Written Answers Nos. 347-366
347. Deputy John Lahart asked the Minister for Health the number of delayed discharges in each public and voluntary hospital at the end of December 2020; and the total number in 2020 for each public or voluntary hospital in tabular form. [3059/21]
Amharc ar fhreagra348. Deputy John Lahart asked the Minister for Health the number of bed days lost in each public and voluntary hospital owing to delayed discharges in 2020, in tabular form. [3060/21]
Amharc ar fhreagraI propose to take Questions Nos. 347 and 348 together.
A delayed transfer of care occurs when a patient has been deemed clinically fit for discharge from an acute bed but their discharge is delayed because they are waiting for some form of ongoing support or care following their discharge. There are many reasons for this, such as a patient undertaking the application process for NHSS, awaiting assessment for a home support package, homelessness, ward of court application, and the availability of other health care or social care resources.
With regard to the Deputy's specific questions on the numbers of patients with delayed transfers of care and the associated numbers of bed days lost, in each public and voluntary hospital, I have asked the HSE to respond directly with the requested information.
349. Deputy John Lahart asked the Minister for Health the percentage of clinical status 1 ECHO incidents responded to by first responder in seven minutes and 59 seconds or less; the percentage of clinical status 1 DELTA incidents responded to by a patient-carrying vehicle in seven minutes and 59 seconds or less for each ambulance station in each month in the year to the end of December 2020 or the latest date available in tabular form. [3061/21]
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.
350. Deputy John Lahart asked the Minister for Health the number of patients aged 75 years or over who experienced an emergency department wait time of more than 24 hours during December 2020; the total number in 2020; and the hospitals in which the wait occurred. [3062/21]
Amharc ar fhreagraThere are a number of factors which may affect the waiting times for older patients. In particular, people in the over-75 age category presenting to EDs are more likely to have complex needs and require admission to hospital than the population generally. Nevertheless, the National Service Plan 2020 includes an expected activity target that 99% of patients aged 75 and over attending at an Emergency Department be discharged or admitted within 24 hours and any breach of this target in respect of patients in this age cohort is unacceptable.
This winter is expected to be particularly challenging due to the presence of Covid-19 and the uncertainty around the level of Covid-19 and non-Covid-19 healthcare demands. The HSE Winter Plan, supported by an additional €600m invested in health services, aims to reduce the number of patients waiting on trolleys for hospital admission and reduce Emergency Department waiting times while ensuring that patients and staff alike are protected in the Covid-19 environment.
There are specific supports in the Winter Plan for those at greater risk including older people, the homeless, and people with chronic illnesses, facilitated through additional Community Healthcare Networks, Community Specialist Teams, and Frailty Intervention Therapy Teams operating within acute hospital EDs. These measures will create the foundation and organisational structure through which integrated care will be provided locally within the community at the appropriate level of complexity.
With regard to the Deputy's specific question, I have asked the HSE to respond directly with the requested information.
351. Deputy John Lahart asked the Minister for Health the number of ambulance attendances at each emergency department nationwide in December 2020; the number of such ambulances that waited longer than 20 minutes to hand over patients, get their trolleys back and return to responding to calls; the number that waited longer than 40, 60, 90, 120 and more than 180 minutes for same, respectively in tabular form. [3063/21]
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.
352. Deputy John Lahart asked the Minister for Health the number of spinal fusion patients currently waiting less than four, four to eight and more than eight months, respectively in Our Lady’s Children’s Hospital, Crumlin and Temple Street Children’s University Hospital at the end of December 2020 or the latest date available; and if he will provide the same information for other spinal patients. [3064/21]
Amharc ar fhreagraImproving waiting times for hospital appointments and procedures, including scoliosis services, remains a priority of Government. Despite the challenges resulting from the Covid-19 pandemic last year, by 31st December 2020 Children’s Health Ireland (CHI) had carried out 322 scoliosis procedures, 163 of which were spinal fusions, and 159 other spinal procedures. Overall, scoliosis activity figures for 2020 were 16% lower than in the previous year, despite the necessary curtailment of routine elective surgery in March, April and May last year, significant social distancing measures and Infection Prevention and Control requirements.
