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 Header Item Written Answers Nos. 425-444
 Header Item Covid-19 Tests
 Header Item Primary Care Centres
 Header Item Covid-19 Pandemic
 Header Item Home Help Service
 Header Item Medicinal Products
 Header Item Covid-19 Pandemic
 Header Item Covid-19 Tests
 Header Item Alcohol Treatment Services
 Header Item Health Screening Programmes
 Header Item Legislative Measures
 Header Item Hospital Services
 Header Item Medicinal Products
 Header Item Covid-19 Pandemic
 Header Item Health Services Staff
 Header Item Covid-19 Pandemic
 Header Item Defibrillators Provision
 Header Item Emergency Departments
 Header Item Health Screening Programmes
 Header Item Cancer Services

Tuesday, 9 June 2020

Dáil Éireann Debate

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Written Answers Nos. 425-444

Covid-19 Tests

 425. Deputy Brendan Smith Information on Brendan Smith Zoom on Brendan Smith asked the Minister for Health Information on Simon Harris Zoom on Simon Harris the capacity for testing for Covid-19; the average turnaround time for test results; and if he will make a statement on the matter. [10394/20]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris A robust and real-time process of testing, isolation and contact tracing is central to our public health strategy for containing and slowing the spread of COVID-19, as advocated by WHO, EC and ECDC.

  There is now capacity in place to test 15,000 people a day on a seven day basis. As of midnight Monday 1 June, 348,416 tests have been carried out with an 8% positivity rate overall.

  The target turnaround time from referral to completion of contact tracing is 3 days or less in 90% of cases, while the target turnaround time for negative results is less than 2 days.

  Turnaround times are improving rapidly thanks to process improvements and automation. In over 80% of cases, the turnaround time from referral to completion of contact tracing is now 3 days or less. Over the last week, the median turnaround time has been 2 days. The HSE publishes updates on testing and contact tracing including activity levels and turnaround times on a daily basis. These can be accessed here - https://www.hse.ie/eng/services/news/newsfeatures/covid19-updates

  It is important to recognise that this capacity was developed from a standing start and that huge work has gone in to getting us to the point we are right now. I am confident that the HSE is putting in place the measures to further reduce turnaround times and we are seeing continuing improvement and greater consistency. The HSE continues to streamline the process and to automate where possible.

Primary Care Centres

 426. Deputy Paul McAuliffe Information on Paul  McAuliffe Zoom on Paul  McAuliffe asked the Minister for Health Information on Simon Harris Zoom on Simon Harris the status of the Finglas primary care centre. [10398/20]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris As the Health Service Executive is responsible for the delivery of public healthcare infrastructure projects, I have asked the HSE to respond to you directly in relation to this matter.

Covid-19 Pandemic

 427. Deputy Brendan Smith Information on Brendan Smith Zoom on Brendan Smith asked the Minister for Health Information on Simon Harris Zoom on Simon Harris if there will be an investigation into high levels of Covid-19 infection among healthcare workers; and if he will make a statement on the matter. [10401/20]

 430. Deputy Richard Boyd Barrett Information on Richard Boyd Barrett Zoom on Richard Boyd Barrett asked the Minister for Health Information on Simon Harris Zoom on Simon Harris if he will provide a detailed report on Covid-19 infections amongst health workers; his views on the request by an organisation (details supplied) for an inquiry into these infection levels; and if he will make a statement on the matter. [10422/20]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris I propose to take Questions Nos. 427 and 430 together.

  Gathering and reporting on demographic details of confirmed cases of COVID-19, such as healthcare worker status, is a complex and technical process involving multiple steps of data collection, processing and analysis. I have agreed with the HSE that such information would be made available on a weekly basis.

