Gino Kenny
Question:5. Deputy Gino Kenny asked the Minister for Health if he is aware of a severe shortage of public health nurses in Dublin Mid-West; and if he will make a statement on the matter. [19873/24]
Ceisteanna Eile - Other Questions
Health Services Staff
Joan Collins
Question:22. Deputy Joan Collins asked the Minister for Health the emergency measures the Government will put in place to ensure developmental checks resume in Dublin 8, 10 and 12, given the severe lack of child developmental checks in the area. [19450/24]
This question is on the severe shortage of public health nurses in the Dublin Mid-West area. This is not an isolated situation and it is the same across a lot of community healthcare organisations, CHOs. I would like to get the Minister's thoughts on the shortages, especially in Dublin Mid-West.
I propose to take Questions Nos. 5 and 22 together.
I thank Deputies Kenny and Collins for raising this matter. On the back of their questions I engaged with my officials and the HSE on this. As per the questions, they are accepting there are shortages affecting the child development checks in Dublin south and Dublin west. The public health nurse service is experiencing significant shortages in Dublin south and west and the HSE has said recruitment is especially challenging. It has advised the local services is working to ensure those with the greatest need in the community are prioritised and that site-specific contingency plans continue to be refined monthly.
I fully recognise the frustration and worry of parents who are struggling to access the routine checks. I emphasise that if any parents have an active concern about their child they should contact their GP or local health office. We want to ensure the delivery of the full range of services provided by the public health nurses. We are progressing several initiatives at a national level within both my Department and the HSE to address the challenges with recruitment. There is an embargo in place, which the Deputies will be aware of. It is having an effect. This is one of the areas it is having an effect on. Before the embargo there were challenges with public health nurse recruitment into these teams and it is something the HSE is looking at to see what additional supports can be put in place. One of the advantages of moving to the regions this year is they will be able to deploy and redeploy healthcare professionals on a priority basis. What I see happening here is the inverse care law, meaning the communities and the families who need the additional public health supports the most are getting it the least. It is not something we are satisfied with at all and I am engaged with my Department and the HSE to increase the amount of public health nursing services available because I fully accept it is a real worry for parents.
This has been going for a number of years. There are parts of Lucan, north Clondalkin and Newcastle where parents of newborns and infants have had no checks on their children. That can only be a bad thing. I was looking at the trend in the last five years when it comes to public health nurses. There has been a steady decline in retention of them. That is very worrying because, as the Minister knows, a child needs at least three to four developmental checks throughout their first four years and if they are not getting them things will be missed. That is extremely worrying in the context of newborns and infants This has to be acknowledged and rectified because otherwise certain things, especially around children, will go unnoticed and that can only have detrimental effect on children and parents.
It sounds a bit like "Groundhog Day". I have been raising this issue for the last year. I raised it in last March and April in relation to the Curlew Road, Armagh Road and Old County Road health centres. We were told that two teams were to be put into Armagh Road, or rather that there were 4.6 public health nurses between Armagh Road and Curlew Road and they were going to be put into the former centre. Two of them would be looking after the child developmental checks and two would be looking after elderly persons' care. We were advised at the time that one person would be retiring and another would be going on maternity leave, bringing the figure down to 2.6. They certainly have not been able to keep on top of the needs of the community. I raised it a couple of weeks ago with the Minister but I have had more people contacting me about their child not getting the developmental checks. People have been waiting for 24 months. One parent was told they would be lucky to get a four-year developmental check. There needs to be a serious approach to this. I was told recruitment was a problem last time and it is still a problem. Nothing seems to have been done in the meantime to deal with this urgent issue for children.
I thank Deputies Collins and Kenny. This is a serious issue and I fully accept the Deputies' representations. I absolutely take Deputy Collins's point. We cannot have children not getting these developmental checks, we cannot have parents who are worried and we certainly cannot have the kinds of delays the Deputy has referenced. I will commit to taking this up at a senior level within the HSE this week to see what measures can be put in place. If there is a certain area that is significantly understaffed, and there is, we need to look at deployment from other areas. It is simply not enough to say that a certain community will just have to deal with these delays while services in other communities are fully staffed and getting what they need. I will commit to raising this directly with the HSE and asking for a rapid temporary solution. I imagine such a solution would involve some deployment from other areas. We will also see what can be done to accelerate hiring and to deal with maternity cover, which was another issue Deputy Collins raised. I am certainly not going to stand here and say that the status quo is sustainable because it certainly is not.
I received a response to a parliamentary question on the issue of public health nurses in Dublin Mid-West. I was slightly shocked at the response from the HSE. It said that, in that particular area, Dublin Mid-West, it had not recruited one public health nurse. It is a really damning indictment of where we are at if the HSE cannot recruit one. Zero have been recruited. There are obviously factors contributing to nursing staff, highly educated and highly motivated people, deciding not to go into this service. There has to be other incentives to encourage people who have been educated in this field to go back into public health nursing. Public health nursing is of enormous importance not only for infants, as I have mentioned, but for elderly people. If they are not getting that treatment in a primary care setting, that can only be detrimental to their health and to society.
