Written Answers Nos. 289-308
289. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he and his Department have coordinated the roll-out of Covid-19 vaccines; the extent to which the process is smooth and effective; and if he will make a statement on the matter. [7733/21]
Amharc ar fhreagraThe Government is committed to the timely implementation of a COVID-19 immunisation programme.
In this regard, a High-Level Taskforce on COVID-19 was established to support my Department and the HSE in developing a national strategy and the implementation plan for the 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 Department of Health has overall responsibility for policy development on matters related to COVID-19, including the Vaccine Allocation Strategy.
Operational matters, including implementation of the rollout of the COVID-19 vaccination programme, is the responsibility of the HSE.
290. Deputy Bernard J. Durkan asked the Minister for Health the extent of the provision made for the various categories of patient awaiting Covid-19 vaccination; if the vaccination process will be rolled out on time and in sufficient numbers to make a serious impact on the spread of the virus; and if he will make a statement on the matter. [7734/21]
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 will receive the vaccine first.
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.
The next group to be vaccinated are those aged 70 and older in the following order: 85 and older, 80-84, 75-79, and 70-74. Vaccination of this group will begin this month.
Patients are a diverse group, therefore, each individual will be vaccinated in the group that is appropriate to them.
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.
The evidence will be kept under review and the allocation groups may be updated, where necessary, in light of new evidence.
Further information on the Allocation Strategy can be found at:
https://www.gov.ie/en/publication/39038-provisional-vaccine-allocation-groups/.
Further information on the COVID-19 Vaccination Strategy and Implementation Plan can be found at:
https://www.gov.ie/en/publication/bf337-covid-19-vaccination-strategy-and-implementation-plan/
291. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he expects the health services to be in a position to maintain normal services while at the same time meeting the challenge of vaccination throughout the country; and if he will make a statement on the matter. [7735/21]
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.
292. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he remains satisfied regarding the availability of sufficient hospital beds to meet the ongoing challenges of Covid-19 and at the same time meet the normally expected requirements from non-Covid-19 patients and elective procedures; and if he will make a statement on the matter. [7736/21]
Amharc ar fhreagraSignificant progress has been made in the ten months since the start of the COVID 19 pandemic in relation to the funding and provision of additional hospital beds. The Programme for Government, Our Shared Future, commits to continuing investment in our health care services in line with the recommendations of the Health Service Capacity Review and the commitments in Project Ireland 2040.
The Health Service Capacity Review 2018 found that the net requirement in combination with health system reform is for an additional 2,590 hospital beds by 2031 (2,100 inpatient, 300 day case and 190 critical care). The National Development Plan provides for the addition of the full 2,590 beds by 2027.
The Department of Health is working with the HSE to increase acute capacity in hospitals throughout the country to meet Covid 19 and other health demands. Government allocated €236 million revenue and €40 million capital expenditure as part of Budget 2021 to fund additional acute beds on a permanent basis. This funding will provide, by the end of 2021, an additional 1,146 acute beds (excluding critical care beds). As part of this, over 400 beds, opened in 2019/2020 on a temporary basis, will remain open on a permanent basis.
In addition, a proportion of these 1,146 beds are being provided as part of the HSE’s Winter Plan 2020/21. The Winter Plan aims to provide additional health service capacity across a range of services. Initiatives comprise additional acute and community beds to increase acute capacity, help reduce admissions and facilitate egress. The HSE has reported that 427 of these beds had opened by 4th February. This represents a significant step towards achieving the recommendations in the 2018 Health Service Capacity Review.
Furthermore, significant additional critical care capacity has been put in place in response to the Covid-19 pandemic, with funding for 40 additional adult critical care beds provided in March 2020. A Strategic Plan for Critical Care was noted by Government in December 2020 and aims to bring permanent adult critical care capacity in Ireland to 321 by the end of 2021 and to 446 in the long term, in line with the recommendations of the Health Service Capacity Review.
A total of €52m was provided to advance the Critical Care Strategic Plan in Budget 2021. This will retain, on a permanent basis, the 40 adult critical care beds put in place on a temporary basis last year and add significant new build bed capacity, as well as allowing for the development of a workforce plan and education initiatives to grow the critical care workforce.
However, where necessary, the number of critical care beds can surge beyond the baseline of 280-285 as part of an emergency response. This is the scenario that our hospitals are in now. The HSE has advised that surge capacity up to around 350 is possible while maintaining clinical risk at an acceptable level. The greater the reliance on surge ICU capacity, the greater the clinical risk with potential impact on patient outcomes.
The situation which is now being faced by our critical care units presents a greater challenge than even the first wave of COVID. While there are indications the number of patients in ICU are plateauing at a high level, it remains essential that we stay at home and reduce the transmission of Covid-19 in the community as much as we possibly can as the only way to reduce the numbers of Covid patients requiring ICU care.
