January 28, 2014
Deputy John Deasy asked the Minister for Health if he is concerned that Ireland is falling short of the 75% flu vaccination target for older age groups, according to a progress report on the 2009 EU Council Recommendation; and the reason Ireland’s vaccination coverage dropped from 70% in 2008/09 to 56.3% in 2011/2012.
REPLY / Minister James Reilly:
In Ireland the Health Protection Surveillance Centre (HPSC) collates influenza vaccine uptake statistics in those aged 65 years and older based on data obtained from the Primary Care Reimbursement Service (PCRS), HSE- Finance Shared Services. These data provide information on the number of patients vaccinated with influenza vaccine (by age group and HSE-Area of residence), attendance at GP clinics and pharmacies for vaccination and the number of registered medical and GP visit cardholders aged 65 years and older. The number of patients vaccinated with influenza vaccine refers to GP and pharmacy paid claims for influenza vaccination reported by the PCRS and so are dependent on GPs’ and pharmacist’s claims for reimbursement. Data from pharmacies are only available for the 2012/2013 influenza season when administration of influenza vaccine by pharmacists commenced.
As highlighted, the uptake of influenza vaccine in those aged 65 years and older decreased from 70% in the 2008/2009 to 56.9% in 2011/2012. These estimates are based on PCRS data received by HPSC. The uptake in the season 2008/2009 was the highest uptake reported. The reason for this decline is unknown but as previously stated may be due to data received by PCRS which is dependent on GPs’ and pharmacist’s claims for reimbursement. Data from pharmacies were only available for the 2012/2013 influenza season when administration of influenza vaccine by pharmacists commenced which may have influenced 2011/2012 season data. In addition, during the period 2011/2012 data reported were not complete as PCRS did not report vaccinations administered by GPs and claimed through the new vaccination claiming system. The 2012/2013 dataset is not fully complete from PCRS and it may improve when the complete dataset is received. In 2008/2009 there were a number of high profile avian influenza H5N1 outbreaks in UK and other European countries. It is also possible that the higher uptake noted that year reflected a mistaken belief that seasonal influenza vaccine would protect against H5N1 avian influenza.
Of note is that a national telephone survey undertaken after the 2012/2013 influenza season measuring influenza vaccine uptake reports 59.9% coverage (provisional data) in those aged 65 years and over which is similar to the uptake recorded in the previous season i.e. 2011/2012 season. This survey also explored the reasons for non-vaccination among respondents. Respondents in the age group 65 years and over perceived themselves as not needing the influenza vaccine and of not being at risk of contracting influenza. In those who were vaccinated, recommendation by the GP was a strong predictor of influenza vaccination.
As pointed out the influenza vaccine coverage in this age group is below the WHO target of 75% and this is of concern. Efforts to improve flu vaccine uptake in those aged 65 years and older are made annually by launching the influenza vaccination campaign (media and written materials by the National Immunisation Office) at the start of the influenza season. In addition, HSE areas communicate to all nursing homes and residential care units at the start of each flu season regarding the importance of improving influenza vaccine uptake among elderly residents.
Table 1: Cumulative percentage seasonal influenza vaccine uptake in Medical Card Holders aged 65 years and older by season (September – August), attending GP clinics. (Click table to enlarge view)
Deputy Deasy asked the Minister for Health the reason flu vaccination rates for Irish persons with chronic medical conditions/risk groups were just below 29% in 2009/2010 the most recent available data compared to 70% in the Netherlands; and the reason vaccination rates among healthcare workers here reached only 18% in 2011/12 down from 26.5% in 2009/10.
REPLY / Minister James Reilly:
I am informed by the HSE that provisional data from the National Telephone Survey 2013 indicates that among those in the age group 18 - 64 years, with chronic medical conditions, self-reported influenza uptake for the 2012 - 2013 season was 28.4%. There has been little change from uptake in this group previously reported from the National Telephone Survey undertaken in 2010 (for the 2009 - 2010 season). In general, data from previous surveys has found that low uptake among groups recommended vaccine is based on lack of self-perceived risk and need for vaccination. A GP or clinician recommending influenza vaccine is a predictor of vaccine acceptance (source: National Telephone Survey 2010).
Based on data from a European survey (VENICE II survey, 2011 - 2012 influenza season), only three of 28 EU member states (UK, the Netherlands, France) were able to provide administrative data relating to influenza immunisation among individuals with clinical risk (aged 6 months - 64 years). The influenza vaccine uptake in this group ranged from 29.7% (France) to 73.6% (the Netherlands). An additional three countries provided survey based data for that season (Portugal, Norway and France). The range of uptake was 31% (Portugal) to 45.6% (France- estimated based on a number of surveys).
