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 Header Item Written Answers Nos. 633-647
 Header Item Covid-19 Pandemic
 Header Item Cannabis for Medicinal Use
 Header Item Cannabis for Medicinal Use
 Header Item Suicide Prevention
 Header Item Health Services
 Header Item Hospital Appointments Status
 Header Item Guardians Ad Litem
 Header Item Dental Services
 Header Item Dental Services
 Header Item Dental Services
 Header Item Dental Services
 Header Item Covid-19 Pandemic
 Header Item Dental Services
 Header Item Covid-19 Pandemic
 Header Item Dental Services

Tuesday, 6 October 2020

Dáil Éireann Debate
Vol. 998 No. 5
Unrevised

First Page Previous Page Page of 120 Next Page Last Page

Written Answers Nos. 633-647

Covid-19 Pandemic

 633. Deputy Aengus Ó Snodaigh Information on Aengus Ó Snodaigh Zoom on Aengus Ó Snodaigh asked the Minister for Health Information on Stephen Donnelly Zoom on Stephen Donnelly when permission will be given to senior citizens day centres to open, even in a limited way to help tackle the isolation which elderly residents in the complex feel, especially those with limited mobility and or poor visibility, whose only human contact other than medical appointments is often the hour or two which they spend at the day centres when open. [28109/20]

Minister of State at the Department of Health (Deputy Mary Butler): Information on Mary Butler Zoom on Mary Butler We all know that community services such as day care and respite services play an important role in enabling older people to continue living in their communities and maintain their social connections. These services contribute to positive ageing and better overall health. However, the introduction of physical distancing, isolation and restricted contact with family and loved ones has changed the usual dynamic of social interaction.

The HSE continues to work closely with providers and community staff to identify where service is most required and has been undertaking risk assessments of local services. This is to ensure, insofar as possible, that Day Care services and respite services can resume in the context of COVID-19 and having regard for Public Health advice.

Services will resume when it is safe to do so; when all infection prevention and control measures and the requirements of physical distancing can be maintained, so as to protect service users and staff and prevent any further spread of the virus. Some Day Centres may not be suitable for reopening due to the constraints of their physical environment and it will be necessary to continue or expand alternative service delivery models developed during recent months. Some of the issues identified the HSE include;

- Day Care Centres operated in shared public facilities where other groups are also accessing the building and the risk of infection spread.

- A number of HSE Day Care Centres are attached to HSE Residential Care Units and the clients of both the Day Care Centres and the residents from the Residential Care Unit are in the same location and use shared facilities.

- Transport of clients to the Day Care Centres where family cannot assist.

- Availability of isolation areas, should a client or a member of staff become unwell.

I understand the impact that the continued delay in the re-opening of day centres and the restoration of respite services is having on older people and the important role this service can play in their lives. I have asked the HSE to ensure that it continues to assess the risks and benefits of re-opening, as well as continuing to expand and explore alternative ways of delivering services to this vulnerable group. I am also continuing to meet with groups that work with and on behalf of older people to see how they can best be supported during this challenging time.

Cannabis for Medicinal Use

 634. Deputy David Cullinane Information on David Cullinane Zoom on David Cullinane asked the Minister for Health Information on Stephen Donnelly Zoom on Stephen Donnelly his views on the import and distribution of medicinal cannabis through community pharmacies following a referral from a general practitioner or consultant; and if he will make a statement on the matter. [28119/20]

Minister for Health (Deputy Stephen Donnelly): Information on Stephen Donnelly Zoom on Stephen Donnelly In June 2019, the Minister for Health signed legislation to underpin the operation of the Medical Cannabis Access Programme (MCAP). This is a 5-year pilot programme, restricted to prescribing of cannabis-based products by medical consultants, for patients with certain medical conditions who have exhausted all other available medical treatment options. Those conditions are:

- Spasticity associated with multiple sclerosis

- Intractable nausea and vomiting associated with chemotherapy

- Severe, refractory (treatment-resistant) epilepsy.