  The HSE Health Protection Surveillance Centre (HPSC) has prepared a summary of confirmed cases in healthcare workers (HCWs). As of the 30th May at midnight, the HPSC has advised that 8,018 cases of COVID-19 are in HCWs. This is 32% of all confirmed cases. This does not mean that 32% of all HCWs have COVID-19, as has been mis-reported, but rather that 32% of all cases in Ireland have occurred in someone who has reported being a HCW.

  The HPSC advises that the number of HCW cases has been declining week on week since mid-April. In the week 22 (24-30 May), there were 103 new COVID-19 confirmed cases in HCWs. This compares to 145 in week 21 and 470 in week 20.

  My Department is advised that the transmission route for HCWs is sought through the contact tracing process. A broad approach is taken when determining if a HCW confirmed case acquired it in a healthcare setting. This broad approach may lead to an overestimation of healthcare setting transmission. The HPSC advises that if a HCW is noted as a confirmed case and has one of the following, their mode of transmission is recorded as "healthcare setting acquired":

  Confirmed mode of transmission is healthcare setting acquired or

  Close contact with another confirmed case of COVID-19 in a healthcare or workplace setting or

  Linked to an outbreak in a healthcare setting.

  The HPSC advises that 60% of cases in healthcare workers have "healthcare setting acquired" recorded as the likely source of transmission.

  My Department and I are having a further meeting with the trade unions today.

Home Help Service

 428. Deputy Jim O'Callaghan Information on Jim O'Callaghan Zoom on Jim O'Callaghan asked the Minister for Health Information on Simon Harris Zoom on Simon Harris if further home help hours will be offered to a person (details supplied). [10407/20]

Minister of State at the Department of Health (Deputy Jim Daly): Information on Jim Daly Zoom on Jim Daly As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Medicinal Products

 429. Deputy Cathal Crowe Information on Cathal Crowe Zoom on Cathal Crowe asked the Minister for Health Information on Simon Harris Zoom on Simon Harris the steps he will take in relation to the need to access a drug by a person (details supplied). [10413/20]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris 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 Act and the national framework agreed with industry, a company must submit an application to the HSE to have a new medicine added to the reimbursement list.

Reimbursement is for licenced indications which have been granted market authorisation by the European Medicines Agency or the Health Products Regulatory Authority.

In making a relevant reimbursement decision, the HSE is required under the Act to have regard to a number of criteria including the health needs of the public, cost effectiveness, potential or actual budget impact and efficacy.

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 HSE has received an application for pricing and reimbursement of pembrolizumab (Keytruda) indicated as monotherapy or in combination with platinum and 5-fluoroucil, for the first-line treatment of metastatic or unresectable recurrent head and neck squamous cell carcinoma (HNSCC) in adults whose tumours express PD-L1 with a combined positive score.

In November 2019, the HSE commissioned an NCPE rapid review with respect to this indication. On 2 January 2020, the NCPE completed this rapid review and recommended that a full HTA be undertaken in order to assess the clinical effectiveness and cost effectiveness of pembrolizumab compared with the current standard of care. In January 2020, a full pharmacoeconomic assessment was commissioned by the HSE and this assessment is now underway.

  Question No. 430 answered with Question No. 427.

Covid-19 Pandemic

 431. Deputy Richard Boyd Barrett Information on Richard Boyd Barrett Zoom on Richard Boyd Barrett asked the Minister for Health Information on Simon Harris Zoom on Simon Harris the details of the guidance the Health Protection Surveillance Centre wrote for the nursing home and homecare sector on Covid-19 infection and transmission prevention; the way in which this guidance issued; and if he will make a statement on the matter. [10423/20]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris The HSE through the Health Protective Surveillance Centre has developed an extensive body of guidance and support tools to assist in the management of COVID-19 cases, including in relation to nursing homes and homecare. This guidance is reviewed and updated regularly as necessary. The current relevant guidelines are the: “Interim Public Health and Infection Prevention Control Guidelines on the Prevention and Management of COVID-19 Cases and Outbreaks in Residential Care."