Possible reasons for higher uptake in the Netherlands may be related to the fact that both vaccine and vaccine administration are free for all, whereas in Ireland although the vaccine is free for all, those individuals without medical or GP only cards are required to pay for administration. It is well documented in international literature that payment for preventive care services (such as vaccination) negatively impacts on vaccination uptake. Additionally, the Netherlands uses computerised medical records to estimate uptake among risk groups. Ireland does not have information systems with which to routinely identify those at risk for vaccination and to monitor uptake among this group.
The most recent data on seasonal influenza vaccination uptake among Health Care workers (HCWs) is available from HPSC. Overall in 2012 - 2013 the percentage uptake among HCWs as reported by participating hospitals was 17.4% (range 10.1% - 27.8%), a slight decrease from 18.0% reported in 2011 - 2012). However, data from the National Telephone Survey 2013 found that self-reported vaccine uptake among HCW participants of 29.5%, suggesting that the data provided by hospitals may be incomplete and not accurately reflect uptake among HCWs, some of whom may obtain vaccination outside the occupational health care department (and therefore not reported by occupational health statistics).
During the current 2013 - 2014 influenza season HSE is working to improve uptake among HCWs in the hospitals and other health care settings. Based on provisional data from HPSC (for October 2013 - January 2014) the estimated uptake among hospital HCWs is 18.1%, and among HCWs in long term care facilities is 22.8%. The slight increase reported in this current season most likely reflects the increased attention and promotion to vaccination within the HSE health care facilities (hospitals and long term care facilities). The data for the complete season will be available following the final request for uptake figures made at the end of the season (May 2014).
Internationally, achieving high influenza vaccine uptake among HCWs is seen as challenging. Within Europe recent data (VENICE II survey, 2011 - 2012 influenza season) reported a wide inter-country variation of influenza vaccine coverage among HCWs, range 6.4% (Poland) to 54.4% (Romania).
Deputy John Deasy asked the Minister for Health his plans he has to extend the provision of additional services in Primary Care Centres to deliver more medical treatment at community level and ease pressure in public hospitals; and if he will outline the types of services that could be extended to these centres.
REPLY / Minister of State Alex White:
The development of primary care is central to the Government's objective to deliver a high quality, integrated and cost effective health system and is a key element of the overall Health Reform Programme. This includes the development of Primary Care Teams (PCTs) and Primary Care Centres (PCCs). The core objective is to achieve a more balanced health service by ensuring that the vast majority of patients and clients who require urgent or planned care are managed within primary and community based settings. This will be achieved by increasing activity in the primary care setting and redirecting services away from acute hospitals to the community.
The development of primary care centres, through a combination of public and private investment, will facilitate the delivery of multi-disciplinary primary health care.
It is the Government’s intention to develop as many primary care centres as possible using one of the following methods:
Considerable progress has been made in the delivery of primary care centres and 34 centres have opened since May 2011.
The establishment of Community Intervention Teams (CITs) is an example of delivering services appropriate for care in the home/community. These Teams work in partnership with PCTs, General Practice, Community Hospitals, home support services, acute hospitals and other professionals, to deliver enhanced services and patient centred care in the most appropriate setting. The benefits of CITs include:
There are currently 7 functioning CITs nationally, with further developments and expansions planned in 2014. The number of patient referrals to CITs in 2013 was 21,493.
Other services scheduled for transfer to Primary Care Centres include the following and these will be progressed further by the HSE during 2014:
The above are examples of routine clinical activity targeted for transfer from acute hospitals to primary care in the short to medium term as the Primary Care Centre infrastructure is developed.
January 15, 2014
Deputy John Deasy asked the Minister for Health the steps being taken to ensure adequate service provision across Irish hospitals for Cystic Fibrosis patients, both children and adults, including specialist isolated treatment facilities, in view of the fact that Ireland has the highest CF rates in the world, with one in nineteen people here carrying the gene.
Reply from Minister James Reilly: Cystic Fibrosis is Ireland's most common life-threatening inherited disease. This Government is acutely aware of the challenges that people with cystic fibrosis and their families face in managing their condition and fully acknowledges the need for and supports the provision of dedicated accommodation in an environment which allows appropriate isolation for improved infection control. Given the need to avoid the exposure of CF patients to possible sources of infection, the aim is to minimise wherever possible the need to admit such patients to hospital and instead to provide treatment on an ambulatory daycare basis, as close as possible to home.