Following the termination of the original private hospital agreement in June, the Government mandated the HSE to seek to agree with the private hospitals a new arrangement which would provide the HSE with access to private hospital capacity to include a safety net arrangement for any further surge of Covid-19 cases. The HSE has advised that all 18 hospitals have now signed Service Level Agreements to provide additional hospital capacity to the HSE, to deal with the surge in Covid-19 cases and any further surges in the pandemic, if they arise within the next 12 months. The arrangement is valid for 12 months and is a standard agreement for all 18 hospitals. Under the arrangement, the hospitals have agreed to supply, depending on the incidence of the disease or the number of patients with Covid-19 in public hospitals, up to 15% or 30% of their capacity. The additional capacity provided by the private hospitals is critical to enabling the public health system cope with large scale surges in the incidences of the disease. It is intended to use the capacity of the private hospitals for urgent, time-dependant and complex care.
It 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.
293. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he remains satisfied that non-Covid hospital procedures continue in sufficient scale to meet the demand; and if he will make a statement on the matter. [7737/21]
Amharc ar fhreagra294. Deputy Bernard J. Durkan asked the Minister for Health the extent to which more than average noticeable waiting lists have built up or are likely to build up arising from Covid-19-related demands and requirements; if backlogs remain manageable; the most apparent disciplines under stress at present; and if he will make a statement on the matter. [7738/21]
Amharc ar fhreagra295. Deputy Bernard J. Durkan asked the Minister for Health if he is satisfied that the provisions currently in place to deal with non-Covid-19-related health demands are sufficient in every respect; his plans for specific changes; and if he will make a statement on the matter. [7739/21]
Amharc ar fhreagraI propose to take Questions Nos. 293 to 295, inclusive, together.
Scheduled care activity was significantly impacted in 2020 by the necessary decision, in line with National Public Health Emergency Team (NPHET) advice to defer most routine elective care appointments and procedures in March, April, and May last year. As a result of the significant disruption in services, hospital waiting list figures at the end of December 2020 were higher than at the start of the year, with the Inpatient / Daycase waiting list 9% higher than at the start of January last year, the Outpatient waiting list 10% higher and the G.I. Endoscopy waiting list showing the greatest percentage growth with a 46% increase. However, the rate of patient referral on to the GI. Endoscopy waiting list declined by just 1% year on year compared to a drop of 13% and 20% in referral rates for IPDC and OPD respectively.
As a result of the deferral of scheduled care, waiting lists reached a peak in May with 86,946 patients waiting for a procedure. With the resumption of scheduled care in June, the HSE took steps to improve patient pathways in the context of the pandemic and infection control measures, and worked to secure new routes to treatment. For example, the HSE sought to optimise productivity through alternative work practices such as telemedicine and the use of alternative settings including private hospitals, community facilities and atypical outpatient settings. As a result of this concerted effort, and supported by the work of the National Treatment Purchase Fund (NTPF), the waiting lists for the top ten high volume Inpatient/ Day Case procedures continued to improve from May 2020 onwards, though it is recognised that some procedures were either slower to recover or are more challenged. More specifically, while by the end of December 2020 cystoscopies, skin lesions, and laparoscopic cholecystectomies had not returned to pre-Covid numbers, it is of note that the number of patients on waiting lists for cataracts, hips/knees, tonsils, septoplasties, dental maxillofacial, and veins had almost returned to pre-Covid figures, if not slightly better.
The work of the HSE to improve access to elective care and reduce waiting times for patients is supported by the NTPF, who in 2020 reviewed strategies to maximise activity and benefit for patients. This included increased use of private hospitals, funding weekend and evening work in public hospitals, funding “see and treat” services where minor procedures are provided at the same time as outpatient consultations, funding hybrid services where public and private hospitals contribute to the treatment of patients, virtual clinics and clinical validation.
At the 16th of December 2020 the NTPF had arranged 31,615 IPDC treatments and 11,504 G.I. Scopes. In terms of Outpatients, the NTPF had approved in principal 70,297 Outpatient appointments. The NTPF was also sanctioned to provide additional diagnostic supports through Emergency Department Authorisation Notifications (EDANs), which allow sites to access available diagnostic capacity in both the public and private sectors to a value of €4m.
€240 million has been provided in Budget 2021 to fund access to care, €210m of which has been allocated to the HSE and a further €30m to the National Treatment Purchase Fund for the provision of treatment as required in both private and public hospitals in order to address capacity issues in acute hospitals and waiting lists.