Scoliosis activity accounts for 20% of overall orthopaedic activity across CHI. In recent years there has been an increased investment in paediatric orthopaedics and scoliosis services, which has improved access to surgery and outpatient appointments. In 2018 Children’s Health Ireland (CHI; previously the Children’s Hospital Group) was provided with an additional €9 million in funding to address paediatric orthopaedic waiting lists, including the provision of scoliosis services.
This funding supported the recruitment of approximately 60 WTE in 2018 and 2019 to enable the expansion of paediatric orthopaedic services including scoliosis services. The posts relate to the multi-disciplinary team at diagnosis, pre-assessment, during surgery in theatre, and post operatively. The majority of posts were allocated to each hospital in 2018.
On 2nd January 2021, the HSE issued correspondence to the Acute hospital system advising of the need to curtail scheduled elective care. This decision was made arising from the rapid increase in Covid-19 admissions and the projected trend in admissions based upon community transmission levels of Covid-19. CHI has advised that under the current HSE guidelines, they have reduced the number of procedures to urgent and those that are time sensitive rather than a blanket cessation of all routine activity as was done in March last year.
CHI have confirmed that urgent Outpatient appointments continue to be held face to face, while some routine appointments have been deferred. Many specialties have switched to virtual appointments with some blended face to face appointments where deemed appropriate.
Patient safety remains at the centre of all hospital activity and elective care scheduling. To ensure services are provided in a safe, clinically-aligned and prioritised way, hospitals are following HSE clinical guidelines and protocols. The HSE have confirmed that this position will be reviewed weekly throughout January.
Key social distancing measures and Infection Prevention and Control requirements, such as the current two-metre distancing, have had a material impact on the available physical space to deliver services, including scoliosis procedures. However, Children’s Health Ireland have confirmed that time dependent and urgent procedures will continue to be undertaken in CHI.
In relation to the specific query raised regarding the number of children currently waiting less than 4, 4 to 8 and more than 8 months, respectively in Our Lady’s Children’s Hospital, Crumlin and Temple Street Children’s University Hospital at the end of December 2020, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
355. Deputy Michael Healy-Rae asked the Minister for Health the status of an appointment for a person (details supplied); and if he will make a statement on the matter. [3080/21]
Amharc ar fhreagraIt is recognised that waiting times for scheduled appointments and procedures have been impacted in the last year as a direct result of the COVID-19 pandemic.
The HSE is currently recommending that only critical time dependent elective procedures are undertaken at this time due to the on-going and significant increased demand for bed capacity related to Covid-19.
This decision was made arising from the rapid increase in Covid-19 admissions and to ensure patient safety and that all appropriate resources were made available for Covid-19 related activity and time-critical essential work.
Patient safety remains at the centre of all hospital activity and elective care scheduling. To ensure services are provided in a safe, clinically-aligned and prioritised way, hospitals are following HSE clinical guidelines and protocols.
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.
357. Deputy Kathleen Funchion asked the Minister for Health if he will facilitate a person (details supplied) in receiving a HPV vaccine without incurring the €500 fee. [3082/21]
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.
358. Deputy Fergus O'Dowd asked the Minister for Health the provision that will be made to ensure nursing home residents will receive the Covid-19 vaccine before 24 January 2021 in circumstances in which there is an outbreak of Covid-19 in a nursing home; if decisions have been made in cases in which Covid-19 free nursing home residents should not receive the vaccine due to the fact they are living in a facility in which a Covid-19 outbreak has occurred; if so, the details of same; and if he will make a statement on the matter. [3090/21]
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.
