Written Answers Nos. 166-177
166. Deputy Alan Kelly asked the Minister for Health the engagements he has had with the private hospital owners' association regarding access to those hospitals since he became Minister; and if he will make a statement on the matter. [33473/20]
Amharc ar fhreagraIn March, in anticipation of the projected surge in Covid-19 cases and the expected impact on the health care system, a critical part of the response was to urgently ramp up capacity for acute hospital care facilities. An important 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.
Following termination of the agreement the Government mandated the HSE to seek to agree, with the private hospitals on a new arrangement which would provide the HSE with full access to private hospital capacity in the event of a surge of Covid-19 cases and separately with ongoing agreed access, in conjunction with the National Treatment Purchase Fund, to private hospital services to address the HSE's priority needs in providing both urgent time-critical care and addressing elective care for public patients experiencing delays.
In August the HSE initiated a procurement process to secure access to additional acute services and diagnostic capacity from private providers which is required to address anticipated shortfalls over the next two years. The process is due to be completed soon, and a panel put in place, following which each hospital will run mini competitions for the services they need.
In the meantime, the Department has approved a temporary HSE arrangement for the treatment of patients in private hospitals pending the finalisation of the national procurement process. The negotiations in the event of a surge are ongoing.
In relation to the engagements I have had with the Private Hospitals Association since I became Minister, the information requested by the Deputy is provided in the attached table, which details contacts between the Department of Health and the Private Hospitals Association from 29th June 2020 to 23rd October 2020.
|
Date |
Time |
Name of DoH Staff in Contact with PHA |
Contact Type |
Name of PHA Contact |
Broad description of meeting/email/call |
|
06/07/2020 |
19:24 |
Minister's Diary email |
|
Iarla Mongey obo John Hurley |
Letter requesting meeting |
|
08/07/2020 |
15:08 |
Minister's Diary email obo Matthew O'Gorman (Private Secretary to Minister Donnelly) |
|
Iarla Mongey obo John Hurley |
Acknowledgment |
|
10/09/2020 |
16:53 |
Minister's Diary email |
|
Iarla Mongey obo John Hurley |
Request for meeting in respect of winter planning and other potential assistance |
|
11/09/2020 |
18:35 |
Minister's Diary email |
|
Iarla Mongey obo John Hurley |
Acknowledgment |
|
06/10/2020 |
09:02 |
Susan Mitchell (Advisor to Min Donnelly) |
|
Iarla Mongey |
Fowarded meeting request |
|
07/10/2020 |
13:40 |
Miriam Rooney (Private Secretary to Minister Donnelly) |
|
Iarla Mongey obo John Hurley |
Forwarded meeting request |
|
16/10/2020 |
16:52 |
Minister's Diary email obo Miriam Rooney |
|
Iarla Mongey obo John Hurley |
Acceptance of meeting request |
|
20/10/2020 |
In the am |
Denise Kelly (Minister's Diary) |
Phone Call |
Iarla Mongey |
Confirming list of attendees/ details for upcoming meeting |
|
20/10/2020 |
15:12 |
Minister's Diary email |
|
Iarla Mongey |
Provided list of attendees |
|
21/10/2020 |
15:00 - 16:00 |
Minister Donnelly, Greg Dempsey (Deputy Secretary General), David R Smith (Director) |
Meeting |
Iarla Mongey, John Hurley, Bill Maher, James O'Donoghue, Nadia Putoshilova |
Winter Initiative, Level 5 (Video Conference) |
167. Deputy Pádraig O'Sullivan asked the Minister for Health if the reimbursement of onpattro or patisiran will be included in the extra €50 million for new medicines access as committed to in Budget 2021; and if he will make a statement on the matter. [33312/20]
Amharc ar fhreagra1274. Deputy Patricia Ryan asked the Minister for Health if he will fund gene-silencing treatment for amyloidosis such as patisiran and equivalent drugs; and if he will make a statement on the matter. [32884/20]
Amharc ar fhreagraI propose to take Questions Nos. 167 and 1274 together.
The 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.
