Thursday, 30 Sep 2021

Written Answers Nos. 331-351

Medical Register

Ceisteanna (331)

David Cullinane

Ceist:

331. Deputy David Cullinane asked the Minister for Health the number of medical graduates who emigrated in each of the past five years; and if he will make a statement on the matter. [47227/21]

Freagraí scríofa

Minister for Health

The Medical Council is the custodian of the Irish Medical Register. When a doctor decides to come off the Irish Medical Register they apply for a voluntary withdrawal from the register, which is manually processed by the Executive of the Medical Council and is recorded daily.

Not all doctors who voluntarily withdraw from the register emigrate. Some leave the register for multiple reasons such as retirement, family reasons or change of career/role. The figures for total voluntary withdrawals are mapped in Figure 1 of Appendix 1, attached.

Following voluntary withdrawal from the register, medical practitioners are routinely emailed a brief questionnaire to explore the reasons for leaving the register. In response to this, a breakdown of doctors who responded to this survey with an Irish basic medical qualification is described in Table 1. Appendix 1.   2021 figures are correct as of 28/09/21. Response rates to this survey range from 75%-98%.

The Medical Council conducts a number of research projects each year which are published by the Council, examining all aspects of the register with an in-depth review of voluntary withdrawal data.

[<a ref="https://data.oireachtas.ie/ie/oireachtas/debates/questions/supportingDocumentation/2021-09-30_ pq331-30-09-21_en.docx ">Medical Register</a>]

Nursing Homes

Ceisteanna (332)

David Cullinane

Ceist:

332. Deputy David Cullinane asked the Minister for Health the number of public and private nursing home beds in the State; and if he will make a statement on the matter. [47228/21]

Freagraí scríofa

Minister of State at the Department of Health

Nursing home care is provided through a mixture of public, voluntary and private provision.  Under the Health Act, 2007, all nursing homes must register with the Health Information and Quality Authority.  At present HIQA has advised the Department that there are 31,950 beds (long-stay and short-stay) registered with the Authority. This information may be subject to minor change, as further notices of decision are issued in response to applications to vary, register or renew registration for nursing homes between now and the end of the year. 

Home Help Service

Ceisteanna (333)

David Cullinane

Ceist:

333. Deputy David Cullinane asked the Minister for Health the number of home help hours provided annually by the HSE in each of the years 2017 to 2020; the number of home help hours provided in these years by private companies; and if he will make a statement on the matter. [47229/21]

Freagraí scríofa

Minister of State at the Department of Health

As this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.

Mental Health Services

Ceisteanna (334)

David Cullinane

Ceist:

334. Deputy David Cullinane asked the Minister for Health the total spend on mental health in each of the years 2017 to 2020; and if he will make a statement on the matter. [47230/21]

Freagraí scríofa

Minister of State at the Department of Health

As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Mental Health Services

Ceisteanna (335)

David Cullinane

Ceist:

335. Deputy David Cullinane asked the Minister for Health the number of children and adolescents currently accessing CAMHS; the number of children currently on the waiting list for initial assessment by CAMHS; the length of time they have been waiting for an initial assessment; and if he will make a statement on the matter. [47231/21]

Freagraí scríofa

Minister of State at the Department of Health

As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Vaccination Programme

Ceisteanna (336, 338, 343, 345)

David Cullinane

Ceist:

336. Deputy David Cullinane asked the Minister for Health if he will provide details of the roll-out of the Covid-19 vaccine booster programme for vulnerable persons; the way appointments will be issued; the basis on which vulnerable patients are being decided; the criteria being used to determine the higher risk category; and if he will make a statement on the matter. [47234/21]

David Cullinane

Ceist:

338. Deputy David Cullinane asked the Minister for Health the timelines for the roll-out of the Covid-19 vaccine booster programme for all vulnerable persons; and if he will make a statement on the matter. [47236/21]

Carol Nolan

Ceist:

343. Deputy Carol Nolan asked the Minister for Health the details of the roll-out of the Covid-19 vaccine booster programme for vulnerable persons; the way in which appointments will be issued; the basis upon which vulnerable patients are being decided; the criteria being used to determine the higher risk category; and if he will make a statement on the matter. [47261/21]

Carol Nolan

Ceist:

345. Deputy Carol Nolan asked the Minister for Health the details of the timelines for the roll-out of the Covid-19 vaccine booster programme for all vulnerable persons; and if he will make a statement on the matter. [47263/21]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 336, 338, 343 and 345 together.

