Written Answers Nos. 1034-1053
1034. Deputy Cormac Devlin asked the Minister for Health the stage of the Roadmap for Reopening Society and Business in which it is envisaged groups of more than 50 persons will be able to attend indoor religious and spiritual gatherings; and if he will make a statement on the matter. [18857/20]
Amharc ar fhreagraAs the Deputy is aware, on 19 June 2020, the then Taoiseach, on behalf of the Government, announced the restrictions that would be eased and the measures that will be in place in Phase 3 of the Roadmap for Reopening Society & Business. On Thursday 25 June the Government confirmed the move to Phase 3 of the Roadmap from Monday, 29 June 2020. Information and advice about the restrictions that have been eased as part of Phase 3 and the measures that are now in place are available on the Government website at www.gov.ie/en/publication/d06271-easing-the-covid-19-restrictions-on-29-june-phase-3/.
Gatherings of 50 people (indoor) and 200 people (outdoor) are permissible in line with the public health guidance on mass gatherings, which is also available on the Government website at www.gov.ie/pdf/?file=https://assets.gov.ie/77452/39d51b02-5633-4e2f-a070-4551a3521081.pdf#page=6. The limits will increase to 100 (indoors) and 500 (outdoors) in phase 4. This will be subject to continued progressive improvements in the health indicators identified in the Framework for Future Decision-Making described in the Roadmap.
As the Deputy is aware, religious buildings and places of worship may also now be reopened, in line with public health guidelines. The Government has exempted places of worship from the regulations restricting numbers on mass gatherings. The exemption applies to places of worship only and not to any gatherings that may take place after the religious ceremony such as wedding receptions.
Detailed Covid-19 Guidance has been developed for religious services. The Cabinet Committee reviewed the guidance, which state that an assessment should be carried out for each premises to determine how many can attend within the requirements of social distancing.
The Cabinet Committee decided that where the size of the premises allows for a capacity of greater than 50 this may be permitted only where:
- Social distancing guidelines are adhered to
- The premises can be subdivided into distinct sections (cordoned or marked appropriately) of not more than 50 persons in each section
- There is a minimum of 4m between sections
- Each section has its own entrance/exit route
- There are separate arrangements for elements of the service involving close contact, e.g. the distribution of Holy Communion
- Strictly no movement of people between sections before, during or after the service
- The premises is well-ventilated.
Account must also be taken regarding the risk of congregation by people outside before and after any services, having regard to outdoor overall limits on mass gatherings and arrangements for staggered exiting after ceremonies
The use of face coverings is strongly recommended for such indoor settings.
1035. Deputy Cormac Devlin asked the Minister for Health if universal access to Covid-19 testing will be established to support patients who require a test before attending hospitals for day or other procedures; and if he will make a statement on the matter. [18858/20]
Amharc ar fhreagraFollowing advice issued by National Public Health Emergency Team (NPHET), and from the end of March, 2020, the HSE took measures to restrict non-essential hospital services to slow the spread of COVID-19.
As part of the easing of restrictions, NPHET has revised its recommendations and the delivery of non-essential health services, including hospital day services, are now starting back gradually. Hospitals have developed new ways of working and, guided by appropriate clinical and operational decision making, the patient's healthcare advice will depend on the type of hospital visit.
The HSE website provides details on services currently available and operational in each hospital. This information is reviewed frequently and provides up-to-date announcements on services available at each site at the following link https://www2.hse.ie/services/hospital-service-disruptions/hospital-service-disruptions-covid19.html.
In relation to testing, the HSE has developed guidance for the management of planned hospital admissions for non-COVID care which sets out advisory testing strategies for hospital patients, available at: www.rcsi.com/dublin/-/media/feature/media/download-document/dublin/covid-19-section/surgical-practice/other-national-clinical-programmes-and-recognised-bodies/ncagl-acute-operations-interim-guidance-on-the-management-of-planned-hospital-admission-for-non.pdf. This guidance seeks to provide an advisory framework for mitigating risks associated with the delivery of non-COVID care while COVID-19 continues to be prevalent, and testing provides one of a number of such mitigation measures. Other efforts that can be taken to reduce risk would include, for example, self-isolation for 2 weeks in advance of admission. These measures are discussed directly with patients who have a planned admission to hospital to ensure an appropriately tailored approach is adopted for each individual patient's circumstances.