On 10 March 2020, the HSE issued Interim Guidance on Transfer between Care Facilities, which included preliminary guidance on the transfer of hospitalised patients from an acute hospital to a residential care facility in the context of the global COVID-19 pandemic. The guidance based on the best available information at the time set out the various procedures to be followed, including:

- Patients with COVID-19 should not be transferred to a LTRC until they had two consecutive tests indicating virus not detected.

- Patients who were symptomatic and were contacts of a confirmed COVID-19 case should only transfer if the persons had a test indicating virus not detected and it was possible for that person to be isolated for the relevant incubation period;

- Patients who were asymptomatic and were contacts of a confirmed COVID-19 case should only transfer if it was possible for that person to be isolated for the relevant incubation period;

- Transfers from hospitals with no evidence of spread of COVID-19 should proceed as normal, except patients with respiratory tract infection meeting the then criteria for COVID-19 testing – in those cases testing should be carried out and the result should be virus not-detected before transfer.

As this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.

Covid-19 Tests

 432. Deputy Richard Boyd Barrett Information on Richard Boyd Barrett Zoom on Richard Boyd Barrett asked the Minister for Health Information on Simon Harris Zoom on Simon Harris the details of the programme to test and keep testing homecare workers that work with the most vulnerable of persons; and if he will make a statement on the matter. [10424/20]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris A robust and real-time process of testing, isolation and contact tracing is central to our public health strategy for containing and slowing the spread of COVID-19, as advocated by the WHO and ECDC.

  All healthcare workers meeting the current case definition for COVID-19 are referred for testing in line with current testing criteria. There is extensive guidance in place for healthcare workers and this can be found on the HPSC website: https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/guidance/guidanceforhealthcareworkers/. There is also clear guidance in place for the assessment, testing and return to work of healthcare workers. https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/algorithms/Algorithm%20for%20Testing%20and%20Return%20to%20Work%20of%20Symptomatic%20HCWs.pdf

  The HSE has advised that where healthcare workers, including home support workers, require a test, they are prioritised and there is no delay in scheduling a test appointment. Where a person in receipt of home support requires a test, this is also the case.

  In addition, current guidance requires the testing of all staff and residents when a new case emerges in a long term residential care facility (including mental health facilities) that have not yet had a case.

  It is important to note that testing is only one element of a comprehensive strategic response to COVID-19. Testing for COVID-19 only provides a point-in-time result. It confers no guarantee that the individual with a 'not detected' result is not incubating the infection or the level of virus is below detectable levels at the time of the test.

  Targeted, risk-based testing can yield important data to inform control measures, but does not constitute a control measure in and of itself. Testing should only be undertaken based on a public health risk assessment. A comprehensive response to the COVID-19 pandemic must include a strong focus on infection prevention and control and additional measures such as prompt identification and exclusion from work of symptomatic healthcare workers for example.

Alcohol Treatment Services

 433. Deputy Róisín Shortall Information on Róisín Shortall Zoom on Róisín Shortall asked the Minister for Health Information on Simon Harris Zoom on Simon Harris the considerations that have been given to alcohol delivery services; and if he will make a statement on the matter. [10431/20]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris Alcohol delivery services are governed by the Intoxicating Liqour Acts and as such are not within the remit of my Department.

Health Screening Programmes

 434. Deputy Bernard J. Durkan Information on Bernard J. Durkan Zoom on Bernard J. Durkan asked the Minister for Health Information on Simon Harris Zoom on Simon Harris when cancer screening services such as CervicalCheck which were postponed due to Covid-19 will resume; and if he will make a statement on the matter. [10435/20]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris As this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.

Legislative Measures

 435. Deputy Bernard J. Durkan Information on Bernard J. Durkan Zoom on Bernard J. Durkan asked the Minister for Health Information on Simon Harris Zoom on Simon Harris when the Regulated Professions (Health and Social Care) (Amendment) Bill 2019 is likely to be restored to the Houses of the Oireachtas with a view to early passage; and if he will make a statement on the matter. [10436/20]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris I would hope to have the Regulated Professions (Health and Social Care) (Amendment) Bill 2019 Bill restored to the Seanad Order Paper as soon as possible, noting that this will require a resolution of the House.

