Louise O'Reilly (Dublin Fingal, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

1235. To ask the Minister for Health further to the recommendations contained in the British Government’s report on antimicrobial resistance (details supplied) his plans to enact the key recommendations contained in the report here; and if he will make a statement on the matter. [25378/16]

Louise O'Reilly (Dublin Fingal, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

1236. To ask the Minister for Health if he will recommend, as part of the ongoing discussion on a national action plan on antimicrobial resistance, the setting of targets for the reduction of usage and or prescribing of antibiotics in health care settings, particularly in primary care; and if he will make a statement on the matter. [25379/16]

Louise O'Reilly (Dublin Fingal, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

1237. To ask the Minister for Health if he will recommend, as part of the ongoing discussion on a national action plan on antimicrobial resistance, the introduction of diagnostic testing at primary care level to alleviate the over prescription of antibiotics and other microbes to treat viruses and infections; if consideration will be given to rolling out a pilot scheme on this similar to those being run in Britain; and if he will make a statement on the matter. [25380/16]

Louise O'Reilly (Dublin Fingal, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

1238. To ask the Minister for Health the status of the Irish national action plan on antimicrobial resistance that is aligned with the global action plan; if submissions have been called for; when the action plan will be finished; if the action plan will be published in advance of the World Health Assembly in 2017; if Members of the Oireachtas or the relevant Oireachtas committees will receive a briefing on this, particularly given its importance in terms of future healthcare planning; and if he will make a statement on the matter. [25381/16]

Louise O'Reilly (Dublin Fingal, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

1239. To ask the Minister for Health if the National Interdepartmental AMR consultative committee has met, or sought submissions from, external groups, organisations or medical companies on its work or the national action plan; if not, if he will recommend that external submissions be sought; and if he will make a statement on the matter. [25382/16]

Louise O'Reilly (Dublin Fingal, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

1240. To ask the Minister for Health if, and the way, the national interdepartmental AMR consultative committee is measuring the number of persons or incidents where antimicrobial resistance has occurred within the health care services here; if work is being undertaken to examine the costs and knock-on effects on other parts of the health service because of AMR and the over prescription of antibiotics; and if he will make a statement on the matter. [25383/16]

Simon Harris (Wicklow, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I propose to take Questions Nos. 1235 to 1240, inclusive, together.

The rise in antimicrobial resistance is universally recognised at global, European and national levels, including Ireland, as one of the greatest potential threats to human and animal health with possible serious consequences for public health, animal welfare and the agriculture and food sectors.

There is international consensus through the 'One Health' Initiative to which the WHO (World Health Organisation), FAO (Food and Agriculture Organisation) and the OIE (World Health Organisation for Animal Health) are signatories, that tackling the global public health threat of AMR requires action across human and animal health sectors, agriculture and the wider environment. The 'One Health' concept is a worldwide strategy for expanding interdisciplinary collaborations and communications in all aspects of health care for humans, animals and the environment.

The Lord O'Neill Report referenced by the Deputy is welcomed by Ireland and is a valuable addition to the serious debate on the worldwide threat of antimicrobial resistance. The author's concerns about both the human and economic costs of increasing resistance to often life saving treatment in the form of antibiotics is a matter which is being addressed at international, EU and national levels. The Report's recommendations on reducing demand for antimicrobials, improving global surveillance of drug resistance and antimicrobial consumption in humans and animals are in line with the WHO Global Action Plan on Antimicrobial Resistance which Ireland supports.

In relation to the setting of targets for the reduction of usage and or prescribing of antibiotics, particularly in primary care, the Director General of the HSE has set up a Taskforce to address the issue of healthcare associated infections (HCAIs) and antimicrobial resistance (AMR). The group is tasked with addressing the above issue and is drafting an Action Plan to address aspects relating to antimicrobial resistance. Currently, there is limited surveillance data on antimicrobial prescribing in the community, thus work on setting targets is still being progressed.

For the first time the Department's National Healthcare Quality Reporting System (NHQRS) Second Annual Report 2016 reported data on antibiotic consumption in the community. The community antibiotic consumption dataset contains regional monthly wholesaler to retail pharmacy sales data from over 95% of the wholesalers and manufacturers in Ireland.

Prescription level data from the Primary Care Reimbursement Service (PCRS) has shown a decrease in the number of antibiotic prescriptions in recent years, and there is some indication that the quality of antibiotic prescribing in the community is improving in line with national guidelines. The HSE is currently working towards developing and implementing a system to provide prescription-level surveillance and audit data for antimicrobial prescribing in Primary Care, which would include individual prescriber feedback to support improved prescribing practices.

In the meantime other actions by the Executive to address this issue include:

- Updating the antimicrobial prescribing guidelines for use in primary care settings.

- A list of “preferred antibiotics” has been developed for Primary Care settings and there are a series of implementation programmes underway to promote the use of a restricted number of antibiotics in community settings (including educational sessions for GPs, promotion via the HSE Medicines Management Programme, and an improvement project based in GP Out-Of-Hours centres).

- The national primary care prescribing guidelines () include recommendations around diagnostic testing for some specific conditions.

- There have been a series of public information campaigns targeting community antibiotic use between 2008 and 2014. Post marketing surveillance has shown an improvement in public knowledge around antibiotics.

