Written Answers Nos. 702-721
702. Deputy Patricia Ryan asked the Minister for Health if he will prioritise funeral directors and their staff to receive the Covid-19 vaccine in order that they can continue their essential service; and if he will make a statement on the matter. [3762/21]
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.
703. Deputy Joe Carey asked the Minister for Health if he will amend statutory instrument 296/2020 to make the wearing of face coverings mandatory in banks, credit unions and post office premises; and if he will make a statement on the matter. [3766/21]
Amharc ar fhreagraAs the Deputies are no doubt aware, a person, without reasonable excuse, must wear a face covering when using public transport, in retail outlets, shops and shopping centres, in other indoor spaces such as libraries, cinemas and cinema complexes, theatres, concert halls, bingo halls, museums, businesses carrying out cosmetic nail care or nail styling, hair care or hair styling, tattoo and piercing services, travel agents and tour operators, laundries and dry cleaners and licensed bookmakers.
The regulations relating to face coverings have recently been amended to include post offices, credit unions and banks.
The relevant Regulations in relation to face coverings which remain in place until 9 June, 2021 can be found at: https://www.gov.ie/en/collection/1f150-view-statutory-instruments-related-to-the-covid-19-pandemic/
The current advice in relation to face coverings is available at -https://www2.hse.ie/conditions/coronavirus/face-masks-disposable-gloves.html and http://www.gov.ie/facecoverings/
704. Deputy Mattie McGrath asked the Minister for Health if a detailed breakdown will be provided of the total number of staff employed by the HSE (details supplied) broken down in tabular form; and if he will make a statement on the matter. [3767/21]
Amharc ar fhreagraI am delighted to speak on this today. I salute the architects of the Good Friday Agreement and the peace that we now enjoy. I look forward to the New Decade, New Approach agreement. I happened to be in the residence of the British ambassador in Washington two years ago, on the day before St. Patrick's Day. The most senior civil servant in Northern Ireland at the time, whose name eludes me but I am sure the Minister knows him, had to take the stage instead of the First Minister or deputy First Minister, who were there, because they were not active or functioning. He was quite annoyed. He left his hair down because he was retiring. He really gave out that they did not get their act together and were not working together. I think of all the work done by the likes of the former Minister of State and Senator, Martin Mansergh, Fr. Alec Reid and many others, including the former Taoiseach, Bertie Ahern, to get the peace we have and then we see the legacy issues that are not being dealt with.
Before we can really embrace the New Decade, New Approach agreement, we must deal with these legacy issues. If we take the Omagh bomb and Mr. Michael Gallagher and his family and the other families, it was a terrible atrocity. The former Taoiseach, Enda Kenny, promised to meet Mr. Gallagher, and said what he would do for him, but when he got into power he abandoned him like a hot potato. He promised he would get truth and justice with Fine Gael in government but it did not happen.
The former Garda John White died during the year. His mother was laid to rest only last week. She was broken-hearted after the way her son was treated. He made efforts to ensure the Omagh bomb was not delivered or planted. He was mistreated and sidelined by the Garda powers. He was made a scapegoat. We must deal with these legacy issues.
Recently, it was the anniversary of Aidan McAnespie. I did not know him but my wife's brothers and sisters worked with him in Monaghan and the treatment he received and testament he told them. Every other day he arrived in work late because of blackguarding, skulduggery and ill-treatment at the checkpoint in Aughnacloy. It was common knowledge they were going to do something serious to him and they murdered him.
There has been no sign of any meaningful investigation or inquiry into these issues. Where are the new decade, new visions and new approach? We must sort out the legacy issues and we must be meaningful, honest and upfront. We can only do so much down here but we must not mislead families in the North who want justice or play politics with them and then abandon them. I salute Michael Gallagher and what he does every year on the commemoration committee. He continues to go through trauma. We must be honest with ourselves and be fair and reasonable to the people who expect us to help them.
