Written Answers Nos. 435-452
435. Deputy Pearse Doherty asked the Minister for Health the number of children with complex needs who are in receipt of paediatric home-care packages nationally, by CHO area, in tabular form; and if he will make a statement on the matter. [5952/18]
Amharc ar fhreagraAs this question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply.
436. Deputy Willie Penrose asked the Minister for Health the steps he will take to have a decision reviewed to refuse an application for a primary medical certificate by a person (details supplied); and if he will make a statement on the matter. [5965/18]
Amharc ar fhreagraThe eligibility criteria for a Primary Medical Certificate are set out by the Department of Finance, as the Disabled Drivers and Disabled Passengers (Tax Concessions) Scheme is a Revenue Commissioners Scheme.
The Senior Medical Officer for the relevant local HSE administrative area makes a professional clinical determination as to whether an individual applicant satisfies the medical criteria for a Primary Medical Certificate. An unsuccessful applicant can appeal the decision of the Senior Medical Officer to the Disabled Drivers Medical Board of Appeal, which makes a new clinical determination in respect of the individual. After six months, a person can reapply for a Primary Medical Certificate if there is a deterioration in their condition.
The Regulations mandate that the Disabled Drivers Medical Board of Appeal is independent in the exercise of its functions in order to ensure the integrity of its clinical determinations. The Disabled Drivers Medical Board of Appeal comes under the remit of the Department of Finance.
437. Deputy Willie Penrose asked the Minister for Health his plans to contract additional theatre facilities in part of replacement for theatre facilities at the Midland Regional Hospital, Mullingar, County Westmeath; the number of such theatres planned; the additional facilities that are planned to be provided by the HSE at this hospital as part of the overall development of same to accommodate the population of this area; the estimated capital expenditure that will be required in order to allow those facilities to proceed; and if he will make a statement on the matter. [5968/18]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to you directly.
438. Deputy Louise O'Reilly asked the Minister for Health the details of the demonstration project pilot sites to establish collaborative care pathways for persons with complex neuro-rehabilitation needs; and if he will make a statement on the matter. [5996/18]
Amharc ar fhreagra439. Deputy Louise O'Reilly asked the Minister for Health the resources committed to the establishment and operation of the demonstration project pilot sites to establish collaborative care pathways for persons with complex neuro-rehabilitation needs; the provision made in the Estimates process and service plan for same; and if he will make a statement on the matter. [5997/18]
Amharc ar fhreagra440. Deputy Louise O'Reilly asked the Minister for Health the timeframe for the establishment, roll-out and operation of the demonstration project pilot sites to establish collaborative care pathways for persons with complex neuro-rehabilitation needs as part of the national policy and strategy for the provision of neuro-rehabilitation services in Ireland; the timeframe for learnings and national roll-out; and if he will make a statement on the matter. [5998/18]
Amharc ar fhreagra441. Deputy Louise O'Reilly asked the Minister for Health the organisations in each CHO area involved in the demonstration project pilot sites to establish collaborative care pathways for persons with complex neuro-rehabilitation needs as part of the national policy and strategy for the provision of neuro-rehabilitation services in Ireland; and if he will make a statement on the matter. [5999/18]
Amharc ar fhreagra442. Deputy Louise O'Reilly asked the Minister for Health when the working group of the national policy and strategy for the provision of neuro-rehabilitation services in Ireland will be established; and if he will make a statement on the matter. [6000/18]
Amharc ar fhreagra443. Deputy Louise O'Reilly asked the Minister for Health the costs associated with the establishment and operation of the demonstration project pilot sites to establish collaborative care pathways for persons with complex neuro-rehabilitation needs; and if he will make a statement on the matter. [6001/18]
Amharc ar fhreagraI propose to take Questions Nos. 438 to 443, inclusive, together.
The Programme for a Partnership Government includes a commitment to publish "a plan for advancing Neuro-rehabilitation services in the community". The Health Service Executive (HSE) Social Care Division and the HSE National Clinical Programme for Rehabilitation Medicine are working in tandem to progress the implementation of the National Policy & Strategy for the provision of Neuro-rehabilitation services.