On 2nd January 2021, the HSE issued correspondence to the Acute hospital system advising of the need to curtail routine 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. The HSE recommends that only critical time dependent elective procedures are undertaken due to the on-going and significant increased demand for bed capacity related to Covid-19.
Following the termination of the original private hospital agreement in June 2020, the Government mandated the HSE to seek to agree with the private hospitals a new arrangement which would provide the HSE with access to private hospital capacity to include a safety net arrangement for any further surge of Covid-19 cases. The HSE has agreed a new safety net arrangement with all 18 private hospitals to deal with the current surge in Covid-19 cases and any further surges in the pandemic, if they arise within the next 12 months. The agreement provides that the HSE can access up to 15% or 30% of the private hospitals’ capacity depending of the incidence of the disease in the community or the number of Covid-19 positive patients in general or ICU beds in public hospitals. The private hospital capacity obtained by the HSE is being used to free up capacity in the public hospitals, mainly for urgent, time-dependant and complex care.
In relation to contingency planning for a post Covid-19 scenario, my Department, the HSE and the NTPF are continuously reviewing waiting lists with a view to ensuring that services for scheduled care are resumed as soon as it is deemed safe to do so in line with HSE clinical guidelines.
296. Deputy Bernard J. Durkan asked the Minister for Health if a particular effort can be made to address pressures for endoscopy, oncology or other treatments given the extent to which the Covid-19 pandemic is impacting the services; and if he will make a statement on the matter. [7740/21]
Amharc ar fhreagraThe Covid-19 pandemic has presented an unprecedented challenge to the operation of the health system, highlighting key capacity challenges across the system. Government has therefore made available a similarly unprecedented level of investment for 2021, targeted at supporting the resilience and preparedness of the health service, increasing capacity including in primary and community settings in support of the Slaintecare vision of care provided at the lowest possible level of complexity. Funding of €240m has been provided in Budget 2021 to fund access to care, for provision of treatment in both private and public hospitals to address capacity issues and waiting lists.
In regard to cancer specifically, the National Action Plan on Covid-19 identified the continued provision of cancer care as a priority. Cancer services continue to operate in line with guidance issued by the National Cancer Control Programme (NCCP). My Department and the NCCP are working to ensure the continued provision of cancer services where safe and appropriate, engaging with hospital management and staff. GP referrals to cancer diagnostic services will continue to be accepted. Medical and radiation oncology services continue. Particular emphasis is being placed on ensuring that all time-dependent cancer surgeries are continued, much of them in private hospitals. Trends in numbers coming forward to diagnostic services, and the level of attendances for appointments for treatment, are being monitored closely.
Funding of €12m was allocated specifically for the restoration of cancer services in the context of COVID-19 in Budget 2021. This funding is being used to support diagnostic services, virtual clinics and triage, organisation of treatment services, minor capital works and psycho-social supports. A further €20m has been allocated for the continued implementation of the National Cancer Strategy this year. This funding will facilitate developments across prevention, diagnosis, treatment and patient supports.
297. Deputy Bernard J. Durkan asked the Minister for Health the degree to which the issue of medical cards has been streamlined to minimise delays given the extent to which the Covid-19 pandemic continues to impact the health services; and if he will make a statement on the matter. [7741/21]
Amharc ar fhreagraAs the administration of the medical card scheme comes under the remit of the HSE, the Deputy's question has been referred to the HSE for direct reply.
298. Deputy Bernard J. Durkan asked the Minister for Health the extent to which dental and optical services have been affected by the Covid-19 pandemic; if plans are in hand to address any issues arising; and if he will make a statement on the matter. [7742/21]
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.
299. Deputy Bernard J. Durkan asked the Minister for Health the degree to which child and adult mental health services can be improved in the short to medium term given the serious shortcomings that have existed for some time; and if he will make a statement on the matter. [7743/21]
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.
300. Deputy Bernard J. Durkan asked the Minister for Health his views on whether a special task force might address the shortcomings in the mental health services, with particular reference to the need to provide for those seeking institutional care or specific treatment not currently readily available in Ireland; and if he will make a statement on the matter. [7744/21]
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.
301. Deputy Bernard J. Durkan asked the Minister for Health the degree to which diabetes remains an issue of concern to his Department, with particular reference to the need to co-ordinate and enhance the availability of services throughout the country in addition to educational and informational campaigns to alert the public to the seriousness of the condition; and if he will make a statement on the matter. [7745/21]
Amharc ar fhreagraDiabetes occurs as a consequence of the human body being unable to produce sufficient amounts of the hormone insulin, which regulates blood glucose, or to use insulin effectively. People with diabetes are unable to metabolize glucose appropriately and as a result, blood glucose levels remain above normal levels and over time can damage blood vessels. This can lead to long-term damage and disabling and potentially fatal health complications. In high-income countries, including Ireland, diabetes is a leading cause of cardiovascular disease, blindness, kidney failure and lower-limb amputation.