On 8 September, I announced an update to the Covid-19 vaccination programme following further advice from the NIAC. The Committee has recommended a booster dose of an mRNA vaccine (irrespective of whether the primary vaccination course was of an mRNA or adenoviral vector) for residents aged 65 years and older living in Long Term Residential Care Facilities and for those aged 80 years and older living in the community. I have accepted this advice and the HSE has been requested to make the necessary arrangements to operationalise the recommendations. The NIAC continues to examine emerging evidence regarding booster vaccines for those with waning immunity and reduced effectiveness in other groups.

As the logistics of the rollout are a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.

Vaccination Programme

Ceisteanna (337, 344)

David Cullinane

Ceist:

337. Deputy David Cullinane asked the Minister for Health if cardiac patients will be contacted in the early stages of the roll-out of the Covid-19 vaccine booster programme for vulnerable persons; if heart failure patients will be considered as vulnerable patients given their high-risk category; and if he will make a statement on the matter. [47235/21]

Carol Nolan

Ceist:

344. Deputy Carol Nolan asked the Minister for Health if cardiac patients will be contacted in the early stages of the roll-out of the Covid-19 vaccine booster programme for vulnerable persons; if heart failure patients will be considered as vulnerable patients given their high-risk category; and if he will make a statement on the matter. [47262/21]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 337 and 344 together.

On 8 September, I announced an update to the Covid-19 vaccination programme following further advice from the NIAC. The Committee has recommended a booster dose of an mRNA vaccine (irrespective of whether the primary vaccination course was of an mRNA or adenoviral vector) for residents aged 65 years and older living in Long Term Residential Care Facilities and for those aged 80 years and older living in the community.

I have previously accepted the NIAC recommendations regarding the extension of the primary vaccination course with an mRNA dose for immunocompromised individuals aged 12 years and older irrespective of whether the initial doses were an mRNA or adenoviral vector vaccine.

I have accepted the NIAC advice regarding booster doses and the HSE has been requested to make the necessary arrangements to operationalise the recommendations. The NIAC continues to examine emerging evidence regarding booster vaccines for those with waning immunity and reduced effectiveness in other groups.

Question No. 338 answered with Question No. 336.

Health Services

Ceisteanna (339)

Louise O'Reilly

Ceist:

339. Deputy Louise O'Reilly asked the Minister for Health the status of any review of eligibility policy for medical services as outlined in Sláintecare; and if he will make a statement on the matter. [47237/21]

Freagraí scríofa

Minister for Health

The development of a Citizen Care Masterplan has begun under Reform Programme 2: Addressing Health Inequalities – Toward Universal Healthcare of the recent Sláintecare Implementation Strategy & Action Plan 2021 – 2023.

The Citizen Care Masterplan aims to inform policy decision-making around equitable allocation of resources of all types and includes the development of frameworks for eligibility, population-based resource allocation, workforce planning, and capital and estates planning. 

An initial review of eligibility commitments in key policies has been completed and will inform the progression of a business case to develop policy proposals and options for achieving universal eligibility across hospital and community settings. 

The following will be considered: 

- the range of services to be provided on a universal basis 

- the rationale and methodology for eligibility/entitlement for the services, and 

- financial mechanisms and phasing.

This analysis will then inform the preferred future eligibility framework to deliver universal access to healthcare for decision by Government. 