The Minister replied to me last May saying that the HSE had established a community nursing national oversight group in 2022. What has that group done? We have known that there is a crisis in public health nursing for the last two, three and four years. What are we doing to fundamentally resolve that issue? It is a postcode thing. Children in areas like Drimnagh, Crumlin, Walkinstown and Islandbridge are not getting their developmental checks. I have also had to represent a number of elderly people who are trying to get support in their homes. You are running around on a helpline and going from one person to the next. It is just not good enough. I thank the Minister for saying that he will raise this. Will he get back to us directly at that point to let us know what is happening in the area and what emergency supports he is going to give to make sure these children get their checks?
I agree that it is not good enough. We need a resolution to this and we need it more quickly than one is now coming about. I will raise it with the HSE and come back to the Deputies with a note. If they would like, I will set up a meeting with HSE officials so that they can explain exactly where we are. Other parts of the country are not experiencing this difficulty. Some might be but there are plenty of well-staffed public health teams all over the country. We have invested a huge amount in public health and massively increased our community-based teams, including the primary care teams and older persons teams. There has been very substantial investment. I want to better understand why we have such a specific recruitment problem in this area because, as I have said, other parts of the country are very well served and very well staffed. I will revert to the Deputies with a note. Following that, if they would like a sit-down meeting with the community teams in the HSE, they can let me know and I will certainly arrange one.
GPs will not accept parents going to them to look for developmental checks. Parents have tried that. That is not an option.
I am not proposing that they ask GPs to do the developmental checks. What I mean is that, if parents see something with their child that they are concerned about, they should go to the GP. I am not asking the GPs to replace the public health nurses in providing the general checks.
It is left to the parents to ascertain if their children are not well.
Nursing Homes
Cathal Crowe
Question:6. Deputy Cathal Crowe asked the Minister for Health if a new capital funding stream to support the voluntary nursing home sector in meeting HIQA requirements and upgrading facilities can be considered; and if he will make a statement on the matter. [19781/24]
The Minister of State will know about this question because we recently discussed it in a lot of detail. Will she give consideration to a new capital funding stream to support the voluntary nursing home sector in meeting HIQA requirements and providing for all of the upgrades required each year, which are quite costly?
Before I resume my seat, I will congratulate the Minister of State, Deputy Colm Burke, on his elevation. I was sitting right beside him the day before the Minister of State appointments were to be made and his phone buzzed. We all joked that he was getting the call. That was not the call but he did get the call the following day. He deserves his elevation and I congratulate him.
I thank the Deputy for his question. I also congratulate the Minister of State, Deputy Colm Burke, as I know the Minister, Deputy Donnelly, also does, on sitting here beside us answering questions on public health and drugs.
On the Deputy's question, voluntary organisations form an essential and integral part of the overall health and social care system. Historically, the voluntary sector was the first to provide hospital and social care to the poor and to the most vulnerable in Irish society. Voluntary long-term residential care centres are run by a variety of groups including registered charities, community groups and religious orders. Voluntary nursing homes providers are key players in the Irish long-term residential care sector, operating approximately 10% of centres and delivering approximately 9% of beds. This is a great opportunity to speak about the voluntary sector. We do not often get such an opportunity.
Last week, the Deputy and I had a meeting with two voluntary providers from the Clare area. It was a very positive meeting. There are different ways in which voluntary nursing homes can avail of additional funding. Voluntary and private nursing homes in the mid-west are currently tendering to provide step-down facilities to support the throughput in University Hospital Limerick. That is the first way. The other way is through a scheme I introduced earlier this year, the new capital nursing home resident safety improvement scheme, which has been open for applications since 2 February. The scheme was established to provide funding to eligible private and voluntary nursing homes towards structural works carried out. The closing date for applications to this scheme is 15 November. Importantly, it is backdated to 1 January 2020. I will revert to the Deputy with more information in my next contribution.
We had a very positive meeting last week with the Oireachtas Members from Clare. We met Marie O'Malley, representing Carrigoran House, and Michael Harty, formerly of this House, representing the home at Cahercalla. Both of those community hospitals provide fabulous care. These are outstanding facilities in our county providing healthcare to those at an advanced stage of life who have ailing health. It is not just about the beds, but all of the ancillary stuff such as the recreation rooms, gardens and other environments. However, it is very costly to run these facilities. Across the town, in Ennis, there is the fabulous St. Joseph's Hospital, which is also a geriatric hospital but which is funded very differently. It is directly funded by the HSE. These community hospitals would say that the significant costs associated with complying with HIQA requirements and making structural upgrades each year are very difficult for them to meet. Meanwhile, although St. Joseph's does not have a perfect column of funding coming in the whole time, it is ultimately managed by the HSE and can go to the Department if it needs funding. That is not so for the home at Cahercalla or Carrigoran House. Perhaps a new fund or bursary could be devised in the next budget.
