Written Answers Nos. 675-699
675. Deputy Catherine Connolly asked the Minister for Health if the nine community healthcare organisations have now completed their assessments of all centres in which persons are living in congregated settings including direct provision centres to establish the state of readiness; the outcome of these assessments; if a copy of these reports will be made available; and if he will make a statement on the matter. [9227/20]
Amharc ar fhreagraAs this is a service matter I have asked the HSE to respond directly to the Deputy as soon as possible.
676. Deputy Mattie McGrath asked the Minister for Health if he will address a series of matters relating to the agreement with private hospitals (details supplied); and if he will make a statement on the matter. [9239/20]
Amharc ar fhreagraThe Government published its Action Plan in Response to Covid-19, on March 16 2020. In anticipation of the projected surge in Covid-19 cases and the expected impact on the health care system, a major part of the Action Plan was to urgently ramp up capacity for acute hospital care facilities. A critical element of the strategy was to put in place an arrangement with the private hospitals to use their facilities as part of the public system, to provide essential additional acute hospital services for the duration of the emergency.
The terms of the arrangement reflected the expected Covid-19 pandemic at time of signing. It is in place for three months up to the end of June. The arrangement with the private hospitals was reviewed at the end of May, and the Government decided that the existing arrangement should not be extended beyond the end of June. It has however mandated the HSE to negotiate a new arrangement with private hospitals which would provide the HSE with full access to private hospital capacity in the event of a surge of Covid-19 and separately with ongoing agreed access, to enable the HSE to meet essential and elective care needs.
Department officials engaged with the insurers at the outset of the private hospitals agreement. In order to assist health insurance customers impacted by the Covid-19 national response, each of the insurers have announced a range of supportive measures for their customers.
In relation to the use of private hospital capacity, as of May 28 2020, 8,472 patients had been discharged from private hospitals having undergone an inpatient procedure since the arrangement between the HSE and private hospitals came into force. In the same period 30,041 daycase procedures took place in private hospitals, as well as 42,305 diagnostic appointments and 25,095 outpatient appointments.
Guidance on patient pathways to mitigate the risks associated with the delivery of non-covid care, for patients and healthcare workers, and support safe delivery of care has been developed under the auspices of the Expert Advisory Subgroup of NPHET (EAG) and approved in principle by NPHET. It is recommended that in-patient occupancy levels are maintained at 80% to facilitate the requirement to address surge safely. Utilisation rates show a growing increase in the rate of use of inpatient beds in private hospitals. Preliminary figures from the HSE indicate that as of 28 May 2020, 54% of private inpatient beds were in use, up from 43% at the start of May.
In response to the Covid-19 pandemic the HSE had to take measures to defer all non-urgent elective scheduled care activity, including outpatient clinics. This was to ensure patient safety and that all appropriate resources were made available for Covid-19 related activity and time-critical essential work. This decision was in line with the advice issued by the World Health Organisation, and the National Action Plan in response to Covid-19. The trajectory of the disease means there is now an opportunity for increasing the provision of non-covid care including more routine care.
My Department, the HSE and the National Treatment Purchase Fund are currently working together to estimate the impact of Covid 19 on Scheduled Care waiting lists, with a view to informing activity going forward. As the system continues to deliver Covid-19 and non-Covid 19 care side-by-side over a more prolonged period, my Department and the HSE will continue to work closely together to protect essential non-Covid 19 acute care and progress the provision of more routine non Covid-19 care.
Where possible, hospitals are working to find innovative ways to enable service provision, which include virtual clinics for some out-patient department appointments. The HSE website provides details on services currently available and operational in each hospital on its website. This information is reviewed frequently and provides up-to-date announcements on services available at each site (https://www2.hse.ie/services/hospital-service-disruptions/hospital-service-disruptions-covid19.html).
677. Deputy Mattie McGrath asked the Minister for Health when early intervention and disability services will be resumed; his plans to deal with the huge backlogs that will have built up during the period of lockdown; the reason it is not possible to have speech and language therapy and so on when such appointments can be held while maintaining a two metre distance; and if he will make a statement on the matter. [9240/20]
Amharc ar fhreagraAs the Deputy's question relates to a service issue, it has been referred to the HSE for direct reply.
678. Deputy Brendan Smith asked the Minister for Health when construction will commence on a project (details supplied); the timescale for the construction and completion of this facility; and if he will make a statement on the matter. [9246/20]
Amharc ar fhreagraAs the HSE has responsibility for the provision, along with the maintenance and operation of Primary Care Centres and other Primary Care facilities, the Executive has been asked to reply directly to the Deputy.
679. Deputy Brendan Smith asked the Minister for Health when he will establish a mental health task force to ensure a co-ordinated approach to the provision of adequate supports in a timely manner to persons with mental health issues arising from the Covid-19 pandemic; and if he will make a statement on the matter. [9251/20]
Amharc ar fhreagraWork on a revised mental health policy has been on-going and final draft was agreed by cabinet Social Policy Committee in December 2019. The government must next review and approve the policy at which point the policy can then be published. This policy was developed following a process of research into international innovation and best practice in the field of mental health and an extensive national consultation of over 1,000 service users, family members, friends and carers, and other stakeholders. The revised policy contains an implementation roadmap that organises recommendations into short (0-6 months); medium (6-18 months) and long term (beyond 18 months) actions that will be costed within the various time frames allocated.