Medical Cards

Ceisteanna (340)

Louise O'Reilly

Ceist:

340. Deputy Louise O'Reilly asked the Minister for Health the way that patients with progressive, life-limiting conditions will be able to access medical cards in the future; and if he will make a statement on the matter. [47238/21]

Under the Health Act 1970, eligibility for a medical card is based primarily on means. The Act obliges the HSE to assess whether a person is unable, without due hardship, to arrange general practitioner services for himself or herself and his or her family, having regard to his or her overall financial position and reasonable expenditure.

The issue of granting medical or GP visit cards based on having a particular disease or illness was previously examined in 2014 by the HSE Expert Panel on Medical Need and Medical Card Eligibility. The Group concluded that it was not feasible, desirable, nor ethically justifiable to list medical conditions in priority order for medical card eligibility. In following the Expert Group’s advice, a person’s means remains the main qualifier for a medical card.

However, every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines. The HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income threshold where they face difficult financial circumstances, such as extra costs arising from an illness. Social and medical issues are also considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services.

Furthermore, the HSE also has a system in place for the efficient provision of medical cards in response to emergency situations i.e. in circumstances where persons are in need of urgent ongoing medical care or are receiving end of life care.  In these cases, a medical card is issued within 24 hours of receipt of the required patient details and completed medical report by a healthcare professional.  Additionally, patients who have been certified by their treating Consultant as having  a prognosis of 24 months or less to live are also now eligible for a medical card.

Finally, it should be noted that since 2015 medical cards are awarded without the need of a financial assessment to all children under 18 years of age with a diagnosis of cancer, for a period of five years.

Hospital Staff

Ceisteanna (341)

Matt Shanahan

Ceist:

341. Deputy Matt Shanahan asked the Minister for Health the additional recruitment that has taken place at UHW in terms of roles (details supplied); and if he will make a statement on the matter. [47257/21]

Freagraí scríofa

Minister for Health

In 2016, the Herity Report concluded that the needs of the effective catchment population of University Hospital Waterford (UHW) could be accommodated from a single Cath lab and recommended that the operating hours of the existing Cath lab should be extended.

The HSE has advised that discussions are still on-going to commence extended working days (8am-8pm) in the Cath Lab in University Hospital Waterford in.  It is intended to progress to 7 day extended hours working on an incremental basis during 2021.

The Programme for Government commits to the delivery of a second cath lab in University Hospital Waterford.   The Contractor for the construction of the new Cath Lab at University Hospital Waterford (UHW) was formally appointed on 25th March 2021. The project commenced on 17th May 2021 with a 13 month works programme. The project could not commence earlier due to levels of Covid Infection presenting at UHW. 

It is expected the main Contractor will hand over the project by the end of June 2022. Equipping and commissioning will follow for a period of 2 months and the Cath Lab is expected to be available for operational use from September 2022 onwards.

The Herity Report also recommended that the current 9 to 5 provision of emergency pPCI services at UHW should cease to allow the hospital to focus on the much larger volume of planned work. The then Minister for Health asked the Department to address the implications of this recommendation by arranging for a National Review of Specialist Cardiac Services. 

The National Review of Specialist Cardiac Services commenced in January 2018. This Review aims to achieve optimal patient outcomes at population level with particular emphasis on the safety, quality and sustainability of the services that patients receive by establishing the need for an optimal configuration of a national adult cardiac service. This aligns with the Sláintecare reform programme.

While substantial progress has been made on the Review, the COVID-19 Pandemic has impacted on its progress. Work has now recommenced on the Review to progress this with a view to completion over the coming months. As part of this, the Steering Group, under the Chairship of Prof Philip Nolan, has reconvened and a meeting was held on 20th September.

As the issues raised in the deputy’s question are service matters, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.