As I have said, the scheme I was speaking about will run through 2024 and allows eligible voluntary and private nursing homes to apply for up to €25,000 from a fund of €10 million to support structural works relating to fire safety and infection prevention. The first payments were made on 28 March, when a total of €1.86 million was paid to 82 nursing homes. That has been very welcome. I take on board the point the Deputy is making. The challenge for me is that the Department of Health is obliged to deliver policies underpinned by the principle of equity of access to related services or supports. We cannot decide to just support the voluntary sector as against the private sector. There is also a large number of small family-run community-based nursing homes.
Further to the Deputy's query, I had a meeting yesterday with officials in the Department and we are looking at ways to further support the voluntary and smaller nursing home sector, maybe in relation to buildings that are built with multiples of years.
I thank the Minister of State. That meeting sounds very positive. Long ago I used to believe the budget was set each autumn but I know work on the new budget has already begun. It is positive the Minister of State has had those negotiations and talks.
Even though we are talking about our country's older population, a comparison could be drawn with childcare at the other end of the age spectrum. In childcare, there is the private sector, the public sector and community childcare. There are funding columns, though childcare providers say they are not perfect and there are shortfalls. It is important that the likes of Cahercalla and Carrigoran have something beyond the current fund. The current fund is positive but putting in fire doors is quite expensive. I believe a standard single fire door at the moment costs around €7,000. The capital expansion these hospitals merit needs a better funding column. The Minister of State did it for St. Senan's, Kilrush last year and there was a fabulous outcome but it should be broadened.
I would love to see community hospitals moved from section 39 to section 38 arrangements so they are directly funded, like St. Joseph's, Ennis, by the HSE and there is no annual scratching of heads about how to fund it. They would have certainty that there would be money to properly run these facilities. They are wonderful and deserve as much State backing as we can give them.
I am conscious of the financial challenges faced by the nursing home sector but this year, the budget will be €1.5 billion to support 22,700 people under the fair deal scheme. There was an additional €45 million provided last year to increase the rates of fair deal. Many of the nursing homes which renegotiated saw an uplift, in rural areas of between 8% and 9% and in urban areas of between 6% and 7%. That increase is continuing this year. Both nursing homes we spoke to last week were tied into a three-year plan but are renegotiating so should see an uplift in what they are getting.
I take on board the question the Deputy raised. I took it seriously and we have already started exploring mechanisms. It is important to say the Department of Health is obliged to deliver policies underpinned by the principles of equity of access to related services or supports. I am bound by that code.
Can I correct the record? I said "public childcare" but I meant childcare providers that are engaged with ECCE contracts. There is no public childcare per se.
While we are correcting things on equity, I made a mistake. I forgot to let in Deputy Murnane O'Connor. She can come in now but I will not bring in the Minister of State again.
You are very good. Thank you very much.
It was good the Minister of State spoke of voluntary homes and care homes, such as those in Carlow and Kilkenny, and I thank her for the funding. Deputy Crowe spoke of care homes needing funding. We all respect the HIQA reports and whatever but I spoke to the Minister of State recently about looking at local authority grants for when a HIQA inspection came on and they wanted an extra bedroom, bathroom or something like that. Maybe different Departments could help the Minister of State's Department with grants so if one was under pressure we would all work together and try to get that extra funding.
A nursing home was on to me recently where all the residents have medical cards but are all being charged for their blood tests. Is there anything we can do to help these residents? It is important they do not have all these extra fees. I thank the Minister of State for all the work she is doing.
Charitable and Voluntary Organisations
Joan Collins
Question:7. Deputy Joan Collins asked the Minister for Health the reason youth service workers employed through the City of Dublin ETB channel of funding in the drugs and alcohol task forces have not received the October 2023 WRC 8% pay rise or had their wages restored to pre-2009 cuts levels; and what detailed measures the Government is putting in place that pay rises are specifically accounted for in channels of funding. [19270/24]
I ask why youth service workers employed through the City of Dublin Education and Training Board channel of funding in the drugs and alcohol task forces have not received the October 2023 WRC 8% pay rise or had their wages restored to pre-2009 cuts levels. What detailed measures is the Government putting in place so that pay rises are specifically accounted for in channels of funding?
I thank the Leas-Cheann Comhairle, Deputy Crowe and the Minister of State, Deputy Butler, for their kind comments. I thank Deputy Collins for tabling this question.
