Medicinal Cannabis - Update (2)

The Health Products Regulatory Authority has recommended access to medicinal cannabis under a monitored, five-year programme, confined to a number of specific illnesses.

HPRA CEO Lorraine Nolan told members of the Oireachtas Health Committee that the authority could not recommend widespread access to cannabis for the treatment of a range of medical conditions.
However, Ms Nolan said that access could be facilitated under appropriately-controlled circumstances where adequate assurance of patient safety and follow-up can be provided.
The HPRA provided an expert report to Minister for Health Simon Harris on the use of medicinal cannabis following cross-party support for legislation proposed by AAA-PBP TD Gino Kenny.
The HPRA specified three conditions that could be part of a monitored pilot programme: spasticity associated with MS, intractable nausea and vomiting associated with chemotherapy, and severe, treatment-resistant epilepsy.
Ms Nolan said that to date there is an absence of scientific data demonstrating the effectiveness and safety of cannabis products.
"There is insufficient information on the treatment of long-term medical conditions, such as those for which there is a public focus.
"In addition, most cannabis products available under international access schemes do not meet pharmaceutical quality requirements for medicines," Ms Nolan told members.

The HPRA said its position is based on current

scientific evidence, and will be kept under review

She also said the review highlighted significant gaps between the public perception of effectiveness and safety, and the regulatory requirement for scientific data which is mandatory to determine the role of cannabis as a medicine.
The HPRA report concluded that cannabis for medical use should only be initiated as part of a structured process of formal on-going clinical evaluation in patients with the clearly defined medical conditions.
This position is based on current scientific evidence and will be kept under review.
The Principal Officer of the Department of Health told the committee that the minister described the HPRA report as a "milestone" in the development of policy on medicinal cannabis.
Eugene Lennon also told members that patients accessing the proposed programme would be required to be under the care of a medical consultant.
"The minister intends to progress the establishment of this access programme as a priority. But to be clear, patients accessing cannabis under the programme, will need to be recommended for cannabis treatment by a relevant medical consultant involved in the patient's care," Mr Lennon said.
He also said that officials were examining legislation required to underpin the programme.
The committee was told that 40 countries were surveyed in the expert report. In Europe, 16 countries do not have any access programmes, nine have programmes for exceptional use similar to that advised by the HPRA, and three countries have wider access programmes.
Mr Lennon confirmed to Sinn Féin deputy Johnathan O'Brien that one licence had been already been granted to a patient for access to medicinal cannabis, while a second application had not been granted.

Medicinal Cannabis - Update (1)

A mother who has travelled from her home in Cork to Dublin to campaign for greater access to cannabis-based medication has arrived at the Dáil.

Vera Twomey began her 260 km journey on foot, last Monday.
An injury to her knee meant she completed the final stages in a wheelchair.

Hundreds of supporters joined Vera Twomey outside Dáil Éireann
She wants her seven-year-old daughter Ava, who has a rare form of epilepsy, to be allowed access to medicinal cannabis.
The family's request for the medicines, under a special licence was rejected.
The Department of Health has said it is in the process of setting up a compassionate access programme.



She has been accompanied most of the way by PBP-AAA TD - Gino Kenny.

HSE - Staff and Pay Concerns

Major tensions between the Department of Health and the HSE over the agency's management of pay and staff levels have been revealed in documents released to RTÉ News, under the Freedom of Information Act.

The Health Service Executive has been warned that the staff recruitment moratorium may be re-instated, if the executive breaches a new 2016 Pay and Staffing Agreement.
That agreement reached in July, also released under the FoI request, says that the HSE cannot exceed a ceiling of 106,396 staff by the end of this year - an increase of 2,500 staff on last December's level.
On 2 June, the Department of Health expressed its "very serious concern at the faillure of the HSE to submit a complete Pay and Numbers Strategy in a timely fashion", while recruitment continued without sanction.
It also reveals that the HSE was undertaking a 'look-back', to see if hospital groups and individual hospitals had funded extra posts, contrary to procedures.

Dept of Health concern
On 14 April, Secretary General of the Department of Health Jim Breslin, wrote to Director General of the HSE Tony O' Brien to raise matters of particular concern on outstanding management and reporting requirements.
The partially-redacted letter, criticises the HSE for failing to complete workforce plans in time.
It says that HSE employment levels increased by 611 in February, with an increase of 5,445 since December 2014, "following an exceptional level of recruitment throughout last year".
It notes that the figures show an increase in overtime and absence rates, with only a very modest reduction in agency spending.

The Health Service Executive has been warned that

the staff recruitment moratorium may be re-instated

HSE response
In his response to Mr Breslin on 22 April, Mr. O' Brien said the HSE service plan for this year had identified a potential deficit for acute hospitals of €225m and further financial risks were flagged in other areas.
He said the HSE had undertaken substantial work to produce a 2016 Pay and Numbers Strategy, for all of its divisions.
Mr O' Brien warned that the main challenge was that the financial allocation for 2016 did not fully fund the level of staff employed and agency and overtime costs in place at the end of 2015.
He said there was a significant and sustained increase in the number of people presenting at hospital Emergency Departments "which puts upward pressure on pay".
There was an emerging challenge to "curtail homecare services" in line with the service plan funding.
The letter goes on to state: "2015 was also a year in which a regulatory report pointed to significant managerial accountability for past failure to provide for safe staffing levels in certain hospital services, despite the prevailing employment moratoria and funding reductions which were a feature of that time".





