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Wednesday, 21 Oct 2020

Written Answers Nos. 242-261

Covid-19 Pandemic

Ceisteanna (242)

Róisín Shortall

Ceist:

242. Deputy Róisín Shortall asked the Minister for Health further to Parliamentary Question Nos. 459 of 15 September 2020, 133 of 7 October 2020 and 174 of 14 October 2020, if his Department will provide a sample showing the exact format of the medical certificate required to certify that a secondary school student falls into one of the categories for a face covering exemption; if a copy of this sample medical certificate will appear on his Department’s website; if he will provide a link to same; and if he will make a statement on the matter. [31926/20]

Amharc ar fhreagra

Freagraí scríofa

As the Deputy is aware, the Resilience and Recovery 2020-2021: Plan for Living with COVID-19 was published by the Government on 15 September, 2020. This Plan provides a framework setting out Ireland's approach to managing and living with COVID-19 in a range of areas over the next 6 - 9 months.

The Deputy may wish to note that there is ongoing and close consideration being given by Government to the policy in relation to schools. The Plan acknowledges the key role of schools in supporting not just the academic progress of our children and young people, but their overall physical and mental health and wellbeing. Ensuring that schools can remain safely open in the context of the escalation of restrictive measures remains a Government priority. 

The Deputy should note that the wearing of face coverings in schools is a matter for the Minister for the Department of Education and Skills. 

I understand that the Department of Education and Skills has published clarification on the use of face coverings for schools. As previously indicated to the Deputy by my colleague the Minister for Education and Skills, a medical certificate can take a written format once it is a certified by an appropriate medical authority, such as a G.P.  

Up-to-date Government advice and resources for schools, parents and students in the context of COVID-19 is published at https://www.gov.ie/backtoschool.

Alcohol Treatment Services

Ceisteanna (243)

Marian Harkin

Ceist:

243. Deputy Marian Harkin asked the Minister for Health when funding will be made available to support the delivery of community action on alcohol from the additional funding announced in Budget 2021; and if he will make a statement on the matter. [31927/20]

Amharc ar fhreagra

Freagraí scríofa

The national drugs, strategy, Reducing Harm Supporting Recovery, provides an integrated public health approach to drugs and alcohol use.

The Department is developing a new education and prevention funding scheme which will be launched towards the end 2020. This scheme will include the use of evidence-based approaches to mobilising community action on alcohol.

I want to strengthen the delivery of substance use education across all sectors in order to prevent the use of drugs and alcohol at a young age and to increase awareness of the risks of drug and alcohol use.  

Medical Cards

Ceisteanna (244)

John Lahart

Ceist:

244. Deputy John Lahart asked the Minister for Health when the threshold for medical cards will be raised as committed to in budget 2020 in order that persons can apply for same [31942/20]

Amharc ar fhreagra

Freagraí scríofa

The Health (General Practitioner Service and Alteration of Criteria for Eligibility) Bill 2020, enacted on 2nd August 2020, provided for an increase to the gross medical card income limits for those aged 70 and over to €550 per week for a single person and to €1,050 per week for a couple.

The Government has recently approved the necessary funding required to implement this measure and the new increased income limits will take effect from November 1st  2020.  

Officials in the Department of Health are therefore now making the necessary arrangements to commence the relevant section of the Act and are engaging with the HSE's National Medical Card unit to ensure all operational arrangements are in place for implementation of this measure.

Hospital Appointments Status

Ceisteanna (245)

Seán Sherlock

Ceist:

245. Deputy Sean Sherlock asked the Minister for Health if an appointment already in place for a person (details supplied) in County Cork will be brought forward in view of the urgency of their case [31966/20]

Amharc ar fhreagra

Freagraí scríofa

It is recognised that waiting times for scheduled appointments and procedures have been impacted as a direct result of the COVID-19 pandemic.

In response to the Covid-19 pandemic the HSE had to take measures to defer most scheduled care activity in March, April, and May of this year. 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 National Public Health Emergency Team (NPHET) in accordance with the advice of the World Health Organisation.

The resumption of services from June onwards has allowed for increased activity, with the HSE utilising innovative methods including telemedicine to facilitate patient appointments. Patient safety remains at the forefront of service resumption. To ensure services are re-introduced in a safe, clinically-aligned and prioritised way, hospitals are following HSE clinical guidelines and protocols which has resulted in reduced capacity and activity.

