Written Answers Nos. 288-307
288. Deputy Pádraig O'Sullivan asked the Minister for Health the disability day services that have not reopened since Covid-19; when it is planned to open services fully; and if he will make a statement on the matter. [43650/20]
Amharc ar fhreagraAll day service locations with the exception of those being utilised as COVID-19 Isolation or testing centres have reopened since August.
There are currently 7 day service locations nationally that are being used for COVID-19 isolation or testing centres: one in CHO1; two in CHO2; one in CHO3 and three in CHO9.
Service users that usually received their supports from these locations are now either receiving supports at another location or receiving outreach or home-based supports. A further location will resume as a day service location in the coming weeks as an alternative COVID-19 test facility has been procured.
Day services re-opened at 39% capacity throughout August and early September. For the duration of the COVID-19 emergency day service capacity is reduced, this is due to the physical limitations of the buildings available, the lack of mainstream community activities, and the continued restrictions imposed by social distancing guidance. Many people with disabilities have underlying health conditions, and as the threat of COVID-19 remains, unfortunately so too does the need for these restrictions.
In September, Minister Donnelly and I announced that €7.5 million is being made available in 2020 to increase disability day services by one day a week for 14,940 adults. I also secured funding under the Budget to maintain this increase in 2021.
The funding will be used to augment staffing levels so that adults that currently live at home with their families will receive an average of an additional day of service at a day service location over and above what they have been receiving since day services resumed in August. Chief Officers were asked to immediately progress plans with the service provider sector to expedite the recruitment of the staff in this regard.
289. Deputy Pádraig O'Sullivan asked the Minister for Health if the HSE will engage with companies to negotiate a suitable price for the drug dupilumab for the treatment of severe atopic eczema; and if he will make a statement on the matter. [43651/20]
Amharc ar fhreagra298. Deputy Emer Higgins asked the Minister for Health if he will work with the HSE to secure equitable access to dupilumab for atopic eczema patients; and if he will make a statement on the matter. [43716/20]
Amharc ar fhreagra333. Deputy Cian O'Callaghan asked the Minister for Health when the drug dupilumab will become widely available for persons with atopic eczema; and if he will make a statement on the matter. [43911/20]
Amharc ar fhreagraI propose to take Questions Nos. 289, 298 and 333 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 HSE has advised that it has received pricing and reimbursement applications for two indications of Dupilumab (Dupixent®):
- For the treatment of moderate-to-severe atopic dermatitis in adult patients who are candidates for systemic therapy.
- For the treatment of moderate-to-severe atopic dermatitis in adolescents 12 years and older who are candidates for systemic therapy.
The HSE received an application for pricing/reimbursement of Dupilumab in November 2017 from the manufacturer for the treatment of moderate-to-severe atopic dermatitis in adult patients who are candidates for systemic therapy. The HSE commissioned a full HTA on 29 November 2017 as per agreed processes. This assessment was completed on 12 December 2019 with the NCPE recommending that Dupilumab be considered for reimbursement if cost-effectiveness could be improved relative to existing treatments.
Subsequently, the HSE received an application for the pricing/reimbursement of Dupilumab on 13 December 2019 for the treatment of moderate-to-severe atopic dermatitis in adolescents 12 years and older who are candidates for systemic therapy.
The HSE commissioned the rapid review process on the 17 December 2019. Following receipt of a rapid review dossier, the NCPE advised the HSE on the 17 January 2020 that a HTA was not recommended and that Dupilumab not be considered for reimbursement for this indication at the submitted price.
The HSE engaged in commercial negotiations with the company in February 2020 regarding both the adult and adolescent populations.
The final HTA report concerning Dupilumab was reviewed by the HSE Drugs Group, along with the outputs of commercial negotiations, and the patient group submission received during the HTA process. The HSE Drugs Group considered all the evidence and gave a recommendation to the HSE Executive Management Team (EMT) not to support reimbursement of Dupilumab for the treatment of moderate-to-severe atopic dermatitis in both adults and adolescents 12 years and older who are candidates for systemic therapy.
The HSE has confirmed that the applicant company was issued with notice of the proposed decision of the HSE EMT not to support reimbursement on 21 August 2020. On 18 September 2020, the applicant company submitted representations with respect to this application.
