Written Answers Nos. 277-296
277. Deputy Patricia Ryan asked the Minister for Health the current projected final cost of the National Children's Hospital; when the hospital is expected to open; and if he will make a statement on the matter. [62610/22]
View answerThe new Children’s Hospital (NCH) project comprises the main hospital on a shared campus at St James’s, the Outpatient and Urgent Care Centre at Connolly Hospital, Blanchardstown, and the Outpatient and Emergency Care Centre at Tallaght University Hospital. The two satellite centres that are key to the project are open and operational.
Works on the main site are progressing well with the NCH clearly visible on the Dublin skyline as external scaffolding is being taken down. The major focus throughout 2022 has been the internal fit-out. The most advanced areas have finished floors, walls, ceilings and joinery, such as nursing stations and medical equipment installed and plumbing of the ensuite bathroom fittings. Other areas such as the Emergency Department, Imaging, Critical Care and Therapy areas are progressing at pace. The first of the clinical rooms have been completed, with the other 4,600 to follow in a sequenced manner over the coming months. Nevertheless, this remains a very complex project with over 40,000 activities detailed in the contractor’s programme, to complete over 6,000 spaces within the new building.
The National Paediatric Hospital Development Board (NPHDB) has advised that the main contractor’s own schedule suggests completion of the project can be achieved by March 2024 which would mean the NCH at St James’s could open in the second half of 2024, at the earliest, after the necessary commissioning period. The NPHDB is working to ensure that contractor will meet its own schedule.
In 2018, Government approved a capital budget of €1.433bn for the NCH project. This included the capital costs for the main hospital at St James's Hospital campus, the two satellite centres, equipment for the three sites, and the construction of the carpark and retail spaces. To date, just over €1.1bn of the €1.433bn budget has been drawn down for works on the project across the three sites.
Additional costs in relation to the integration and transfer of the services of the three children’s hospitals to the new sites and the electronic health record brings the total budget to €1.73 billion.
There are a number of items not included in this investment figure as there was no price certainly for them and nor can there be, for some, for the duration of the project. These include the sectoral employment order, recovery by the contractor for construction inflation greater than 4%, the impact of Covid-19, statutory changes, any change in scope resulting in healthcare policy changes, uncosted provisional sums, the impact of Covid-19, the contractors right to claim for additional true costs in line with public works contract provisions, and implementation of the 2019 PwC report recommendations.
Brexit, the pandemic and the invasion of Ukraine have severely impacted construction sector supply chains, energy and transport costs, and the NCH project is not immune to these external challenges. Every effort is being taken to mitigate the risks but these externalities beyond the control of the contractor and the NPHDB make speculation and more definitive forecasting unwise at this point in time.
Delay is the biggest contributor to cost and any formal request for an increase in budget will be made through existing governance structures for Government approval as appropriate.
280. Deputy Pauline Tully asked the Minister for Health if he will provide this Deputy with the Children's Disability Network Team Staff Census and Workforce Review 2022; and if he will make a statement on the matter. [62624/22]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
281. Deputy Duncan Smith asked the Minister for Health if he will undertake a review of the current BreastCheck screening process (details supplied) in conjunction with the National Screening Advisory Committee to report breast density in BreastCheck to ensure women are informed appropriately and to give consideration to extending the breast check programme to younger women, who are more likely to have dense breasts; and if he will make a statement on the matter. [62629/22]
View answerI am fully committed to supporting our population screening programmes which are a valuable part of our health service, enabling early treatment and care for many people, and improving the overall health of our population.
Any decisions about changes to the screening programmes, such as further widening the age eligibility, will be made on the advice of our National Screening Advisory Committee (NSAC). This independent expert group considers and assesses evidence in a robust and transparent manner, and against internationally accepted criteria. It is important we have rigorous processes in place to ensure our screening programmes are effective, quality assured and operating to safe standards, and that the benefits of screening outweigh the harms.