The HSE continues to optimise productivity through alternative work practices such the use of alternative settings including private hospitals, community facilities and alternative outpatient settings.

The National Treatment Purchase Fund has also recommenced arranging treatment in both private and public hospitals for clinically suitable patients who have been waiting for long periods on public hospital waiting lists.

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 Health Service Executive to respond to the Deputy directly, as soon as possible.

Disability Services Data

Ceisteanna (246, 247, 248)

Sorca Clarke

Ceist:

246. Deputy Sorca Clarke asked the Minister for Health the rate of pay for personal assistants in each CHO area who work with disabled persons to ensure they live independent lives [31971/20]

Amharc ar fhreagra

Sorca Clarke

Ceist:

247. Deputy Sorca Clarke asked the Minister for Health if there is a standard hourly rate paid to agencies that employ personal assistants to work with disabled persons to ensure they live independent lives [31972/20]

Amharc ar fhreagra

Sorca Clarke

Ceist:

248. Deputy Sorca Clarke asked the Minister for Health his plans to introduce a standardised rate of pay for all personal assistants employed to work with disabled persons in assisting them live independent lives. [31973/20]

Amharc ar fhreagra

Freagraí scríofa

I propose to take Questions Nos. 246 to 248, inclusive, together.

Much of the Personal Assistant (PA) service is delivered by Private Providers or Voluntary Service Providers funded under Section 39 of the Health Act. The rates these Providers pay their staff are not aligned to public pay scales; rather they relate to historical/legacy pay rates that the Providers have agreed with their staff. It is not within the remit of the Department of Health or Health Service Executive (HSE) to determine these pay rates.

The remainder of the PA service is provided by the HSE and under Section 38 of the Health Act. As this is a service matter, I have asked the HSE to respond to the deputy directly, as soon as possible.

Medicinal Products

Ceisteanna (249)

Marc MacSharry

Ceist:

249. Deputy Marc MacSharry asked the Minister for Health if his Department has set targets for increasing the use of generics medicine within the medicines market here; if so, the targets; the extent to which Ireland compares to other EU countries in the use of generic medicines; the estimated extra saving envisaged in 2021 by increased use of generics medicines; and if he will make a statement on the matter. [31975/20]

Amharc ar fhreagra

Freagraí scríofa

As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.

Medicinal Products

Ceisteanna (250)

Marc MacSharry

Ceist:

250. Deputy Marc MacSharry asked the Minister for Health if his Department has set targets for increasing the use of biosimilars medicine within the medicines market here; if so, the targets; the extent to which Ireland compares to other EU countries in the use of biosimilar medicines; the estimated extra saving envisaged in 2021 by the increased use; and if he will make a statement on the matter. [31976/20]

Amharc ar fhreagra

Freagraí scríofa

As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.

Medicinal Products

Ceisteanna (251)

Marc MacSharry

Ceist:

251. Deputy Marc MacSharry asked the Minister for Health if he has reviewed the proposals from a group within a report (details supplied) which suggest that if implemented, there could be savings of up to a further €1 billion over the next five years in reducing the cost of medicines here; his engagement on the matter; his views on the cost of medicines here; and if he will make a statement on the matter. [31977/20]

Amharc ar fhreagra

Freagraí scríofa

The report mentioned has not been brought to my attention or to the attention of my officials in the Department. However, the matters raised are important objectives within the Department. Securing affordable access to existing and new medicines in a timely manner is a key objective of the Irish Health Service. However, the challenge is delivering on this objective in an affordable and sustainable way. Expenditure on medicines represents one of the largest areas of expenditure across the health service and will continue to grow in the years ahead.

The Department of Health is fully supportive of domestic policies that maximise efficiency in our medicines usage. The HSE is actively engaged in implementing effective policy levers across a number of domains and under several initiatives, including those under the Acute Hospitals Drugs Management Programme (AHDMP), the Medicines Management Programme (MMP), and within the Primary Care Eligibility & Reimbursement Service (PCERS).

Foe example, in relation to biosimilar medicines, the AHDMP has a biosimilar strategy in place since 2017. This is making considerable progress using a collaborative approach to bring about changes in prescribing practice.  