There has been significant investment in services for people with cystic fibrosis in the past few years including a new dedicated CF unit opened in 2012 at St Vincent's University Hospital, the National Adult Referral Centre; a new purpose-built dedicated Ambulatory Outpatient facility at Beaumont Hospital for patients with CF; a new outpatient facility at CUH which was completed with local philanthropic support from Build4Life as well as Exchequer funding. Other capital projects currently underway include a dedicated paediatric out-patient CF unit at Galway University Hospital which is expected to be completed during 2014; and the development of a CF unit in CUH, for which funding has been raised by Build4Life. As the Deputy will be aware, Build4Life has raised the issue of ringfencing of these beds for patients with CF. I understand that the HSE and Build4Life are now in a process which I hope will bring about a resolution shortly.
A further key initiative in recent years has been the introduction of newborn screening for cystic fibrosis in July 2011. This test is included as part of the National Newborn Bloodspot Screening Programme. Early identification and care will enhance the outcomes for children with CF. Last year, the new CF drug ivacaftor (Kalydeco) was made available and it is estimated that approximately 120 patients will be suitable for treatment with this new drug.
A Cystic Fibrosis Clinical Programme has now been established as one of the HSE's National Clinical Programmes. Its aim is to provide the framework to ensure that patients with CF receive optimal care to preserve/enhance their quality of life and improve health outcomes and wellbeing within the context of the three key objectives of all of the National Clinical Programmes - to improve the quality of care provided, to improve access to specialist services and to improve cost-effectiveness and efficiency.
January 15, 2014
Deputy John Deasy asked the Minister for Health if his attention has been drawn to the developing crisis regarding cystic fibrosis beds in Cork University Hospital; and the position regarding the supposed ringfencing of agreed beds for CF patients in the context of substantial fundraising by the Build4life voluntary charity.
Reply from Minister James Reilly: At the outset, I want to commend Build4Life on its achievement in raising €2.3m to fund this unit in Cork University Hospital. The situation that has now arisen in relation to this development is regrettable. I understand that the HSE and Build4Life are now in a process which I hope will bring about a resolution shortly.
I understand that the proposed Unit will have 20 beds, 10 of which will be designated for patients with CF, eight within the unit with two additional isolation beds provided in the Renal Unit. I have been assured that patients with CF will have priority access to these ten beds at all times. The ring fencing of beds for CF patients has been an issue in other hospitals around the country but has been resolved through written agreements and good operational procedures. I am confident that a similar agreement can be reached in this instance.
The key issue is that patients with CF are assured that sufficient beds will be available when they are needed, but at the same time, when beds are not needed for CF patients, they can be freed up for other very ill patients with respiratory and other conditions. I note that Cystic Fibrosis Ireland has expressed its confidence that, following discussions, an agreement can be drawn up that will allow building to commence.
January 15, 2014
Deputy John Deasy asked the Minister for Health the level of services that will be provided by the eye unit at Waterford Regional Hospital into the future in the context of the rearrangement of hospital services.
Reply from Minister James Reilly: Last May, I published the Government's plan to reorganise public hospitals into more efficient and accountable Hospital Groups which will harness the benefits of increased independence and greater control at local level. The establishment of acute hospitals into a small number of groups, each with its own governance and management, will, I believe, provide an optimum configuration for hospital services to deliver high-quality, safe patient care in a cost effective manner. The Deputy will be aware that the establishment of hospital groups was committed to in ‘Future Health: A Strategic Framework for Reform’ and is a key building block in delivering on the Programme for Government commitment to fundamentally reform our health service.
Hospital Groups will be required, within one year, to develop a strategic plan which will outline how they will provide more efficient and effective patient services; how they will reorganise these services to provide optimal care to the populations they serve; and how they will achieve maximum integration and synergy with other Groups and health services, particularly primary care and community based services. The role of individual hospitals within each group will be considered in detail in the context of this strategic plan.
Waterford Regional Hospital is part of the South/South West Group along with Cork University Hospital/CUMH; Mercy University Hospital; South Tipperary General Hospital; South Infirmary Victoria University Hospital; Kerry General Hospital, Bantry General Hospital; Mallow General Hospital, and Lourdes Orthopaedic Hospital, Kilcreene. It will therefore be a matter for the South/South West Group to determine where services, including ophthalmology, will be located within the Group, taking into account the health needs of the population as well as Government policy.
