Covid-19 deaths in nursing homes to examine the nursing homes with high and low Covid-19 death rates in order to learn from their experiences and provide answers for the many loved ones who lost family members; and if he will make a statement on the matter. [63370/21]
View answerThere has been significant and ongoing consideration of the impact of COVID-19 and the evolution of the response to it since the start of the pandemic. Various examinations and development of reports have been undertaken, with a focus on COVID-19, its impact on nursing homes and on the lessons from the pandemic 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, including the Expert Panel report, 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.
The independent COVID-19 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 in nursing homes. This Expert Panel report has added 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) 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 and HIQA, and the HPSC is developing a further update to this analysis.
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 of the Expert Panel report have been implemented, including the ongoing provision of a range of supports to Nursing Homes. Almost €123 million was provided to nursing homes under the Temporary Assistance Payment Scheme up to January 2022. The outbreak assistance element of the Scheme continues to be made available to end of March 2022.
In addition to the prioritisation of first round and booster vaccination among nursing home residents and staff, the substantial provision of State supports to nursing homes continues, including access to clinical supports through COVID-19 Response Teams (CRTs) and Outbreak Control Teams, supply of PPE free of charge, public health guidance and training resources, and temporary accommodation for staff. Supply of PPE also includes FFP2 masks. Serial testing was reintroduced to all nursing homes for two cycles as part of a targeted intervention to provide important information on the distribution of cases and risk across nursing homes. The first cycle, running for 2 weeks, commenced in early December and the second cycle commenced in early January. As part of Budget 2022, €17.6 million will be allocated for the continued implementation of the Expert Panel Report.
Significant work is ongoing to develop both a policy on adult safeguarding in the health and social care sector, which will be the basis for related underpinning legislation and on a regulatory review to enhance HIQA’s enforcement and oversight powers for nursing homes, building on the robust structures already in place.
The Government and the relevant agencies continue to have a priority focus on managing the response to COVID-19, especially in respect of nursing homes.
As you are aware the booster vaccination programme is continuing its successful rollout and nursing home residents were prioritised for boosters. The prevalence of the more transmissible Omicron variant has rapidly increased in Ireland, and this poses an ongoing risk.
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. I have had ongoing engagement including a number of meetings with family members to listen to and consider their experiences and have communicated/shared their views with relevant agencies.
1480. Deputy Neasa Hourigan asked the Minister for Health the number of inspections of public and privately run nursing homes carried out by the Health Information and Quality Authority in 2021 and to date in 2022 in relation to their compliance with ventilation regulations and standards; if he is satisfied that infection prevention and control measures as they relate to ventilation are being appropriately enforced in public and privately run nursing homes; and if he will make a statement on the matter. [63372/21]
View answerThe Chief Inspector of Social Services in 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 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. In 2020 there were 392 inspections, in 2021 555 took place.
Regulation 17 the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 requires a nursing home to have “ventilation, heating and lighting suitable for residents in all parts of the designated centre which are used by residents”. Regulation 27 states that the “registered provider shall ensure that procedures, consistent with the standards for the prevention and control of healthcare associated infections published by the Authority are implemented by staff”. Furthermore, both the National Standards for Residential Care Settings for Older People in Ireland and the National Standards for Infection Prevention and Control in Community Services set out requirements in relation to adequate ventilation. The Chief Inspector, in discharging their duties, determines through examination of all information available to them, including site inspections, whether a nursing home meets the requirements set out by the Regulations and the National Standards.
The registered providers of nursing homes are responsible for ensuring that bedroom accommodation, communal and dining spaces are well ventilated and not overcrowded, while balancing this requirement against the comfort needs of residents.
Public Health and Infection Prevention & Control guidelines, published by the Health Protection Surveillance Centre, provide information on the prevention and management of respiratory infections in residential care settings. It remains critical that adherence to the established infection prevention and control (IPC) practices, including basic IPC measures, is maintained. Public health advice remains that strict adherence to IPC is a key measure to mitigate the spread COVID-19.
This guidance is kept under continuing review as new evidence and data emerges with the latest guidance coming into effect on 17 January 2022.
1481. Deputy Imelda Munster asked the Minister for Health if the HSE intends to ensure that all future contracts with nursing homes contain provisions ensuring that residents who are medical card holders are not charged for items or services which are covered by the medical card; if consideration has been given to seeking to similarly resolve the matter with regard to existing contracts; if he has considered addressing the matter through legislation; and if he will make a statement on the matter. [63373/21]
View answerThe NHSS, commonly referred to as Fair Deal, is a system of financial support for people who require long-term residential care. Participants contribute to the cost of their care according to their means while the State pays the balance of the cost. The NHSS covers the cost of the standard components of long-term residential care which are:
- Nursing and personal care appropriate to the level of care needs of the person;
- Bed and board;
- Basic aids and appliances necessary to assist a person with the activities of daily living; and
- Laundry service.
The Comptroller and Auditor General's Report of May 2020 recommended that the Department of Health, in conjunction with the HSE, should consider reviewing the cost components of long term residential care to ensure that all relevant costs are identified and included. The Department has agreed to this action, and officials within the Department of Health are engaging with their counterparts in the HSE to explore the development of an appropriate process for reviewing the cost components.
A person's eligibility for other schemes, such as the medical card scheme or the drugs payment scheme, is unaffected by participation in the NHSS or residence in a nursing home. In determining the services covered by the NHSS it was considered very important that the care recipient and the taxpayer would be protected and would not end up paying for the same services twice. For this reason, medications and aids that are already prescribed for individuals under an existing scheme are not included in the services covered by the NHSS, as this would involve effectively paying twice for the same service. However, whilst nursing home residents should not be charged for items provided by the medical card, they may also choose to access such services privately.
Although the NHSS covers core living expenses, residents can still incur some costs in a nursing home, such as social programmes, newspapers or hairdressing. In recognition of this, anyone in receipt of financial support under the NHSS retains at least 20% of their income. The minimum amount that is retained is the equivalent of 20% of the State Pension (Non-Contributory). An operator should not seek payment from residents for items which are covered by the NHSS, the medical card or any other existing scheme.
Part 7 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 stipulates that the registered provider of the nursing home must agree a contract in writing with each resident on their admission to the nursing home. This contract must include details of the services to be provided to that resident and the fees to be charged. Residents should never be charged fees which are not set out in the contract. The Department of Health and the HSE are not a party to such contracts which are concluded between each resident and their nursing home. Registered providers of nursing home care are obliged to provide an accessible and effective complaints procedure.
Concerns about additional charges should in the first instance be taken up with the nursing home provider. The Office of the Ombudsman can examine complaints about the actions of a range of public bodies and, from 24 August 2015, complaints relating to the administrative actions of private nursing homes. The Office of the Ombudsman normally only deals with a complaint once the individual has already gone through the complaints procedure of the private nursing home concerned.
The Competition and Consumer Protection Commission (CCPC) is an independent statutory body with a dual mandate to enforce competition and consumer protection law in Ireland. CCPC’s mission is to promote competition and enhance consumer welfare. The CCPC has published consumer protection guidelines for contracts of care in long-term residential care services for older people. The guidelines set out the obligations and responsibilities that providers must adhere to under consumer protection law and are aimed at providing greater transparency, clarity and certainty for consumers.
1482. Deputy Imelda Munster asked the Minister for Health the number of residents in private nursing homes that are medical card holders; and if he will make a statement on the matter. [63374/21]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
Question No 1483 answered with Question No. 1448.