705. Deputy Marian Harkin asked the Minister for Health the date for completion of the National Children’s Hospital; if enforceable penalty clauses form part of the main contract given recent construction delays and ongoing and increasing costs of the project; and if he will make a statement on the matter. [3777/21]
Amharc ar fhreagraAs the National Paediatric Hospital Development Board (NPHDB) has statutory responsibility for planning, designing, building and equipping the new children's hospital, I have referred your question to the NPHDB for direct reply.
706. Deputy Fergus O'Dowd asked the Minister for Health the process by which general practitioners nationwide were invited to the mass vaccination centres during the weekend of 16 and 17 January 2021; if general practitioners were invited by county; if not, if they were randomly selected and so on; the process to ensure they are vaccinated as soon as is possible in cases in which they were not invited; and if he will make a statement on the matter. [3784/21]
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.
707. Deputy Peadar Tóibín asked the Minister for Health if he and HSE management will engage with local community groups in Carrick-on-Suir, County Tipperary regarding the discontinuation of inpatient palliative care at St. Brigid’s Hospital; and if he will make a statement on the matter. [3791/21]
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.
708. Deputy Gino Kenny asked the Minister for Health the status of the private nursing home sector with particular reference to staffing levels, financial viability and supports being offered to the sector; and if he will make a statement on the matter. [3792/21]
Amharc ar fhreagra710. Deputy Gino Kenny asked the Minister for Health his plans in the event of the closure of either private or public nursing home facilities; and if he will make a statement on the matter. [3794/21]
Amharc ar fhreagra711. Deputy Gino Kenny asked the Minister for Health if a copy of contingency plans he may have for various adverse scenarios affecting private nursing homes will be provided; if a summary will be provided of these plans with particular reference to crises in staffing and in the event of serious Covid-19 outbreaks; and if he will make a statement on the matter. [3795/21]
Amharc ar fhreagra712. Deputy Gino Kenny asked the Minister for Health if he has examined the option of emergency State intervention or State control of private nursing homes; if so, if costings for the acquisition and or operation of private facilities are available; and if he will make a statement on the matter. [3796/21]
Amharc ar fhreagraI propose to take Questions Nos. 708, 710, 711 and 712 together.
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 180 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 1,800 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 .
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.
The State’s responsibility to respond to the public health emergency created the need for the HSE to set up a structured support system in line with NPHET recommendations. This has been a critical intervention in supporting the resilience of the sector in meeting the unprecedented challenges associated with COVID-19.
These supports remain in place and have encompassed:
- Enhanced HSE engagement
- Temporary HSE governance arrangements
- Multidisciplinary clinical supports at CHO level through 23 COVID-19 Response Teams
- Access to supply lines for PPE, medical oxygen etc
- Serial testing in nursing homes
- Access to staff from community and acute hospitals
- Suite of focused guidance, including comprehensive guidance on visiting nursing homes
- HIQA COVID-19 quality assurance regulatory framework
The Temporary Assistance Payment Scheme which provides additional funding to private and voluntary nursing homes that require it has been extended until the end of June 2021. Given the importance of facilitating safe visiting over the winter period, it was decided to expand the eligibility criteria under TAPS on a once-off basis to allow a claim of up to €2,500 per eligible nursing home as a contribution towards the cost of visiting infrastructure. This was intended to support nursing homes in creating additional safe visiting spaces and enhancing current visiting spaces. As of 21 January, there have been 4,845 claims processed, with total payments of over €63.6m of direct financial support provided to the sector.
Since 2009 the Health Information and Quality Authority, HIQA, is the statutory independent regulator in place for the nursing home sector, whether a HSE managed or a private nursing home. The functions and powers of the Chief Inspector are set out in Parts 7, 8 and 9 of the Health Act 2007 (as amended). The Statutory powers include the cancellation of registration under section 51 of the Act and the urgent action under section 59 of the Act to attach, vary or remove a condition of registration or cancellation of registration.