Following many months of extensive negotiations in the WRC an agreement was reached in November 2023 which saw an increase in funding for pay of staff in section 39 organisations, as well as section 10 and section 56 organisations. An overall phased increase of 8% was agreed, with an initial increase of 3% backdated to April 2023, a 2% increase from 1 November 2023 and a further increase that came into effect on 1 March 2024.
It is important to acknowledge the vital role these organisations and their staff play in our health and social care sectors. They continue to have a key role in providing services to people with disabilities, vulnerable children and older people, as well as in other social care settings. The Government has a clear interest in ensuring the stability and sustainability of these services.
The objective of the HSE is to ensure all employees can access their entitlements under the WRC agreement. It has already made significant payments to qualifying organisations and continues to work with each of the organisations to ensure payments are made without delay.
As this process continues, it has come to light that there are other community groups which are funded through different pathways and, although operating similarly, are not technically section 39 organisations, such as local drug and alcohol task force groups, and which have not been encompassed within the existing process. The Department is now aware of the issue that has arisen and is liaising with other relevant Departments to explore how it can be resolved satisfactorily and in a timely manner.
That is interesting. I raised this issue on Leaders' Questions again a couple of weeks ago. The way the funding seems to operate with section 10, section 39 and section 56 organisations and all the private charitable status groups makes it difficult to see where an 80% increase in an area has to be met through existing funding. My understanding is the Department of Health has the funding. The agreement is 8%. It has given it to the HSE. The HSE distributes it to City of Dublin ETB, while the Department of Justice distributes it to prison links officers in the drugs task forces. The prison links and youth sections have not even got their 2009 restoration. People working in vulnerable areas are being left in vulnerable positions from the point of view of being attracted to the private sector and other areas for better wages. That has to be looked at. Will the Minister of State provide more detail on what he is doing, given the awareness the Department has now?
Officials from the Departments of Health and Children, Equality, Disability, Integration and Youth, the HSE and Tusla were invited to attend a WRC process on 16 October 2023 following similar engagements with trade unions representing section 39 and section 56 bodies in recent months. Following productive engagements with the WRC, strike action was averted. This is a recognition of the importance and regard the Government and its agencies have for the sector. The commitment of all parties to this matter has been evident and is indicative of a collective recognition of the difficulties facing the sector.
While the Government has engaged in the process and agreement has been reached, it is worth noting section 39 and section 56 organisations are not public bodies and the terms and conditions of employment for staff in these organisations are ultimately between the employer and employee. Although it is not the employer, the Department is aware staff employed across hundreds of funded organisations have been employed using a multiplicity of terms and conditions, including different rates of remuneration, and are dependent on Government funding.
On the people dealing with the drugs task force, I understand that while some may be working for section 39 organisations, they were funded through a different process, rather than through the HSE. That is why they fall outside the qualifying criteria. Efforts are being made to resolve the issue and, hopefully, it will soon be resolved.
Pre-2009 and the crash, all these workers were linked in with public sector pay and got increases as public sector workers got their increases. That is my understanding from talking to people in the canal drugs task force and other task forces.
That link was broken in 2009. I am sure the Minister of State will agree it is a serious issue that these workers have not had their pay restored since 2009. These people are getting up in the morning, going to work, applying their services and then coming home. They have bills to pay, so it is important they get redress quickly. What efforts are being made to ensure funding is provided to ensure these workers have their pay restored and receive the increase under the agreement reached at the Workplace Relations Commission? I have asked the Canal Communities Local Drug and Alcohol Task Force to give me examples of people who have not been paid. I will give the Minister of State that information when I get it.
Most of the funding for section 39 and section 56 organisations comes through the HSE. The funding for some of the programmes that employ people did not necessarily come through the HSE and therefore they fell outside the agreement that was reached under the WRC. It is my understanding there are further discussions on that issue and every effort is being made to resolve it. It affects a small but important group and every effort will be made to find a solution to the problem.
Where does the funding come from to pay these workers, if not the HSE?
It is not necessarily from the HSE. It comes from different sources, which is one of the problems.
I thank the Minister of State.
Dental Services
Jennifer Murnane O'Connor
Question:8. Deputy Jennifer Murnane O'Connor asked the Minister for Health the reason there is currently no orthodontic treatment in Carlow; when he expects it to be provided; and when it will be implemented. [19782/24]
There is currently no orthodontic treatment service available in Carlow. When does the Minister expect this service to be provided and when will it be implemented?
I thank the Deputy for her ongoing representations, made on behalf of the good people of Carlow, on the health services they deserve.