The Committee's first Annual Call for proposals for new screening programmes or changes to our existing programmes received a significant response. Following submissions received from several sources, including from BreastCheck, the Committee has asked HIQA to analyse the evidence for expansion of the age range eligibility of the programme from age 45 to 49 and 70 to 74 years, in line with the European Commission Initiative on Breast Cancer (ECIBC) guidelines. HIQA have also been asked by the Committee to consider the issue of breast density as it might relate to the lower age expansion of the BreastCheck Programme, as it considers the evidence for age eligibility expansion in the programme.
Under the EU Beating Cancer Plan, updated Council recommendations on cancer screening are also expected to be published shortly. These final recommendations for breast and other cancer screening programmes will be considered by the National Screening Advisory Committee. The NSAC will consider the recommendation and advise the Minister and Department of Health on the evidence as it applies to Ireland.
282. Deputy Thomas Gould asked the Minister for Health the timeline for the reopening of Keltoi. [62694/22]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
283. Deputy Thomas Gould asked the Minister for Health the timeline for delivery of the new elective hospital in Cork; and when this will be fully operational. [62695/22]
View answerOn 7 December, the Government approved the next stage of the Enhanced Provision of Elective Care Programme and progression of the development of new Elective Hospitals in Cork and Galway. The preferred site in Cork, recommended to be brought forward into the planning phase, is at St Stephen's Hospital, Sarsfield Court.
It is difficult to be definitive about timelines due to the many complexities to delivery, including the challenges facing the construction sector (due to Brexit, the global pandemic, the invasion of Ukraine, global supply chain difficulties and shortages of construction raw materials). Notwithstanding, the Department of Health and HSE will work to ensure the expedient development and delivery of the new Elective Hospital in Cork and we hope that it will be open from 2027 and fully operational by 2028.
284. Deputy Thomas Gould asked the Minister for Health the number of WTE staff in each of the Cork CDNTs; and the number by role that is considered a full cohort in tabular form.; and if he will make a statement on the matter. [62696/22]
View answer285. Deputy Thomas Gould asked the Minister for Health the number of children currently awaiting first appointment and treatment in each of the Cork CDNTs by waiting time in tabular form. [62697/22]
View answerI propose to take Questions Nos. 284 and 285 together.
As these are service matters, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
286. Deputy Thomas Gould asked the Minister for Health the average wait time by residential addiction treatment facility. [62698/22]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
287. Deputy Thomas Gould asked the Minister for Health the number of children in County Cork currently awaiting an appointment for audiology by waiting time in tabular form. [62699/22]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
288. Deputy Thomas Gould asked the Minister for Health the number of children in County Cork currently awaiting an appointment for ophthalmology by waiting time in tabular form. [62700/22]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
289. Deputy Thomas Gould asked the Minister for Health the number of children in County Cork currently awaiting a scoliosis operation by waiting time in tabular form. [62701/22]
View answerI sincerely regret that children can experience a long waiting time for scoliosis treatment and remain conscious of the burden that this places on them and their families.
Earlier this year I approved a €19 million ambitious plan from Children’s Health Ireland to reduce the number of children waiting for spinal orthopaedic procedures (scoliosis/spina bifida) by the year end.
This funding will provide additional theatre access at Temple Street and Crumlin, diagnostic MRI capacity and enable further activity and paediatric theatre lists at Cappagh Hospital or Cappagh Kids.
The additional activity is targeted at reducing the number of children waiting long periods for orthopaedic procedures (including scoliosis and spina bifida), and long waiting times have come down since January 2022; for those waiting for a spinal fusion there has been a 44% reduction in those waiting over 12 months and a 24% reduction in those waiting over 4 months.
However, despite undertaking a record number of spinal procedures, corresponding reductions in the waiting list have been offset by a significant increase in demand and referrals compared to previous years with a 30% increase in additions to the spinal surgery list compared to 2021. Furthermore, unfortunately some of the additional investment in beds, MRI and theatre capacity will not come on stream until Q1 2023, having been delayed due to building and installation challenges. CHI has also experienced delays in recruiting the highly specialised staff required.
In October due to an unprecedented increase in demand through ED’s and Urgent Care Centres and the resulting pressure on its hospitals capacity, CHI has had to reduce planned elective and routine inpatient admissions and this will continue over the winter period.