The HSE has established a National Steering Group to develop an Implementation Framework for the National Neuro-rehabilitation Policy and Strategy which comprises representatives across the whole health system including Heads of Social Care, Rehabilitation Medicine Programme, Acute Hospital services, Mental Health, Primary Care and Health and Wellbeing, Health and Social Care Professionals, Public Health and the Neurological Alliance of Ireland.
The focus of the HSE National Steering Group is to develop a framework which is implementable across the country. This framework is scheduled for completion by June of this year. The Steering Group considers that a Managed Clinical Rehabilitation Network model represents best practice as a means of providing neuro-rehabilitation care and support/accommodation needs.
As the questions raised by the Deputy relate to the detail of the Health Service Executive's ( HSE ) implementation of the Strategy I have arranged for the questions to be referred to the HSE for direct reply.
444. Deputy James Browne asked the Minister for Health further to Parliamentary Questions Nos. 383, 384, 385, 410, 411 and 412 of 30 January 2018, the person or body that made the decision to provide a trivalent rather than quadrivalent vaccine as part of the HSE’s winter initiative plan; and if he will make a statement on the matter. [6038/18]
Amharc ar fhreagra445. Deputy James Browne asked the Minister for Health further to Parliamentary Question Nos. 383, 384, 385, 410, 411 and 412 of 30 January 2018, if the World Health Organization has recommended trivalent and not quadrivalent vaccines to be used here; and if he will make a statement on the matter. [6039/18]
Amharc ar fhreagraI propose to take Questions Nos. 444 and 445 together.
Influenza vaccine is most effective when circulating viruses are well-matched with viruses contained in vaccines. Due to the constant evolving nature of influenza viruses, the WHO Global Influenza Surveillance and Response System – a system of National Influenza Centres and WHO Collaborating Centres around the world – continuously monitors the influenza viruses circulating in humans and updates the composition of influenza vaccines twice a year. For many years, WHO has updated its recommendation on the composition of the vaccine (trivalent) that targets the three most representative virus types in circulation (two subtypes of influenza A viruses and one influenza B virus) and since the 2013–2014 northern hemisphere influenza season, a fourth component is recommended to support quadrivalent vaccine development. Quadrivalent vaccines include a 2nd influenza B virus in addition to the viruses in trivalent vaccines
The influenza vaccine purchased by HSE is based on WHO advice on the composition of influenza virus vaccines for use in the 2017/8 northern hemisphere Flu season issued on 2 March 2017. It recommended that trivalent vaccines for use in the 2017-2018 northern hemisphere influenza season contain the following:
- an A/Michigan/45/2015 (H1N1)pdm09-like virus;
- an A/Hong Kong/4801/2014 (H3N2)-like virus; and
- a B/Brisbane/60/2008-like virus.
In Ireland the National Immunisation Advisory Committee (NIAC) an independent committee of the Royal College of Physicians of Ireland which comprises experts in a number of specialties including infectious diseases, paediatrics, and public health makes recommendation on vaccination policy in Ireland. Their recommendations are based on the prevalence of the relevant disease in Ireland and international best practice in relation to immunisation. This season (2017/18) the HSE procured the trivalent inactivated Influenza vaccine (Split Virion) BP seasonal influenza vaccine for all those in the recommended at risk groups and health care workers and carers. The trivalent vaccine used in Ireland is the most widely used influenza vaccine in Europe.
Initial evidence suggests that the vaccine provides higher protection against the Influenza A strains than recent years (H3N2 & H1N1). While it is less effective against the B strains predominating this year, people who received the flu. Vaccination remains the most effective means of preventing infection by seasonal influenza viruses and can reduce severe disease that can lead to hospitalisation and death.
