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Dáil Éireann debate -
Tuesday, 29 May 2018

Vol. 969 No. 7

Other Questions

Cancer Screening Programmes

Thomas P. Broughan


42. Deputy Thomas P. Broughan asked the Minister for Health the status of the CervicalCheck test scandal; the number of women who have availed of the free follow-up smear tests; the laboratory being used to examine the results of the tests; the changes he plans to the programme and the regular audits of same; and if he will make a statement on the matter. [23145/18]

On 11 May the Minister announced a package of services for anyone who wanted to avail of a new cervical smear test. How many women have availed of it? What is the Minister doing to ensure their tests and results will be delivered speedily and what laboratory is involved? We have all been astonished by the courage of Vicky Phelan and Emma Mhic Mhathúna, in particular, but there has been severe criticism recently that the package of measures is not being delivered speedily and that the Minister is not fulfilling the promises he made just a few weeks ago.

I assure the Deputy that rolling out the package of supports is a priority. Not only did we appoint a national lead within the HSE to co-ordinate it, but we have also instructed that lead to ensure public health nurses are assigned in each of the community healthcare organisations, CHOs, to liaise with the families. I do not want to hear of any woman or her family having to go to a meeting in Dublin or being dragged to meet the HSE. I want to see the infrastructure in place for a public health nurse to visit that woman or her next of kin in an appropriate setting for the family, for example, around the kitchen table in the family home. A number of such meetings have taken place and I am informed that a great deal of progress has been made. Without naming anyone in the Dáil, I have put some of the women affected in contact with the person co-ordinating this work nationally to ensure their feedback will go directly to the HSE. I will personally monitor the position closely.

As the Deputy knows, there was a significant downward trend in the incidence of invasive cervical cancer between 2010 and 2015 and we are seeing improvements in five-year survival rates. For that progress to continue, it is essential that women keep participating in cervical screening. Recent weeks have shaken confidence in many aspects of CervicalCheck, but participating in screening is vital if we are to continue to see a reduction in the incidence of invasive cervical cancer. It is welcome that so many women who have been adversely impacted jon or treated poorly by the health service have echoed that message.

As part of ensuring women can feel trust and confidence in the CervicalCheck programme and that it is well managed and quality assured, I have asked Dr. Gabriel Scally to carry out a scoping inquiry into all aspects of CervicalCheck. I expect him to report to me at the end of June. He is due to produce a progress report in the first week of June. Separately, there will be an international clinical expert review panel led by the Royal College of Obstetricians and Gynaecologists, as I believed it was important to involve external persons. It will review the screening history of all women who have developed cervical cancer and participated in the screening programme since it was established. This will provide independent clinical assurance for women about the timing of their diagnoses and any issue related to their treatments and outcomes.

Additional information not given on the floor of the House

On the number of free follow-up smear tests, the HSE has advised that this information is not available, given that there is always a time delay between when the smear test sample is taken by the smear taker and notification of the smear is received by CervicalCheck from the laboratories. Tests are examined in three laboratories, with approximately 50% of the testing done in Ireland and 50% abroad. All three laboratories meet quality assurance standards and are certified by the relevant national authorities. The clinical advice is that there is no evidence that the clinical and technical aspects of the programme have performed outside or below international standards or the quality guidelines set for the programme. However, smear tests can produce both false positive and false negative results. I have asked the HSE to introduce HPV testing as soon as possible as the primary screening method for the prevention of cervical cancer. The HPV test is a more accurate testing mechanism than liquid-based cytology, the current testing mechanism, and its use would result in fewer false negative results. Its introduction is in line with developments in cervical screening internationally.

I welcome the Minister's commitment personally to monitor the delivery of the package he announced on 11 May, but he did not address my question about laboratories-----

-----specifically MedLab Pathology and Clinical Pathology Laboratories, CPL, on the one hand, and the Coombe Hospital, on the other. To reassure people in seeking follow-up tests, will the Minister outline which laboratories will be used? At the weekend The Sunday Business Post reported that the minimum time for the study of each test was approximately six minutes under the protocol. It was not clear whether the protocol was being adhered to by the American laboratory. What is the position in that regard? The HSE would not offer a reply on it to the media.

