Update 21 June 2021: Controversy continues as partners of pregnant women are still not allowed to attend hospital appointments

Despite the HSE issuing guidance weeks ago, controversy remains that many partners of pregnant women are being denied access to hospitals for key appointments with their pregnant partners. After a debate in the Seanad on 21 June 2021, Minister for Health Stephen Donnelly said that all of the State’s maternity units will be following the same visiting guidelines for patients’ partners by the end of today. 

Minsiter Donnelly said ‘that a plan is being worked on… to facilitate emergency visits by partners to maternity units for cases such as miscarriage…. in the coming weeks it will be rolled out across the country . . . we’re only talking three or four weeks, the emergency visits will be facilitated’.

On Monday, the Seanad was told that hospitals in Kilkenny, Tipperary and Wexford have not been complying with HSE guidelines on easing visiting restrictions in maternity units. Examples were given where partners are recently not being allowed in for labour or where their partner had had a miscarriage. 

Last week, HSE chief Paul Reid said that 16 of the 19 maternity units in the State were complying with easing restrictions.

Update 8 December 2020: Partners of pregnant women allowed to attend 20-week scan

In response to the COVID-19 pandemic, the Health Service Executive (HSE) has since March 2020 limited the attendance at pregnancy scans to only a pregnant woman herself. In response to growing public pressure, with many stories emerging of women receiving difficult news alone and partners not being able to share in important moments, the HSE will now allow partners to attend appointments, scans and the full duration of labour.

Essential health services are being maintained during the coronavirus outbreak. In the COVID-19 Action Plan published on 16 March, it specified that the HSE would:
• Ensure ongoing services for specialties including trauma, cancer, obstetrics, CF and organ transplant services
• Engage acute oncology clinical nurse specialists to reduce the number of oncology patients being admitted to acute services and to avoid unnecessary admissions through Emergency Departments
• Maintain urgent (elective) activity including urgent diagnostics, cancer rapid access clinics and dialysis
• Maintain community care including for socially vulnerable groups, community palliative care, mental health, home support and short-term / transitional / long-term care for older people and those within our specialist disability services
• Support general practice in delivering on-going essential care of patients
• Support community pharmacists in delivering on-going care of patients
• Ensure provision of essential patient transport to maintain healthcare access

From 28th March 2020, all non-essential surgery, health procedures and other non-essential health services are postponed. All visits to hospitals, residential healthcare centres, other residential settings or prisons are stopped with specific exemptions on compassionate grounds. Essential services include essential primary and social care services, Emergency Departments, maternity care, urgent acute care, urgent outpatient and elective activity.

On 3 April, the Minister for Health Simon Harris signed two statutory instruments to relieve some of the pressures on our GPs, pharmacists and patients in accessing prescriptions. The Minister signed the Medicinal Products (Prescription and Control of Supply) (Amendment) Regulations 2020 allowing for the electronic transfer of prescriptions to a pharmacy via an approved electronic system: the HSE's Healthmail system. In addition, the maximum period of validity of a prescription is increased from six months to nine months as of the date specified on the prescription. Some temporary changes to the way in which prescriptions can be repeated are also being introduced to enable pharmacists to ensure the continuity of care of patients without necessarily requiring a new prescription. Pharmacists are to be allowed by law to dispense medicines outside the dates spelled out in prescriptions according to their own professional judgement.

There are a range of supports being provided to vulnerable people at home as increasing restrictions are placed on people at home and in long-term care facilities. On 2nd April 2020, the government launched ‘The Community Call’, a major initiative that links local and national government with the community and voluntary sectors. The purpose of the Community Call is to coordinate community activity, direct community assistance to where it is needed, and marshal the volunteering energy of the country.

The immediate focus is on older people and the most vulnerable, and mobilising a rapid response in every county to make sure everyone is looked after. A free phone number is being advertised for every county so that people can connect and get support locally.

There is specific information on the HSE website in relation to minding your mental health during the outbreak. The HSE Chief Operations Officer was previously the national lead for mental health. She is one of the leadership present at each of the HSE press conferences and at each acknowledges the impact on mental health and encourages people to seek access to services and support, much of which is now online or through telephone contact.

On 20 March at the daily press briefing from the NPHET, Dr Ronan Glynn, Deputy Chief Medical Officer, Department of Health, said: ‘We are aware that the actions we must take as a nation can lead to individuals feeling isolated and anxious. Be mindful of your mental health during this time, try to keep to a routine, maintain a healthy, balanced diet, and remember distancing doesn’t have to mean social isolation – stay in touch with family and friends, use technology to stay connected. There are resources to help you mind your mental health on HSE.ie.’