January 15, 2014
Deputy John Deasy asked the Minister for Health the position regarding the reported transfer of up to 1,200 cataract operations awaited by patients on the Waterford Regional Hospital list to private hospitals; the average cost to the Health Service Executive of outsourcing such surgery per patient; if there was any consultation with the salaried consultants at WRH who are both contracted and keen to carry out these procedures; and if he is concerned that this effectively represents a double payment by the State.
Reply from Minister James Reilly: In relation to the specific query raised by the Deputy, as this is a service matter it has been referred to the HSE for direct reply.
January 15, 2014
Deputy John Deasy asked the Minister for Justice and Equality the estimated number of person's imprisoned in Ireland for non-payment of court fines in each of the years 2008, 2009, 2010, 2011, 2012.
Reply from Minister Alan Shatter: A breakdown of the number of persons imprisoned solely for non-payment of fines for each of the years 2008, 2009, 2010, 2011, 2012 is set out above.
I can advise the Deputy that the number of such persons held in custody at any one time is a tiny fraction of the overall prisoner population. To illustrate this point, on 14 January, 2014, 6 people, 0.15 percent, out of a prison population of 3,973 in custody that day fell into this category.
January 15, 2014
Deputy John Deasy asked the Minister for Justice and Equality the average sentence actually served by persons for non-payment of court fines; and the average current cost to the State, per day, of accommodating a typical fine defaulter in the prison system.
Reply from Minister Alan Shatter: I wish to advise the Deputy that it is not possible to provide the information without a manual examination of records. This exercise would entail the diversion of a disproportionate and inordinate amount of staff time which could not be justified in current circumstances.
However, I can advise that in 2012 there were a total of 8,304 committals to prison for non-payment of a Court ordered fine. Based on a statistical sample, the Irish Prison Service has determined that the vast majority of these committals spent less than 2 days in custody and on average spent 1 day in custody.
I am strongly of the view that we need to keep the numbers of people committed to prison for the non-payment of fines to the absolute minimum. The Fines Payment and Recovery Bill, which was published last July and scheduled for Dáil Committee Stage on 22 January, represents a major reform of our fine payment and recovery system and provides for the payment of fines by instalment and attachment of earnings.
Allowing everyone to pay a fine by instalment and introducing attachment of earnings are important new reforms to the fine collection system which will lead to improved collection rates for fines. The new measures provided for, combined with the requirement that judges must take a person’s financial circumstances into account when setting a fine, should result in a reduction in the number of people committed to prison.
When this Bill is enacted, it will be easier for people to pay a fine and where they fail to do so, there will be sufficient alternatives available to the courts to all but eliminate the need to commit anyone to prison for the non-payment of fines.
The average cost of accommodating a typical fine defaulter based on the 2012 'Cost of Offender figures (including variable costs of prisoner catering, prisoner gratuity, bedding, prisoner toiletries, dentist fees and medicines) equates to €10.44 per prisoner space per day.
January 15, 2014
Deputy John Deasy asked the Minister for Justice and Equality the average length of sentence actually served in cases where convicted persons are sentenced to periods of imprisonment of 12 months, two years, three years, four years, five years, six years, seven years, eight years, nine years, 10 years.
Reply from Minister Alan Shatter: I wish to advise the Deputy that it is not possible to provide the statistical breakdown, as requested, as this would require the manual examination of thousands of individual prisoner records. This exercise would entail the diversion of a disproportionate and inordinate amount of staff time which could not be justified in current circumstances.
All sentenced prisoners serving a sentence in excess of 1 month, with the exception of Life sentenced prisoners, persons convicted of debtor offences and persons convicted of contempt of court, are entitled to remission on their sentence length of one quarter. The Prison Rules, 2007 allow for the discretionary granting of additional remission, up to one third as opposed to the standard rate of one quarter. That said, this additional concession will only be awarded in exceptional cases where I am satisfied beyond any doubt that the prisoner concerned has demonstrated that she/he meets the requirements as set out in Rule 59 of the Prison Rules.
Further, the Criminal Justice Act 1960, as amended by the Criminal Justice (Temporary Release of Prisoners) Act 2003 provides that sentenced prisoners may be approved temporary release whether it be for a few hours or a more extended period. Finally, prisoners sentenced to a period of 1 to 8 years, upon serving 50 per cent of their sentence, can be assessed for suitability for alternatives to imprisonment such as the Community Return Scheme.