Hospital Services

 436. Deputy Mattie McGrath Information on Mattie McGrath Zoom on Mattie McGrath asked the Minister for Health Information on Simon Harris Zoom on Simon Harris when St. Brigid's Hospital, Carrick-on-Suir, County Tipperary will be returned to its normal operations; the reason the hospital has been kept idle when the numbers of cases in County Tipperary no longer justify this approach; if he will give a written commitment regarding the future of the hospital; and if he will make a statement on the matter. [10451/20]

Minister of State at the Department of Health (Deputy Jim Daly): Information on Jim Daly Zoom on Jim Daly As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Medicinal Products

 437. Deputy Louise O'Reilly Information on Louise O'Reilly Zoom on Louise O'Reilly asked the Minister for Health Information on Simon Harris Zoom on Simon Harris if his attention has been drawn to problems in procuring epanutin 50mg infatabs for patients prescribed same; if his attention has further been drawn to conflicting information regarding the shortage from industry and the Health Products Regulatory Authority; his plans to rectify the situation in order to minimise harm to patients; and if he will make a statement on the matter. [10455/20]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris The Marketing Authorisation Holder (MAH) for the anti-epileptic medicine Epanutin confirmed a shortage of its Epanutin Infatabs 50mg Chewable Tablets presentation. which contains the active ingredient phenytoin, commencing November 2019. The shortage is due to a manufacturing site change and other changes to the manufacturing process of this particular product and the resulting shortage is not confined to the Irish market. The company is taking all possible steps to ensure that normal supply resumes as soon as possible.

However, in order to mitigate any impact of the shortage to patients, the company is supplying the product it places on the Australian market under a different brand name, Dilantin Infatabs 50mg Chewable Tablets, to meet the needs of Irish patients. This product contains the same active ingredient, phenytoin, and is owned by the same company.

On the 9th of October 2019, healthcare professionals were alerted in advance of the shortage, advising that pharmacy staff and patients should be made aware of the issue and of the replacement product that would be made available. A copy of this letter is available on the Health Products Regulatory Authority (HPRA) website. Ireland has a multi-stakeholder medicine shortage framework in place, coordinated by the HPRA, in order to prevent, wherever possible, and manage medicine shortages when they occur. The HPRA remains in regular contact with the MAH regarding the interruption in supply of Epanutin 50mg Infatabs.

Patients or their carers who have any questions or concerns in relation to the temporary alternative presentation of phenytoin are advised to speak with their pharmacist or other healthcare professional responsible for their epilepsy care.

Covid-19 Pandemic

 438. Deputy Louise O'Reilly Information on Louise O'Reilly Zoom on Louise O'Reilly asked the Minister for Health Information on Simon Harris Zoom on Simon Harris if his Department is working with health facilities to deliver measures to allow for some level of visitation by family members; and if he will make a statement on the matter. [10456/20]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris While visiting restrictions are required in the context of a pandemic situation, national guidance issued by the Health Service Executive (HSE) and available on the Health Protection Surveillance Centre (HPSC) website advocates a compassionate and practical approach in relation to visiting by friends and family.

A updated guidance document on Infection Prevention and Control Precautions for Possible or Confirmed COVID-19 in a Pandemic Setting was published on 3 June 2020. It notes that while visiting restrictions will be required in a pandemic, local risk assessment and practical management must be considered, ensuring the response is both pragmatic and proportionate. Specific scenarios where a compassionate and practical approach is required include care of the dying.