During mid/late March, there were high numbers of clusters of older people contracting and dying from COVID-19 in nursing homes. The NPHET recommended increased measures to support nursing homes residents in the context of the overarching response to COVID-19. These were announced on 05/04/2020 and include
• staff screening in nursing homes twice a day
• COVID-19 testing will be prioritised for staff
• the HSE will provide access to PPE, expert advice and training
• each nursing home will be identifying a COVID-19 lead
• Staff movement across residential facilities will be minimised
• the HSE will support staff with alternative accommodation and transport, if required
• a temporary COVID-19 Financial Support Scheme is being introduced by Government and will be established to support the critical services provided by nursing homes. The Scheme will provide a temporary assistance payment to support private and voluntary nursing homes in managing any outbreak that occurs.  It is envisaged that the scheme will operate for a 3 month period. It will be reviewed after the first month’s operation.

Significant efforts are being made through regular briefings of the Chief Medical Officer, the government and the HSE to make the public aware that non-COVID-19 service delivery is continuing despite the Covid-19 pandemic. People are encouraged to contact their GP or health service by phone to access care.
For example on 6 May, the following text was in a HSE tweet, ‘If you have chronic illness & are feeling unwell, don’t ignore your symptoms, call your GP. They can assess you over the phone to ensure the best treatment plan. If you need emergency health care please dial 999 or 112, our services are open & working. #ItsInOurHands #coronavirus’.

On 4 May, the following text was in another HSE tweet: ‘Remember our Emergency Departments are open 24/7 for people who are seriously ill or injured and if their life is at risk. Stroke and heart attacks are life-threatening medical emergencies. If you or someone else is showing signs of a stroke or heart attack, don’t wait, call 999. The main stroke symptoms can be remembered with the word FAST: Face dropping; Arms weakness; Speech difficulty; Time to act.
The symptoms of a heart attack can include chest pain, pain in other parts of the body, shortness of breath, nausea, an overwhelming sense of anxiety, feeling light-headed, coughing, vomiting, and or wheezing. If you need medical advice, please call your GP. @HSElive’.

At the HSE weekly operational update on 3 May 2020, HSE chief Paul Reid outlined how hospital beds emptied and acquired for the surge,  will be used for additional non-COVID-19 work.

For the week up to 28 April, there was increased attendance of 8.6% in Emergency Departments (EDs) attendances but it is still 30% below the same period last year. In terms of ED admissions, they went up by 3.35, 23% lower than last year. Significant increase in delayed discharges from hospital to home or nursing homes.
In a recent survey of the population, when people were asked why they were delaying access care, more than half said it was because of fear of infection if they attend a healthcare facility. The HSE is preparing a report on how to provide non-covid services in the context of Covid-19 which will be made available when it is passed by the HSE Board( https://www.pscp.tv/w/1OyKAYYLjWyKb).

Services for vulnerable groups:

The NPHET has a specific subgroup on vulnerable groups. Dr Kathleen MacLellan, Assistant Secretary Department of Health, member of NPHET is the Chair of NPHET Vulnerable People Subgroup. This issued a checklist for those providing services to vulnerable people: https://www.hse.ie/eng/services/news/newsfeatures/covid19-updates/partner-resources/checklist-for-those-providing-services-to-vulnerable-people.pdf

The HSE has a range of multi-disciplinary teams supporting the COVID-19 response to vulnerable groups.

The HPSC has a guidance document that gives general advice about preventing the spread of COVID-19 and dealing with cases of COVID-19 in Homeless settings and for Travellers, Roma, International protection applicants (IPAS), refugees and other vulnerable groups. These can be applied in hostels, hubs or residential settings such as Direct provision and those without clinic or in-house nursing, medical or healthcare support (https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/guidance/vulnerablegroupsguidance/COVID-19-Guidance-for-vulnerable-groups-settings.pdf).

The HSE has a Model of Care (MoC) which lays out, in a clear format, guidance for healthcare organisations and healthcare workers for the assessment and management of COVID-19 (https://hse.drsteevenslibrary.ie/c.php?g=679077&p=4841241). The HSE has also issued consensus advice to at risk groups
(https://hse.drsteevenslibrary.ie/c.php?g=679077&p=4841345).

On 5 May when some restriction measures were eased, guidance on cocooning to protect people over 70 years and those extremely medically vulnerable from COVID-19 – this includes advice on what people should do if they have hospital and GP appointments and advice for people living in long-term care facilities, either for the elderly or persons with disabilities (https://www.gov.ie/en/publication/923825-guidance-on-cocooning-to-protect-people-over-70-years-and-those-extr/).