Regarding the clinical audit and reviews, have there been contacts with all of the doctors who did not inform their patients of the false negative results?

At the request of many Deputies, the laboratories we use and their performance are specifically within Dr. Scally's terms of reference because I do not feel qualified nor, I respectfully suggest, is anyone in the House to make these adjudications.

All of the laboratories being used meet international standards and follow the quality guidelines set for the programme. The clinical advice is that there is no evidence that the clinical and technical aspects of the programme have performed outside or below international standards. That is what I am told now and what I believe based on what I am told. We need to allow Dr. Scally to make his adjudications. The laboratory at the centre of the Vicky Phelan case is not being used by CervicalCheck.

On the number of free follow-up smear tests, the HSE has advised that the information is currently not available, given that there is always a time delay between when the smear test sample is taken by the smear taker and the notification of the smear being received by CervicalCheck from the laboratories. I will ask the HSE to make that available to Deputy Broughan when it becomes available. Tests are examined in three laboratories, with approximately 50% of the testing done in Ireland and 50% done abroad. I assure women that all three laboratories meet quality assurance standards and are certified by the relevant national authorities.

I will continue the last point I mentioned about clinicians who have been involved in the 209 cases which led to this scandal. Has there been contact with all of those? What are the Minister's plans for mandatory reporting and the patient office? Does he intend to set that up as an independent agency? The Minister got a €685 million increase in the 2018 health budget. What kind of additional funding does he anticipate for 2019 to address some of the terrible issues that have come forward in this cervical smear check scandal?

I have not negotiated my Estimates for 2019 with the Minister for Finance, and Public Expenditure and Reform, yet. The Government has made it clear in a number of decisions that whatever financial supports are required will be provided. The Taoiseach has made it clear here on the record of this House and the Government has given me assurances about the funding of the practical measures that we are putting in place. On mandatory reporting and mandatory open disclosure, I have received permission from the Government to progress the patient safety Bill. That will bring in mandatory open disclosure for serious reportable incidences. I have given an assurance that that will include issues relating to screening. I also want to move to HPV testing this year. I asked the HSE to introduce HPV testing as the primary screening method for the prevention of cervical cancer as soon as possible. The HPV test is a more accurate testing mechanism than liquid-based cytology which is the current testing mechanism. It would have fewer false negative results and its introduction is in line with developments in cervical screening internationally. It would place this country to the forefront. I hope, by accelerating that, that it could be something positive to come with regard to women's health and screening.

Cancer Screening Programmes

Thomas P. Broughan


43. Deputy Thomas P. Broughan asked the Minister for Health if there will be a full audit of all cancer screening programmes; when these audits will be completed; when the results of such audits will be laid before Dáil Éireann; and if he will make a statement on the matter. [23144/18]

I will follow on from the Minister's last point on cervical testing. Will he accelerate that into 2018 to move towards the HPV testing? On the overall programme, we are approximately 12 years into the 2006 strategy for cancer control, including BreastCheck, CervicalCheck, BowelScreen and Diabetic RetinaScreen. What type of audits are the Government and Department ordering on the whole range of cancer screening services? How does the Minister plan to expand that?

On HPV testing, I asked the Health Information and Quality Authority, HIQA, to carry out a health technology assessment on this and it came back recommending HPV testing. I decided in February that we would move ahead with the introduction of that later this year. I have asked that that be accelerated. It is a big body of work. It will also provide the opportunity for the reconfiguration of the laboratories that we are using in Ireland. I have said on a number of occasions that this is nothing to do with safety or quality assurance. Instinctively, I would like to be able to use Irish laboratories and develop our own services here, should that be possible. I have asked officials to examine that.

Following on from the recent issues relating to the disclosure of the results of the CervicalCheck clinical audit, I have established the scoping inquiry being led by Dr. Gabriel Scally. He will review all aspects of CervicalCheck and examine the other screening programmes operated by the National Screening Service, particularly relating to quality assurance, clinical audit, open disclosure and governance. The Deputy's point is well-made. Screening has saved lives in this country, whether BreastCheck, BowelScreen or CervicalCheck. We know that it has saved lives. It is also important that we continue to see if there are areas in which we can do better and if we can learn from other countries. While we have somebody doing an external review of CervicalCheck, it seems sensible to me to ask that they would also look at the other screening programmes and examine them, particularly with regard to quality assurance, open disclosure and governance.