The revised policy recommends the establishment of a National Monitoring and Implementation Committee (NIMC) to oversee the implementation of the policy over the next ten years. In addition, the policy recommends that a national mental health and wellbeing strategy be developed by Healthy Ireland.
The Department of Health would consider that the process which led to the finalisation of the new policy was very comprehensive as regards research and consultation, including detailed engagement with the Oireachtas Committee on the Future of Mental Health and with many other stakeholders, and therefore a high-level taskforce is not warranted at this stage. Our focus now is on setting up a focussed comprehensive implementation process with the HSE, once the new policy is approved by Government.
However, in view of the recent requests, the Department of Health proposes that such a task force could be established as a sub-committee of the NIMC and work with the members of the Healthy Ireland mental health promotion strategy group to expand provision of existing Covid-19 interventions.
This approach maximises collaboration and efficiency and ensures a strong implementation focus while minimising duplication of work, given that the proposed taskforce would carry out similar work to developments already afoot. Additionally, as the same personnel who have been involved in the above developments are likely to be involved in future developments going forward, this avoids duplication and creates space for mental health plans to be created without risk of overlap. The development of such a structure would take account of priority needs identified during and following Covid-19.
With regards to the provision of mental health services during Covid-19, a planning Group (HSE, Department of Health, NGO sector) has been established to plan for additional current and/or anticipated needs as the crisis extends in duration. There are existing HSE guidelines, published in 2014, on ‘Psychosocial and Mental Health Needs following Major Emergencies’. These guidelines recognise that prior to, during and following national emergencies there would be a need to support certain members of the population with their emotional, cognitive, social and physical needs.
The HSE is continuing to provide all community services, in so far as possible, while following Covid-19 guidelines to ensure the protection of patients and staff. At present, there is a range of existing services which offer online text and telephone supports to people seeking mental health information and advice. These include Samaritans, Pieta House, MyMind, Turn2Me; Aware, Crisis Text Ireland, Shine, BeLongTo, LGBT Ireland, Jigsaw, Bodywhys and Childline. The YourMentalHealth.ie website provides a ‘one-stop-shop’ portal for people seeking information, supports and services, including information on accessing urgent help and a mental health text messaging support service is available 24 hours a day, 7 days each week to connect people with trained volunteers. NGOs currently funded by the HSE are being supported and encouraged to develop updated responses to the Covid-19 outbreak. Details of these services are listed on the HSE website, www.yourmentalhealth.ie, and information on available services is also provided through the free mental health telephone information line, 1800 111888.
In order to respond to the anticipated additional needs of the population during this crisis, additional online services are being delivered to support the population, including online counselling, expanded crisis textline support and online life skills training, building on existing pilot schemes and developments in digital mental health in recent years.
680. Deputy Brendan Smith asked the Minister for Health his plans to make greater use of capacity in both public and private hospitals; and if he will make a statement on the matter. [9253/20]
Amharc ar fhreagraA major part of the Government's Action Plan in response to Covid-19 was to substantially increase the capacity of public healthcare facilities to cope with the anticipated additional demand. In order to urgently ramp up capacity for acute care facilities, an arrangement was agreed with the private hospitals to use their facilities as part of the public system on a temporary basis, to provide essential services. A Heads of Terms of an Agreement between the HSE and the Private Hospitals was agreed at the end of March 2020 and all 18 of the acute private hospitals signed up to it. Under the arrangement, all patients in the private hospitals are treated as public patients and their treatment is prioritised based on clinical need. Provision was made under the agreement to allow for continuity of care for patients who were in a private hospital or attending for treatment at the time the Heads of Terms of the Agreement were agreed, on the grounds that these patients would be treated as public patients.
The agreement was reviewed at the end of May and the Government decided that the existing arrangement should not be extended beyond the end of June. It has however mandated the HSE to negotiate a new arrangement with private hospitals which would provide the HSE with full access to private hospital capacity in the event of a surge of Covid-19 and separately with ongoing agreed access, to enable the HSE to meet essential and elective care needs.
Guidance on patient pathways to mitigate the risks associated with the delivery of non-covid care, for patients and healthcare workers, and support safe delivery of care has been developed under the auspices of the Expert Advisory Subgroup of NPHET (EAG) and approved in principle by NPHET. It is recommended that in-patient occupancy levels are maintained at 80% to facilitate the requirement to address surge safely. Utilisation rates show a growing increase in the rate of use of inpatient beds in private hospitals. As of 28th May 2020, 54% of private inpatient beds were in use, up from 43% at the start of May.
The HSE is currently working to develop a continuity of services plan to examine how healthcare activity suspended because of Covid-19 can be resumed while maintaining acute occupancy at 80% to provide for surge capacity in the event of a further wave of Covid-19. This work should enable non-urgent elective care to resume within the necessary constraints.
The key to maintaining reduced acute hospital occupancy is to address the gap between capacity and demand as set out in the Health Service Capacity Review 2018. The HSE has advised that plans to address the findings of the capacity review are currently being revised in response to the emerging and potential long-term impact of Covid-19, and my Department is continuing to engage with the HSE in this regard.