14 June 2020: Bereavement support line

To offer comfort and support to those who have lost a loved one during COVID-19, whether to the virus or not, the Irish Hospice Foundation, in conjunction with the Health Service Executive, have set up a support line which went live on 9 June 2020 (https://healthservice.hse.ie/staff/news/general/irish-hospice-foundation-and-hse-launch-first-bereavement-support-line.html). Grieving has been different since the start of the pandemic. People have not been able to participate in the usual rituals nor have they been able receive family and community support in normal ways.

The line is available from 10am to 1pm, Monday to Friday to adults who have been impacted by bereavement during COVID-19 (https://hospicefoundation.ie/bereavement-2-2/bereavement-support-line/). The line offers a confidential space to speak about one’s experiences and to ask questions, a person to listen and provide comfort and emotional support, and information about practical supports.

16 June 2020: If you can’t talk about it, text about it - new text base mental health service is launched

During this period of heightened stress for many people as a result of living through the pandemic, a new text based mental health service funded by the Health Service Executive was launched on Tuesday 16 June by the Minister for Health Simon Harris. The first of its kind for Ireland, Crisis Text Line is a free 24/7 text service providing everything from a calming chat to immediate support for people going through a mental health or emotional crisis (https://www.irishtimes.com/life-and-style/health-family/crisis-text-line-launches-24-hour-mental-health-service-1.4277617).

The service has a staff of 15 full time and 18 part time employees and 300 volunteers. It uses an artificial intelligence (AI) system to analyse a texter’s initial message, scanning keywords, phrases, and even emojis to determine the level of severity(https://www.hse.ie/eng/services/news/media/pressrel/live-saving-innovative-24-7-text-service-launches-in-ireland.html). The service allows trained Crisis Volunteers to volunteer from home. Crisis Volunteers complete a 30-hour training and have 24/7 supervision by full-time mental health professionals.

While long-established call services exist for people in crisis, this is the first one to operate by text and to be available 24 hours a day and seven days per week. The service will benefit those people who do not feel comfortable making a call. A pilot of the programme found that most of the people availing of the service were between the ages of 16-34.

Update 26 November 2020: Up to 2,000 missed or late cancer diagnoses due to COVID-19

Professor Risteárd Ó'Laoide, the HSE’s National Cancer Control Programme director spoke at a HSE press briefing on 26 November 2020 outlining cancer data and said that as many as 2,000 people who have developed cancers may not yet have presented for diagnosis or care (https://www.pscp.tv/w/cpO5czFBbWp6T0dEZGRZRWV8MWxQS3FYYVZkWVB4YvpiBOSKnc7jSuZWAFobe0rRVgQA8mgr1CF9hiCM59ry?t=14s).

He detailed the impact of COVID-19 on referrals for breast, lung and prostate cancer services. The number of breast cancers diagnosed in April 2020 was down by one third compared with the same month in 2019. The number of lung cancers diagnosed was down by almost a half, while the number of prostate cancers in April fell to just 16% of the number of cases diagnosed during the same month last year. The figures presented showed that for all three cancers cases detected were below last year's from the period March to May. There was some catch up in the second half of 2020, so that by the end of August the number of breast cancers diagnosed this year to date was 98% of last year's levels, while the number of lung cancers diagnosed was 95% of last year's levels. However, by the end of August the number of prostate cancers diagnosed this year was just 66% of last year's levels.

Professor O'Laoide said that when other types of cancers are included the total number of ‘lost’ cancers due to COVID-19 could be as high as 2,000 cases. He said counterparts in Northern Ireland and the UK are reporting a similar experience.

Update 3 September 2020: HSE’s providing free online stress control programme

The HSE’s Health and Wellbeing section announced its online, free Stress Control programme on 3 September 2020. The programme, which helps participants deal with their stress and learn skills to support their mental wellbeing, is made up of six online sessions lasting 90 minutes.

This is the fourth series in the Stress Control programme. Over 10,000 Irish viewers have already used the programme since April. It is a free, user-friendly resource which includes information booklets, relaxation and mindfulness tools to support people to find what works for them.
 
http://stresscontrol.ie and yourmentalhealth.ie

Update 01 September 2020: Minister announces expanded vaccine programme and GP COVID consultations to remain free

On 1 September 2020, Minister for Health, Stephen Donnelly announced an expanded flu vaccination programme alongside the extension of special payments to GPs to ensure COVID-19 consultations remain free of charge to everyone. As part of Ireland’s plan for living with COVID-19 an expanded flu vaccination programme has been put in place with the aim of reducing the overall spread of flu in the community and flu-related hospital admissions through increased vaccination in vulnerable groups.