Pay and Staffing Ceiling Set
The HSE's Pay and Numbers strategy was finally approved in July, by Minister for Public Expenditure and Reform Paschal Donohoe and sets binding pay and staffing levels on the HSE for this year. The staff ceiling is 106,396.
Under the agreement, the Department of Health is responsible for ensuring the HSE does not break that ceiling.
The document warns that in the event the HSE's pay bill deviates significantly, such that an overrun is considered likely, the staffing moratorium may be reinstated.
The 'Staffing Resource Management Framework/Delegated Sanction for the Department of Health' says the HSE must operate within the 2016 ceiling and that where a post is to be filled, it is expected that the HSE will seek to fill it at the lowest possible grade and ensure appointments are at the minimum of the scale.
In June, the Government agreed an extra allocation of around €500m, to mainly deal with the HSE's projected budget overrun for this year.

Variations in Hospital Death Reports

The figures are contained in the first annual report of the National Healthcare Quality Reporting System, which measures the performance of the health service across a number of indicators. File photograph: Reuters

 A number of hospitals have significantly higher death rates due to heart attacks and strokes than the national average, according to a new report from the Department of Health.

 The rate at which patients die in hospital from heart attacks (acute myocardial infarction) has dropped 40 per cent in a decade and the Irish mortality rate is well below the OECD average.

The Mater Hospital in Dublin, Midland Regional Hospital in Portlaoise and Kerry General Hospital recorded the lowest death rates within 30 days of admission for a heart attack.

The figures are contained in the first annual report of the National Healthcare Quality Reporting System, which measures the performance of the health service across a number of indicators.

The report says differences may arise for many reasons, and not just because of the quality of care provided. It says the indicators measured act like smoke alarms by attracting attention and enabling people to determine whether the problem is caused by smoke (lesser urgency) or fire (priority for action).

The report also says some areas of the health service are performing well.  Immunisation rates have improved, death rates from heart attacks have fallen, survival rates from cancer are improving and the incidence of hospital acquired infections has dropped sharply.

Areas where there is room for improvement are also identified. These include cervical cancer survival rates and falling uptake of breast cancer screening.

View pdf of Report here

View article on Irish Times

Doctors to be obliged by law to tell patients of errors

Doctors and health professionalswill in future be obliged by law to tell patients where mistakes or accidentstake place in their treatment, the Oireachtas committeeon health and childrenhas heard.

Minister for Health Leo Varadkar said it was the equivalent of a motoring “hit and run” for doctors and health professionals to fail to make such disclosures and to live up to their duty of candour.

“I find that [behaviour] really appalling and it is not the type of medicine I was trained in.”

Mr Varadkar told the committee if doctors did adhere to their duty of candour and open disclosure and informed patients when adverse clinical outcomes had occurred, “ a lot fewer people would sue”.

The Minister said he now intended to legislate to make open disclosure a legal requirement.

Earlier, he told the committee the health service clearly has insufficient funding to address all areas of concern immediately.  Addressing the committee regarding spending for this year, he said the budget available would allow for a start to stabilising health service funding.

He claimed the health service was now in a more stable financial position than it had been for many years.

There was “undoubtedly a strong case for increased health funding in the years ahead”, he said.  However, increased spending without reform would not resolve the difficulties which the health service faced.

View here on Irish Times

Healthy Ireland survey

More than 10,000 Irish households are to be surveyed to find out just how healthy the nation is, mentally and physically, the Department of Health has confirmed.

The Healthy Ireland survey is the first for seven years and will start in the coming weeks.

The Department and Healthy Ireland said the households to be surveyed have been randomly selected and they hope the results will be available by May 2015.

The survey, conducted by Ipsos MRBI, will look at a number of key health indicators including:

• Nutrition;
• Alcohol consumption;
• Smoking;
• Level of physical activity;
• Weight management;
• Wellbeing.

“If we are going to help people to stay healthy, we need to have an idea of how healthy they are,” said Health Minister Leo Varadkar. “So this new survey will be really useful in making sure that the right policies are in place. It will also tell us what areas we need to focus on in future.

“The Healthy Ireland initiative was set up to improve the nation’s physical and mental health. We haven’t had a comprehensive survey since 2007, and there have been huge changes since then. On the one hand, more people are more aware of the importance of diet, lifestyle, health, wellbeing and mental fitness. But as a nation, we now face even bigger challenges on obesity, stress, diet, and many other areas. So there’s a big job ahead of us.”

He said the results of the survey would give his department a “baseline” set of data, telling it how healthy or unhealthy Ireland is.

View more here

Law for standardised cigarette packs moves closer

The Government has this week approved the General Scheme for legislation to provide for much larger health warnings on cigarette packets. The Cabinet has approved the Heads of the Bill that will make it mandatory for tobacco to be sold in Standardised Packaging which will greatly increase the health warnings and reduce the ability of tobacco manufacturers to promote their brand.

The Public Health (Standardised Packaging of Tobacco) Bill 2013 will outlaw forms of branding such as trademarks and logos on cigarette packs and on roll-your-own packs and will determine the size and positioning of the warnings.

 Ireland’s standardised packaging will have graphic warnings and text selected from a library of graphic images and warnings developed by the European Commission for Member States

There is strong evidence that standardised packaging will increase the effectiveness of health warnings, reduce false health beliefs about cigarettes and reduce brand appeal particularly among youth and young adults.

Click here to view full DOH press release

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