The MMP completed an evaluation process in 2019 for the identification of the best-value biological (BVB) medicines for TNF- inhibitors under the High-Tech Drug arrangements. In June 2019, a system of gain-share was introduced and is administered by the PCERS with the objective of encouraging the prescribing of the BVB medicines. This has been largely successful in increasing uptake of these medicines.

While progress has been positive, the Department of Health and HSE are continuously monitoring and evaluating the effectiveness of current levers to ensure that the State can capitalise on the most efficient policy approach.

Disability Services Provision

Ceisteanna (252)

Jennifer Carroll MacNeill

Ceist:

252. Deputy Jennifer Carroll MacNeill asked the Minister for Health when a person (details supplied) will receive a residential placement considering that they are already on the HSE’s list for emergency residential care; and if he will make a statement on the matter. [31979/20]

Amharc ar fhreagra

Freagraí scríofa

The Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives.

As the Deputy's question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy, as soon as possible. 

Vaccination Programme

Ceisteanna (253)

Michael Healy-Rae

Ceist:

253. Deputy Michael Healy-Rae asked the Minister for Health the reason for the delay with the distribution of the flu vaccine (details supplied); and if he will make a statement on the matter. [31998/20]

Amharc ar fhreagra

Freagraí scríofa

The Government is expanding the provision of vaccination without charge to all of those in the at-risk groups, including healthcare workers, and to all children aged from 2 to 12 years.  Vaccines will be administered via GPs and pharmacists, as in previous years.

The HSE has placed orders for 1.35 million doses of the Quadrivalent Influenza Vaccine (QIV) for the forthcoming winter.  Following a delay in the delivery of the first batch of vaccines, the first deliveries of the QIV influenza vaccines to all sites (GPs, pharmacists, nursing homes etc.) started on 17th September.

By the end of the second cycle of deliveries, in the week ending 9 October, approximately 800,000 doses of influenza vaccine were delivered to over 3,000 sites across the country. This represents an increase of 25% in quantities of vaccine delivered when compared with 2019. To date all sites have received 75% of the quantity used last season, and the allowance for the third delivery which began from 15th October will increase this to 90%. Further stocks will be available for the fourth round of deliveries.

It had been intended to commence and complete deliveries earlier, but delays on the part of the manufacturer resulted in a longer than intended delivery schedule. However, the HSE is satisfied that sufficient vaccine has been ordered to vaccinate all those in the HSE defined at-risk groups and all shipments will have arrived into Ireland before the end of October. The current distribution process to GP, pharmacists, hospitals and nursing homes will ensure an equitable distribution of the vaccine to all target groups for vaccination around the country. 

Deliveries of the children’s flu vaccine started on the 28th of September, and all of the total order of 600,000 doses is expected by mid-October, as planned.

Those not covered by the publicly funded influenza vaccination programme can avail of influenza vaccination from GPs and pharmacists on a private basis. 

Hospital Data

Ceisteanna (254)

Cormac Devlin

Ceist:

254. Deputy Cormac Devlin asked the Minister for Health the number of ICU units by public hospital in tabular form; the details of ICU surge capacity available; and if he will make a statement on the matter. [32031/20]

Amharc ar fhreagra

Freagraí scríofa

At the start of the year, permanent adult critical care capacity in Ireland stood at 255 beds, according to the National Office of Clinical Audit. This included 204 Level 3 ICU beds and 51 Level 2 HDU beds.  As part of the initial response to the pandemic, funding was provided for an additional 40 adult critical care beds in March 2020 as well as two paediatric beds. The HSE has advised that between 280 and 285 critical care beds are currently open, with the number open any given day subject to fluctuation in respect of available staff and other operational considerations.

Where necessary, the number of critical care beds can surge beyond the baseline of 280-285 as part of an emergency response. However, it is essential to understand that the use of surge capacity for critical care is necessarily tied to a reduction of services in other areas of the hospital. Moreover, the clinical advice is clear that the greater the reliance on surge ICU capacity, the greater the clinical risk with potential impact on patient outcomes.

Our critical care units have coped well so far, largely due to the fact that the curve was flattened successfully in early stages. As a result, our outcomes for Covid patients in ICU have compared well with other jurisdictions including the UK.

Budget 2021 will allocate funding totalling €52m in 2021 to critical care. This will retain, on a permanent basis, the 42 critical care beds put in place on a temporary basis this year and add significant new capacity. Funded adult critical care beds will increase to 321 by end 2021, an increase of 66 over the baseline number of 255 funded beds in 2020. Funding for 2021 will also include money to allow for the development of a workforce plan as well as education initiatives to grow the critical care workforce.