As the Deputy will also be aware, I have engaged on a cross-party basis about the terms of reference for this inquiry. It is fair to say that they are comprehensive and reflect the issues raised by all parties in this House. I gave the written submissions that were given to me by the Opposition to Dr. Scally and asked that not only does he act on the terms of reference, but considers all of this. The inquiry is expected to issue its first report at the beginning of next month and its final report by the end. A website has been established,, which provides a public-facing presence for the inquiry and will enable it to communicate progress with all interested parties.

I notice when one looks for statistics on various screening programmes that the last statistics for BreastCheck were from 2015, when 199,000 or so women were invited for screening. Of those, I think 146,000 attended, which was an uptake rate of almost 75%. It was the highest number ever screened by BreastCheck in a single year. Why do we not have the relevant statistics for BreastCheck, for example, for 2016 and 2017? Similarly, on the bowel-screening programme, the last figures I was able to look at were for 2012 to 2015. When will we get a more up to date report on that? For example, the uptake rate for bowel screening was just 40%, which seems very low. As the Minister rightly says, the screening programme has had a tremendously positive impact on our health, although we obviously still need to spend significant funding on prevention, especially with regard to obesity. Why do we not have more up to date reports? Will we get more feedback on the total screening programme for the next while?

I will ask that question of the HSE and revert to Deputy Broughan. I envisage that it is likely that Dr. Scally's report will signpost any areas identified as needing improvements, make recommendations and outline to us what further body of work needs to be done. I want to take the opportunity, on the record of the Dáil, to reiterate the point about screening not being a diagnostic tool. I am not suggesting the Deputy said it is but it is important that over the last weeks, we have all become very conscious of that. The difference between screening and diagnostic screening is important. Screening helps to save lives but it is not a diagnostic tool. I hope that we will have an opportunity shortly to work with stakeholders, whether the Irish Cancer Society, Patients' Association, the Marie Keating Foundation or our own health messaging within the health service, to take the opportunity to promote screening but also to explain and communicate to our public what screening is and is not. As part of its work, the HSE serious incident management team, SIMT, has examined whether a formal audit process as carried out by the CervicalCheck programme exists in BreastCheck or BowelScreen. The examination by the SIMT found that there is no comparable formal audit process in place with either BreastCheck or BowelScreen but we have asked Dr. Scally to look at all these matters.

When the Taoiseach was in Deputy Harris's Department, I remember asking three years ago on behalf of women constituents about mammogram machines. I think he told me there were 30 machines, they had an eight year lifespan and there were complaints about the kinds of machines that we were using. Has the replacement programme that the Taoiseach, Deputy Varadkar, referred to at that stage been completed? Are there further improvements in that regard to take account of the views of women in particular?

In the interests of providing accurate information, I will have to check that. I do not have a note available to me about that. I will check for the Deputy if the mammogram machines have been upgraded since he last asked the question of my predecessor and will revert to him directly.

Dietician Service Provision

Kevin O'Keeffe


44. Deputy Kevin O'Keeffe asked the Minister for Health the community nutrition and dietetic services which will be available in north County Cork from May 2018. [23553/18]

It would be remiss of me, being on the losing side, not to congratulate the Minister on the Government's success in amending the Constitution and I look forward to working with him on the initiative. Hopefully he will keep his commitment to providing the healthcare services that will be required. Going back to nuts and bolts, in north Cork, there is a dietician position vacant. It is ironic since the Minister of State, Deputy Catherine Byrne, sitting next to the Minister has dealt with other issues in north Cork, in Fermoy.

I will be brief. Another invaluable service is out of action in north Cork. Patients who live on their own need dietetic care services when they leave an acute hospital. They need to be able to consult dieticians and GPs. The HSE must buck the trend and employ extra staff.

I am pleased to inform the Deputy that the Health Service Executive has advised my Department that approval for a locum dietitian in Cork north has been given and the recruitment process is under way. The Health Service Executive envisages that this post will be filled by late June. I am also pleased to advise the Deputy that the Health Service Executive has further informed my Department that the vacant post for a dietitian in North Lee has been filled and the successful dietitian for this position is due to start work in July. The situation with vacant positions arose due to staff absences as a direct result of statutory leave such as maternity leave.