I will provide some good news on the orthodontic lists. For people in Carlow, rather than getting the service in Carlow, the priority is getting the service for these children. I will report to the Deputy and the House some very good news. Over the last few years, we have invested a lot of money in getting children the orthodontic care they need. The waiting lists have been too long. I am very happy to say that we have had a 44% reduction in the number of children waiting. This is fantastic, and I acknowledge the work of the HSE and our oral health community in achieving it. Some areas have seen a remarkable reduction. The Dublin and mid-Leinster region has, believe it or not, seen a 78% reduction in the list, which really is great to see. The south east has seen a 21% reduction in the list, which is encouraging. Now we want to make sure that everybody begins to see those very big redactions.
The Deputy will be aware that the HSE provides the orthodontic treatment for patients referred by a HSE dentist before the child's 16th birthday. That is for orthodontic assessment. The current HSE model for the service is provided by HSE specialist consultant orthodontists. It is concentrated into regional orthodontic units to ensure the necessary equipment and clinical skills are available and that the units have sufficient throughput. We are taking a regional approach to this by creating hubs because our first priority is that the children get the care they need as quickly as possible. It is the case that care is being provided on a regional rather than county basis. We have had a 21% reduction in the numbers waiting and we need to keep pushing with that.
I thank the Minister for that positive news. It is important. Carlow town is bigger than Kilkenny city. Central Statistics Office figures for the most recent census show that the population of Carlow town has grown by nearly 9% to nearly 28,000, while Kilkenny city has a population of 27,500. The Minister has given me good news, which I welcome, but we need to have our own services. I spoke to the HSE about having an injury clinic, and I have also spoken to the Minister about that several times. We have a huge facility in St. Dympna's Hospital in Carlow. The X-ray unit operates part time but it should be full time. We need to look at the services there. Carlow is not competing with Kilkenny but the town is growing rapidly and needs its own services.
There might be some competition with Kilkenny but I take the Deputy's point. She can rest assured that this Government will continue to invest in health services for the people of Carlow. I was delighted to be able to visit, with Deputy Murnane O'Connor, the upgraded ambulance base in Carlow in the last few days. We now want to continue with that progress of the permanent ambulance base in a state-of-the-art facility across the road in the other facility.
On orthodontics specifically, the south-east region includes Waterford, Wexford, Kilkenny and south Tipperary. The region is served by the regional orthodontic unit in Waterford, which is the main service. There are supporting clinics in Kilkenny, Clonmel and Enniscorthy. We can always keep that under review.
I welcome the reduction in the numbers on the treatment lists and I am aware of the Minister's commitment. He was in Carlow last week and we were delighted to have him down. Carlow needs to have the services it does not have at the moment. While she was not giving out to me, a constituent spoke to me about having to go to Kilkenny for orthodontic treatment. As the Minister said, some people travel to Waterford. Some parents have to take a day off work. They do not mind that but the main issue is that the population of Carlow is growing so rapidly that we need services in the county. If we had these services, we would be helping Kilkenny and other areas. I am looking for a commitment to provide an injury clinic. I want to get as much for Carlow as I can. Again, I welcome the reduction in the numbers waiting for orthodontic treatment.
We are currently drafting the implementation plan for the next three years of the national oral health policy. There will be a regional view but with something as specialist as orthodontic care, the priority is making sure children get the care. We all want care provided as close to us as possible and we must always strive to do that. While orthodontic treatment is, hopefully, one of a small number of interventions a child might need in their entire life, it can be life-changing. As parents, we may have to travel a bit further on one, two or three days but our priority is getting our children the care they need. I fully accept the Deputy's point that we want to have that care provided as close to the patient and as close to the child as possible.
We will move on now to Question No. 10.
I understood that Question No. 9 in the name of Deputy David Staunton was next and I could take it on his behalf.
On a general point, I am faced here with late requests, which means that Members with questions down will not be reached. Deputy Ó Murchú submitted his request in plenty of time yesterday. There may have been a breakdown in communications somewhere. I was aware that Deputy Ó Murchú was substituting. He did everything right and notified us yesterday. I will proceed to Question No. 10 and perhaps Deputy Bruton will check if a written notification was submitted to the office.
I thank the Leas-Cheann Comhairle.
Dental Services
David Cullinane
Question:10. Deputy David Cullinane asked the Minister for Health his plans to expand public dentistry; and if he will make a statement on the matter. [19778/24]
What are the Minister's plans to expand public dentistry services? I have spoken to the Minister previously about orthodontic care. I refer in particular to the hundreds of under-18s who are on the waiting lists for orthodontic treatment. In my area, I refer to the centre based in Louth County Hospital. Category four cases are being dealt with privately and huge amounts are being spent on those. We are glad to see people receiving treatment but category five cases, which are more critical, are not being treated and people are still waiting on a solution.
I have just had a back-and-forth discussion on this issue with Deputy Murnane O'Connor.