National Treatment Purchase Fund

Ceisteanna (342)

Matt Shanahan

Ceist:

342. Deputy Matt Shanahan asked the Minister for Health the NTPF activity in relation to UHW waiting lists over the past five years; the individual procedures outsourced; the name of the hospital systems to which such NTPF activity was awarded and carried out; the proportion of these allocations that were achieved in each individual hospital system by name; and if he will make a statement on the matter. [47259/21]

Freagraí scríofa

Minister for Health

The information requested by the Deputy is being collated by Department officials and a deferred reply will be submitted within ten working days.

Question No. 343 answered with Question No. 336.

Question No. 344 answered with Question No. 337.

Question No. 345 answered with Question No. 336.

Question No. 346 answered with Question No. 308.

Hospital Services

Ceisteanna (347)

Bríd Smith

Ceist:

347. Deputy Bríd Smith asked the Minister for Health his views on the lack of separate wards in hospitals to treat women experiencing stillbirth or miscarriage; his further views on the fact that the loss, trauma and devastation experienced by women in these situations is compounded by not having a dedicated, separate space in which to grieve and process their loss; his plans to address this; and if he will make a statement on the matter. [47272/21]

Freagraí scríofa

Minister for Health

I can assure the Deputy that significant progress has been to implement the National Standards for Bereavement Care following Pregnancy Loss and Perinatal Death since their publication in 2016. Specialist Bereavement Teams have been established in all 19 maternity hospitals/units, each with a Clinical Midwife Specialist in Bereavement, and the majority of maternity units also now have a specific Bereavement Room.  In line with the Standards, this ensures that families who have experienced a bereavement, get high standard, compassionate care in an appropriate setting, and a setting that affords them privacy and dignity at a very difficult and distressing time.  There are also quiet rooms available in most units to facilitate parents spending time with their baby.  The Department has been assured that all units continue to implement the Standards, and this is closely monitored by the Bereavement Standard Implementation Steering Group which reports to the National Women & Infants Health Programme.

In relation to separate wards in hospitals to treat women experiencing stillbirth or miscarriage, as this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible. 

Hospital Services

Ceisteanna (348)

Bríd Smith

Ceist:

348. Deputy Bríd Smith asked the Minister for Health the improvements planned in the area of care for women experiencing stillbirth or miscarriage in maternity hospitals; if there are plans to provide separate rooms and wards for those experiencing loss; his plans to consult with women who have had to deal with stillbirth and miscarriage to include their input into appropriate compassionate care in the aftermath of the loss of a child; and if he will make a statement on the matter. [47273/21]

Freagraí scríofa

Minister for Health

The Government is committed to the progressive development of maternity services.  In 2016, Ireland’s first National Maternity Strategy was published, as well as the HSE’s National Standards for Bereavement Care following Pregnancy Loss and Perinatal Death. The National Maternity Strategy recognises the importance of improving and standardising bereavement care throughout our maternity services and recommends the implementation of the National Standards for Bereavement Care following Pregnancy Loss and Perinatal Death. The Standards are designed to enhance bereavement care services for parents who experience a pregnancy loss or perinatal death and cover all pregnancy loss situations from early pregnancy loss to perinatal death.

There has been significant progress to implement the National Standards for Bereavement Care following Pregnancy Loss and Perinatal Death. This includes the development of Specialist Bereavement Teams in all 19 maternity hospitals/units, each with a Clinical Midwife Specialist in Bereavement, and the majority of maternity units also now have a specific Bereavement Room. This ensures that families who have experienced a bereavement, get high standard, compassionate care in an appropriate setting, and a setting that affords them privacy and dignity at a very difficult and distressing time.  There are also quiet rooms available in most units to facilitate parents spending time with their baby.  The Department has been assured that all units continue to implement the Standards, and this is closely monitored by the Bereavement Standard Implementation Steering Group which reports to the National Women & Infants Health Programme.