My Department, the HSE and the National Treatment Purchase Fund are currently working together to estimate the impact of Covid-19 on Scheduled Care waiting lists with a view to informing activity going forward. As the system continues to deliver Covid-19 and non-Covid-19 care side-by-side over a more prolonged period, my Department and the HSE will continue to work closely together to protect essential non-Covid-19 acute care and progress the provision of more routine non-Covid-19 care.
681. Deputy Joe O'Brien asked the Minister for Health if mandatory quarantining is envisaged for overseas visitors as international travel begins to resume; the length of time the quarantining period will be; if facilities have been sourced; and if he will make a statement on the matter. [9260/20]
Amharc ar fhreagraAs the number of indigenous cases here declines and Ireland eases some restrictions, the relative importance of the risk of importation of cases from overseas increases. Ultimately, the progress towards suppression of community transmission which has been achieved and which should allow for greater resumption of social and economic life in Ireland could be endangered.
Based on public health guidance and the understanding of the possible length of incubation of Covid-19, public health advice for passengers arriving into the State from overseas is to self-isolate for 14 days.
It is a legal requirement for passengers arriving from overseas to complete a COVID-19 Passenger Locator Form.
My Department, in consultation with other relevant Departments, is developing proposals to strengthen the 14 days' self-isolation arrangements for travellers from overseas. These proposals would include possible enforcement measures. The issue of imposing mandatory quarantine for a 14 day period, to be considered as the situation evolves, was mentioned in the Roadmap for Reopening Society & Business.
Along with interdepartmental work, there is also ongoing close engagement at political and official levels with the authorities in both Northern Ireland and the UK on the issue of international travel measures.
682. Deputy Darren O'Rourke asked the Minister for Health his views on whether the agreement with private hospitals is providing value for money; his plans for the agreement; his plans to extend or cancel the contract; and the timeline and the criteria to be used to make this decision. [9285/20]
Amharc ar fhreagraA major part of the Government's Action Plan in response to Covid-19 was to substantially increase the capacity of public healthcare facilities to cope with the anticipated additional demand. In order to urgently ramp up capacity for acute care facilities, an arrangement was agreed with the private hospitals to use their facilities as part of the public system on a temporary basis, to provide essential services. A Heads of Terms of an Agreement between the HSE and the Private Hospitals was agreed at the end of March 2020 and all 18 of the acute private hospitals signed up to it. Under the arrangement, all patients in the private hospitals are treated as public patients and their treatment is prioritised based on clinical need. Provision was made under the agreement to allow for continuity of care for patients who were in a private hospital or attending for treatment at the time the Heads of Terms of the Agreement were agreed, on the grounds that these patients would be treated as public patients.
The agreement was reviewed at the end of May and the Government decided that the existing arrangement should not be extended beyond the end of June. It has however mandated the HSE to negotiate a new arrangement with private hospitals which would provide the HSE with full access to private hospital capacity in the event of a surge of Covid-19 and separately with ongoing agreed access, to enable the HSE to meet essential and elective care needs.
Under the agreement payment to the private hospitals is on a cost only Open Book model whereby the hospitals will be reimbursed only for the operating costs properly incurred during the period. The costs that will be covered will be limited to normal costs of operating the hospital. While the private hospitals are paid a monthly sum equal to 80% of estimated monthly costs, the hospitals will only receive their actual operating costs when these have been verified. The final cost will be verified by independent firms of accountants appointed by the HSE and the private hospitals and there will be an arbitration mechanism in place in the event of any disagreement.
As the funding of the agreement is based on cost recovery, validated costs will not be available until the agreement is completed, however it is estimated that the cost of the agreement will be of the order of €300m.
683. Deputy Darren O'Rourke asked the Minister for Health his plans for the return of non-Covid-19 healthcare in acute hospitals; the timeline for same; and if he will make a statement on the matter. [9287/20]
Amharc ar fhreagraIn line with the National Action Plan for Covid-19, delivery of essential non-Covid care has continued to date, although at significantly lower volumes than previously, often in alternative locations and using innovative methods of care delivery. Where possible, hospitals are working to provide services in a different way, which includes virtual clinics for some out-patient department appointments.
The HSE has advised it is currently working to develop a continuity of services plan to allow for the safe delivery of care. Additionally, my Department, the HSE and the National Treatment Purchase Fund are working together to estimate the impact of Covid-19 on scheduled care waiting lists with a view to informing activity going forward.
As the system continues to deliver Covid-19 and non-Covid-19 care side-by-side over a more prolonged period, my Department and the HSE will continue to work closely together to protect essential non-Covid-19 acute care and progress the provision of more routine non-Covid-19 care.
684. Deputy Darren O'Rourke asked the Minister for Health when a person (details supplied) will receive a hospital appointment. [9288/20]
Amharc ar fhreagraUnder 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.
The National Waiting List Management Policy, a standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, since January 2014, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the HSE, sets out the processes that hospitals are to implement to manage waiting lists.
In response to the Covid-19 pandemic the HSE had to take measures to defer all non-urgent elective scheduled care activity, including outpatient clinics. This was to ensure patient safety and that all appropriate resources were made available for Covid-19 related activity and time-critical essential work. This decision was in line with the advice issued by the World Health Organisation, and the National Action Plan published on 16 March. The trajectory of the disease means there is now an opportunity for increasing the provision of non-covid care including more routine care. It is envisaged that the private hospitals will play an important role in this regard.