Commercial suppliers whose cannabis products have been reviewed and are considered to have met the specified requirements set out in the legislation and are in line with the clinical guidance for the MCAP, will have their products added to Schedule 1 of the Misuse of Drugs (Prescription and Control of Supply of Cannabis for Medical Use) Regulations 2019. Once the products are listed in Schedule 1 of these Regulations the suppliers will be permitted to supply these products to the Irish market, in line with legal and regulatory requirements. Cannabis products will only be listed in Schedule 1 of the Regulations once they have been assessed as suitable for medical use under the MCAP.

To date three products have been added to Schedule 1 of the Misuse of Drugs (Prescription and Control of Supply of Cannabis for Medical Use) Regulations 2019. The three products are:

1. Aurora High CBD Oil Drops

2. CannEpil ™

3. Tilray Oral Solution THC10:CBD10 25ml.

The HSE has engaged in discussions with the suppliers of these products, regarding pricing and supply information. The HSE will consider such information, in line with the Health (Pricing and Supply of Medical Goods) Act 2013. The programme will not become fully operational until pricing and supply matters are agreed.

Once the Medical Cannabis Access Programme commences the HSE will establish and maintain a Register to facilitate the enrolment and recording of certain data including patient identifiers (in anonymised format), prescribers enrolled in the Programme, as well as prescribed / supplied medical cannabis products. The Department can advise that while the MCAP register is not currently operational, engagement is ongoing with the HSE in regard to progressing same.

Prescribers (medical consultants on the specialist register) will be able to prescribe cannabis for medical use to patients as set out in the legislation. It is important to understand that it will only be possible for specialist consultants to prescribe a specified controlled drug (medical cannabis products) under the Access Programme, once suppliers make these products available on the Irish market. Prescribers should also refer to the clinical guidelines prepared by the Expert Reference Group, available on the Department of Health Website.

Pharmacists will be able to dispense Cannabis for Medical Use to patients as set out in the legislation, on foot of a valid prescription, once suppliers make the specified controlled drugs available on the Irish market. Pharmacists should also refer to the Clinical Guidelines prepared by the Expert Reference Group, available on the Department of Health website.

The offences and penalties for unauthorised supply and possession of controlled substances remain unchanged.

It is important to note that where a cannabis product is a specified controlled drug legally permitted for medical use, in connection with the MCAP, this does not signify any endorsement whatsoever of the safety, quality or efficacy of the specified controlled drug for the indication prescribed and the Minister for Health will have no liability in respect of the use of such products by a person issued with a prescription by their clinician under this Regulation. The use of a cannabis product for the purposes of the MCAP is a matter for the patient and their medical advisor.

Cannabis for Medicinal Use

 635. Deputy David Cullinane Information on David Cullinane Zoom on David Cullinane asked the Minister for Health Information on Stephen Donnelly Zoom on Stephen Donnelly the process for access to medicinal cannabis through the EMA compassionate use access programme; and if he will make a statement on the matter. [28120/20]

Minister for Health (Deputy Stephen Donnelly): Information on Stephen Donnelly Zoom on Stephen Donnelly There is no access to medicinal cannabis through an EMA compassionate use access programme.

  However, in June 2019, the Minister for Health signed legislation to underpin the operation of the Medical Cannabis Access Programme (MCAP). This is a 5-year pilot programme, restricted to prescribing of cannabis-based products by medical consultants, for patients with certain medical conditions who have exhausted all other available medical treatment options. Those conditions are:

  Spasticity associated with multiple sclerosis

  Intractable nausea and vomiting associated with chemotherapy

  Severe, refractory (treatment-resistant) epilepsy.

  For more information relating to the MCAP, including FAQs, please see the Department of Health’s website at the following link.

  www.gov.ie/en/publication/90ece9-medical-cannabis-access-programme/.

  Commercial suppliers whose cannabis products have been reviewed and are considered to have met the specified requirements set out in the legislation and are in line with the clinical guidance for the MCAP, will have their products added to Schedule 1 of the Misuse of Drugs (Prescription and Control of Supply of Cannabis for Medical Use) Regulations 2019. Once the products are listed in Schedule 1 of these Regulations the suppliers will be permitted to supply these products to the Irish market, in line with legal and regulatory requirements. Cannabis products will only be listed in Schedule 1 of the Regulations once they have been assessed as suitable for medical use under the MCAP.