In addition to the National Standards, a National Maternity Bereavement Experience Survey is being developed by HIQA in conjunction with the Department of Health and the HSE. The survey will provide an opportunity to consult with women who have dealt with miscarriage and stillbirth. This will be the first national survey asking bereaved parents about their experiences of maternity care in Ireland. The survey will gather bereaved parents’ lived experiences of maternity care throughout the duration of their pregnancy, hospital admission, postnatal and follow-up care. The findings of this national survey will drive service improvements in maternity care, acknowledging what is working well and identifying areas where improvements are needed.

This survey is currently under development and was due to begin surveying bereaved parents later in 2021. However, in light of the difficulties posed by the cyber-attack on the HSE’s IT systems, the survey has been postponed for a period of 4 months. It is anticipated that surveying of parents will commence in February or March of 2022.

Hospital Appointments Status

Ceisteanna (349)

Brendan Griffin

Ceist:

349. Deputy Brendan Griffin asked the Minister for Health if a person (details supplied) will be considered for an appointment. [47286/21]

Freagraí scríofa

Minister for Health

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.

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.

Vaccination Programme

Ceisteanna (350)

Dara Calleary

Ceist:

350. Deputy Dara Calleary asked the Minister for Health if a HPV vaccination will be offered to a child (details supplied). [47311/21]

Freagraí scríofa

Minister for Health

The immunisation programme in Ireland is based on the advice of the National Immunisation Advisory Committee (NIAC). The committee's recommendations are based on the prevalence of the relevant disease in Ireland and international best practice in relation to immunisation. It makes recommendations on vaccination policy to my Department. The NIAC continues to revise recommendations to allow for the introduction of new vaccines in Ireland and to keep abreast of changes in the patterns of disease. Therefore, the immunisation schedule will continue to be amended over time.

In 2009, the NIAC recommended HPV (human papillomavirus) vaccination for all 12 to 13 year old girls to reduce their risk of developing cervical cancer when they are adults. In September 2010, the HPV vaccination programme was introduced for all girls in first year of secondary school.

In June 2017, on foot of the NIAC’s recommendation that the HPV vaccine should also be given to boys, my Department asked the Health Information and Quality Authority (HIQA) to undertake a health technology assessment (HTA) to establish the clinical and cost-effectiveness of extending the immunisation programme to include boys in the first year of secondary school.

The HIQA completed the HTA in December 2018, recommending that the HPV immunisation programme be extended to include boys. A policy decision was made to extend the HPV immunisation programme to include boys, starting in September 2019, with the introduction of a 9-valent HPV vaccine.

The ages at which vaccines are recommended in the immunisation schedule are chosen by the NIAC in order to give each child the best possible protection against vaccine preventable diseases. As the HPV vaccine is preventative it is intended to be administered, if possible, before a person becomes sexually active, that is, before a person is first exposed to HPV infection.

Therefore, the gender-neutral HPV vaccination programme targets all girls and boys in first year of secondary school to provide maximum coverage. All vaccines administered through the School Immunisation Programme are provided free of charge.

My Department will continue to be guided by NIAC's recommendations on any emerging evidence on this issue in the future.

Anyone not in 1st year of secondary school or age equivalent in special schools or home schooled during the 2020/2021 school year who wishes to get the HPV vaccine, must go to their GP or sexual health clinic and pay privately for the vaccine and its administration. This applies to everyone whether or not they have a medical card/GP visit card, as it is outside of the HPV immunisation programme.

At the request of my Department, the HIQA are conducting a Health Technology Assessment (HTA) on a school based HPV mop-up vaccination programme (for those that were previously eligible and missed or turned down the vaccine). The HIQA has confirmed that this HTA has been added to its work programme for 2021/2022 and I have requested that my officials give consideration to the outcome of this work in the context of the immunisation programme.

Ambulance Service

Ceisteanna (351)

Peter Burke

Ceist:

351. Deputy Peter Burke asked the Minister for Health the number of ambulance calls in the past three months; the average ambulance call-out time to arrival at the scene of a patient, by functioning area, in tabular form; and if he will make a statement on the matter. [47318/21]

Freagraí scríofa

Minister for Health

As this is a service matter I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.