The HSE reviewed these representations, as is required in such circumstances under the 2013 Act, and engaged in a meeting in November 2020 with the applicant company to discuss the submission.
The HSE has advised that the process is still ongoing and that the matter will be included on the agenda for the HSE Drugs Group’s meeting in January 2021.
The HSE Executive Management Team is the decision-making body for the reimbursement of medicines under the Health Act 2013 and will, on receipt of the outcome of the Drugs Group's deliberations, make the decision on whether Dupilumab will be reimbursed.
290. Deputy Thomas Gould asked the Minister for Health if his attention has been drawn to a situation in which persons who are required to access preoperative Covid-19 testing are forced to travel to the hospital or a sister hospital and cannot avail of this through the centralised testing system, particularly in circumstances in which this is a significant distance from their home address and in view of Crumlin children’s hospital's agreement with a private hospital to reduce the backlog. [43659/20]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
291. Deputy Seán Canney asked the Minister for Health his plans to allow yoga to recommence during Covid-19 restrictions; and if he will make a statement on the matter. [43662/20]
Amharc ar fhreagraThe Government appreciates that there are many aspects of normal life that have been altered by the emergence of COVID-19, and the response that has been required. It also recognises that these changes are difficult for many people. However, it is the case at present that many of the things which we have previously taken for granted are no longer accessible in the same way due to the risks that they pose and the ease with which this virus spreads in particular conditions.
The Government’s medium-term Strategy Resilience and Recovery 2020-2021: Plan for Living with COVID-19, sets out Ireland's approach to managing and living with COVID-19, in a range of areas, over a period of 6 – 9 months.
The Plan aims to allow society and businesses to operate as normally as possible, while protecting our key priorities of supporting and maintaining health and social care services, keeping education and childcare services open and protecting the most vulnerable members of our communities.
The Plan consists of 5 levels. Each level sets out what is permitted for social or family gatherings, work and public transport, bars, hotels and restaurants, exercise activities and religious services, at that moment in time. Each level contains a “basket” of measures which are intended, collectively, to contribute to lowering the risk of transmission of Covid-19 in alignment with the risk level at that time. The set of measures, individually, do not comprise a list of activities or places which are equally safe. Instead, they are “baskets” of measures which are informed by public health understanding of the disease. The measures in place for each level reflect the prevailing disease situation and recognise that we can and must prioritise some activities over others.
As I'm sure you can appreciate, COVID-19 spreads when individuals and groups come into close contact with one another, enabling the virus to move from one person to another. COVID-19 is infectious in a person with no symptoms, or for the period of time before they develop symptoms. The numbers of people allowed to gather in different scenarios in the Government Plan are based on a review of international practice and the judgment of public health experts. It seeks to balance the risks of different types of gatherings against the desire to allow normal activities to proceed in so far as possible.
As the Deputy is aware, Ireland is currently at level 3 of the Plan. Information in relation to the public health measures in place at all levels of the Plan, including information in relation to indoor gatherings and indoor and exercise classes and is available at:- https://www.gov.ie/en/publication/ad569-level-3/
292. Deputy Ged Nash asked the Minister for Health if he will clarify the future of Sruthan House, Dundalk, County Louth; and if he will make a statement on the matter. [43670/20]
Amharc ar fhreagraThe 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 this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
295. Deputy Michael Healy-Rae asked the Minister for Health the location in which a person (details supplied) can dispose of medical waste; and if he will make a statement on the matter. [43700/20]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
296. Deputy Pearse Doherty asked the Minister for Health the reason a person (details supplied) in County Donegal has to attend for an early-morning Covid-19 test appointment in Mayo hospital four days prior to an appointment in the hospital; the reason a Covid-19 test cannot be carried out in County Donegal; and if he will make a statement on the matter. [43710/20]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
297. Deputy Emer Higgins asked the Minister for Health if he will consider granting a nominal retention bonus to nurses, midwives and healthcare workers who have worked throughout Covid-19; and if he will make a statement on the matter. [43715/20]
Amharc ar fhreagraBoth I and my Department recognise that our dedicated health care workers play a key role in our national effort against Covid-19. Their determination and commitment to assisting our sick and vulnerable to get the medical treatment they need, has and continues to be, very much appreciated.