  To date three products have been added to Schedule 1 of the Misuse of Drugs (Prescription and Control of Supply of Cannabis for Medical Use) Regulations 2019. The three products are:

  1. Aurora High CBD Oil Drops

  2. CannEpil ™

  3. Tilray Oral Solution THC10:CBD10 25ml.

  The HSE has engaged in discussions with the suppliers of these products, regarding pricing and supply information. The HSE will consider such information, in line with the Health (Pricing and Supply of Medical Goods) Act 2013. The programme will not become fully operational until pricing and supply matters are agreed.

  Once the Medical Cannabis Access Programme commences the HSE will establish and maintain a Register to facilitate the enrolment and recording of certain data including patient identifiers (in anonymised format), prescribers enrolled in the Programme, as well as prescribed / supplied medical cannabis products. The Department can advise that while the MCAP register is not currently operational, engagement is ongoing with the HSE in regard to progressing same.

  Ministerial Licence under Section 14 of the Misuse of Drugs Acts 1977-2016

  Pending full operation of the MCAP and for medical indications not included in the MCAP, doctors may continue to utilise the Ministerial licencing route to prescribe medical cannabis for their patients, should they wish to do so. In line with the Chief Medical Officer's advice, the granting of a licence for cannabis for medical purposes must be premised on an appropriate application being submitted to the Department of Health, which is endorsed by a consultant who is responsible for the management of the patient and who is prepared to monitor the effects of the treatment over time. This information can be found at the following links:

  www.gov.ie/en/publication/1a5c4e-applying-to-the-minister-for-health-for-a-medical-cannabis-licence/.

  www.gov.ie/en/publication/e35cb4-ministerial-licence-application-process/.

  It is important to note that the medical decision to prescribe or not prescribe any treatment, including cannabis treatment, for an individual patient is strictly a decision for the treating clinician, in consultation with their patient. The Minister for Health has no role in this clinical decision-making process.

  I hope that this information is of assistance.

Suicide Prevention

 636. Deputy Niamh Smyth Information on Niamh Smyth Zoom on Niamh Smyth asked the Minister for Health Information on Stephen Donnelly Zoom on Stephen Donnelly if a suicide crisis assessment nurse will be provided in counties Cavan and Monaghan. [28122/20]

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

Health Services

 637. Deputy Niall Collins Information on Niall Collins Zoom on Niall Collins asked the Minister for Health Information on Stephen Donnelly Zoom on Stephen Donnelly the guidelines for an event (details supplied); if he will provide a contact person for the event organisers to liaise with either in the HSE or his Department; and if he will make a statement on the matter. [28126/20]

Minister for Health (Deputy Stephen Donnelly): Information on Stephen Donnelly Zoom on Stephen Donnelly As the Deputy is aware, Resilience and Recovery 2020-2021: Plan for Living with Covid-19 was published by the Government on 15 September, 2020. This Framework sets out Ireland's approach to managing and living with COVID-19 in a range of areas over the next 6 - 9 months.

  The plan sets out five levels of response, each with a number of measures designed to help us all lower COVID-19 transmission, and setting out what is permitted at that moment in time. It aims to allow society and businesses to be able to operate as normally as possible, while continuing to suppress the virus. The plan is framed to account for periods which there is a low incidence of the disease, with isolated clusters and low community transmission, through to situations where there is a high or rapidly increasing incidence, widespread community transmission and the pandemic is escalating rapidly in Ireland and globally. It recognises the need for society and business to be allowed to continue as normally as possible and is designed so that either national or county level restrictions can be applied.

  Each level outlines what is permitted for social or family gatherings, work and public transport, bars, hotels and restaurants, exercise activities and religious services. The Framework was informed by expert advice and recommendations from the National Public Health Emergency Team (NPHET).