As the Deputy is aware, dietitians lead the development and provision of clinical services and programmes targeted to prevent and treat malnutrition, diabetes and obesity in both adults and children. Community dietitians work in the HSE alongside GPs and other HSE health professionals as part of the primary care team. Community dietitians are also involved with nutrition health promotion work in the community and training other health professionals regarding nutrition.

I acknowledge the Minister of State's response, which I am grateful for. I thank her very much.

Could we say the question is concluded and move on?

I acknowledge the reply and hope the HSE will follow through on what has been promised. I look forward to a positive response at the end of June. I thank the Minister of State very much.

I will provide Deputy O’Keeffe with a copy of the reply.

Health Services Staff

Billy Kelleher


45. Deputy Billy Kelleher asked the Minister for Health if 100 front-line psychology staff are being required to undergo training to remain qualified for their jobs. [23535/18]

Are 100 front-line psychology staff being required to undergo training to remain qualified for their jobs?

In 2015, the HSE established a group to review the eligibility criteria for employment as a psychologist in the HSE psychological services. This came about in response to ongoing issues with the eligibility criteria for recruitment to HSE psychologist positions.

The review was completed in 2016 and made recommendations which have been accepted in full by the HSE. Both clinical and counselling psychologists are now eligible for employment across all four care groups. It was also decided to move the qualification requirement away from named psychology qualifications solely. Instead, a combination of qualification and placements or supervised work experience will be considered when determining a person's eligibility for employment. These criteria will come into effect in October 2019.

Existing psychologists will only be required to have completed additional placements if they wish to apply for a competition, for example, in respect of a promotional opportunity, from October 2019. It is intended that existing psychologists will be facilitated to acquire the necessary supervised work experience should they wish to compete in any future competitions. There is no compulsion, however, to complete placements or additional training to remain in existing roles. Anyone remaining in a role does not need to do any additional placement or training. The change relates to people newly entering a role or those engaging in promotional opportunities. We will ensure that existing psychologists will be facilitated to acquire the necessary supervised work experience.

The change comes about following on from a significant body of work that has been done and the view that we needed to move away from the qualification requirement only to look at the idea of a combination of qualification with placements or supervised work experience, all with the aim of assisting patients in the health service.

Some concern has been raised on this issue. The Minister may be aware there is a pressing matter of the requirement for 100 front-line psychology staff being required to undergo training to remain qualified for their jobs. Changes to criteria have meant a large number of counselling and educational psychologists are being required to complete extensive in-service training to maintain eligibility for their jobs. For educational psychologists that will mean 60 days in-service training to be completed prior to October 2019. For many counselling psychologists it will mean 120 days or even 180 days in-service training. By contrast, psychologists who have recognised placements could be deemed eligible even with no post-training experience. According to some, the criteria for determining which placements are acceptable and which are unacceptable have been poorly defined and appear to have been enacted in an ad hoc and highly restrictive manner. For example, experience in the Irish Prison Service does not count as experience in adult psychology and experience with specialist services does not count at all, even when those services are operated by the HSE itself.

I thank Deputy Browne for bringing the information to my attention. I will ask the HSE to examine what he has said and revert directly to him on it.

In 2015, the HSE established a review group to examine the eligibility criteria for employment as a psychologist. In its review the group was guided by the changes to models of care, by service user safety, by maximising our resources and flexibility in response to service need, as well as by developments in training and education in professional psychology disciplines. The review was completed in 2016 and made recommendations to the HSE. The review group decided to review the existing care group delineation and to move the requirement away from named psychology qualifications solely to that combination of qualification and placement. A key recommendation is the reduction in care groups from eight to four, effective from 1 March 2016.

A group will be formed comprising the health business services recruitment managers and principal psychology managers. This group will consider any new definitions to be used in advance of competitions, as well as dealing with unforeseen or difficult decisions that may arise. This will ensure that fairness and consistency can be protected. I will ask that they take on board the point Deputy Browne has made. A national psychology placement office will also be established to assist with placement identification and allocation. To prepare for its implementation, a project team will be established to advance the recommendations. There is quite a significant lead-in time to get this right and I will make sure any engagement that needs to happen with stakeholders does take place.