In line with the 2013 Health 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.
The additional funding of €50m provided for new medicines in Budget 2021 will allow the HSE to provide access to medicines which have been recommended by the HSE Drugs Group, on the basis of efficacy and value for money in line with the 2013 Health Act, and ultimately provide more medicines to Irish citizens.
I am advised by the HSE that it received an application in December 2018 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 HTA was commissioned by the HSE. This assessment was completed in February 2020, with the NCPE recommending that patisiran (Onpattro®) not be considered for reimbursement unless cost-effectiveness could be improved relative to existing treatments.
The HTA report with respect to patisiran (Onpattro®) was reviewed by the HSE Drugs Group, along with the outputs of commercial discussions with the applicant which took place in May 2020, and the patient group submission received during the HTA process. The HSE Drugs Group have requested patient and clinician engagement input via the Rare Diseases Technology Review Committee (RDTRC) to assist the group in making its recommendation to the HSE EMT regarding reimbursement of patisiran (Onpattro®). This medicine is currently under review with the RDTRC.
The application for patisiran (Onpattro®) remains under consideration with the HSE and is being assessed in line with the 2013 Health Act.
I am further advised by the HSE that it has received an application in August 2019 for the reimbursement of inotersen (Tegsedi®) for the treatment of stage 1 or stage 2 polyneuropathy in adult patients with hereditary transthyretin amyloidosis (hATTR).
On 26 August 2019, the HSE commissioned a rapid review with respect to this indication. Following receipt of a rapid review dossier, the NCPE advised the HSE on 7 October 2019 that a full Health Technology Assessment (HTA) was required for this medicine to assess the clinical effectiveness and cost effectiveness of inotersen compared with the current standard of care.
The HSE commissioned a full HTA on 9 October 2019 as per agreed processes. To date, the applicant has not submitted a HTA dossier to the NCPE for assessment. A completed HTA is required to progress this application, as per the formal processes governing the pricing and reimbursement of medicines.
168. Deputy Michael Moynihan asked the Minister for Health the status of waiting lists for speech and language therapy, occupational therapy and physiotherapy; and if he will make a statement on the matter. [33453/20]
Amharc ar fhreagraThe 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.
169. Deputy Alan Dillon asked the Minister for Health the status of the new pharmacy contract and new community pharmacy services; when contract negotiations will be concluded; and if he will make a statement on the matter. [33608/20]
Amharc ar fhreagraI value the important role community pharmacists play in our Irish Health Service in the delivery of holistic patient care. I fully acknowledge that community pharmacists have played a pivotal role in responding to the health needs of the public during the COVID-19 crisis.
Community pharmacists have ensured the continued availability of a professional, accessible service for the public and have successfully managed to alleviate the worries and concerns of the population around continuity of medicine supply.
There has been regular engagement with the Irish Pharmacy Union (IPU) throughout the past number of months and a significant number of contingency measures have been put in place under the Medicinal Products (Prescription and Control of Supply) Amendment Regulations, 2020, intended to relieve the pressures on community pharmacies.
Officials in my Department and the HSE initiated work early in 2020 to prepare for contractual engagement with the Irish Pharmaceutical Union. However, the disruption and reprioritisation arising from the Covid-19 pandemic has meant that this work has not progressed.
However, the HSE has established a contingency planning working group with the IPU and the Pharmaceutical Society of Ireland to support the implementation of all COVID-19 support measures. The Group’s primary role is to examine the operational and clinical challenges confronting community pharmacists during the COVID-19 emergency.
This working group also presents an opportunity to discuss the strategic direction of the profession which will be valuable in the context of any future contractual reform.
170. Deputy Johnny Guirke asked the Minister for Health the number of persons awaiting face-to-face psychology appointments prior to March 2020; the number of appointments conducted in the period March 2020 to August 2020; and if he will make a statement on the matter. [25984/20]
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.