Others across the public and private sectors also deserve to be commended for their efforts in combatting the pandemic. Negotiations are currently underway regarding a successor agreement to the Public Service Stability Agreement 2018-2020. It should be noted that the pursuit of cost increasing pay claims are specifically excluded under the terms of the PSSA. This means that any bonus including additional pay is not permitted under the PSSA.
299. Deputy Neale Richmond asked the Minister for Health if he will increase the number of medical interns in 2020 in response to Covid-19 and to encourage more graduates to stay in Ireland to train as doctors; and if he will make a statement on the matter. [43723/20]
Amharc ar fhreagraAt the beginning of the COVID-19 crisis, there was an urgent need to expand the healthcare workforce. This was done through a variety of measures, including the increase of the number of medical interns. 734 medical intern posts are traditionally available in Ireland each year. Due to the exceptional circumstances arising from the COVID-19 pandemic, 992 medical intern places were made available for the 2020/2021 intake. Through the Winter Plan and National Service Plan for 2021, there is a comprehensive resourcing strategy to permanently expand the health service workforce by 15,838 whole-time equivalents. There is a variety of recruitment strategies and campaigns planned. Currently, it is not envisioned that additional medical interns will be required, but this option remains open to the Health Service Executive should they require it. Naturally I would encourage more medical graduates to stay in Ireland, and to continue their training here. The significant increase in intern numbers put in place in 2020 was a direct response to the COVID-19 crisis. For July 2021, it is considered likely that there will be available a sufficient number of Basic Specialist Training (BST) posts to accommodate the additional doctors (subject to their suitability), who will be completing their internships in that month, and who will wish to apply directly to a BST programme. I hope that these doctors will stay and train in Ireland, and contribute to the forthcoming exciting opportunities in the Irish health system, as it develops in line with the Sláintecare reform programme.
301. Deputy Robert Troy asked the Minister for Health if a dental examination can be scheduled for a person (details supplied) in County Westmeath. [43743/20]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
302. Deputy Neale Richmond asked the Minister for Health the plans in place to decrease the time between EMA approval and reimbursement of new treatments to promote earlier access in Ireland with the latest innovations in care; and if he will make a statement on the matter. [43747/20]
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 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 (the NCPE). They use a decision framework to systematically assess whether a drug is cost-effective as a health intervention.
As outlined in the IPHA agreement, and in line with the 2013 Act, the HSE will decide, within 180 days of receiving an application (or a longer period if further information is sought from the company), to either add the medicine to the reimbursement list or agree to reimburse it as a hospital medicine, or refuse to reimburse the medicine.
The HSE strives to reach a decision in as timely a manner as possible. However, because of the significant monies involved, it must ensure that the best price is achieved, as these commitments are often multi-million euro investments on an ongoing basis. This can lead to a protracted deliberation process.
When there is a proposed decision by the HSE not to support reimbursement of a medicine, there is an extension in this timeline. This is due to the requirement of the HSE to issue a “notice of proposal”, and to allow 28 days for manufacturers to make representations to reconsider their decision. The HSE must then consider those representations and make a formal decision.
The Government wants new and innovative medicines to be available to our citizens as quickly as possible, but this can only be achieved if medicines are priced by the pharmaceutical industry in a viable and sustainable manner.
Ireland has been engaging over the past number of years with a number of voluntary EU forums. In June 2018, Ireland joined the Beneluxa Initiative on Pharmaceutical Policy. This Agreement is in line with the objective of working with other European countries to identify workable solutions, in an increasingly challenging environment, to secure timely access for patients to new medicines in an affordable and sustainable way. In June 2019, Ireland became a Founding Member of the International Horizon Scanning Initiative which is being established as part of the work programme of Beneluxa.
As the Deputy will be aware, additional funding of €50m was provided for new medicines in Budget 2021. This funding will allow the HSE Executive Management Team to approve new and innovative 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.
305. Deputy Michael Ring asked the Minister for Health if an application for a medical card by a person (details supplied) can be processed in view of the fact that the person has submitted all of the requested information; and if he will make a statement on the matter. [43758/20]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
307. Deputy Kathleen Funchion asked the Minister for Health if he will intervene in the case of a person (details supplied). [43761/20]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