359. Deputy Fergus O'Dowd asked the Minister for Health if information is available on whether nursing homes are observing the recommendation of the nursing home expert panel report which highlighted the fact that nursing home staff should not cross over from one facility to another to reduce the risk of Covid-19 transmission in view of the extreme staff shortages that have now been highlighted in nursing home facilities due to Covid-19 related absences particularly some of the larger nursing home groups which multiple facilities in Ireland; and if he will make a statement on the matter. [3092/21]
Amharc ar fhreagraIn March 2020, the National Public Health Emergency Team, as part of a package of public health measures recommended that staff movement across long-term residential care settings should be minimised to support COVID-19 transmission risk mitigation
The Nursing Homes Expert Panel report, published in August 2020, made 86 recommendations on a range of issues, including in relation to ensuring that safe staffing is available in nursing homes, that staff should not work across multiple sites, that infection prevention and control measures are in place and that PPE is readily available and utilised appropriately. The Department continues to engage, including through the Implementation Oversight Team and the Reference Group with the HSE as a nursing home provider and with the representative body for private and voluntary nursing homes on the implementation of the recommendations of the Nursing Homes Expert Panel report.
As you are aware, the epidemiological situation in relation to COVID-19 has deteriorated, including in relation to nursing homes. Preliminary data from the Health Protection Surveillance Centre (HPSC) indicates that there are over 165 open outbreaks, which is over 5 times the amount of nursing home outbreaks open in mid-December. As noted by the Expert Panel and the European Centre for Disease Control (ECDC), where there are high rates of community transmission, the risk to nursing homes is high. The HSE indicates that the recent changes in the incidence of COVID-19 nationally and, in particular, in nursing homes have presented significant staffing challenges across healthcare settings. The HSE is indicating that over 1,000 nursing home staff are presently absent as a result of COVID-19. As you will appreciate this is placing significant challenges on nursing homes. The HSE and HIQA are activating all of the available and established supports; however, staffing, particularly nursing staff, remains a particular challenge. Having regard to the current challenges, it is necessary to prioritise adequate levels of staffing in nursing homes, which may require the temporary redeployment of staff to other facilities to support safe care for residents. Where possible, the HSE is redeploying its own staff to other public and private nursing homes to support the safe delivery of care.
The established serial testing programme for nursing home staff remains a key support mechanism and is now in its seventh cycle. The testing programme is a critical part of the ongoing response to COVID-19 in nursing homes and allows for the early detection of cases and targeting of the early intervention of COVID-19 Response and Outbreak Control Teams. Over the coming weeks, where appropriate, the frequency of testing will be temporarily increased to a weekly basis under the guidance and advice of the relevant local HSE teams in agreement with nursing homes.
Additionally, the comprehensive range of public health and infection prevention and control advice remains to be of critical importance, including the appropriate use of PPE. The HSE and HIQA has developed and delivered comprehensive training resources and webinars for staff in relation to these matters.
360. Deputy Michael McNamara asked the Minister for Health when dental staff will start to receive the Covid-19 vaccination; if they will be included in the priority list for roll-out of the vaccination; and if he will make a statement on the matter. [3103/21]
Amharc ar fhreagraThe COVID-19 Vaccine Allocation Strategy sets out a provisional list of groups for vaccination. The Strategy was developed by the National Immunisation Advisory Committee (NIAC) and my Department, endorsed by the National Public Health Emergency Team (NPHET), and approved by Government on 8 December 2020.
Vaccine allocation is a matter for my Department and further information is available here: https://www.gov.ie/en/publication/39038-provisional-vaccine-allocation-groups/.
The rollout of the COVID-19 vaccination programme is the responsibility of the HSE.
The aim of the COVID-19 vaccination programme is to ensure, over time, that vaccine will become available to vaccinate all of those for whom the vaccine is indicated. Given that there will be initially limited vaccines available, it will take some time for all to receive those vaccines and that has necessitated an allocation strategy to ensure that those most at risk of death and serious illness receive the vaccine first.
The priority is to first vaccinate and protect directly the most vulnerable amongst us, that is, those most likely to have a poor outcome if they contract the virus. The priority is to directly use vaccines to save lives and reduce serious illness, hence the focus on the over 65 year old cohort in long term residential care facilities, and healthcare workers in frontline services often caring for the most vulnerable.
All of the groups will be covered as further vaccine supplies become available and the immunisation programme is rolled out nationally.
The evidence will be kept under review and the allocation groups may be updated, where necessary, in light of new evidence.