Good progress is being made. I know there are still parents who are anxiously waiting. I fully accept that and we must get to all of these children. It is important to note that in the lifetime of this Government, the number of children waiting has fallen by 44%. That is great to see. In the Dublin and mid-Leinster region, there has been a reduction of nearly 80% in the number of children waiting. There is good momentum.
This is being done through various streams. It is through public funding obviously and then, as the Deputy rightly identified, we have made significant money available over the past number of years for private care because we need to get these children seen.
We invest a little over €200 million every year in public oral healthcare services. An additional €17 million in one-off funding has been invested in recent years.
In the longer term, the national oral health policy sets out a complete transformation of oral healthcare services and the expansion of the care available for children and adults. I recognise that children are still waiting too long. We are on our way to bringing those waiting lists right down to meet the agreed all-party targets.
For children, the HSE is developing comprehensive, prevention-focused oral healthcare packages, starting with those aged from birth to two years of age. Those are being supported by nearly €5 million in additional funding.
Additional information not given on the floor of the House.
This will support children to attend a local dentist from birth, representing a significant expansion of care compared to the current model, which centres on three examination appointments starting at the age of seven.
For adult medical card holders, €10 million in additional funding supported the introduction in 2022 of additional preventative care to the dental treatment services scheme and a substantial increase in fees. This has increased both the number of patients seen and the treatments provided. The HSE is currently developing the clinical aspects of new packages of preventative care for DTSS patients as the first phase of reform of the medical card scheme.
We all welcome the moves relating to preventative care. As part of a perfect solution, we would eventually have a sufficient level of public dentistry to provide what is required. I am glad that some people are getting necessary dental care through the private sector. The numbers have obviously jumped. In 2021, in the Louth-Meath area, 77 patients were accepted at a cost of €200,995. By 2023, that figure had risen to 256 patients at a cost of €889,530. These are category four patients whereas the parents of category five children are regularly contacted and asked if the children have gone to the North. We need to find a fix for this. We are told that the HSE is carrying out an assessment of feasibility for a similar initiative but we need to see some detail about it because if some of these cases are left, the children will end up in detrimental circumstances.
I fully take on board what the Deputy said. It is very worrying for these children and their parents. Good progress is being made. We have to go further. I am happy to ask my Department to engage with the HSE and revert to the Deputy along with Deputy Cullinane, who tabled the question, with a note relating to category five and give them more detail for Louth and Meath, the counties referred to by Deputy Ó Murchú.
I would appreciate that. The parents are very worried and probably a bit perturbed when they are contacted the HSE, not with a date but to ask whether they have already taken action by going to the North. As much as we want public provision, we need to find a solution for these patients similar to category four patients. I ask for that note as soon as possible. It would really make a difference.
I was contacted by a parent who is particularly worried. The child will be 17 this Christmas and has been waiting a number of years for this treatment and the parent is afraid the child will age out. Those are the circumstances we need to deal with. Another case involves a 37-year-old woman with a diagnosis of autism. She needs particular treatment relating to an abscess in her teeth and jaw. She thought she had found a solution through the cross-Border initiative in April but she does not have it at this point. I will give the details to the Minister. This is someone in severe pain. We have made representations to the HSE.
The Deputy referred to two cases. If he send me the details, I will ask the HSE to take a look and revert to him directly.
Medical Aids and Appliances
Ruairí Ó Murchú
Question:11. Deputy Ruairí Ó Murchú asked the Minister for Health if he will provide an update on the review under way into the funding and provision of post-mastectomy products; when the review will be completed; if stakeholders, including cancer survivors and post-mastectomy product fitters, will be consulted; and if he will make a statement on the matter. [19294/24]
I ask the Minister to provide an update on the review underway into the funding and provision of post-mastectomy products, when the review will be completed and if stakeholders, including cancer survivors and post-mastectomy product fitters, will be consulted? We all know the issue that blew up inside this Chamber and on the Joe Duffy show on radio. I was contacted by Alison McCabe from Breastcare by Alison. I met her at her home and can see the great work she does with women in a really difficult set of circumstances. I know the Minister has made promises so this is just about making sure we follow through on them and provide the supports people require.
What happened here was that the HSE published national procedures without discussing the issue with me and without proper consultation with the Department. I got a phone call from a fantastic activist who is also a Fianna Fáil councillor, Teresa Costello, asking me what in the name of God I was doing removing supports from women. I said that under no circumstances were any supports being removed from anybody. I said that a review was in place but the purpose of the review is to provide additional supports. We know that women with medical cards have some supports but those supports differ by region and very little is available for women who do not have medical cards.
I was as shocked as anybody else to hear that a policy that most certainly was not agreed had been launched. It was disappointing that information that was incorrect got covered nationally. It caused an awful lot of upset to an awful lot of women and there was no need for it. We clarified very quickly that this was not a policy and was certainly not something that was going to be authorised.