1037. Deputy Johnny Mythen asked the Minister for Health the projected retirement figures for mental health staff in each of the years 2020 to 2025; if the posts will be refilled; and if he will make a statement on the matter. [18870/20]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
1038. Deputy John McGuinness asked the Minister for Health further to Parliamentary Questions Nos. 709 and 726 of 7 July 2020 and the replies of the HSE, if he will request the chairperson of the disabled drivers medical board of appeal to provide the information requested; the reason an official (details supplied) was not informed that the decision of 2016 to issue a primary medical certificate in the case may have been overturned; the status of the 2016 primary medical certificate which issued on the basis of the person being permanently disabled; and the reason for the poor communications on the issue and the lack of information provided in the reply to the parliamentary question. [18875/20]
Amharc ar fhreagraThe Minister for Finance has responsibility for the Disabled Drivers and Passengers (Tax Concessions) Scheme which is operated by the Revenue Commissioners. To qualify for the Scheme, an applicant must be in possession of a Primary Medical Certificate.
The extent of the involvement of Health Service Executive (HSE) personnel in the Scheme relates to making a professional clinical determination as to whether an individual applicant meets the specified medical criteria. This determination is undertaken by Senior Medical Officers for the relevant HSE Community Health Organisation, on behalf of the Department of Finance and the Revenue Commissioners. As the Scheme is a Tax Concessions scheme, these HSE personnel have no role in setting or amending the eligibility criteria, which is the responsibility of the Minister for Finance.
As the matter of assessment by a HSE Senior Medical Officer is a service matter, I have arranged for the Deputy's question to the HSE for investigation and direct reply to the Deputy.
With regard to the Deputy's question concerning the Disabled Drivers Medical Board of Appeal, an unsuccessful applicant can appeal the HSE's Senior Medical Officer's decision to the Disabled Drivers Medical Board of Appeal, which is under the auspices of the Minister for Finance. This Appeal Board makes a new clinical determination in respect of the application and is independent in the exercise of its functions. After six months, an individual may reapply if there is a deterioration in their condition. I suggest that the Deputy refer his question regarding the Appeal Board to the Minister for Finance.
1039. Deputy Chris Andrews asked the Minister for Health if a person (details supplied) will be given an urgent date for two vital surgeries to be performed in view of the fact the person has been over a year on the waiting list. [18882/20]
Amharc ar fhreagraIn response to the Covid-19 pandemic the HSE had to take measures to pause most elective scheduled care activity with effect from the end March 2020. 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 National Public Health Emergency Team (NPHET) and in accordance with World Health Organisation guidelines, and the National Action Plan.
To ensure services are re-introduced in a safe, clinically-aligned and prioritised way, the HSE launched its Strategic Framework for ‘Service Continuity in a Covid Environment’ on 24th June 2020. Its implementation will ensure service resumption is done in an integrated way. This will involve a phased approach to ensure community services are strengthened. The Framework will also consolidate new ways of working and build on international knowledge. The HSE is currently developing a Service Continuity Roadmap for the resumption of services across the health system. My Department, the HSE and the National Treatment Purchase Fund are currently working together to evaluate the impact of Covid 19 on Scheduled Care waiting lists, in order to be prepared to address pent up demand.
Under the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
The National Waiting List Management Policy is a standardised approach used by the HSE to manage scheduled care treatment for in-patient, day case and planned procedures. It sets out the processes that hospitals are to implement to manage waiting lists and was developed in 2014 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.
In relation to the particular query raised, as this is a service matter, I have asked the HSE to investigate the matter and provide you with a direct response.
1040. Deputy Mark Ward asked the Minister for Health his views on the appointment of a national director for mental health in the HSE (details supplied); when the examination will conclude; and if the new national director for mental health will report directly to the CEO of the HSE. [18884/20]
Amharc ar fhreagraI have asked the HSE to respond to the Deputy directly on this matter.
1042. Deputy Neasa Hourigan asked the Minister for Health if it is safe for blind persons to use a sighted guide in view of Covid-19 health restrictions; his plans to issue guidance on same; and if he will make a statement on the matter. [18889/20]
Amharc ar fhreagraI would like to assure the Deputy that my Department is extremely cognisant of the impact which the emergence of Covid-19 has had on all members of the community, including those with physical disabilities. I note the concerns that have been raised in particular with regard to the public health guidance on social distancing and the challenge this presents for those who are blind or visually impaired.