Frontline healthcare workers (HCWs) in direct patient contact roles will be vaccinated in Group 2. This includes HCWs working in public, private, and voluntary settings. Other HCWs, not in direct patient contact, will be vaccinated in Group 4.
361. Deputy Eoghan Murphy asked the Minister for Health if he is considering using doses of different vaccines for the same person as is reported to be the stated policy in the UK but which is contrary to the official guidance adopted in the US; and his views on this practice. [3105/21]
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.
362. Deputy Eoghan Murphy asked the Minister for Health the level of engagement his Department has had with general practitioners, dentists and other medical professionals regarding the sharing of vaccine roll-out information which could then be shared with their concerned patients who would like to know when they will receive the vaccine. [3106/21]
Amharc ar fhreagraThe COVID-19 Vaccine Allocation Strategy sets out a provisional list of groups for vaccination. The Strategy was developed by the National Immunisation Advisory Committee (NIAC) and my Department, endorsed by the National Public Health Emergency Team (NPHET), and approved by Government on 8 December 2020.
Vaccine allocation is a matter for my Department and further information is available here: https://www.gov.ie/en/publication/39038-provisional-vaccine-allocation-groups/.
The rollout of the COVID-19 vaccination programme is the responsibility of the HSE. The HSE has confirmed that they have regular engagement on the sequencing of front line healthcare workers.
The aim of the COVID-19 vaccination programme is to ensure, over time, that vaccine will become available to vaccinate all of those for whom the vaccine is indicated. Given that there will be initially limited vaccines available, it will take some time for all to receive those vaccines and that has necessitated an allocation strategy to ensure that those most at risk of death and serious illness receive the vaccine first.
The priority is to first vaccinate and protect directly the most vulnerable amongst us, that is, those most likely to have a poor outcome if they contract the virus. The priority is to directly use vaccines to save lives and reduce serious illness, hence the focus on the over 65 year old cohort in long term residential care facilities, and healthcare workers in frontline services often caring for the most vulnerable.
All of the groups will be covered as further vaccine supplies become available and the immunisation programme is rolled out nationally.
The evidence will be kept under review and the allocation groups may be updated, where necessary, in light of new evidence.
364. Deputy Cian O'Callaghan asked the Minister for Health if his attention has been drawn to the fact that autism services will not be provided to a child (details supplied) until 2025; his plans to address the matter; and if he will make a statement on the matter. [3119/21]
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.
365. Deputy Ciarán Cannon asked the Minister for Health when he plans to have Dupilumab added to the HSE's reimbursement list for the treatment of severe eczema. [3128/21]
Amharc ar fhreagra399. Deputy Róisín Shortall asked the Minister for Health if a decision on the reimbursement of Dupilumab, a drug to treat severe atopic eczema, was reached at the HSE drugs group meeting of 12 January 2021; and if he will make a statement on the matter. [3262/21]
Amharc ar fhreagraI propose to take Questions Nos. 365 and 399 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 licensed 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 HSE Drugs Group is the national committee which the HSE has in place to make recommendations on the pricing and reimbursement of medicines. The membership of the HSE Drugs Group includes public interest members and clinicians.
The final HTA report and NCPE recommendations concerning Dupilumab were reviewed by the HSE Drugs Group, along with the outputs of the 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 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 Health Act, and engaged in a meeting in November 2020 with the applicant company to discuss the submission.
The HSE has advised that the HSE Drugs Group, having reviewed the above representations at their January 2021 meeting, supported reimbursement of Dupilumab for a defined subgroup of the full licensed indication. The Drugs Group recommendations have been progressed to the HSE EMT.
The HSE EMT will consider the HSE Drugs Group's recommendations and the applicant’s representations before making a final decision on whether Dupilumab will be approved for reimbursement, in line with the 2013 Health Act.
366. Deputy Róisín Shortall asked the Minister for Health the HSE staffing levels in each month since February 2020; the breakdown of those attending the workplace or on paid or unpaid leave in tabular form; and if he will make a statement on the matter. [3130/21]
Amharc ar fhreagraAs this is a service issue, I have asked the Health Service Executive to respond directly to the Deputy, as soon as possible.