My Department, the HSE and the National Treatment Purchase Fund are currently working together to estimate the impact of Covid 19 on Scheduled Care waiting lists, in order to be prepared to address any backlog or pent up demand. My Department continues to ensure that the resources available throughout our health system are best utilised at this unique and challenging time.
In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
685. Deputy Darren O'Rourke asked the Minister for Health when a person (details supplied) will receive a hospital appointment. [9289/20]
Amharc ar fhreagraUnder 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.
The National Waiting List Management Policy, a standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, since January 2014, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the HSE, sets out the processes that hospitals are to implement to manage waiting lists.
In response to the Covid-19 pandemic the HSE had to take measures to defer all non-urgent elective scheduled care activity, including outpatient clinics. This was to ensure patient safety and that all appropriate resources were made available for Covid-19 related activity and time-critical essential work. This decision was in line with the advice issued by the World Health Organisation, and the National Action Plan published on 16 March. The trajectory of the disease means there is now an opportunity for increasing the provision of non-covid care including more routine care. It is envisaged that the private hospitals will play an important role in this regard.
My Department, the HSE and the National Treatment Purchase Fund are currently working together to estimate the impact of Covid 19 on Scheduled Care waiting lists, in order to be prepared to address any backlog or pent up demand. My Department continues to ensure that the resources available throughout our health system are best utilised at this unique and challenging time.
In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
686. Deputy Darren O'Rourke asked the Minister for Health if Ireland will support the Costa Rica and World Health Organisation proposal to create a global pooling mechanism for rights in the data, knowledge and technologies useful in the prevention, detection and treatment of the Covid-19 pandemic which is scheduled to be launched on 29 May 2020; and if he will make a statement on the matter. [9294/20]
Amharc ar fhreagraThe WHO and Costa Rica proposal on a global pooling mechanism of Covid-19 related health technologies was launched on Friday 29 May 2020. The contents of this proposal are of cross-sectoral relevance and are being considered by a number of Government Departments including the Department of Foreign Affairs and Trade, the Department of Health, and the Department of Business, Enterprise and Innovation.
687. Deputy Mary Lou McDonald asked the Minister for Health the progress made on the commitment to introduce a statutory home care scheme. [9312/20]
Amharc ar fhreagraA high-quality, consistent home-support service, focused on keeping people well in their homes and communities for as long as possible, is a key enabler to ensuring that people across a continuum of care get the right care, in the right place, at the right time. In this regard, my Department is in the process of developing a statutory scheme for the financing and regulation of home support.
As part of this, work is on-going to determine the optimal approach to the development of the scheme within the broader context of the Sláintecare reforms. Work undertaken in 2019 focussed on the design of the scheme, the options for regulation, and a review of existing services. In 2020, it had been intended to focus on piloting a reformed model of service delivery for home support services, the development of the evidence base for the financing of home support services; and the development of a framework for the regulation of these services.
Progress on the development of the scheme, including the planned testing of a pilot scheme in 2020, has been impacted by the ongoing work and diversion of resources as part of the response to COVID-19. However, my Department remains committed to bringing forward this work as a priority, taking on board the learning from the response to COVID-19, in order to support people to age well and continue to live independently in their homes for as long as possible.
688. Deputy Mary Lou McDonald asked the Minister for Health the 2020 budgetary allocation of his Department for the implementation of the national dementia strategy. [9313/20]
Amharc ar fhreagraThe National Dementia Strategy was published in December 2014, with the aim of improving care, services and supports for people with dementia.
The HSE currently provides approximately €9 million per annum for intensive home care packages, including in the region of €7.9 million for dementia-specific packages. Since the packages were introduced at the end of 2014, 443 dementia-specific intensive homecare packages have been delivered, with 124 active at the end of May 2020.
People with dementia can also benefit from standard home support services. An additional €52 million was provided in 2020 for home support services, bringing the total budget in 2020 to almost €490 million and a target in the National Service Plan 2020 to deliver over 19.2 million hours of home support. It was intended that over 53,700 people would be in receipt of home support services at any one time, including approximately 235 people who would receive intensive home support packages to a level of 360,000 hours. However, the spread of COVID-19 is posing significant challenges for many areas of the health service, including home support services.
The HSE provides in the region of €12 million in annual funding to a range of organisations who deliver dementia-specific respite, home care, day care, cognitive stimulation therapy, social clubs and supports for family carers around the country.
In addition, the HSE provides €400,000 per annum in support for the Dementia Adviser Service which spans 12 counties and is operated by the Alzheimer Society of Ireland. In line with the continued rollout of the Sláintecare Implementation Plan, €10 million has been secured in Budget 2020 to enhance Community Services including allied health professionals, with a full year investment of €60 million for 2021. As well as providing for up to 1,000 therapists, nurses and other professionals in the community, this funding will also facilitate the recruitment of additional dementia advisers, whose information, advice and signposting service is highly valued by people with dementia and their families and carers.
€6.26 million has been secured through the 2016, 2017 and 2018 Dormant Accounts Action Plans for a range of dementia projects completed or being rolled out by the HSE's National Dementia Office. Funded projects include a national network of memory technology resource rooms, the mapping of dementia-specific community based services, a national rollout of the Dementia Training Programme for HSE homecare staff, a national intellectual disability memory service and a review of the diagnostic process for people with early-onset dementia.