Ultimately, safeguarding and maintaining the highest possible levels of quality and child safety is the absolute priority for Children’s Health Ireland.
There will be further investment in 2023, targeted at scoliosis surgery. Total funding of €443 million is being allocated to tackle Waiting Lists, which includes €123 million in recurrent funding and will encompass priority areas such as Spina Bifida and Scoliosis.
In relation to the specific query raised, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
290. Deputy Thomas Gould asked the Minister for Health the number of WTE staff in each of the Cork CAMHS teams; and the number by role that is considered a full cohort in tabular form. [62702/22]
View answerAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
291. Deputy Thomas Gould asked the Minister for Health if he will provide an update on the proposed supervised injection facilities in Dublin, Cork and Limerick. [62703/22]
View answerThe legislation providing for the establishment, licensing and operation of supervised injecting facilities is set out in the Misuse of Drugs (Supervised Injecting Facilities) Act 2017 (No 7 of 2017). The Act refers to the operation of a facility in respect of certain premises.
The Government decision approving the provision of supervised injecting facilities envisages the initial establishment of such a facility in Dublin city centre on a pilot basis. Funding has been provided to the HSE to establish a SIF in Dublin city. The contract to provide this service was awarded to Merchants Quay Ireland in 2018.
In December 2019, An Bord Pleanála granted planning permission to Merchants Quay Ireland for a medically supervised injecting facility. Leave to apply for a Judicial Review of the decision by An Bord Pleanála was granted by the High Court in February 2020.
In November 2021, following a Judicial Review, the planning decision was overturned by the High Court and remitted back to An Bord Pleanála for further consideration. It is not appropriate to comment on or prejudge the outcome of this process.
Following an evaluation of the pilot SIF in Dublin, consideration will be given to extending supervised injecting facilities to other urban areas where there is a demand for such a service.
I am committed to the establishment of a supervised injecting facility in Dublin city, as a harm reduction and life-saving service.
292. Deputy Thomas Gould asked the Minister for Health if he will provide an update on the provision of a replacement GP service in Blarney. [62704/22]
View answer293. Deputy Thomas Gould asked the Minister for Health if GMS patients can receive support in accessing their interim GP service in Blarney given the distance between the two surgeries. [62705/22]
View answerI propose to take Questions Nos. 292 and 293 together.
As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
294. Deputy Thomas Gould asked the Minister for Health the number of GMS GPs in Cork by LHO in 2017 and as of December 2022. [62706/22]
View answer295. Deputy Thomas Gould asked the Minister for Health the number of GMS patients in Cork by LHO in 2017 and as of December 2022. [62707/22]
View answerI propose to take Questions Nos. 294 and 295 together.
As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
296. Deputy Aindrias Moynihan asked the Minister for Health the measures that are being taken to address the issue of shortage of supplies for penicillin; if pharmacists can have the facility to change prescriptions to another form of antibiotic; and if he will make a statement on the matter. [62713/22]
View answerUnfortunately, medicine shortages have become increasingly prevalent worldwide over the past decade and are a feature of modern health systems around the world. There are many reasons for such shortages including shortages of raw materials, manufacturing difficulties, logistical/transport issues or product recalls due to potential quality defects.
Medicines shortages can therefore originate at any point in the supply chain and can involve and impact on many different stakeholders. Accordingly, medicines shortages require a multi-faceted, multi-stakeholder response to ensure patient safety, continuity of care and protection of public health. Ireland has a multi-stakeholder medicines shortages framework in place, coordinated by the Health Products Regulatory Authority (HPRA), to prevent, wherever possible, and manage medicine shortages when they occur.
The HPRA is generally informed of a medicine shortage by the relevant pharmaceutical company. Shortages can also be notified to the HPRA by other stakeholders across the health system. In each case, the HPRA will work with relevant stakeholders as necessary, including the HSE, to coordinate an effective approach to the management of a confirmed product shortage. There are shortages of some antibiotics affecting Ireland and other EU countries currently. These relate to manufacturing delays, production capacity issues and increased demand. The supply situation is more complex currently due to the concern over Strep A infections and the time of the year.