446. Deputy James Browne asked the Minister for Health if his Department and-or the HSE have in the past seven years entered into contracts with charitable organisations whereby these contracts included a clause regulating and-or restricting the communication of these charities with the media; and if he will make a statement on the matter. [6041/18]
Amharc ar fhreagraThe information requested by the Deputy is not immediately available. My Department does not, in general, enter into contracts with charitable organisations. However, I will survey the Department and should such any such contract exist, with such restriction clauses, I will provide the requested details to the Deputy. A primary function of the HSE is to manage and deliver health and personal social services and may have contracts with charitable organisations.
I have arranged for your question to be referred to the HSE for direct reply to the Deputy.
447. Deputy James Browne asked the Minister for Health if his Department and-or the HSE have in the past seven years entered into contracts with section 38 and or section 39 organisations whereby these contracts included a clause regulating and-or restricting the communication of these organisations with the media; and if he will make a statement on the matter. [6042/18]
Amharc ar fhreagraMy Department does not enter into contracts with section 38 or section 39 organisations.
A primary function of the HSE is to manage and deliver health and personal social services. It can either do this itself or it can enter an arrangement under section 38 or section 39 of the Health Act 2004 with a service provider to deliver the service. The legal framework available to the HSE for funding such service providers is set in sections 38 and 39 of the Health Act 2004.
Under section 38 the HSE may enter into an arrangement with a body or person for the provision of health and personal social services on behalf of the HSE; the employees of such a body are public servants. Under section 39 the HSE may give assistance to any person or body that provides services similar or ancillary to those provided by the HSE; the employees of such bodies are not public servants.
The HSE has established a framework of governance over funded organisations including a requirement for those organisations to sign a service level agreement or a grant aid agreement depending on the level of grant funding being provided. Agencies in receipt of funding in excess of €250,000 are subject to a service level agreement and agencies in receipt of funding less than €250,000 are subject to a grant aid agreement.
Since the details contained in those service arrangements and conditions set regarding the services in question are a matter for the HSE, I have referred this PQ to the HSE for direct reply.
448. Deputy Eugene Murphy asked the Minister for Health his views on the administration of the Gardasil vaccine to persons who develop types of auto antibodies that were not present before the vaccine was administered (details supplied); and if he will make a statement on the matter. [6048/18]
Amharc ar fhreagra450. Deputy Eugene Murphy asked the Minister for Health his views on whether general practitioners should inform persons (details supplied) of post-Gardasil vaccine reactions. [6050/18]
Amharc ar fhreagraI propose to take Questions Nos. 448 and 450 together.
Vaccination is regarded as one of the safest and most cost-effective of all health care interventions. It is also one of the most effective ways a parent can protect the health of their child. Ireland’s childhood immunisation programmes have had a huge impact in improving the health of the Irish population. Diseases that used to be common in this country and around the world such as polio, measles, diphtheria, whooping cough and many other serious infectious diseases are now preventable by vaccination.
The Health Products Regulatory Authority (HPRA) and the European Medicines Agency (EMA) continually monitor adverse events to vaccination. HPV is one of the most closely studied and monitored medicinal products. The vast majority of reports received by the HPRA have been consistent with the expected pattern of short term adverse side effects for the vaccine, as described in the product information. The most frequently reported side effects are local redness and /or swelling at the point of injection and fever. These are usually mild and temporary reactions to any kind of vaccination. Fainting has occurred after vaccination with Gardasil, especially in adolescents.
The HSE is committed to providing accurate information for parents about diseases, the vaccines to prevent them and side effects to allow them to choose whether to give consent to vaccination. All the information provided to parents about vaccination is prepared from the available licensed documentation for each vaccine, the Summary of Products Characteristics (SPC) and Patient Information Leaflet (PIL).
All medicines, including vaccines are subject to on-going review and evaluation of all available data from a range of sources, including systematic scientific literature review, to consider any impact that their data may have on the overall assessment of the benefits and risks of a medicinal product. Taking into account the totality of the available information, the benefits of the HPV vaccines continue to outweigh their risks. The safety of these vaccines continues to be monitored at EU level through the European Medicines Agency (EMA) and its expert committees, which includes representatives from member state competent authorities such as the Health Products Regulatory Authority (HPRA).