In the first instance, the primary responsibility for the provision of safe care and service to nursing home residents’ rests with individual nursing home operators. If the Chief Inspector cancels a registration under section 51 and the cancellation takes effect, or if the Chief Inspector obtains an order to cancel a registration in accordance with section 59 and the cancellation takes effect then under section 64 of the Act the Chief Inspector notifies the HSE of the cancellation of the registration and of the date on which this takes effect. The HSE must make alternative arrangements, as soon as practicable for residents where registration has been cancelled and closure orders have been secured by HIQA. Pending these alternative arrangements, the HSE, either with the consent of the registered provider or by order of the District Court shall take charge of the designated centre.
The first stage of the Covid-19 Vaccine Programme commenced on 29th December in hospital settings with the aim of moving quickly to commence vaccinations in nursing homes spread across the country with an estimated 29,000 residents and c.41,000 staff. Last week, the HSE completed roll out of the first vaccine dose to the majority of residents and staff in nursing homes. Due to outbreaks of Covid-19, a very small number of facilities were not included in this first series of vaccinations on public health advice, while, in a significant number, not all residents or staff could be included in the vaccination programme due to their Covid status. Those residents and staff who were unable to receive a first dose will be included once deemed safe to do so. This week, roll out of the second vaccine dose will begin in 27 nursing homes.
As a number of the issues raised by the Deputy are service matters I have asked the HSE to respond directly to the Deputy as soon as possible.
709. Deputy Gino Kenny asked the Minister for Health his views on the most recent figures for HSE recruitment of healthcare workers particularly recruitment of care professionals from the private nursing home sector; and if he will make a statement on the matter. [3793/21]
Amharc ar fhreagraAt the end of the December, the health sector workforce had a total of 126,174 WTE. This is an increase of 6,357 WTE since the end of December 2019. Nursing and Midwifery had the largest yearly growth in 2020, with an increase of 1,712 WTE. These impressive increases are due to a variety of COVID-related initiatives, along with recruitment provided for under the Winter Plan and Budget 2021.
The Winter Plan 2020/2021 outlined the need for 12,522 additional staff, while Budget 2021 made funds available for these staff and an additional 3,216. Together with the HSE, we are aiming to increase the health sector workforce by 15,838 WTE, from Budget 2020 funded levels. Provisional HSE end of 2020 WTE targets aimed for an increase of 4,155 WTE. The end of year actual increase of 6,357 WTE is already ahead of this projection. We are delighted with this strong progress that has already been made towards the long-term strengthening of the health service. My Department continues to work with the HSE to ensure the 2021 targets are met.
Regarding the hiring of staff who worked in private nursing homes, applications for posts in the HSE are open to all candidates that display the desired skills and qualifications for the post applied for. The HSE is not targeting, nor does it intend to target the staff of nursing homes in any of its recruitment campaigns. Hospital Groups and the Community Health Organisations are cognisant of the staffing difficulties faced by the nursing home sector during the current pandemic. Indeed, the HSE are very much aware of the interdependencies of their services in the provision of care to nursing home clients.
Recruitment in the HSE is subject to the provisions of the Public Service Management (Recruitment and Appointments) Act, 2004 and is regulated by the Commission for Public Service Appointments (CPSA). This regulatory framework provides that recruitment in the HSE must centre on the following five recruitment principles: Probity, Merit, Best Practice, Fairness and Transparency.
The HSE cannot exclude nursing homes staff from applying for positions or prevent them from taking up offers of employment for prolonged periods of time; it would be a breach of its Recruitment Licence to do so. It is ultimately the personal choice of any individual to determine whether or not they wish to apply for employment with the HSE, and many factors will influence such a decision. Those who are successful at competition are entitled to take up the role offered to them. In such cases, the HSE will facilitate generous notice periods to support nursing homes to recruit replacement staff.
713. Deputy Gino Kenny asked the Minister for Health if his attention has been drawn to the fact that during the first wave of the Covid-19 pandemic there were at one point over 2,000 vacant beds in the hospital system due to the cancellation of elective procedures and the reduction in non-Covid hospital admissions; the reason for missed targets despite this spare capacity given patient experience times failed to meet targets in many instances and times for persons over 75 years of age grew in this period; and if he will make a statement on the matter. [3797/21]
Amharc ar fhreagraThe National Service Plan 2020 includes an activity target that 99% of patients aged 75 and over attending at an Emergency Department will be discharged or admitted within 24 hours and any breach of this target in respect of patients in this age cohort is regretted. There 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.