I note the Minister's point that the criteria only apply to those looking for promotion. In a written reply to Deputy Thomas Byrne last month it was stated that the requirement to complete placements only affects those who apply for recruitment campaigns. That amounts, however, to saying that as long as someone does not want to progress in his or her career, it will not affect that person. Surely that is absurd.

I understand too that the Fórsa trade union has objected to the position taken by the HSE and has sought a meeting with the HSE corporate employee relations service. Does the Minister not realise that retrospectively applying new and potentially highly inappropriate criteria to existing staff is unheard of in the manner in which it is being done? The HSE seems to be prepared to allow this to happen with little regard for the impact on service division or the enormous amount of stress being placed on staff in the circumstances.

I will ask the HSE to engage with all unions in this matter. The terms and conditions of existing staff members are not being changed, but what we are saying, for good reason, which is grounded in trying to improve the experience of the service user and based on a very comprehensive and detailed review that was carried out, is that qualifications should also be matched with experience relating to placement.

I take the Deputy's point about what is appropriate placement and appropriate work experience. I will ask for that to be fed in directly to the group that is going to be formed, involving both health business service recruitment managers and principal psychology managers as well. The idea is that this group will iron out any such difficulties to ensure fairness and consistency. The HSE will also establish a national psychology placement office to assist in the allocation of placements as well. I am happy to keep in touch with the Deputy on this matter and I hope it can be ironed out for all.

Question No. 46 replied to with Written Answers.

Mental Health Services

James Browne


48. Deputy James Browne asked the Minister for Health the plans in place to expand talk therapies in mental health services. [23529/18]

What are the Minister for Health's plans to expand talk therapies in mental health services?

The choice of care for a patient is determined by the needs of the individual patient. Both talk therapy and medication are included in this process as options to consider. HSE specialist mental health services provide a wide range of talking therapies in both child and adolescent mental health services, CAMHS, and adult mental health services.

The HSE also provides talk therapies at primary care level through directly employed staff, for example, psychologists in primary care and counsellor therapists in counselling in primary care and the National Counselling Service. Counselling in primary care was launched in July 2013. This was established to provide counselling for patients experiencing mild to moderate psychological difficulties who present in the primary care setting. All adults in receipt of a medical card are eligible for the service. Since its establishment the service has grown rapidly with almost 19,300 referrals during 2017 and counselling provided from more than 180 locations nationwide. These services have been enhanced recently through the recruitment of 114 assistant psychologists in primary care. The HSE also employs counsellors, therapists and psychologists in primary care addiction services.  In addition to directly employed staff, the HSE funds partner organisations such as Jigsaw to provide talk therapies.

In order to ensure greater consistency and equity of access to these services HSE mental health commenced a service improvement project in January 2018 with a view to developing a model of care for adults who attend specialist mental health services accessing talking therapies. While the project focuses specifically on adults attending specialist mental health services, it will also describe other services that currently provide talk therapies from HSE funding. Building on a stepped care approach, the model of care is expected to involve an assessment of the need for talking therapies taking into account stakeholder perspectives and the prevalence of mental health disorders within the adult population. It will consider evidence-based talking therapies that are best suited to meet the identified needs and outline a recommended operational model for talking therapies provided by general adult community mental health teams.

I thank the Minister. In its submission to the Joint Committee on the Future of Mental Health Care, the Irish College of General Practitioners said: "Our health system would appear to value machines, hospitals, and drugs over talk therapy, time to care and social support." Irish general practices are slowly getting bigger. As the proportion of single-handed GPs, which is now at only 18%, is reducing and more GPs are working in practices with three, four or more GPs, these larger practices could very usefully incorporate an on-site strand of talk therapy delivered within GP practices. The trendsetting practices are actively exploring the use of relevant innovative care.

The HSE spends 40 times more on medication than counselling services to treat mental health illnesses. Counselling and talk therapies can often be effective for mild to moderate mental health difficulties but these therapies are vastly under-resourced in Ireland. People battling mental illnesses need more access to counselling and talk therapies with less reliance on medication. Much of the evidence suggests that because of a lack of alternative pathways in giving mental healthcare support to their patients, GPs are either relying on accident and emergency departments or on medication. I am not saying that medication is being prescribed inappropriately but that GPs are having to rely on it because of a lack of alternative healthcare pathways.