In summer 2019, a €1 million fund was made available for community and voluntary groups to continue to support older people to stay well and remain connected with their local community. Approximately €250,000 of this funding is dedicated to dementia related initiatives.
689. Deputy Marc Ó Cathasaigh asked the Minister for Health when consultants will be able to schedule public appointments for patients they had been treating in a private capacity prior to the Covid-19 crisis; and if he will make a statement on the matter. [9319/20]
Amharc ar fhreagraA major part of the Government's Action Plan in response to Covid-19 was to substantially increase the capacity of public healthcare facilities to cope with the anticipated additional demand. In order to urgently ramp up capacity for acute care facilities, an arrangement was agreed with the private hospitals to use their facilities as part of the public system on a temporary basis, to provide essential services. A Heads of Terms of an Agreement between the HSE and the Private Hospitals was agreed at the end of March 2020 and all 18 of the acute private hospitals signed up to it. Under the arrangement, all patients in the private hospitals are treated as public patients and their treatment is prioritised based on clinical need. Provision was made under the agreement to allow for continuity of care for patients who were in a private hospital or attending for treatment at the time the Heads of Terms of the Agreement were agreed, on the grounds that these patients would be treated as public patients.
The agreement was reviewed at the end of May and the Government decided that the existing arrangement should not be extended beyond the end of June. It has however mandated the HSE to negotiate a new arrangement with private hospitals which would provide the HSE with full access to private hospital capacity in the event of a surge of Covid-19 and separately with ongoing agreed access, to enable the HSE to meet essential and elective care needs
In response to the COVID-19 pandemic the HSE had to take measures to defer all non-urgent elective scheduled care activity, including outpatient clinics. This was to ensure patient safety and that all appropriate resources were made available for COVID-19 related activity and time-critical essential work. This decision was in line with the advice issued by the World Health Organisation, the measures set out in the Action Plan in Response to Covid-19 and the recommendation of NPHET. The NPHET has now recommended that steps be taken to resume non-urgent scheduled care in the context of the safe care guidelines set out by its Expert Advisory Group.
690. Deputy Bríd Smith asked the Minister for Health his views on calls to facilitate visits by relatives and loved ones to the elderly in residential settings, for example, by using outdoor areas and timetabled visits with at least one or two family members per week; if he will request that nursing home managers prioritise planning to allow for such visits in the immediate future in view of the trauma inflicted on residents during the lockdown; and if he will make a statement on the matter. [9326/20]
Amharc ar fhreagraIt is important to recognise that the current social distancing measures were introduced for the overarching public health good and for the protection of all people in Ireland, particularly those who are most vulnerable to this virus. We all recognise the unprecedented impact on people’s daily lives and I am aware of how difficult the current restrictions on visiting are for both nursing home residents and their families. However, the current expert guidance should continue to be adhered to.
Appropriate evidence-based guidance to support the work of health and social care providers on a range of issues, including infection prevention and control, has been developed by the HSE and the HPSC and is updated regularly, as appropriate, and made available on their websites. The latest HPSC Interim Public Health and Infection Prevention Control Guidelines on the Prevention and Management of COVID-19 Cases and Outbreaks in Residential Care Facilities and Similar Units was published on 2nd June (version 5). These are available on the HPSC website.
This guidance provides the most up to date advice and information on the public health management and infection prevention and control measures, to inform and advise local planning and management in community residential facilities.
The Taoiseach recently announced a Roadmap for the future easing of restrictions on a phased basis. Phase 3, from 29 June, will see the commencement of a phased approach to visiting at hospitals, residential healthcare centres and other residential settings bearing in mind the particular features of types of settings and each individual centre. I am hopeful we will be able to make progress on this and other innovative measures to allow some level of interaction between residents and their families in line with the Roadmap.
691. Deputy Bríd Smith asked the Minister for Health the date on which his Department received the HIQA report containing a list of nursing homes which it was of the view might struggle with the Covid-19 crisis; the actions taken on foot of this; if direct contact was made with these residential settings; and if he will make a statement on the matter. [9327/20]
Amharc ar fhreagraOn 13th March HIQA provided the Department with a list of 19 HSE/HSE funded nursing homes identifying that as these had multi-occupancy rooms this created infection prevention risk. This information was sent by the Department on the same day to the HSE for their attention and the HSE has confirmed on-going risk management of these centres.
On 29th and 30th of March key officials from the Department, HIQA, HPSC and HSE met to discuss nursing homes. It was agreed that representatives from the Department, HIQA, HSE and HSPC would collaborate to prepare a paper, encompassing a framework of necessary information, for consideration by the NPHET at its meeting of 31st March on the specific issues and risks relating to COVID-19 infections in residential healthcare facilities. To inform the development of the paper, HIQA provided an information framework document to the team on March 30th. A variety of potential risks were identified. These included the risk of small providers, access to infection prevention and control (IPC) advice, access to PPE and timely access to testing. Following consideration of the paper referred to at the above NPHET meeting of 31st March, NPHET requested HIQA to risk assess all nursing homes and liaise with relevant national and regional governance structures as necessary in light of mitigating actions. This was part of an overall package of public health measures recommended following this meeting.