What I did on the back of that was ask the HSE to go back to the drawing board. I told it that under no circumstances was I authorising a policy that took away any existing supports. I want a policy that levels up and that considers women who do not have medical cards as well. Those options are being finalised and costed. Obviously, I will need to find money for them but then I will be reviewing them.
Hopefully, that will be done as soon as possible. The Leas-Cheann Comhairle allowed a breach of protocol and I thought it was very useful when the Minister got up and explained that this was not going to happen. There is a need to deal with protocols regarding how stuff like this happens.
More important, we need to ensure this review involves engagement with consultants, breast care nurses and mastectomy fitting professionals, a number of whom have contacted Members of the Oireachtas about this matter. We know there is a difference depending on where people are. The Minister mentioned the need to ensure women are covered across the board regardless of whether or not they have a medical card. There is also a question about the application process. In a lot of cases, it is people like Alison McCabe who would submit the applications for the women with whom she deals, which takes that burden off them. I do not know if it is necessarily a good idea for fittings to take place in cold hospital settings where women may have had their surgery. It would be preferable if this did not happen. Is there information about a timeline?
Regarding the proposal that was put together, the HSE did consult various stakeholders, including included service users, nurses, health and social care professionals and the Irish Cancer Society. I have also met fitters and suppliers and they asked that their views be considered, which is fine. Of course, we should listen to them and I am sure they will have something to add. Unfortunately, the HSE did not consult my Department because it would have got a very different answer.
I am very open to whatever works for women. Ultimately, all that matters is where the services are provided and where the fittings are done. As part of a big national push on women's healthcare services and also on affordability, we want to make sure we do whatever works for women who need to avail of these products. We will keep a very open mind on input from all sides.
There was a slight problem with notifications. We will now take Question No. 9. We will probably only have time for one more question and perhaps part of another one. The notification of Deputy Stanton's substitution was sent in yesterday so we can proceed.
In that case, my question is out.
Yes. This will save people sitting around. If we have time, we will take Deputy Mac Lochlainn's question.
Cancer Services
David Stanton
Question:9. Deputy David Stanton asked the Minister for Health if a governance structure exists in the HSE to oversee the provision of care for people genetically predisposed to cancer; and if he will make a statement on the matter. [19460/24]
Deputy Staunton asked me to take this question for him. He is concerned that genetic variants are responsible for between 5% and 10% of cancers. He is concerned about whether we have an adequate funding model and about the waiting lists for this genetic testing because effective screening reduces healthcare substantially in the longer term.
The national cancer strategy provides recommendations concerning the monitoring, testing and provision of comprehensive care to people who have an inherited predisposition to cancer, and the national cancer control programme, NCCP, leads on the development of services for this potential patient cohort. The national cancer control programme hereditary model of care was published last August. I recognise that Deputy Staunton has been advocating on this issue for some time. That is a very important step forward. The national cancer strategy was launched in 2017. It has taken time to get to the hereditary model of care but it has now been published. It is a plan for the further development of services for people who have a predisposition to cancer. A steering group is in place, which is chaired by the director of the NCCP and includes patient representatives. Under this model, specialist cancer services will work as part of a national genetic service. This is being supported by an investment of nearly €5 million in the national genetics and genomic strategy, which was launched a little over a year ago, and an additional 18 posts. We are very aware of this issue. The hereditary cancer model of care is going to help with that. I know there are people who might want to be tested for the BRCA gene. Testing and identification can be life-changing and life-saving, so this is certainly an area on which we are progressing.
Deputy Staunton is very concerned about the current waiting lists. The Irish Cancer Society reports waiting lists of up to two years for testing. There is then potentially a further two years waiting for the risk-reducing procedure that the test may have signalled. Is the Minister monitoring waiting times? Will the new initiative involve a multi-annual plan for staffing and investment so that this programme is not competing with other urgent care that might squeeze it out?
The service line is essentially a subset of the national cancer strategy, so any funding we get will be in the context of funding through next year for the national cancer strategy. There is also a separate funding line for the genetics and genomic strategy, which is fairly recent. Specifically on those services for patients with a predisposition to cancer, we have direct ordering of BRCA testing, which was introduced in 2017 for ovarian cancer patients. It was expanded to breast cancer patients in 2021 and to prostate cancer patients in 2023. Last year, some 700 patients were tested, so there has been a very encouraging expansion of the service. I do not have the figures, but we are looking at the time it is taking. Some affected families have told me that they want to see the waiting time greatly reduced.
I ask the Minister to check those waiting times and report back to me and Deputy Staunton because the Irish Cancer Society is signalling quite long waiting times. For a screening test that can reduce long-term healthcare, it is to be hoped that it could be made more prompt.