I thank Deputy Browne. I agree with him and I know that the Minister of State, Deputy Jim Daly, does as well. The HSE's mental health services are working with the Department of Health on a project which aims to improve access to mental health information and support through the harnessing of communication technologies. There are a number of strands to this project. First, there will be enhanced web-based mental health information which will be signposted to ensure the widest possible access to information on both mental health conditions and on our mental health services. There will be an enhanced text-based live chat active listening service which will respond to queries on mental health and a telephone service that will direct people to appropriate and relevant mental health support services. There will also be a feasibility study on the provision on online therapies and a framework for the quality standards required for the provision of such services. Included in this work will be a pilot study examining the feasibility and utility of providing access to Internet-based counselling services from a primary care service.

HSE specialist mental health services provide a wide range of talking therapies in both child and adolescent mental health services, CAMHS, and adult mental health services. These include specialist behavioural therapy, specialist cognitive behavioural therapy and behavioural family therapy. Additionally the HSE provides talk therapies at primary care level through directly employed staff, including our psychologists in primary care and our counsellor therapists in counselling in primary care and, as I have outlined, the National Counselling Service. As I have already stated, these services have been enhanced but there is absolutely room to do more in this regard. I agree with the Deputy's sentiment in that respect.

I thank the Minister. I would simply repeat the figure that I previously stated. We spend €400 million a year on psychotropic drugs but we only spend €10 million on talk therapies. We hear about pilot studies and programmes but they are not being rolled out nationwide. Things seem to take so long. Take Jigsaw as an example. It started as a pilot and is a phenomenal programme. However, I was told 18 months ago that it was going to arrive in Tipperary within a couple of months. It is still not there. It needs to be rolled out across the country. There is a crisis in the waiting lists for our child and adolescent mental health services. That is partially because there is a crisis in our waiting lists for access to child psychologists, which in turn is developing because there is a crisis in respect of the complete lack of availability of talk therapy. In other words, when children first need supports they are not there. They then need access to psychologists but cannot get to them and the next thing is that they are in CAMHS. When children who are growing rapidly, both biologically and emotionally, do not get early intervention very quickly the long-term effects can be profound. Talk therapies need to be provided at a much greater level than they are at the moment.

I thank Deputy Browne for his point. We are in agreement on this issue. We need to see a greater roll-out of these services. However, I would point out that the data are encouraging in terms of the number of people now being seen. Taking the example of counselling in primary care from 2015 to 2017, in 2015, 17,002 people were referred to the service, which increased to 18,471 in 2016 and increased further to 19,279 in 2017. We have also seen an increase in the number of people opting in to the service from 9,835 in 2015 to 11,454 in 2016 and 11,810 in 2017. We expect the total number of both children and adults in that service to be 20,528 in 2018, up from 19,279 the previous year. We expect the number of people opting in to the service to increase to 13,008, up from 11,810 in 2017.

Occupational Therapy

Margaret Murphy O'Mahony


47. Deputy Margaret Murphy O'Mahony asked the Minister for Health his views on concerns being expressed by occupational therapists in relation to new assessment of needs procedures for children with disabilities. [23505/18]

The Minister of State is very welcome to the Chamber. I ask him for his views on the concerns being expressed by occupational therapists in respect of the new assessment of need procedure for children with disabilities.

I apologise to the Leas-Cheann Comhairle and Deputy Margaret Murphy O'Mahony for the delay. As the Deputy is aware, a revised standard operating procedure for assessment of need has been developed to ensure that there is a standardised approach to assessment across the whole country.  The purpose of this procedure is to ensure children with disabilities and their families access appropriate assessment and intervention as quickly as possible. Under the revised procedure an assessment of need will comprise a preliminary team assessment that will identify initial interventions and any further assessments that may be required. The assessment will usually be undertaken by a children’s disability service. This service is composed of a number of health professionals, including occupational therapists, who will be tasked with delivering interventions. While not required under the Act, diagnostic assessments will continue to be provided, as appropriate, and any diagnosis will be captured in the child’s service statement as part of the assessment of need process.