As we continue to reopen the country safely, every step is being guided by our developing understanding of the disease and the related public health advice.
As I am sure the Deputy can appreciate, the evidence relating to the SARS-CoV-2 virus is constantly evolving. Public health advice relating to Covid-19 is kept under continuous review by the National Public Health Emergency Team (NPHET) and is published by my Department and available at www.gov.ie/en/organisation/department-of-health, by the HSE available at www.hse.ie and by the Health Protection Surveillance Centre (HPSC), published at www.hpsc.ie/.
In recognition of the potential for Covid-19 to impact disproportionately on some members of the community, a Vulnerable Peoples Subgroup of the NPHET has also been established and it includes among its membership the Disability Federation of Ireland, so as to ensure the collective voice of the disability sector is appropriately represented.
To recall, the public health advice which applies to all of us is to:
- wash your hands frequently with soap and water or use an alcohol-based hand rub if your hands are not visibly dirty
- practice good respiratory hygiene, that is, when coughing and sneezing, cover your mouth and nose with flexed elbow or tissue – discard tissue immediately into a closed bin and clean your hands with alcohol-based hand rub or soap and water
- maintain physical distancing, that is, leave at least 2 metres (6 feet) distance between yourself and other people, particularly those who are coughing, sneezing and have a fever
- avoid touching your eyes, nose and mouth – if you touch your eyes, nose or mouth with your contaminated hands, you can transfer the virus from the surface to yourself.
The most important action we can take to protect ourselves from Covid-19 is regular hand washing and good respiratory hygiene.
Furthermore, any individuals providing assistance to blind persons should be aware of the public health guidance, and should not provide guidance if they themselves are unwell or have been in recent contact with a case of Covid-19, and should wear face coverings if unable to maintain physical distancing.
In addition, the NPHET has provide advice relating to face coverings on an ongoing basis and advises the wearing of a non-medical face covering in a number of circumstances which include:
- when on public transport
- when in indoor public areas including retail outlets
- by people visiting the homes of those who are cocooning
- by people who are being visited in their homes by those who are cocooning
- all visitors to residential care facilities and
- in indoor work environments where it is difficult to maintain a two-metre distance.
Individual judgement or preference should be used to consider the wearing of face coverings in other environments.
Cloth face coverings are not recommended for children under the age of 13. This is because young children may not follow advice about wearing a mask correctly and avoiding touching it.
It is important to emphasise that the wearing of face coverings is an additional hygiene measure and should not take the place of good hand hygiene, respiratory etiquette and other personal protective public health measures. Face coverings should be used properly, in line with the guidance and to wash hands before putting them on and taking them off.
The latest public health advice on face coverings is available at the following links and is updated on a regular basis:
www.gov.ie/facecoverings.
https://www2.hse.ie/conditions/coronavirus/face-masks-disposable-gloves.html.
As the Deputy is aware, on Friday 10 July 2020, having consulted with the Minister for Transport, Tourism and Sport and the Minister for Justice and Equality, I signed the Health Act (Covid-19)(Face Coverings on Public Transport) Regulations 2020. The regulations provide that, from 13 July 2020, members of the public shall not, without reasonable excuse, travel by public transport without wearing a face covering.
Reasonable excuse includes where a person:
- cannot put one on, wear or remove a face covering because of any physical or mental illness, impairment or disability or without severe distress
- needs to communicate with another person who has difficulties communicating
- removes the face covering to provide emergency assistance or to provide care or assistance to a vulnerable person
- removes the face covering to avoid harm or injury, or the risk of harm or injury
- removes the face covering to take medication.
The Regulations do not apply to children under the age of 13 years.
In relation to the specific issues raised by the Deputy with regard to sighted guides, I have asked the HSE to to review existing guidance and supports to see if further guidance for blind persons is required in the context of Covid 19. I would also note that it is advisable that any individuals providing assistance to blind persons should also be aware of the public health guidance, and not attempt to provide support of this kind if they themselves are unwell or have been in recent contact with a case of Covid19, and should wear face coverings if unable to maintain physical distancing.