I will ask the Department to revert to Deputies Bruton and Staunton. I want to mention good progress in two other areas. Two new types of testing were introduced last year for specific treatments. The first was homologous recombination deficiency testing for treatment of ovarian cancer. The second test is for NTRK gene fusions, which can lead to cancers of the brain, head, neck, thyroid, soft tissue, lung and colon. Also, the NCCP breast family history project is under way. This will streamline and standardise the service for asymptomatic individuals at elevated risk of developing breast cancer due to their family history. We are approaching it both in terms of the identification through family and also through gene testing. I will get back to the Deputies on the waiting times for BRCA testing.
Health Services Staff
Pearse Doherty
Question:12. Deputy Pearse Doherty asked the Minister for Health when he will meet with the Donegal branch of an organisation (details supplied) to address its concerns regarding broken promises to improve diabetes services in Letterkenny University Hospital; and if he will make a statement on the matter. [19824/24]
The Donegal branch of Diabetes Ireland is urgently requesting a meeting with the Minister. He met the group briefly in a hotel in Donegal in 2022. The group was hoping to meet with the Minister last year, but the situation has got even worse since the meeting happened in 2022. The issue concerns adults with type 1 diabetes and the lack of endocrinologists, podiatrists and advanced nurse practitioners. We are asking for an urgent intervention and that the Minister meet the group at the earliest opportunity to hear about the issues and try to get them resolved.
As the Deputy said, I have met the group in question, which is very active and effective in Donegal. I will highlight some of the important progress that our healthcare workers in Letterkenny University Hospital, LUH, have achieved. It really is very encouraging to see. In the last while, they have reduced the number of patients awaiting first appointment by two thirds, which is fantastic. I will double-check, but I think in just the last year they brought that figure down from 243 patients to just 85. Obviously, we want to bring it within the normal Sláintecare target of between ten and 12 weeks, but a reduction of two thirds is very encouraging to see. All patients with type 1 diabetes are now getting their first appointment within six to eight weeks, which was not the case previously. Most patients with type 2 diabetes have been waiting less than six months and that figure is also coming down. Our target is ten to 12 weeks, whereas previously the waiting time was up to two years. I commend the healthcare workers in LUH and the community on this huge achievement. Why is it happening? It is partly because we opened a new community hub in February last year. This has resulted in important improvements in patient care, with 10,000 individual patient interactions with more than 2,000 patients completed since its opening.
Regarding the concerns raised, recruitment for the consultant post in the community hub is also under way. The recruitment for the endocrinology posts is being advanced. I know there is frustration and that these posts have been advertised before. The fact that we are now advertising for them under the new consultant contract should make a significant difference.
What the Minister has just read out does not tally with the request for the meeting that has been sent to him. The Donegal branch of Diabetes Ireland has said that the situation with patient safety at the hospital is "beyond critical". There is currently no endocrinologist in the hospital and there are three vacant posts. There are no advanced nurse practitioners. Two posts were not approved by the HSE. There are no podiatrists and there are also two vacant posts in podiatry. There is no access to pump therapy. There are no psychology supports. LUH has the worst record of recall for type 1 diabetes patients, with waiting lists of more than three years. That information is in the correspondence sent to the Minister. There is something badly wrong with what the Minister is being told, through Saolta University Health Care Group, I assume, given what is actually happening on the ground. As the Minister acknowledged, the Donegal branch of Diabetes Ireland is highly respected.
The branch members have met various Ministers over the years, including the current Taoiseach, James Reilly and the Minister. I ask him to meet them please at the earliest opportunity.
I thank the Deputy. As he said, the focus right now is on getting these consultants in place. I fully accept that. Letterkenny has approved two full-time posts, with 100% commitment at the hospital and, as the Deputy said, there is also a third post. The focus is on these endocrinology posts. There was very effective intervention by central HSE for recruiting more consultants for Letterkenny, on the back of the visit I had there some time ago. I will engage again with central HSE and the HR team to see what else we can do.
We have the new consultant contract in place. The Deputy aware of the discussions between the NHS and the HSE and the fact that we are paying twice what NHS consultants are getting. It is a very attractive contract for international recruitment. I will ask the HSE to engage specifically with Letterkenny, as it has done on other specialties. We need to get these three endocrinologists in place. As he pointed out, and as the community knows, it is the hiring of these endocrinologists and support staff that will get the diabetes services the people of Donegal need and deserve.
Will the Minister meet the Donegal branch of Diabetes Ireland? As he knows, it is highly respected. He needs to meet its members face-to-face to get their account of what is happening so he can best address the issues.
Certainly the next time I am in Donegal there will be no issue with that. We are very clear on what the issue is; it is a lack of recruitment. We have the money and we have the posts. We need the advanced nurse practitioners and the endocrinologists. I want to use the time to get the posts in place. I am very aware of the issues being raised and there is ongoing engagement through the HSE. Of course we would never rule out a future meeting.