- A very successful public information website () was developed by HSE, ICGP, and IPU, and launched in 2014, promoting self-care for self-limiting illnesses and avoiding unnecessary antibiotic use.

- Ireland has taken part in European Antibiotic Awareness Day since 2008; the initiative has been linked to the launch of professional and public information campaigns.

A recent review of antibiotic prescribing via the Primary Care Reimbursement System (PCRS) has shown a reduction in the rate of antibiotic prescribing, particularly among children and young adults (who have been the principal target groups of public information campaigns in this area, and of the “undertheweather.ie” website). In addition, this review has shown that the pattern of antibiotic prescribing has improved, in line with national primary care antibiotic prescribing guidelines. Diagnostic testing at primary care level is recognised as a useful component in helping to improving prescribing practices and reducing over-prescribing of antimicrobials. There are a number of research studies currently underway looking at novel diagnostic tools in the international setting.

The European Union at both Council and European Parliament levels supports a Community Strategy against AMR having regard to the 'One Health' concept. The Commission's 2012 AMR 5-year action plan has recently been revised throughCouncil Conclusions on the next steps under a ‘One Health’ approach to combat AMR, adopted at the Council's Employment, Social Policy, Health and Consumer Affairs Council (EPSCO) meeting on 17 June last. Ireland has continued to support the EU drive to combat AMR and actively engaged in discussions on the new Council Conclusions. The Council calls on Member States to have in place before mid-2017 'a national action plan against Antimicrobial resistance based on the 'One Health' approach and in line with the objectives of the WHO Global Action Plan'.

In recognition of the serious and increasing threat of antimicrobial resistance and the requirement for a ‘whole of Government’ approach to health issues, the Department of Health’s Chief Medical Officer (CMO) and the Department of Agriculture, Food and the Marine’s Chief Veterinary Officer (CVO) established a high level National Interdepartmental AMR Consultative Committee in 2014 to address this issue. The Committee meets Ireland’s requirements to have an Intersectoral co-ordination mechanism for addressing AMR at European level, including the development of a national action plan against AMR as required of Member States in the WHO's Global Action Plan against AMR (2015).

The Committee has a clear role and mandate across the human and animal health sectors. Committee membership consists of representatives of both Departments and of a range of relevant health and veterinary specialist agencies, including other relevant bodies with a remit across the two sectors; membership is representative of major stakeholders. The Committee meets bi-annually and its last meeting was in April 2016. The Committee's work plan for 2016 includes development of a national action plan against AMR, which includes ongoing engagement with all relevant stakeholders, both Committee member and others. This work is continuing and the Committee is scheduled to meet again in late 2016 to assess progress on this major agenda item. It is intended that the National Action Plan will be finalised by mid-2017 in line with European Council requirements. Should the relevant Oireachtas Committee issue an invitation my Department would be happy to brief the Committee on the National Action Plan on AMR when finalised.

HCAI surveillance is complex. Information on excess costs of HCAIs such as prolonged hospital stay, further treatments required, attributable mortality and other complications can be complex to assess, particularly to confirm that complications are directly linked to HCAI episodes and not to other factors. National HCAI surveillance systems at European level are, however, in place and EU Member States collect routinely-generated antimicrobial susceptibility testing data in invasive infections and report to the European Centre for Disease Control (ECDC) through its European Antimicrobial Resistance Surveillance Network (EARS-Net).

The ECDC assesses this data along with estimated costs of increased hospital stays and treatments. European estimates indicate that approximately 4.1 million patients are estimated to acquire a HCAI in the EU each year with 37,000 attributable deaths annually and HCAIs also contributing to an additional 110,000 deaths. The burden of HCAI is also reflected in significant financial losses. According to the ECDC these infections account for approximately €7 billion per year. The ECDC 2011-2012 Point Prevalence Survey of HCAIs and AMR use in European hospitals estimates that Ireland had 494 patients with a HCAI. This equated to a mean of 9,554 beds occupied per day. (A Point Prevalence Survey gives a snapshot picture of the number of patients with a HCAI in hospital at a particular point in time).

The National Clinical Guideline 'Prevention and Control Methicillin-Resistant Staphylococcus aureus(MRSA)', endorsed by the National Clinical Effectiveness Committee (NCEC) in 2013 estimated the cost of HCAI in Ireland for 2011, extrapolated from national (HSE) and international sources, at €118, 257,312 with 29,388 patients acquiring a HCAI.

Management and reduction of Healthcare Associated Infections (HCAIs) is made very challenging by the rise in antimicrobial resistance world wide. The World Health Organisation (WHO) states that the rise in antimicrobial resistance is one of the greatest potential threats to human and animal health at global, European and national levels with possible serious consequences for public health, animal welfare and the agriculture and food sectors.

A wide range of initiatives has been put in place in the Irish health system over several years to address HCAI and AMR including improved surveillance of infections and prescribing, infection prevention and control processes, antimicrobial stewardship initiatives, public and professional awareness raising and with a significant emphasis on the education and training of healthcare professionals.

The prevention and control of healthcare associated infections (HCAIs) and AMR has been a significant patient safety and public health priority for the Department of Health Ireland for numerous years. Ireland as a whole is fully committed to and engaged in addressing resolution of the problem of AMR and will continue to collaborate at international, EU and national levels to this end.