Resilience and Recovery 2020-2021: Plan for Living with Covid-19 specifically deals with the events and exhibition sector and the government will continue to work with the sector to progress the development of agreed protocols to enable the hosting of trade events in the near future. The Deputy may wish to note that my colleague Minister of State Robert Troy TD in the Department of Business, Enterprise and Innovation has met with sector representatives.

  The Deputy may also wish to note that the number of people allowed to gather in different scenarios in the plan is based on a review of international practice and the judgment of public health experts. It seeks to balance the risks of different types of gatherings against the desire to allow normal activities to proceed in so far as possible. It is not possible to say what circumstances will apply in the future due to the nature of the virus that has caused this global pandemic and the concerns that remain about the very serious threats to health that can be caused by Covid-19. The measures in place and the public health advice have been adapted to the changing circumstances and this will continue to be the case for the foreseeable future.

Hospital Appointments Status

 638. Deputy Michael Healy-Rae Information on Michael Healy-Rae Zoom on Michael Healy-Rae asked the Minister for Health Information on Stephen Donnelly Zoom on Stephen Donnelly the status of an appointment for a person (details supplied); and if he will make a statement on the matter. [28142/20]

Minister for Health (Deputy Stephen Donnelly): Information on Stephen Donnelly Zoom on Stephen Donnelly It is recognised that waiting times for scheduled appointments and procedures have been impacted as a direct result of the COVID-19 pandemic.

In response to the Covid-19 pandemic the HSE had to take measures to defer most scheduled care activity in March, April, and May of this year. 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. To ensure services are re-introduced in a safe, clinically-aligned and prioritised way, hospitals are following HSE clinical guidelines and protocols which has resulted in reduced capacity and activity

The HSE continues to optimise productivity through alternative work practices such the use of alternative settings including private hospitals, community facilities and alternative outpatient settings.

The National Treatment Purchase Fund has also recommenced arranging treatment in both private and public hospitals for clinically suitable patients who have been waiting for long periods on public hospital waiting lists.

Under the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.

The National Waiting List Management Policy is a standardised approach used by the HSE to manage scheduled care treatment for in-patient, day case and planned procedures. It sets out the processes that hospitals are to implement to manage waiting lists and was developed in 2014 to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care.

In relation to the particular query raised, as this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.

Guardians Ad Litem

 639. Deputy Bernard J. Durkan Information on Bernard J. Durkan Zoom on Bernard J. Durkan asked the Minister for Health Information on Stephen Donnelly Zoom on Stephen Donnelly the reason a person (details supplied) has been issued with a summons in respect of an alleged breach of guardian ad litem regulations given that they were unable to persuade their child otherwise; if instead urgent action will be taken in respect of their child; if immediate arrangements will be made to provide a course of adequate treatment for the child; and if he will make a statement on the matter. [28148/20]

Minister of State at the Department of Health (Deputy Mary Butler): Information on Mary Butler Zoom on Mary Butler My Department has made enquiries with the Department of Children and Youth Affairs in relation to the first part of this question, as Guardian Ad Litems come under their remit, however, they have stated that there are no Guardian Ad Litem regulations currently in place, therefore, any breach/summons would not be under Guardian Ad Litem regulations.

Furthermore, the Department of Justice has stated that no Minister can give the reasons behind a Judge’s decision to issue a summons and neither should they comment on such a decision.

With regard to the health-related aspects of this question, as this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible on this matter, along with the Deputy’s previous question of 30th September in relation to the same individual, which was already submitted to the HSE for direct reply to the Deputy.

Dental Services

 640. Deputy David Cullinane Information on David Cullinane Zoom on David Cullinane asked the Minister for Health Information on Stephen Donnelly Zoom on Stephen Donnelly the number of children on dental and orthodontic services waiting lists; the number waiting 0 to 6, 6 to 12 months, 1 to 2, 2 to 3 and 3 plus years, by LHO in tabular form; and if he will make a statement on the matter. [28157/20]

Minister for Health (Deputy Stephen Donnelly): Information on Stephen Donnelly Zoom on Stephen Donnelly As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.