171. Deputy Joan Collins asked the Minister for Health if NPHET or his Department has drawn up a formal written memo or advice on zero Covid-19 in view of the Taoiseach stating he is unwilling to embrace zero Covid-19 on advice from NPHET. [33308/20]
Amharc ar fhreagraSince the emergence of COVID-19, the Government has been guided at all times by the emerging scientific understanding of the virus and in particular has been in receipt of advice from the National Public Health Emergency Team (NPHET). The advice of NPHET is usually provided in the form of a letter to the Minister for Health from the Chief Medical Officer, in his role as the Chair of NPHET. This advice is subsequently published on the Government website. It has set out a consistent set of advices and recommendations that are available for inspection by all.
With regard to the Deputies question, the Government has always been clear that a “zero covid” option is not one that is available to Ireland due to a number of factors, most pertinently the border with Northern Ireland and the Common Travel Area. Our proximity to Europe and the nature of the supply chains we are part of, both as an exporter and importer of vital goods, are also relevant in any considerations here.
The clear advice from NPHET has been and continues to be that our overarching objective must be to suppress the virus to the lowest level possible and to maintain it at a low level. This is essential for protecting public health and our core priorities of education, health and social care services and shielding the most vulnerable from the disease.
172. Deputy Cormac Devlin asked the Minister for Health the number of dementia advisers to be recruited in 2021; and if he will make a statement on the matter. [33451/20]
Amharc ar fhreagraThe HSE's National Dementia Office supports the Dementia Adviser Service set up by the Alzheimer Society of Ireland in 2014 to provide a locally-based and individualised information, signposting and emotional support service to people who are concerned about their cognitive health and/or have a diagnosis of dementia and for their families and friends, at all stages of their journey, from diagnosis through to end-of-life. Budget 2020 provided for the recruitment of ten additional dementia advisers to expand the service provided by the existing eight advisers. In 2021, a further 11 dementia advisers will be recruited.
173. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he has put in place measures to address issues arising in the delivery of services in the context of Covid-19; if adequate resources remain available to address in full any issues arising having regard to the experience to date; and if he will make a statement on the matter. [33483/20]
Amharc ar fhreagraAs the Deputy will be aware, the COVID-19 pandemic has led to unprecedented interruption to normal healthcare activity.
Resuming health and social care services and building the health sector capacity and capability for the pressures of Winter 2020 and into 2021 is a priority for the Government.
The Government introduced Level 5 public health restrictive measures to enable a significant suppression of the virus to very low levels of transmission in advance of the winter months. These measures have been introduced to limit the impact on public health while protecting the three core priorities of:
1. Preventing unnecessary disruption to non-COVID health and social care services particularly given the impact on those services in the first half of 2020
2. Protecting medically and socially vulnerable people and
3. Proactively protecting against and averting significant disruption to childcare and education.
It is important to recognise that many vital services have continued throughout the pandemic, ensuring that priority care needs were addressed and the most vulnerable protected even at the height of this crisis.
The HSE published its Strategic Framework for Delivery of Service Continuity in a COVID Environment (June 2020). This ensures that services are restored in a prioritised manner and ensures a safer environment for patients and service users.
The HSE have developed a plan (‘Delivering Health Services in a COVID-19 Pandemic’). This plan includes the normal winter plan that would incorporate enhancement to services to cope with winter pressures, but also takes a more strategic approach by considering actions necessary to resume services and building capacity such that the system can deal with expected demand and pressures to the end of 2020/21.
The plan, and the associated investment required, were considered as part of the Estimates process which concluded with the Government announcing significant additional funding of over €4 billion to the HSE in Budget 2021 which is the largest health increase in the history of the State.
Following the formal notification to the HSE on its financial allocation for 2021, the HSE will produce its National Service Plan for 2021 which will set out the level the type and volume of services that it will provide for the funding allocated.
174. Deputy Claire Kerrane asked the Minister for Health the status of the commitment in the programme for Government to review and update the National Carers’ Strategy; and if he will make a statement on the matter. [25033/20]
Amharc ar fhreagraMy Department is responsible for coordinating the cross-departmental 2012 National Carers’ Strategy, which sets the strategic direction for future policies, services and supports provided by Government Departments and agencies for family carers. The Strategy contains actions to recognise, support and empower carers to manage their physical, mental and emotional health and wellbeing across four national goals.