At the NPHET meeting 17th April an action was agreed that ‘HIQA publishes and assesses a COVID-19 Quality Assurance Regulatory Framework’. This Framework has been designed to ensure that providers are prepared for, and have contingency plans in place for, an outbreak of COVID-19. As part of the programme HIQA has developed a self-assessment tool for nursing home providers. This self-assessment tool sets out the minimum standard required to effectively respond to an outbreak of COVID-19 in a designated centre. This involves a self-assessment by the registered provider and an onsite assessment by inspectors of social services to verify the provider’s compliance against specified regulations.
If further action is required by the registered provider to ensure compliance with the specified regulations, a compliance plan will be issued to the registered provider by the inspector of social services following the in-site assessment.
692. Deputy Bríd Smith asked the Minister for Health the membership of the NPHET committee from its first meetings on Covid-19 in January 2020 to date; the persons added to the committee and when in each case; the reason for their inclusion; and the record of attendance of such persons at subsequent meetings of the committee. [9328/20]
Amharc ar fhreagraThe National Public Health Emergency Team (NPHET) for COVID-19 was established on 27 January 2020 in the Department of Health and is chaired by the Chief Medical Officer. The NPHET oversees and provides national direction, guidance, support and expert advice on the development and implementation of a strategy to contain COVID-19 in Ireland. It advises Government on the public health aspects of what is a cross-Government response to COVID-19 as informed by Ireland's National Action Plan in response to COVID-19 (Coronavirus), published on 16th March.
The NPHET’s membership is multi-disciplinary and multi-sectoral in line with best international practice. Membership comprises representatives from across the health and social care service including the Department of Health (DOH), Health Service Executive (HSE), Health Protection Surveillance Centre (HPSC), Health Information and Quality Authority (HIQA), Health Products Regulatory Authority (HPRA) and others with relevant expertise in health and/or other related matters. Given the nature of the work involved, the need for a timely assessment and response and the flexibility in terms of the disease progression, the membership of the NPHET has evolved since January to encompass additional experts. This may change further over time in line with the expertise required across the response. The Chief Clinical Officer, National Director of Acute Operations and National Director for Community Operations are among the representatives of the HSE.
The membership of the NPHET as at 28 April 2020 is set out in “National Public Health Emergency Team (NPHET) for COVID-19: Governance Structures”, pp. 18. This document can be accessed at the following link: https://www.gov.ie/en/publication/de1c30-national-public-health-emergency-team-nphet-for-covid-19-governance-/.
The minutes for of the NPHET meetings are published on the Department of Health website. The minutes identify those NPHET members in attendance at each meeting since 27 January 2020:
https://www.gov.ie/en/collection/691330-national-public-health-emergency-team-covid-19-coronavirus/.
Where members are not in attendance at a relevant meeting, apologies are recorded in respect of the member in question.
693. Deputy Bríd Smith asked the Minister for Health his plans to ensure nursing homes, especially those in which there were clusters of Covid-19 cases and deaths, will meet HIQA standards, for example, in infection control in the coming months; the steps which will be taken to ensure adequate staffing levels, trained personnel and medical care are in place before the winter and a possible second wave or flu virus arrives; and if he will make a statement on the matter. [9329/20]
Amharc ar fhreagraThe Health Information and Quality Authority (HIQA) is the independent authority established under the Health Act 2007 to drive continuous improvement and to monitor safety and quality in Ireland’s health and personal social care services. Since 2009 the HIQA has been the statutory independent regulator for the nursing home sector. This responsibility is underpinned by a comprehensive quality framework comprising of Registration Regulations, Care and Welfare Regulations and National Quality Standards. These have all been revised and amended since their introduction.
Since the onset of this pandemic, HIQA has put in place a quality assessment process whereby all designated centres, including nursing homes are formally contacted on a regular basis by an inspector of social services to assess how they are coping, the welfare of the residents, any concerns they have, and any deficits identified in their ability to sustain a safe, high-quality service. HIQA has completed a risk assessment of all nursing homes. On 6 April, it commenced a focused COVID-19 Infection Prevention and Control Hub to provide nursing home providers with guidance and supports; including an escalation pathway, where required, to the HSE.
In addition, I would like to note that HIQA has developed a regulatory assessment framework of the preparedness of designated centres for older people for a COVID-19 outbreak. The regulatory assessment framework aims to support those centres that are currently free from COVID-19 to prepare for an outbreak of COVID-19 and put in place the necessary contingency plans. This programme is in line with HIQA’s established Authority Monitoring Approach.
The purpose of this programme is to provide support to nursing home providers to ensure that they are fully prepared and to build confidence in their ability to mitigate and manage COVID-19. The HIQA team will support providers, as necessary, to ensure that they plug into the supports being provided by the HSE.
Nursing home providers are ultimately responsible for the safe care of their residents. All nursing homes, public and private have a duty to ensure continued adherence to the existing regulatory and standards framework in the discharge of their duties.
In addition to the ongoing support of independent regulator the HSE continues to provide unprecedented supports to nursing homes including relevant clinical and infection prevention and control advice, funding, access to PPE and in some cases, where necessary, staffing support.
I would also like to advise the Deputy that there has been ongoing engagement with Nursing Homes Ireland, the representative body for private nursing homes, at Ministerial and Official level.