Those who will gain access to flu vaccines without charge include healthcare workers, children aged 2 to 12 years as well as vulnerable groups usually covered such as older people and those with certain chronic conditions. The vaccine will be administered to children through nasal drops rather than an injection. The vaccine will be available from GPs and pharmacists.
Speaking at the HSE COVID-19 briefing on 3 September, HSE chief Paul Reid said there was a two-week delay in the delivery of one flu vaccine of about two weeks and that the doses for Ireland will be in the first batch of vaccine released. There is no delay in the children’s vaccine.

https://www.gov.ie/en/press-release/b6d08-minister-donnelly-announces-further-winter-planning-measures/?referrer=http://www.gov.ie/en/press-release/39758-minister-donnelly-announces-further-winter-planning-measures-gp-covid-consultations-to-remain-free-expanded-flu-vaccination-programme/

www.pscp.tv/w/ciC3cDFBbWp6T0dEZGRZRWV8MU9kS3JXWmxCQWxHWIJPh5eq8FdJlfSeVgfesE1UzGIn2gSMFa5Y7Mu8V_ko?t=2s


Update 17 July 2020: Impact of Covid-19 on people with disabilities and their carers

On 17 July 2020 the Oireachtas Covid-19 committee heard testimony from disabilities organisations about the impact the pandemic has had on people with disabilities in Ireland (https://www.oireachtas.ie/en/debates/debate/special_committee_on_covid-19_response/2020-07-17/2/).

Already long waiting lists for services such as physio-therapy, occupational therapy, speech therapy and psychology have been exacerbated by temporary closures and postponements (https://www.independent.ie/irish-news/politics/impact-of-covid-19-pandemic-on-disability-services-times-branded-shocking-and-appalling-39376538.html). Other services such as respite, home support and personal assistance have also been impacted greatly. Family carers have stepped in to provide all care for their loved ones during the pandemic and are now experiencing burn-out. Mr Enda Egan, CEO of Inclusion Ireland, said of family carers: ‘People are emotionally, mentally and physically at the end of their capacity to cope’.

Dr Frank Conaty, acting chief commissioner of the Irish Human Rights and Equality Commission, highlighted the human rights implications of the impact of Covid-19 on individuals with disabilities: ‘It is clear that Covid-19 has given rise to significant risks of discrimination and the undermining of rights of persons with disabilities, including the rights of older persons, many of whom have disabilities. While Covid-19 is a once in a generation public health crisis, its impact should be seen in the continuum of how people with disabilities continue to be treated in the design and delivery of public policy. The Covid-19 response has exposed inadequacies of Ireland's public policy for people who live in congregated settings, including nursing homes. This includes disruption of supports in services for people with disabilities and for family carers; accessibility of information for people with disabilities; lack of appropriate data that would allow for more responsive decision-making; education and employment for persons with disabilities; and the noted absence of people with disabilities in decision-making that affects them’ (https://www.irishexaminer.com/news/arid-40017587.html).

Update 17 July 2020: Delay in cancer screenings during Covid-19 pandemic

Testifying before the Oireachtas Covid-19 Committee on 17 July 2020, Ms Rachel Morrogh, director of advocacy and external affairs, and Mr. Donal Buggy, director of services for the Irish Cancer Society warned of the possible effects of the pause in cancer screenings which has taken place during the Covid-19 pandemic.
Ms Morrogh said ‘The impact of these postponements on cancer outcomes will take years to be fully uncovered. The immediate impact is that it has led to thousands of people not being screened, as well as growing waiting lists for cancer tests and treatment. There is little clarity in sight as to how these will be addressed. It is evident that without immediate action there will be excess and avoidable cancer deaths in the years to come as a result of people getting the care they need later than they should. An illustration of this is that we would expect approximately 450 cancers and 1,600 pre-cancers to have been detected in a typical four-month period if the screening services had been operating as normal’ (https://www.oireachtas.ie/en/debates/debate/special_committee_on_covid-19_response/2020-07-17/3/).

Screening programme CervicalCheck has resumed but BowelScreen and BreastCheck have not and may not return until autumn (https://www.thejournal.ie/cancer-backlog-5152711-Jul2020/).