In relation to the specific information requested by the Deputy, I have asked the HSE to respond directly to him.

Hospital Data

Ceisteanna (255)

Cormac Devlin

Ceist:

255. Deputy Cormac Devlin asked the Minister for Health the number of ICU units by private hospital in tabular form; the details of ICU surge capacity that was available during the HSE private hospital contract period; and if he will make a statement on the matter. [32032/20]

Amharc ar fhreagra

Freagraí scríofa

In anticipation of the projected surge in Covid-19 cases and the expected impact on the health care system a major part of the response 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 acute hospital services for the duration of the emergency. Following negotiations with the Private Hospitals Association an overarching agreement with the 18 private acute hospitals was agreed at the end of March. Under the agreement, the HSE secured 100% of the capacity of the private hospitals until the end of June.

The utilisation rate of critical care beds in private hospitals varied throughout the three month period in which the agreement was in place. The HSE has advised the Department that in the last week of April 53% of critical care beds in private hospitals were in use, while in the last week of June 48% of critical care beds were in use.

In terms of wider critical care capacity, as part of work undertaken earlier this year to determine the capacity of the private hospital system, it was estimated that there were 47 ICU beds and 54 High Dependency Unit beds within the private hospital system.

Covid-19 Tests

Ceisteanna (256)

Brendan Smith

Ceist:

256. Deputy Brendan Smith asked the Minister for Health if provision is made to prioritise Covid-19 testing for healthcare workers and their immediate family members in circumstances in which it is deemed necessary; and if he will make a statement on the matter. [32037/20]

Amharc ar fhreagra

Freagraí scríofa

Testing and contact tracing continues to be a key component of the Government’s and the country’s response to the pandemic and the HSE will continue to apply the necessary resources to ensure that our response remains effective.

The HSE is now finalising the future service model for testing and contact tracing. This model will aim to deliver a patient-centred, accessible, consistent, flexible service, with a permanent dedicated workforce. 

In terms of healthcare workers, at present only serial testing of healthcare workers in Residential Care Facilities for Older Persons is ongoing. However, it should be noted that very few other countries have carried out such mass testing in Long Term Residential Care facilities. 

The NPHET will continue as part of a constant process of evaluation to consider and review, based on public health risk assessments, how best to target testing to hunt the virus in populations where it’s most likely and where it will do most harm, and potentially what groups could be prioritised.

Home Care Packages

Ceisteanna (257)

Bernard Durkan

Ceist:

257. Deputy Bernard J. Durkan asked the Minister for Health when a hospital bed including accessories can be provided for homecare in the case of a person (details supplied); and if he will make a statement on the matter. [32054/20]

Amharc ar fhreagra

Freagraí scríofa

As this is an operational matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.

Covid-19 Pandemic

Ceisteanna (258)

Gary Gannon

Ceist:

258. Deputy Gary Gannon asked the Minister for Health his views on human connection and if it is a basic human need; and if so, the way that this affects individuals living alone. [32072/20]

Amharc ar fhreagra

Freagraí scríofa

The COVID-19 pandemic and our response to it has demanded huge sacrifices across all of society, and very noticeably in the area of human interaction and connectedness.  The importance of human connection is emphasised in a recent report, “Loneliness and social isolation in the COVID-19 Pandemic among the over 70s: Data from The Irish Longitudinal Study on Ageing (TILDA) and ALONE”.  This report, launched in July 2020, highlights that measures to reduce the spread of COVID-19, such as social distancing, self-isolating and cocooning among the over 70s, have disrupted familiar routines and social interactions, across multiple groups including among older adults.  Positive social relationships and interactions are important to personal wellbeing at all ages, and can act as protective factors against emotional distress, cognitive decline, and physical disability.  Conversely, feelings of loneliness and social isolation can be harmful to our wellbeing.

A change in the way we live our lives on such a scale as this has demanded a whole of government response, and I would like to highlight some of the initiatives and supports that have been put in place across departments.   Key interventions include funding for the senior alert scheme delivered by Pobal, which enables older people to live securely in their homes through the provision of personal monitored alarms. The Department of Community and Rural Development and the Islands as part of its Covid-19 action plan has increased supports to older people through a partnership with Alone for a crisis telephone support line and follow-on support for those needing it. A new befriending phone call initiative will support participants in the senior alert scheme, which is operated in conjunction with Pobal and Alone.