694. Deputy John Lahart asked the Minister for Health the restrictions in place to prevent minors from purchasing paracetamol tablets in supermarkets and other retail units at self-service tills and other such checkouts; his plans to introduce measures to prevent the abuse of such purchasing; and if he will make a statement on the matter. [9337/20]
Amharc ar fhreagraThere is no prohibition, on age grounds, as regards the retail sale of paracetamol-containing products. The sale of medicines is governed by the Medicinal Products (Prescription and Control of Supply) Regulations 2003, as amended, with specific provisions which apply exclusively to the sale of medicines that consist of, or contain, paracetamol. These regulations provide that paracetamol may only be supplied, without prescription, from pharmacies and non-pharmacy outlets, subject to certain restrictions on presentation and quantities that may be supplied.
Under European and Irish legislation, before a medicine can be placed on the Irish market, the manufacturer must seek an authorisation from the Health Products Regulatory Authority (HPRA), or in the case of certain medicinal products, the European Medicines Agency (EMA). Restrictions on the sale of medicines are based on their licensed indications and the indicated patient population, as contained in the summary of product characteristics (SmPC). The SmPC is a legal document that forms part of the authorisation for a medicine.
The HPRA is the competent authority for the regulation of medicines in Ireland and is responsible for determining the method of sale and supply of a medicine. The HPRA may determine the classification of a medicine as suitable for supply without prescription having regard to the maximum single dose of the product concerned, the maximum daily dose; the strength of the product; its pharmaceutical form; its packaging; or any other circumstances relating to its use as the HPRA may consider appropriate, for example, for a particular indication only.
In determining if a product should be classified as available on general sale in non-pharmacy outlets, the HPRA must have regard to the nature and purpose of the product and must be satisfied that the product concerned can, with reasonable safety, be sold other than under the supervision of a pharmacist. There is generally no prohibition, on age grounds, as regards the retail sale of medicines because the medicines are normally indicated for use in minors as well as adults.
However, in non-pharmacy outlets the pack sizes available are restricted under the legislation to:
- 12 or fewer dosage units, each of which contains more than 120mg of paracetamol but not more than 500mg of paracetamol
- 10 or fewer dosage units, each of which contains more than 500mg of paracetamol but not more than 600mg of paracetamol
In the case of a medicine intended for use in children under 6 years of age:
- Packs must contain 12 or fewer dosage units, each of which contains no more than 120mg of paracetamol
- Pack size of liquid forms should contain 60ml or less with no more than 120mg of paracetamol contained in 5ml
In addition to these requirements, a non-pharmacy retailer may only supply one pack of a paracetamol medicine per sales transaction.
In recent years the HPRA has highlighted to retailers the need to adhere to the legal requirements with respect to selling paracetamol and to ensure that all staff are aware of the restrictions that apply. The HPRA has published a Guidance Note on the Sale of Paracetamol-containing Medicinal Products by Non-pharmacy Retailers: www.hpra.ie/homepage/about-us/publications-forms/guidance-documents/item?id=60380826-9782-6eee-9b55-ff00008c97d0&t=/docs/default-source/publications-forms/guidance-documents/guidance-note-on-the-sale-of-paracetamol-containing-medicinal-products-by-non-pharmacy-retailers
and highlighted in particular the need for vigilance around the responsible selling of paracetamol-containing medicines. http://www.hpra.ie/homepage/medicines/regulatory-information/retailers
In accordance with the HPRA’s guidance retailers are advised to:
- Ensure all staff are aware that only one pack of a medicine containing paracetamol may be sold to a customer per transaction and that this is emphasised in all training for future new staff.
- Use signage to remind staff that only one pack of a medicine containing paracetamol can be sold per transaction.
- Identify all products that contain paracetamol and ensure restrictions are in place so that only one pack of a medicine containing paracetamol can be sold per transaction.
- Ensure that all staff are vigilant for customers attempting to purchase different brands of medicines containing paracetamol.
- Have an alert on the cash register to signal to staff that the product scanned contains paracetamol and, therefore, only one pack may be sold per transaction.
- Implement ‘a block’ at the cash register and self-service tills that does not allow two packs of medicines containing paracetamol to be scanned/sold in one transaction.
- Emphasise to staff that it is not acceptable to bypass the requirement by selling more than one pack to a single customer by carrying out a second, separate, transaction.
Any specific concerns about the sale of paracetamol products can be raised directly with the HPRA via reportacase@hpra.ie.
695. Deputy Seán Haughey asked the Minister for Health if direction and guidance will be given to restaurants on procedures and protocols to be followed on reopening; if consideration will be given to reducing the social distance requirement to one metre in the case of restaurants and similar businesses; and if he will make a statement on the matter. [9347/20]
Amharc ar fhreagraThe Government’s Roadmap for Reopening Society & Business, published on 1 May 2020, sets out an indicative path to the easing of COVID 19 restrictions and other actions in order to facilitate the reopening Ireland’s society and economy in a phased manner. The Roadmap specifies that decisions in relation to which actions will be taken and which public health measures might be lifted will be made in accordance with the Framework for Future Decision-Making which is as follows:
1. Before each Government consideration of the easing of restrictions, the Department of Health will provide a report to the Government regarding the following on/off trigger criteria:
a. The latest data regarding the progression of the disease,
b. The capacity and resilience of the health service in terms of hospital and ICU occupancy,
c. The capacity of the programme of sampling, testing and contact tracing,
d. The ability to shield and care for at risk groups,
e. An assessment of the risk of secondary morbidity and mortality as a consequence of the restrictions.