1043. Deputy Seán Canney asked the Minister for Health the maximum hours of home help available (details supplied); if he will consider increasing the maximum number of hours to 20 in view of the issues with Covid-19 and nursing homes; and if he will make a statement on the matter. [18898/20]
Amharc ar fhreagraAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
1044. Deputy Richard Boyd Barrett asked the Minister for Health the plans that will be put in place for the care of a person (details supplied); and if he will make a statement on the matter. [18902/20]
Amharc ar fhreagraAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
1045. Deputy Joe McHugh asked the Minister for Health if he will consider the EU cross border health directive as a vehicle in the short term for funding of amyloidosis; the time frame for the ultimate funding of amyloidosis; and if he will make a statement on the matter. [18906/20]
Amharc ar fhreagraThe HSE has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drugs schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013. The Act specifies the criteria for decisions on the reimbursement of medicines.
In line with the 2013 Act and the national framework agreed with industry, a company must submit an application to the HSE to have a new medicine added to the reimbursement list.
Reimbursement is for licenced indications which have been granted market authorisation by the European Medicines Agency or the Health Products Regulatory Authority.
HSE decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds, on the advice of the National Centre for Pharmacoeconomics (NCPE).
The NCPE conducts health technology assessments (HTAs) for the HSE and makes recommendations on reimbursement to assist HSE decisions. The NCPE uses a decision framework to systematically assess whether a drug is cost-effective as a health intervention.
I am advised by the HSE that it has received an application for the reimbursement of patisiran (Onpattro®) for the treatment of hereditary transthyretin-mediated amyloidosis (hATTR amyloidosis) in adult patients with stage 1 or stage 2 polyneuropathy.
In January 2019, a full health technology assessment was commissioned by the HSE. This assessment was completed in February 2020 with the NCPE recommending that patisiran (Onpattro®) is not considered for reimbursement unless cost-effectiveness can be improved relative to existing treatments.
The HTA report will be an important input into the decision making processes of the HSE. The HSE is currently reviewing the report received and has recently met with the applicant company to discuss this.
Once negotiations between the HSE and the applicant company are complete, this application must then be formally considered by the HSE Drugs Group. The HSE Drugs Group is the national committee which the HSE has in place to make recommendations on the pricing and reimbursement of medicines. The decision making authority in the HSE is the HSE Executive Management Team.
In general, the HSE's Treatment Abroad Scheme (TAS) does not provide access to drug therapies which are not provided (funded) by the public healthcare system in Ireland. However, I am advised by the HSE that in the case of treatments provided by the National Amyloidosis Centre at the Royal Free Hospital in London a patient can make an application to the TAS. Each application is dealt with by the HSE on an individual basis and subject to independent medical advice.
1046. Deputy Niamh Smyth asked the Minister for Health further to Parliamentary Question No. 556 of 5 March 2020, the status of the provision of home help for a person (details supplied). [18907/20]
Amharc ar fhreagraAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
1047. Deputy Mark Ward asked the Minister for Health if there is funding available for voluntary organisations that are providing a service for persons with both substance addiction and mental health issues; if so, the Department responsible for same; the process involved in submitting an application; and if he will make a statement on the matter. [18912/20]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
1048. Deputy Michael McNamara asked the Minister for Health when persons (details supplied) in County Clare will be reimbursed for prescription charges for each of the years 2017 to 2019 and to date in 2020; and if he will make a statement on the matter. [18923/20]
Amharc ar fhreagraUnder the Health (Pricing and Supply of Medical Goods) Act 2013, the HSE has statutory responsibility for the administration of the community drug schemes; therefore, the matter has been referred to the HSE for attention and direct reply to the Deputy.
1049. Deputy Sean Sherlock asked the Minister for Health if a guarantee will be given that the Covid-19 tracker application does not share the location data, IP addresses or IMEI of persons who download same. [18930/20]
Amharc ar fhreagraOne of the key objectives of the Covid Tracker app was to ensure high levels of adoption by the general public so as to protect as many people as possible from the spread of the virus. This meant that people had to have trust in the app which in turn meant that privacy needed to be central to the design, development and operation of the app. The Irish Covid Tracker app does not share location data, IP address or IMIE data from users of the app.
People do have the choice of entering general location information when using the symptom checker but this data is not linked to them as an individual. It is simply used to inform heat maps of the spread of the virus and to assist in the rapid identification of emerging clusters.