As part of the government response to the COVID-19 crisis, local authorities have established a COVID-19 Community Call Forum. This local forum works with State agencies including the HSE and community and voluntary groups to provide supports or services to any vulnerable person who needs them.  The forum brings together different organisations to provide important services like collection and delivery of essential items like food, ‘meals-on-wheels’, household items, fuel or medicine (in line with guidance), and support for those experiencing social isolation or who are medically vulnerable.

The most recent restrictions put in place will no doubt be challenging for all of us, but particularly those living alone.  With this in mind, the measures include a 'social bubble' to support those who risk isolation for the duration of Level 5.

People in certain categories can form a support bubble with one other household, ideally in the same locality but it can be outside the 5 kilometre limit.  Those who can form a support bubble include: those alone with children under the age of 18, those living alone and with mental health challenges, those sharing parenting or custody arrangements, those living with a partner who has dementia and needs full-time care, and those who live alone and have a carer or carers who supports them.

If the Deputy wishes to clarify any aspect of this issue, he is welcome to contact me separately, and I will be happy to follow up his concerns, as appropriate.

Disability Services Provision

Ceisteanna (259)

Robert Troy

Ceist:

259. Deputy Robert Troy asked the Minister for Health when early intervention services will resume for children with Down's syndrome (details supplied) [32076/20]

Amharc ar fhreagra

Freagraí scríofa

The Programme for Government,  Our Shared Future,  recognises the need to improve services for both children and adults with disabilities through better implementation and by working together across Government in a better way. 

The Government commits to prioritising early diagnosis and access to services for children and ensuring that the most effective interventions are provided for each child, to guarantee the best outcomes.

As this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.

Fishing Industry

Ceisteanna (260)

Michael Healy-Rae

Ceist:

260. Deputy Michael Healy-Rae asked the Minister for Agriculture, Food and the Marine if he will address a matter (details supplied); and if he will make a statement on the matter. [31849/20]

Amharc ar fhreagra

Freagraí scríofa

In December 2018, following a public consultation process in which over 900 submissions were received, the then Minister for Agriculture, Food and Marine announced that vessels over 18m will be excluded from trawling in inshore waters inside the six nautical mile zone and the baselines from 1 January 2020.  A transition period of three years for vessels over 18m targeting sprat was allowed to enable adjustment for these vessels, as the sprat fishery is concentrated inside the six nautical mile zone.   

A Judicial Review was taken by two applicant fishermen challenging the validity of the Policy. An unapproved judgement was issued on 31 July 2020 and the key points to come out of that Judgement is that while the applicants did not succeed on four of the five grounds of challenge, the challenge was made against the entire Policy Directive and was successful.

 The findings on the grounds of challenge were: 

1. The Policy Directive 1 of 2019, which gave legal effect to the policy, was not ultra vires,

2. The Directive did not impinge the applicants' constitutional rights.

3. Given the impact on the applicants there was a particular duty on the Minister to provide a fuller explanation and engage in further talks with the applicants. On this ground the applicants succeeded.

4. The policy directive was not disproportionate to what was to be achieved.

5. The Policy directive did not breach EU law. 

On 6th October 2020, the Judge held in summary that the Court’s final order should be, inter alia, a declaration that Policy Directive 1 of 2019 was made in breach of fair procedures and is void and/or of no legal effect.

I am currently considering, on an urgent basis, the implications of the judgment in consultation with my Department officials and legal advisors

Young Farmers Scheme

Ceisteanna (261)

Richard O'Donoghue

Ceist:

261. Deputy Richard O'Donoghue asked the Minister for Agriculture, Food and the Marine the persons eligible for the young farmers scheme in 2020; the percentage variance from 2019 to 2020; and if he will make a statement on the matter. [31852/20]

Amharc ar fhreagra

Freagraí scríofa

To-date some 7,700 applications have been received under the 2020 Young Farmers Scheme.  These applications are currently being processed by my Department and payments under the scheme are scheduled to commence in early December 2020. The number of eligible applicants under the scheme in 2020 and the percentage variance from 2019 to 2020 will not be available until the required administrative and on-farm checks have been completed on all 2020 applications.

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