Update 8 July 2020: New guidance to support adults with disabilities returning to day services is published
 
‘National Guidance to Support the Framework for the Resumption of Adult Disability Day Services’ was published on 8 July 2020. The guidance was developed to support the reopening of day services for adults with disabilities whose day services were largely closed since the onset of COVID-19 in March 2020. The guidance was welcomed by the new Minister of State with responsibility for Disability, Anne Rabbitte TD.

NGOs working with people with disabilities are very critical of the closure of disability services and the significant impact this has had on people with disabilities and their families, with many receiving little or no support since day services were suspended due to Covid-19. Inclusion Ireland which represents people with Intellectual Disabilities said that the ‘closures, in turn, have had a profound impact on people’s mental wellbeing, with increased reports of challenging behaviour, anxiety and loneliness.’

Inclusion Ireland published research on 8 July 2020 on the effect of the shut down of adult day services for people with intellectual disabilities. The survey of 300 family members and 55 people with intellectual disabilities carried out by the charity found that while some people reported regular contact, daily online activities, and some face-to-face support, more than half (54%) of those who took part in the survey had little to no contact from the service supporting them since March (https://www.irishexaminer.com/breakingnews/ireland/inclusion-ireland-little-or-no-help-for-those-with-disabilities-1010094.html).

On publication of the HSE guidance, the NGOs were critical of the guidance saying that it will reduce capacity to provide services with physical distancing in place no additional financial support for organisations to make physical adjustments to existing services. Also some staff were redeployed from day services to residential services during the height of the pandemic and this will make it hard for day services to resume without these staff. 

The Guidance to support the Framework for the Resumption of Adult Disability Day Services is available at: www.hse.ie/newdirections

Update 6 July 2020: Phased reopening of screening programmes announced

The HSE announced on 6 July that the National Screening Service had began a phased resumption of its screening programmes (https://www.screeningservice.ie/). CervicalCheck began sending invites and reminders to participants in its cervical screening programme on 6 July. Diabetic RetinaScreen resumed screening in early July. However BreastCheck and BowelScreen will not resume until September/October.

The programmes were paused in March 2020 on public health advice due to the COVID-19 pandemic. However, people who were in the screening system at time of pause have continued to be assessed and treated as resources allow. In the case of cervical screening, this means that invitations and reminders will be first sent to people who are overdue a non-routine repeat screening.

The recommencement of screening is underpinned by the assumption that there will be no worsening of the COVID-19 situation & restrictions will continue to ease.

Update 19 May 2020: HSE is preparing a plan for resuming non-COVID healthcare

Speaking at a HSE press conference on 18 May and at the first parliamentary committee on COVID-19 on 19 May, HSE chief Paul Reid said that they in the process of developing a plan to reintroduce healthcare that had been suspended due to the COVID pandemic. He said that the public, the HSE board and staff are very anxious to get non-COVID services up and running, but that it is a key priority for the HSE board to return to return to non-COVID services but it remains ‘high risk’ and they will have to go back to them in a very different way.

At the same committee, secretary general of the health department, Jim Breslin said ‘on advice for NPHET we can now do non-COVID work, we are ramping up and planning how we do that, it will take longer… it will cost more and there is a good chance we will end up doing less over this period. The way to try and buffer that is through the innovation that we have introduced through the use of technology, telehealth and so on but we will be in a very challenged healthcare environment for the foreseeable future’. He also told the committee that non-essential care ‘was not taking place in either public or private hospitals up until the start of this month’.

At the parliamentary committee, Mr Reid said in his opening statement ‘we are anxious to get back to non-COVID levels of service in many of our services, in particular screening services. This will be a very difficult period because we have to restore some of our services in a way that protects the public. Nobody will thank us if we restore services in a way that means we see public health outbreaks of the virus. It is a big challenge to get back to previous levels of services, particularly in cancer treatment. I repeat that if people have symptoms or feel they have symptoms, the clinical pathway is to definitely go back to their GP. Referrals are still taking place for support for people with symptoms. Restoring screening services is one area that Dr. Colm Henry is leading on with my colleague, Ms Anne O'Connor. They will come back with recommendations on how we can restore the range of services in a way that is safe for the public’ (https://www.kildarestreet.com/committees/?id=2020-05-19a.270). He also pointed out that it is not ‘an either-or scenario…. because much of our workforce are workers that we have in the healthcare system engaged in swabbing centres, for example. It is an extra demand on us, but we will have to meet that demand while migrating back to a level of safe non-Covid services’.

HSE press briefing www.pscp.tv/w/cY-xbzFBbWp6T0dEZGRZRWV8MW5BS0VkcndlZWx4TBXgJwYUp_NuVRlV20i7nt3Mg9ZAkaEnGAOdN_nKVxP2