The Data Protection Impact Assessment (DPIA) was published by the HSE on 26 June 2020, along with the source code and provides transparency in relation to what data is collected and how it is processed.
All personal data that is processed by the COVID Tracker app is kept to an absolute minimum in order to preserve the privacy of users. Use of the app is voluntary and data that is provided to the health services is provided on the basis of consent and user preferences. The COVID Tracker app complies with European Commission recommendations and guidance in relation to Covid apps.
All design decisions have been assessed carefully from a data protection point of view. This led to the decision to switch from a centralised model to a more privacy preserving decentralised model during the development phase of the app. Decentralised apps do not store data centrally on HSE or Government servers. Instead, data is held on the users own smartphone.
Observations and guidance from the DPC was also sought and factored into the final design of the Covid Tracker app.
1050. Deputy Sean Sherlock asked the Minister for Health the breakdown of activity levels at a location (details supplied). [18933/20]
Amharc ar fhreagraIn response to the Covid-19 pandemic the HSE had to take measures to pause most elective scheduled care activity with effect from the end March 2020. 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 National Public Health Emergency Team (NPHET) and in accordance with World Health Organisation guidelines, and the National Action Plan.
The trajectory of the disease means there is now an opportunity for increasing the provision of non-covid care including more routine care. NPHET has since revised its recommendation on the pausing of all non-essential health services, with a recommendation that the delivery of acute care be determined by appropriate clinical and operational decision making.
Application of the essential risk mitigating steps set out in the guidance developed under the auspices of the NPHET Expert Advisory group will have operational implications, which will impact on throughput.
Where possible, hospitals are working to find innovative ways to enable service provision, which include virtual clinics for some outpatient 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: (www2.hse.ie/services/hospital-service-disruptions/hospital-service-disruptions-covid19.html).
To ensure services are re-introduced in a safe, clinically-aligned and prioritised way, the HSE launched its Strategic Framework for ‘Service Continuity in a Covid Environment’ on 24 June. Its implementation will ensure service resumption is done in an integrated way. This will involve a phased approach to ensure community services are strengthened. The Framework will also consolidate new ways of working and build on international knowledge. In addition, the HSE published 'A Safe Return to Health Services' last week, which is a Service Continuity Roadmap for the resumption of services across the health system.
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.
In relation to the particular query raised by the deputy concerning the breakdown of activity levels at Mallow General Hospital, as this is a service matter, I have asked the HSE to investigate the issue and provide you with a direct response.
1051. Deputy Robert Troy asked the Minister for Health if a consultant will be appointed for a person (details supplied) without further delay. [18937/20]
Amharc ar fhreagraAs this is a service delivery matter, I have referred the question to the HSE for direct reply to the Deputy.
1052. Deputy Alan Kelly asked the Minister for Health the reason the flu vaccine will not be provided for each person in 2020 (details supplied); and if he will make a statement on the matter. [18939/20]
Amharc ar fhreagraTo mitigate as much as possible the pressure on the health services that would result from a coincidence of the winter flu season and a resurgence of COVID-19, there will be an expanded provision of seasonal influenza vaccine this year. All of those in the at-risk groups aged from 6 months up, including healthcare workers, will be able to access the vaccination without charges. All children aged from 2 to 12 years inclusive will also have access to vaccination without charges. In previous years, only those in the at-risk groups and who also held a Medical Card were able to access vaccination without charges; those in the at-risk groups who did not hold a Medical Card received the vaccine without charge, but typically had to pay a fee to have it administered.
The expanded programme will ensure that those most vulnerable to the effects of influenza will have access to vaccination without charges. By providing vaccination to those most at-risk, and those most likely to require hospitalisation if they contract influenza, the programme will see a reduction in the number of influenza-related hospital admissions, as well as a reduction in the overall spread of influenza infections.
This approach is in line with the advice of the National Immunisation Advisory Committee, and represents a significant step forward in providing vaccination without charges. The expansion will be accompanied by a comprehensive communications campaign to encourage the greatest possible take-up.
1053. Deputy David Cullinane asked the Minister for Health the number and types of beds available in the public health system on 1 January 2020, in tabular form. [18941/20]
Amharc ar fhreagraAs this is a service matter, this has been referred to the HSE for direct response.