Dental Services

 641. Deputy David Cullinane Information on David Cullinane Zoom on David Cullinane asked the Minister for Health Information on Stephen Donnelly Zoom on Stephen Donnelly the number of persons with special needs on dental and orthodontic services waiting lists; the number waiting 0 to 6, 6 to 12 months, 1 to 2, 2 to 3 and 3 plus years, by LHO in tabular form; and if he will make a statement on the matter. [28158/20]

Minister for Health (Deputy Stephen Donnelly): Information on Stephen Donnelly Zoom on Stephen Donnelly As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.

Dental Services

 642. Deputy David Cullinane Information on David Cullinane Zoom on David Cullinane asked the Minister for Health Information on Stephen Donnelly Zoom on Stephen Donnelly the impact of the Covid-19 pandemic on dental and orthodontic services waiting lists; the number of persons waiting 0 to 6, 6 to 12 months, 1 to 2, 2 to 3 and 3 plus years at the end of quarter 2 and 3 2020 compared to quarter 2 and 3 2018 and 2019, by LHO in tabular form; and if he will make a statement on the matter. [28159/20]

Minister for Health (Deputy Stephen Donnelly): Information on Stephen Donnelly Zoom on Stephen Donnelly As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.

Dental Services

 643. Deputy David Cullinane Information on David Cullinane Zoom on David Cullinane asked the Minister for Health Information on Stephen Donnelly Zoom on Stephen Donnelly the number of appointments attended in HSE primary care dental services nationally for the period from 4 March 2019 to 31 May 2019 and from 2 March 2020 to 29 May 2020, in tabular form; and if he will make a statement on the matter. [28170/20]

Minister for Health (Deputy Stephen Donnelly): Information on Stephen Donnelly Zoom on Stephen Donnelly As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.

Covid-19 Pandemic

 644. Deputy David Cullinane Information on David Cullinane Zoom on David Cullinane asked the Minister for Health Information on Stephen Donnelly Zoom on Stephen Donnelly the number of patients that had their appointments cancelled due to the Covid-19 pandemic from 2 March 2020 to 1 September 1 2020, by HSE CHO region in tabular form; the number of these cancellations that refer to patients from mainstream national schools, special classes in mainstream schools, special schools, adults in special care, other special care children and orthodontic patients; and if he will make a statement on the matter. [28171/20]

Minister for Health (Deputy Stephen Donnelly): Information on Stephen Donnelly Zoom on Stephen Donnelly As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.

Dental Services

 645. Deputy David Cullinane Information on David Cullinane Zoom on David Cullinane asked the Minister for Health Information on Stephen Donnelly Zoom on Stephen Donnelly the estimated number of students in 1st, 2nd, 3rd, 4th, 5th and 6th class by CHO region that prior to service disruption due to Covid-19, that is the beginning March 2020, were targeted for dental services for the academic year September 2019 to June 2020, by class; and if he will make a statement on the matter. [28172/20]

Minister for Health (Deputy Stephen Donnelly): Information on Stephen Donnelly Zoom on Stephen Donnelly As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.

Covid-19 Pandemic

 646. Deputy David Cullinane Information on David Cullinane Zoom on David Cullinane asked the Minister for Health Information on Stephen Donnelly Zoom on Stephen Donnelly the average WTE number of dental staff redeployed as part of the Covid-19 efforts, by HSE CHO region, on a weekly basis from 1 March to 1 September 2020, comprising dentists, dental nurses and dental hygienists; and if he will make a statement on the matter. [28173/20]

Minister for Health (Deputy Stephen Donnelly): Information on Stephen Donnelly Zoom on Stephen Donnelly As this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy, as soon as possible.

Dental Services

 647. Deputy David Cullinane Information on David Cullinane Zoom on David Cullinane asked the Minister for Health Information on Stephen Donnelly Zoom on Stephen Donnelly the number of adults by HSE CHO region that are waiting for dental treatment under general anaesthetic; the maximum waiting period per region; and if he will make a statement on the matter. [28174/20]

Minister for Health (Deputy Stephen Donnelly): Information on Stephen Donnelly Zoom on Stephen Donnelly As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.


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