2. It will also provide risk-based public health advice on what measures could be modified in the next period.
3. The Government would then consider what restrictions could be lifted, having regard to the advice of the Department of Health as well as other social and economic considerations, e.g. the potential for increased employment, relative benefits for citizens and businesses, improving national morale and wellbeing etc.
4. It is acknowledged that there is also an ongoing possibility that restrictions could be re-imposed and this process will be carried out on an ongoing basis once every 3 weeks.
As is clear from the framework, it is the Government rather than I or my Department that will decide on any modifications to the current public health measures in place and those decisions will be informed by the status of the on/off trigger criteria and the public health advice received at the time that a decision is being made.
With regard to social distancing, while the evidence relating to the SARS-CoV-2 virus is evolving, it is clear now that the risks of transmission of any respiratory pathogens such as the type that causes Covid-19 are lessened when greater distance is maintained between people. This evidence is kept under review by the National Public Health Emergency Team on a continuing basis.
In general, with the exception of public health advice, the responsibility for providing guidance in relation to a particular sector of our economy or on a specific activity remains with the Government Department with responsibility for that sector or activity. In relation to restaurants and other food related businesses, the Food Safety Authority of Ireland has prepared specific advice which is available on its website at https://www.fsai.ie/faq/coronavirus.html.
696. Deputy Patrick Costello asked the Minister for Health his plans to allow family members to visit and spend some time with persons receiving end-of-life care in hospitals and hospices; and the timeframe for same. [9352/20]
Amharc ar fhreagraWhile visiting restrictions are required in the context of a pandemic situation, national guidance issued by the Health Service Executive (HSE) and available on the Health Protection Surveillance Centre (HPSC) website advocates a compassionate and practical approach in relation to visiting by friends and family, particularly in the context of the care of the dying.
A guidance document on Infection Prevention and Control Precautions for Possible or Confirmed COVID-19 in a Pandemic Setting was published on 8 May 2020. It notes that while visiting restrictions will be required in a pandemic, local risk assessment and practical management must be considered, ensuring the response is both pragmatic and proportionate. Specific scenarios where a compassionate and practical approach is required include care of the dying.
Interim Public Health and Infection Prevention Control Guidelines on the Prevention and Management of COVID-19 Cases and Outbreaks in Residential Care Facilities published by the HSE on 4 May 2020 state that all but essential visiting by family and friends is suspended in the interests of protecting residents at this time. However, the Guidelines also acknowledge that a compassionate, pragmatic and proportionate approach is required in the care of those who are dying. The presence of a person close to the resident should be facilitated in so far as it is possible, and they should be aware of the potential infection risk. Both guidance documents note the need for hand and respiratory hygiene and for the wearing of Personal Protective Equipment (PPE) when required.
The Taoiseach recently announced a Roadmap for the future easing of restrictions on a phased basis. Phase 3, from 29 June, will see the commencement of a phased approach to visiting at hospitals, residential healthcare centres and other residential settings bearing in mind the particular features of types of settings and each individual centre, also considering PPE availability and other protections.
The HPSC is developing guidance on the easing of visiting restrictions and this will be discussed by the National Public Health Emergency Team (NPHET) at the appropriate time. Careful consideration is being given to balance the risk of disease against providing opportunities for loved ones to come together.
697. Deputy Pearse Doherty asked the Minister for Health the number of residents of nursing homes disaggregated by the number or percentage of residents in private and voluntary nursing homes and in public nursing homes. [9353/20]
Amharc ar fhreagraThe Health Information and Quality Authority has advised the Department that there are 575 designated centres registered to provide 32,110 beds, of which 443 are private nursing homes registered to provide 25,361 beds (79% of registered beds), 5 Voluntary Section 38 Arrangement centres registered to provide 450 beds (1.4%), 14 Voluntary Section 39 Assistance centres registered to provide 623 beds (1.9%) and 113 Public (HSE) centres registered to provide 5,676 beds (17.7%).
Please note that the number of registered beds is a maximum figure and that not all beds are occupied at all times.
698. Deputy Pearse Doherty asked the Minister for Health the number of residents of nursing homes who died from Covid-19 related illnesses disaggregated by the number or percentage of those residents in private and voluntary nursing homes and in public nursing homes. [9354/20]
Amharc ar fhreagra699. Deputy Pearse Doherty asked the Minister for Health the number of residents as a proportion of all nursing home residents living in nursing homes reported by HIQA to the HSE as those centres with poor compliance with key regulations, as those services were at increased risk of Covid-19 outbreaks as per HIQA evidence at the Special Committee on Covid-19 Response on 26 May 2020; and the proportion of this cohort of residents living in private and voluntary settings compared to public settings. [9355/20]
Amharc ar fhreagra700. Deputy Pearse Doherty asked the Minister for Health the number of residents living in nursing homes reported by HIQA to the HSE as those centres with poor compliance with key regulations, as those services were at increased risk of Covid-19 outbreaks as per HIQA evidence before the Special Committee on Covid-19 Response on 26 May 2020 who died from Covid-19 related illnesses as a proportion of all those nursing home residents who died from Covid-19 related illnesses. [9356/20]
Amharc ar fhreagraI propose to take Questions Nos. 698 to 700, inclusive, together.
As these are service matters I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