In response to the Covid-19 pandemic the HSE had to take measures in 2020 to defer most scheduled care activity in March, April, and May. 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.
This winter is 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 investment 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.
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.
714. Deputy Gino Kenny asked the Minister for Health his views and the data and on the way in which cancellations and reduced attendance at hospital affected health outcomes of patients generally and specifically in the case of persons over 65 years of age; and if he will make a statement on the matter. [3798/21]
Amharc ar fhreagraI fully acknowledge the distress and inconvenience for patients and their families when elective procedures are cancelled, particularly for clinically urgent procedures. While every effort is made to avoid cancellation or postponement of planned procedures, the HSE has advised that planned procedures and operations can be postponed or cancelled for a variety of reasons including capacity issues due to increased scheduled and unscheduled care demand.
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.
In relation to the particular query raised regarding the health outcomes of patients, as this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
715. Deputy Gino Kenny asked the Minister for Health if he has considered using information on reduced inpatient numbers and associated health outcomes to examine resourcing of care in the community; and if he will make a statement on the matter. [3799/21]
Amharc ar fhreagraIt is recognised that waiting times for acute hospital appointments and procedures have been impacted as a direct result of the COVID-19 pandemic, and as a result of the deferral of elective scheduled care activity in March, April and May of 2020, and since 2nd January 2021. Patient safety remains at the forefront of the HSE decision to defer elective scheduled care activity.
While Inpatient/Daycase waiting lists reached a peak in May 2020 as a result of the deferral of non urgent elective care, steps taken by the HSE to improve patient pathways in the context of the pandemic, and secure new routes to treatment had a positive impact on the overall waiting list. The number waiting for a hospital appointment/procedure dropped by 17% from May to December 2020.
However it should be noted in this context that the COVID-19 pandemic has led to unprecedented interruption to normal healthcare activity in the community sector as it has in the acute sector. Community services are facing equivalent challenges in relation to business and staffing capacity and, in this sense, the ability of the community sector to act as a substitute for the acute sector is limited. It should also be noted that many inpatients may require specialised care that cannot simply be transferred into a community setting.
At the same time, there is a commitment to progressing a strategic agenda that responds to the needs of our population and to demographic trends in line with the vision set out in Sláintecare. Community healthcare spans primary care services, social inclusion services, older persons’ and palliative care services, disability services and mental health services. These services will be significantly strengthened in 2021, facilitated by over €900m in increased funding across a range of reform and investment programmes. This will in turn ease pressure on our hospitals and allow more care to be delivered at home or as close to the patient’s home as possible.
More broadly, the Strategic Framework for Delivery of Service Continuity in a COVID Environment (HSE, June 2020), focusses on restoring our services in a prioritised manner with investments targeted at rebuilding services guided by the principles and priorities of Sláintecare. A Community First approach to the delivery of care will be central to delivering safe, efficient and effective services through winter and beyond. Service delivery will be re-oriented towards general practice, primary care and community-based services. By ‘shifting services left’ and prioritising Primary Care and Community Services, the goals of Sláintecare will be advanced and may mitigate the impact of COVID-19. The enhancement of community services will also allow people to remain at home, prioritising older people and those with chronic conditions.
716. Deputy Gino Kenny asked the Minister for Health if a list will be provided of current contracts that the HSE has with private consultancy firms for each HSE division and directorate, for example, corporate change, disability and so on; and if he will make a statement on the matter. [3800/21]
Amharc ar fhreagra717. Deputy Gino Kenny asked the Minister for Health the estimated spend on private consultancy and auditing services in the HSE in each of the years 2018 to 2020; and if he will make a statement on the matter. [3801/21]
Amharc ar fhreagraI propose to take Questions Nos. 716 and 717 together.
As this is a service matter I have referred this to the Health Service Executive for direct reply to the Deputy.
718. Deputy Robert Troy asked the Minister for Health when he plans to initiate phase three of the vaccine roll-out. [3805/21]
Amharc ar fhreagraThe Government is committed to the timely implementation of a COVID-19 immunisation programme.