Updated COVID-19 guidance on visitations to Residential Care Facilities was published by the HSE on 5 June 2020 and comes into effect from 15 June next. It sets out the criteria for visiting residential care facilities with no ongoing COVID-19 outbreak and for visiting residential care facilities during an outbreak of COVID-19. Indoor visiting in residential care facilities where there is no ongoing COVID-19 outbreak will be permissible from 15 June in circumstances where certain criteria are followed. During an ongoing outbreak of COVID-19 within a residential care facility, the guidance advises that all but essential visiting is suspended in the interests of protecting residents, visitors and staff.

Health Services Staff

 439. Deputy Louise O'Reilly Information on Louise O'Reilly Zoom on Louise O'Reilly asked the Minister for Health Information on Simon Harris Zoom on Simon Harris if all healthcare workers on a temporary contract will be offered a permanent job. [10457/20]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris I have asked the HSE to respond directly to the Deputy on this matter.

Covid-19 Pandemic

 440. Deputy Louise O'Reilly Information on Louise O'Reilly Zoom on Louise O'Reilly asked the Minister for Health Information on Simon Harris Zoom on Simon Harris the current average end-to-end time for testing and contact tracing; and if he will make a statement on the matter. [10458/20]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris A robust and real-time process of testing, isolation and contact tracing is central to our public health strategy for containing and slowing the spread of COVID-19, as advocated by the WHO and ECDC.

I am confident that the HSE is putting in place the measures to further reduce turnaround times and we are seeing continuing improvement. The HSE continues to streamline the process and to automate where possible. A range of process optimisation measures are being put in place, including automated swab appointments; offering the option to receive positive test results by text and enabling out of hours referrals. These are in addition to measures already in place including IT improvement, automation processes, and streamlined transportation logistics.

Regarding current average end-to-end time for testing and contact tracing, as this is an service matter, it has been referred to the HSE for direct reply to the Deputy as soon as possible.

Defibrillators Provision

 441. Deputy Louise O'Reilly Information on Louise O'Reilly Zoom on Louise O'Reilly asked the Minister for Health Information on Simon Harris Zoom on Simon Harris the number of requests made to the HSE in each of the past five years and to date in 2020 for funding for automated external defibrillators by families with inherited heart conditions; the number of these that have been approved; and if he will make a statement on the matter. [10459/20]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris As this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.

Emergency Departments

 442. Deputy Louise O'Reilly Information on Louise O'Reilly Zoom on Louise O'Reilly asked the Minister for Health Information on Simon Harris Zoom on Simon Harris if the emergency department charge will be waived for the provision of post-exposure prophylaxis through emergency departments in view of the fact that in many areas of the country there is no alternative service through which to access it. [10460/20]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris The Health (Out-Patient Charges) Regulations 2013, provide that, subject to specified exemptions, a charge shall be made for out-patient services provided at an emergency department, or any other facility providing similar services, in respect of the first occasion the service is provided in relation to each episode of care.

The Regulations sets out a number of categories of persons who are exempt from this charge including: a person with full eligibility; a child up to the age of 6 weeks; a child in respect of prescribed diseases of a permanent or long term nature; a person who has a letter of referral from a registered general practitioner, and a person whose attendance results in admission as an in-patient.

I have no plans to amend the provisions in relation to the application of this charge.

Health Screening Programmes

 443. Deputy Éamon Ó Cuív Information on Éamon Ó Cuív Zoom on Éamon Ó Cuív asked the Minister for Health Information on Simon Harris Zoom on Simon Harris when screening for cervical cancer, particularly for those with a history of cervical cell changes, will recommence; if a risk assessment has been carried out in relation to delaying these tests; and if he will make a statement on the matter. [10466/20]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris As this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.

Cancer Services

 444. Deputy Éamon Ó Cuív Information on Éamon Ó Cuív Zoom on Éamon Ó Cuív asked the Minister for Health Information on Simon Harris Zoom on Simon Harris when BreastCheck will recommence, particularly for those in the higher-risk category; if a risk assessment has been carried out in relation to delaying these tests; and if he will make a statement on the matter. [10467/20]

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris As this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.


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