These changes will alleviate the current situation where children in some parts of the country may wait a number of years before they can access an assessment. During this period of time they often have little or no access to intervention or support. It is intended that these changes will facilitate children with disabilities to access assessment in a more timely fashion. This represents a significant and positive change for children with a disability and their families.

The Association of Occupational Therapists of Ireland, AOTI, has outlined concerns about the HSE's standard operating procedure for assessment of need. Specifically, occupational therapists are very concerned about the HSE's implementation from 30 April 2018 of the standard operating procedure for the assessment of need. Among other things, they say that "90 minutes is not a sufficient period of time to adequately assess the needs of children with disabilities and we are particularly concerned about the negative impact this aspect of the system will have on children and their families." They say that "[i]t will also place undue pressure on occupational therapists being asked to carry out these assessments and may place them in conflict with AOTI and CORU codes of ethics." Disappointment has also been expressed "that HSE management has failed to properly consult with AOTI on this matter" and AOTI appeals "for them to engage with AOTI and other professional bodies to address our concerns with the new system for Assessment of Need".

I thank the Deputy for raising this important issue. I share her concerns about what is going on in this sector. I will engage with anybody here who wants to sit down and talk about the issues. I accept the genuine concerns about this matter that have been raised by the Deputy. Since the commencement in 2007 of Part 2 of the Disability Act 2005, the HSE has endeavoured to meet its legislative requirements as set out in the Act. As a consequence of a High Court ruling of December 2009, the effect of which was to open eligibility to all children born after 1 June 2002, the number of children aged five and over and of schoolgoing age has increased steadily as a percentage of all applications received. The relevant figure was 26% at the end of 2011 but it had increased to 51% by the end of 2017. This reflects how the number of children seeking access to the assessment of need process tends to accumulate. The number of new applications for assessment under the 2005 Act has increased steadily since it was introduced. Some 1,138 applications were received in a six-month period in 2007, whereas 5,839 applications were received in 2017. Some 43,521 completed applications have been received by the HSE since 2007. I accept the criticism that this is a numbers issue. Substantial work was undertaken during 2017 to address waiting times for assessment of need under the Disability Act 2005. The additional funding secured by the HSE for therapeutic purposes has been invested in the progressing disability services for children and young people programme. The roll-out of this programme since 2014 has entailed targeted investment of €14 million and the provision of 275 additional therapy staff to increase services for children with all disabilities. I will engage with this issue and ensure it is a priority during the negotiations on the Estimates.

I thank the Minister of State for his answer. I appreciate that his heart is in the right place in this regard. His intentions are good. I ask him to keep in mind that consultation is imperative if anything is to work. I ask the Minister of State to comment on the suggestion in the standard operating procedure that referral information will be sufficient in terms of birth and development history, medical history, family history, social and behavioural functioning and current concerns.

Under the revised standard operating procedure for assessment of need, a preliminary team assessment will identify initial interventions and will be followed by any further assessments that may be required. The preliminary team assessment will provide sufficient information to determine whether a child meets the definition of "disability" under the 2005 Act. A child who meets the definition will receive a service statement outlining the services to be provided and the timeline for those services. Children with less complex needs who do not meet the definition or do not have a disability can continue to access services through primary care. A child will receive initial interventions while awaiting further assessment if this is deemed necessary following the preliminary team assessment. This arrangement, which will deliver best practice standards of early intervention for children, was not previously available. I emphasise that we need to invest in these services if we are to develop them.

Question No. 49 replied to with Written Answers.

Emergency Departments Services

Michael McGrath


50. Deputy Michael McGrath asked the Minister for Health the reason for the substantial increase in overcrowding in Cork University Hospital emergency department over the first four months of 2018 relative to the same period in 2017 [23514/18]

This question relates to the overcrowding in the accident and emergency department at Cork University Hospital. Such overcrowding is not uncommon in a number of hospitals throughout the country. We have heard many harrowing stories of individuals, particularly elderly people, who have had to spend over 24 hours in accident and emergency units. They are looking for answers and for progress on this issue.