The National COVID-19 Vaccination Strategy, which was prepared by the High-Level Task Force on COVID-19 Vaccination, was signed off by Cabinet on 15 December 2020.
The vaccines will be rolled out in three phases - the initial roll out, a mass ramp-up and open access. The highest priority groups, those over the age of 65 living in long-term care facilities and frontline healthcare workers in direct patient contact, will receive the vaccine first.
The only substantive limitation on the pace of implementation will be supply. As more vaccines are approved and arrive, the delivery schedule will change.
All of the groups will be covered as further vaccine supplies become available and the immunisation programme is rolled out nationally. This is wholly dependent on supply lines and on candidate vaccines obtaining approval. Therefore, it is not possible at this time to determine a timeframe for the full vaccination programme.
719. Deputy Richard Boyd Barrett asked the Minister for Health the method and parameters for means testing and negotiation of the nursing home support scheme; the considerations made in regard to a spouse who relies on the pension of the person in nursing home care and or availing of the scheme and in cases in which the spouse may not have a State pension or a private pension to live on; and if he will make a statement on the matter. [3807/21]
Amharc ar fhreagraThe Nursing Homes Support Scheme (NHSS), commonly referred to as Fair Deal, is a system of financial support for those in need of long-term nursing home care. Participants contribute to the cost of their care according to their income and assets while the State pays the balance of the cost.
The Scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone and that people are cared for in the most appropriate settings. An applicant to the scheme can choose any public, voluntary or approved private nursing home. The home must have availability and be able to cater for the applicant's particular needs.
Participants in the Scheme contribute up to 80% of their assessable income and a maximum of 7.5% per annum of the value of assets held. Assets include cash assets and all forms of property whether situated in the State or not. The capital value of an individual’s principal private residence (PPR) is only included in the financial assessment for the first three years of their time in care. This is known as the three year cap.
The National Treatment Purchase Fund (NTPF) has been designated by the Minister for Health pursuant to Section 40 of the Nursing Homes Support Scheme Act 2009 as a body authorised to negotiate with proprietors of non-HSE registered nursing homes to reach agreement in relation to the maximum price(s) that can be charged for the provision of long-term residential care services to NHSS residents.
As part of this function, the NTPF will enter into "Approved Nursing Home Agreements" with registered private and voluntary nursing homes to record the maximum price(s) that have been negotiated.
- The Scheme has a number of important safeguards built into the financial assessment which ensures that:
- Nobody will pay more than the actual cost of care;
- An applicant will keep a personal allowance of 20% of his/her income or 20% of the maximum rate of the State Pension (non-Contributory), whichever is greater. This is in recognition of the fact that, although the NHSS covers core living expenses, residents can still incur some costs in a nursing home, such as social programmes, newspapers or hairdressing;
- If an applicant has a spouse/partner remaining at home, they will be left with 50% of the couple’s income or the maximum rate of the State Pension (non-Contributory), whichever is greater;
- If both members of a couple enter nursing home care, they each retain at least 20% of their income, or 20% of the maximum rate of the State Pension (non-Contributory), whichever is greater;
- Certain items of expenditure, called allowable deductions, can be taken into account for the financial assessment, including health expenses, payments required by law, rent payments and borrowings in respect of a person’s principal private residence;
- A person’s eligibility for other schemes, such as the Medical Card Scheme or the Drug Payment Scheme, is unaffected by participation in the Nursing Homes Support Scheme or residence in a nursing home.
720. Deputy Michael Healy-Rae asked the Minister for Health if a matter regarding the case of a person (details supplied) will be addressed; and if he will make a statement on the matter. [3809/21]
Amharc ar fhreagraAs the particular issue raised relates to an individual case, I have arranged for the question to be referred to the HSE for direct reply to the Deputy.
721. Deputy Pearse Doherty asked the Minister for Health when home help support will be provided for a person (details supplied) in County Donegal; and if he will make a statement on the matter. [3821/21]
Amharc ar fhreagraAs this is an operational matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