The Programme for Government commits to reviewing and updating the National Carers' Strategy. In the coming months, my Department will undertake work to determine the best approach to the Strategy update, including through liaison with other Government Departments to identify actions that can be included in an updated Strategy. As an initial step in engaging with key stakeholders in relation to this process, my colleague Mary Butler T.D., Minister of State for Mental Health and Older People, recently held a roundtable meeting to hear directly from family carers about their experience of caring, in particular, since the onset of the Covid-19 pandemic.
Family carers provide selfless and dedicated care to their loved ones, and the Government recognises that the caring role can be challenging, particularly in the current circumstances. My Department secured €2 million in Budget 2021 for the National Carers' Strategy, which will be used to provide a more a standard package of supports to family carers in every region to enable them to continue caring with confidence. The specific measures to be introduced will be determined in the National Service Planning process through service level agreements between the HSE and relevant service providers.
175. Deputy Richard Bruton asked the Minister for Health if there is evidence that Ireland has learned to manage the medical progress of Covid-19 in vulnerable populations since spring; and the way in which it is influencing policy for managing the virus [33392/20]
Amharc ar fhreagraResilience and Recovery 2020-2021: Plan for Living with COVID-19 which was published by the Government, sets out Ireland's approach to managing and living with COVID-19 in a range of areas over the next 6 - 9 months.
The plan sets out five levels of response, each with several measures designed to help us all lower COVID-19 transmission and setting out what is permitted at that moment in time. It aims to allow society and businesses to be able to operate as normally as possible, while continuing to suppress the virus.
Prevention and suppression of the disease in the community is the critical first step to protecting vulnerable groups but specific measures also need to be in place. Keeping the number of cases of COVID-19 as low as possible in the community provides the greatest protection to those who are most vulnerable from the severest impacts of this disease. This is continues to be crucial at the present time given that we remain without effective drug therapies or vaccines with which to respond to COVID-19. As such, preventing people becoming infected is still the most effective tool available to deal with COVID-19.
The Government has already identified the high-risk conditions and places where COVID-19 spreads most easily as well as the groups of people who are most likely to be affected and are most vulnerable to the disease. We continue to ensure implementation of the existing measures and will advance additional measures to prevent spread in these high-risk areas.
We are aware that older people, particularly those who are medically compromised or frailer are at severe risk for poorer outcomes from COVID-19, and that congregated settings such as long-term residential care facilities have been severely impacted.
Earlier this year, the National Public Health Emergency Team (NPHET) recommended the establishment of an Expert Panel on Nursing Homes to examine the complex issues surrounding the management of COVID-19 among this particularly vulnerable cohort. The Report of the COVID-19 Nursing Home Expert Panel includes 86 recommendations in total, over 15 thematic areas, with associated timelines for implementation over the short, medium and long term.
I have established an oversight structure to ensure the implementation of the important recommendations contained in this Report. This encompasses the establishment of both an Implementation Oversight Team and a Reference Group. I can advise the Deputy that there is a key focus on the implementation of recommendations that require immediate action to ensure ongoing preparedness as we move into the winter months.
One of the key recommendations of the Expert Panel is the continuation of the range of enhanced supports to nursing homes including:
- Provision of staff accommodation
- Support to nursing homes through 23 HSE COVID-19 Response Teams
- Provision of PPE free of charge to nursing homes
- Provision of a suite of guidance and expert support, including clinical and infection prevention and control expertise
In line with the recommendations (1.1 and 1.2) of the Expert Panel, these enhanced supports, which were recommended by NPHET at the end of March, continue to be implemented and will remain in place for the foreseeable future.
Prevention and management of outbreaks in vulnerable populations and high-risk settings is an ongoing priority. Outbreak management in these settings is a priority for public health and is overseen by the National Outbreak Control Team who provide regular reports to NPHET.