The HPRA are currently engaging with the MAHs for each of the products in short supply to understand the reason and seek solutions. They continue to liaise with other stakeholders such as the marketing authorisation holders (MAHs) of alternative products and the HSE in addition to publishing the shortage information on the HPRA’s shortage webpage (which includes the product name, active ingredient, the reason for the shortage, the start date, estimated return date and additional information such as the communication from the companies and clinical guidelines developed by the HSE.
As well, the HPRA is identifying and engaging with the suppliers of treatments and alternatives, as indicated by the HSE’s AMRIC team, to highlight the likely increase in demand and provide information on the availability of medicines. To that extent, we understand that alternative strengths, brands and generic medicines are available to ensure continuity of treatment.
The HPRA maintains a policy of accelerated regulatory approval to supply a product originally intended for other markets as Irish-authorised products, if available. The HPRA has engaged with wholesalers to ensure mechanisms are in place to ensure equitable distribution of treatments for cough and cold as well as antibiotics, having received information from one supplier, for example, that individual pharmacies were looking to stockpile by ordering 200 packs of a particular brand of antibiotic. As well, the HPRA has discussed this issue internationally with the EMA and other Member States to coordinate approaches to handling the shortages at an EU level.
In many instances a shortage of a particular medicine is effectively addressed to ensure continuity of care for a patient including through the substitution for a generic version (in the case of a branded medicine short supply) or a generic version from a different manufacturer (in the case of a generic medicine in short supply). Under the Health (Pricing and Supply of Medical Goods) Act 2013 medicines which are deemed to be interchangeable can be directly substituted for one another by a pharmacist.
Where an interchangeable product is not available in Ireland, a pharmacist, in consultation with the prescriber, can source a medicine containing the same active ingredient in order to ensure that continuity of patient care is maintained, wherever possible. Such medicines may be sourced in another European Member State, or by a specialist wholesaler in a third country, and are known as exempt medicinal products (EMPs). EMPs have not been granted a marketing authorisation in Ireland by the HPRA but are sourced in response to a bona fide unsolicited order in order to fulfil the special needs of a patient. These medicines will however have undergone an evaluation of their safety, quality, and efficacy for the granting of their marketing authorisation in another EU Member State or third country by the respective competent authority for medicines.
In other instances, where a medicine shortage occurs due to a more global issue affecting multiple countries, a patient may be directed to return to their clinician to consider prescribing an alternative medicine for the treatment of their condition.
It is important to note that any health system must use evidence base for prudent use of antibiotics.
Antimicrobial resistance has been declared by the WHO as one of the top 10 global public health threats facing humanity, with the misuse and overuse of antimicrobials being the main drivers in the development of drug-resistant pathogens .
Ireland has recently joined to support a Non Paper originating with the NL, regarding Novel stimuli for the development and keeping on the market of antimicrobials. One of the key tenets of this paper is that the revision of the EU pharmaceutical legislation should incorporate measures for prudent and standardised use of antibiotics, such as personalised and evidence-based treatment, the classification of all antibiotics as prescription-only, and harmonisation of product information. Such harmonisation could aid in reducing differences in the prevalence of infectious diseases and antimicrobial resistance in the EU.
The HSE maintains a reimbursement list of medicines that are provided under the General Medical Services (GMS) scheme or the Drugs Payment Scheme (DPS). These products are approved for the schemes by the HSE. In some cases, an alternative product sourced to maintain continuity of care in the event of a medicine shortage may be more expensive than the original medicine prescribed and will not ordinarily be included in the reimbursement list.
However, GMS medical card holders can apply to the local HSE health office to have these costs covered under the discretionary hardship arrangements. Under the DPS an individual or family will pay no more than €80 each calendar month for approved prescribed medicines. In certain cases, the cost of EMPs can be included in the total costs of medicines up to the threshold of €80. Patients are advised to consult with their pharmacist or clinician, who can make an application under the discretionary hardship arrangements on their behalf or to have the product covered by the relevant scheme.
Patients or their carers who have any concerns in relation to temporary alternative products provided because of medicine shortages are advised to speak with their pharmacist or other healthcare professional involved in their care.