The HPRA is responsible for monitoring the safety and quality of all medicines including vaccines that are licensed in Ireland and operates a national adverse reaction reporting system, which members of the public and healthcare professionals are encouraged to submit any suspected adverse reactions through this system. All Reports received by the HPRA are routinely transmitted to the EMA's adverse reaction database for inclusion in global signal detection and monitoring activities. The Patient Information Leaflet provides information on the vaccine, its uses and on any precautions that require advice from a healthcare professional before it is administered.
Adjuvants (immune potentiators or immunomodulators) have been used for decades to improve the immune response to vaccine antigens. The incorporation of adjuvants into vaccine formulations is aimed at enhancing, accelerating and prolonging the specific immune response towards the desired response to vaccine antigens. Advantages of adjuvants include the enhancement of the immunogenicity of antigens, modification of the nature of the immune response, the reduction of the antigen amount needed for a successful immunisation, the reduction of the frequency of booster immunisations needed and an improved immune response in the elderly and immunocompromised.
The question asks me to comment on academic research concerning the HPV vaccine. It would be inappropriate for me, as Minister, to express views on individual pieces of academic research.
I would urge any parent who has doubts or questions about vaccination to engage with their family doctor, or alternatively to visit the HPV website - www.hpv.ie. This source of information is clear and accurate and will answer any queries that you may have.
449. Deputy Eugene Murphy asked the Minister for Health his views on the selection of persons for the trial of vaccines (details supplied). [6049/18]
Amharc ar fhreagraThe efficacy of a vaccine for a specific disease is usually defined as the reduction in the chance of developing the disease after vaccination relative to the chance when unvaccinated, as determined in a prospective randomised controlled trial. Clinical trials submitted in an application for a marketing authorisation to place a medicine on the market are reviewed, including the trial methodology, how biases were controlled, and all aspects of vaccine safety, including allergic reactions. Once the efficacy, safety and quality has been reviewed and the vaccine is considered to have a positive benefit-to-risk balance, it is then authorised. The authorised product information provides information on the safe use of the vaccine, and specifically contraindicates the use of the vaccine in patients with known hypersensitivity to the active substances or other inert ingredients.
Vaccines may be given in accordance with official recommendations but they are never mandated, and the contraindications and warnings outlined in the product information are taken into account prior to administration to a specific patient; for example, hypersensitivity or a patient’s immune status. Vaccines on the market are continuously monitored and this will provide additional safety data on less frequent and rare adverse events. Additionally, ongoing safety studies from the medical literature are reviewed and further changes to the product information may be proposed or, if necessary, a reassessment of its benefit/risk is performed.
In summary, a vaccine is rigorously tested in clinical trials before being authorised for use, and regularly reviewed once it is on the market.
451. Deputy Louise O'Reilly asked the Minister for Health the reason the HSE has discontinued waiting-list targets set in 2017; the number of persons who will be affected; the number of complex cases that are still waiting for surgery; if new more ambitious targets will be now set; and if he will make a statement on the matter. [6064/18]
Amharc ar fhreagraThe NTPF publishes the Inpatient/Daycase and Outpatient waiting list figures by specialty for each hospital on its website each month. This information is available at www.NTPF.ie. The NTPF does not collect data in relation to the number of complex cases within each time-band. The most recent figures published by the NTPF for the end of December 2017 indicate that there is a total of 81,468 people on the Inpatient/Day case waiting list, of which 14,867 are waiting 9-15 months, 3,161 are waiting 15-18 months and 4,495 are waiting over 18 months.
October's Budget announced a total 2018 allocation of €55m for the NTPF for 2018. This significant increase in funding more than doubles the 2017 total allocation of €20m. The NTPF and HSE are in the process of finalising Waiting List Action Plans and Initiatives for 2018. This will include ambitious targets for both the HSE and NTPF to reduce the overall number of patients waiting for treatment.
I expect to publish the 2018 Inpatient Day Case Waiting List Action Plan at the end of February.