Serial testing of nursing home staff, and certain high-risk settings and groups such as meat factories is in place to protect the vulnerable and ensure early identification and interruption of transmission in such high risk settings.
Using their experience to date of the virus, relevant Departments (e.g. the Department of Children, Equality, Disability, Integration and Youth, the Department of Housing, Local Government and Heritage and the Department of Employment Affairs and Social Protection, as well as my own Department) in collaboration with the relevant agencies continue to update plans to protect the most vulnerable so as to align with the escalation framework set out in Resilience and Recovery 2020-2021: Plan for Living with COVID-1 9.
The aim is to ensure specific measures are targeted to people living within particularly vulnerable communities, for example among the Homeless, and in Traveller and Roma communities. These measure include making available adequate public health supports to reduce risk, protect vulnerable residents and make accommodation available for those who may be required to self-isolate and lack appropriate facilities to do so. Local authorities are also continuing to work with the HSE to ensure the safety of households accessing emergency accommodation.
Extensive guidance for medically vulnerable and other vulnerable groups has been produced by the HPSC and can be found at https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/guidance/vulnerablegroupsguidance/ .
176. Deputy David Cullinane asked the Minister for Health his plans for delivering elective only hospitals; and if he will make a statement on the matter. [33612/20]
Amharc ar fhreagraThe National Development Plan stated that, “New dedicated ambulatory elective only hospital facilities will be introduced in Dublin Galway and Cork. These facilities will provide high volume, low complexity procedures on a day and outpatient basis, together with a range of ambulatory diagnostic services. The high volume of demand for such services in these major urban centres is sufficient to justify the construction of dedicated ambulatory centres.”
The Elective Hospitals Oversight Group, chaired by Professor Frank Keane, has completed a Catchment Area Analysis within Dublin, Cork and Galway, within a national capacity context, but also within the catchments defined by the proposed Regional Health Areas, aimed at selected scopes of service.
The Oversight Group is currently developing the preliminary business case including a high-level facilities spatial brief and order of magnitude costs, which details the elective clustering of appropriate activities for each of the three facilities in Dublin, Cork and Galway. This will also include an output and facility specification, based on efficient and effective service delivery. This is due to complete before year-end.
177. Deputy Holly Cairns asked the Minister for Health the position regarding the management and funding of veterinarians who certify small-scale abattoirs and its impact on the processing of animals in abattoirs. [33598/20]
Amharc ar fhreagraThe Food Safety Authority of Ireland (FSAI) is the competent authority with overall responsibility for the enforcement of food safety legislation in Ireland. Responsibility for enforcement of food legislation is managed through service contracts between the FSAI and a number of competent authorities, also known as ‘Official Agencies’. These official agencies include the HSE; Department of Agriculture, Food and the Marine; Local Authorities; and Sea-Fisheries Protection Authority.
Local Authorities (LAs), acting on behalf of the FSAI, are responsible for food law enforcement required under EU food law at certain food businesses with the controls carried out by the Local Authority Veterinary Service (LAVS).
The annual funding provided by my Department to the FSAI is inclusive of funding for the LA service contracts. While funded by my Department, the FSAI is independent in the exercise of its functions.
The FSAI and the County & City Management Association (CCMA) have been engaging for some time regarding the funding and effective delivery of the service. The current LA service contracts with the FSAI are due to expire on 30th November 2020 and the Authority has been working closely with all parties to ensure that a system of food safety controls is in place in LA supervised premises from 1st December 2020.
My Department has agreed to provide additional funding, on a once-off basis in 2021, to the FSAI in respect of the LAVS service contracts for 2021, which in turn is being made available to the LAs by the FSAI. This is in recognition of the need to provide more stability to the food business sector that might be impacted. The additional funding is subject to a number of conditions relating to the development of a new model of service delivery and related service matters.
On 28th October 2020, the CCMA responded to the FSAI’s offer of additional funding confirming that the LAs are prepared to extend the current service contracts until 31st December 2021 in accordance with the terms offered by the FSAI. This arrangement will ensure continuity of current agreements with no impact on abattoirs or food businesses while a new service contract model is being developed.