The most common form of diabetes is type 2, which typically occurs in adults, although it is increasingly seen in young people, including children. Type 1 diabetes typically occurs in children or young people. The third main type of diabetes is gestational diabetes, which occurs because the action of insulin is impaired during pregnancy. Gestational diabetes is becoming increasingly common against rising levels of overweight and obesity as key risk factors. Those with type 1 diabetes require a regular supply of insulin, while type 2 diabetes is largely preventable and complications can be avoided or delayed through a combination of lifestyle changes, medications or insulin therapy, depending on the status of the condition and the stage of the disease in the person concerned.
Globally, the number of people with diabetes has doubled during the past 20 years, making it one of the most important public health challenges facing national health care systems today. The International Diabetes Federation has recently (2019) estimated that approximately 463 million adults (20-79 years) were living with diabetes globally and that by 2045 this will rise to 700 million. In Ireland it is estimated that there are 190,000 people with diabetes. Approximately 30,000 (15%) of these have Type 1 diabetes, or genetic or secondary causes of diabetes. The remaining 160,000 (85%) patients have Type 2 diabetes with a significant proportion of these patients remaining undiagnosed. It is expected that the number of people with Type 2 diabetes will increase by 60% over the next 10-15 years.
The challenge posed by the changing disease burden has been recognized globally, with diabetes featuring high on national and international agendas including the World Health Organisation and the European Commission. At national level countries in Europe have made progress towards developing a systematic policy response to the diabetes burden. Effective treatment reduces the risk of disability or fatal complications and its optimal management requires coordinated inputs from a wide range of health professionals, access to essential medicines and monitoring, and, ideally, a system that promotes patient empowerment and well-coordinated care. In that context in Ireland the HSE Clinical Programme in Diabetes leads the multidisciplinary coordinated response to the challenges posed by diabetes in Ireland and I have asked them to examine the matters raised by the Deputy and provide a response to him as soon as possible.
302. Deputy Bernard J. Durkan asked the Minister for Health the extent to which provision is being made to cater for mental health patients who may also have an addiction; and if he will make a statement on the matter. [7746/21]
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.
303. Deputy Brendan Smith asked the Minister for Health if additional personnel will be provided for child and adolescent mental health services in view of the increasing number of children presenting for assessment and treatment; and if he will make a statement on the matter. [7772/21]
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.
304. Deputy Brendan Griffin asked the Minister for Health the locations for the over-85s vaccination centres in County Kerry; and if he will make a statement on the matter. [7773/21]
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.
305. Deputy Thomas Pringle asked the Minister for Health further to Parliamentary Questions Nos. 834 and 835 of 27 January 2021, the process for getting onto the list for assessment; the first steps for those being approved for an assessment of needs; the staffing levels in the different HSE regions for this process; and if he will make a statement on the matter. [7775/21]
Amharc ar fhreagra306. Deputy Thomas Pringle asked the Minister for Health further to Parliamentary Question Nos. 834 and 835 of 27 January 2021, the number of families seeking assessment; the number of families accepted for assessment in tabular form; and if he will make a statement on the matter. [7776/21]
Amharc ar fhreagra307. Deputy Thomas Pringle asked the Minister for Health further to Parliamentary Questions Nos. 834 and 835 of 27 January 2021, the reason the numbers for areas 1 and 2 are significantly lower than for the other CHOs; the differences in those areas; and if he will make a statement on the matter. [7777/21]
Amharc ar fhreagraI propose to take Questions Nos. 305 to 307, inclusive, together.
The Programme for Government, Our Shared Future, recognises the need to improve services for both children and adults with disabilities through better implementation and by working together across Government in a better way.
The Government commits to prioritising early diagnosis and access to services for children and ensuring that the most effective interventions are provided for each child, to guarantee the best outcomes.
As this is a service matter I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
308. Deputy Thomas Pringle asked the Minister for Health further to Parliamentary Question No. 176 of 10 December 2020, the status of the upcoming review of the Health (Regulation of Termination of Pregnancy) Act 2018; the terms of reference for the review; if submissions will be requested from advocacy and affected groups; and if he will make a statement on the matter. [7778/21]
Amharc ar fhreagraAs the Deputy has noted, I previously answered a question on the review of the operation of the Health (Regulation of Termination of Pregnancy) Act 2018 in response to his Parliamentary Question No. 176 of 10 December 2020.
There is no update on the response provided. Officials in my Department continue to work on details of the review of the operation of the Act, which, as set out in the Programme for Government Our Shared Future, will be conducted in 2021.