I thank the Deputy for raising this question. Under the winter initiative, over 200 additional beds opened this winter across a range of sites, including critical care beds in Cork University Hospital, CUH. A further 30 acute medical beds are scheduled to open later this year in CUH, including two more critical care beds. In addition, CUH has been supported over the recent winter months with additional home support packages and transitional care beds to reduce delayed discharges which affect patient flow and can have an impact on congestion in emergency departments. I welcome the opening of an additional 30 acute medical beds in CUH later this year, along with two more critical care beds. In line with CUH's particular focus on addressing patient flow, it initiated a project in 2017 to improve patient flow and the patient experience. In pointing out that this project, which has continued into 2018, is having a positive impact on trolley performance, I do not mean in any way to detract from the Deputy's point about the difficulties experienced by patients, family members and staff when individuals have to spend long periods on trolleys. However, I have to show respect to the staff, and the patient flow project they have put in place in CUH, by acknowledging that in the first four months of this year, CUH had 15.3% fewer trolleys than it had in the same period in 2017. This reduction was achieved even though patient attendances at CUH's accident and emergency department increased by over 1,000, or approximately 7.8%.

Although the overall situation remains very challenging - we have much more to do - I welcome the reduction in trolley numbers that has been achieved by CUH so far this year. The local initiatives that have been put in place in CUH to improve accident and emergency department performance appear to be having a positive impact. I am in direct touch with some people in the hospital. I get updates on the patient flow project from the clinical director in CUH. I assure the House that as Minister for Health, I am committed to continuing the effort to address overcrowding in our emergency departments. I am particularly focused on the capacity of our system. The decision that was made in previous years to reduce the number of hospital beds in the Irish health service makes no sense to me. As Deputies will be aware, I have received the go-ahead to increase the number of acute hospital beds by over 2,500. I am looking at opportunities to try to front-load those beds. I will be asking each of the hospital groups, including the South/South West hospital group, to identify how many additional beds it requires. I am sure Cork will benefit from that.

I thank the Minister for his reply. I welcome any investment that improves the situation for the people of Cork and the wider Munster region who rely on the services of CUH. Perhaps the Minister could provide more detail on the 30 additional acute medical beds that are scheduled to open in CUH later this year. Those beds have the potential to be of significant benefit. I have highlighted the problems that have been encountered by many elderly people. I am informed that 330 people over the age of 75 had to wait in the accident and emergency department at CUH for more than 24 hours in the first three months of this year. I am sure the Minister will agree that this is not acceptable. I am currently dealing with a case in which an extensive home care package of over 40 hours a week has been approved for a person who is in hospital but would be far better off at home. The HSE has been unable to execute the home care package directly through HSE staff, or through private care providers, for several months now. The capacity issue in this case seems to be a real problem.

If the Deputy wants to correspond with me, I would be grateful to get the details of the case in question. I would be happy to raise it with the HSE because we need to take a serious look at how we can reduce the number of delayed discharges in our health service. I want to see the home care packages that we are funding to help people to get back home deployed as quickly as possible. I will send the Deputy a note on the 30 further acute medical beds that are scheduled to open in CUH later this year. As I have mentioned, two additional critical care beds have been opened in the hospital in recent months. A further two critical care beds are due to open this year. An additional 32 beds - 30 acute medical beds and two critical care beds - are scheduled to open. I remind the House that we announced in the capital plan that an elective hospital will be developed in Cork. This is quite important. I appreciate that a busy acute hospital like CUH, which is dealing with pressures in its emergency department, also wants to be able to tackle its elective waiting lists. It will be of benefit to the Cork area to have a stand-alone elective-only hospital to drive down waiting lists. I look forward to making progress with this project.

Child and Adolescent Mental Health Services Provision

Michael Moynihan


51. Deputy Michael Moynihan asked the Minister for Health the timeframe for bringing child and adolescent mental health services in CHO 4 to the level envisaged in A Vision for Change. [23522/18]

I thank Deputy Moynihan for tabling this question, which relates to child and adolescent mental health services, CAMHS, in CHO 4. The Government remains strongly committed to developing all aspects of mental health services, including CAMHS, as envisaged under A Vision for Change. This is being delivered by the HSE in the context of its agreed annual service plans. Significant progress has been made over recent years, underpinned by additional funding since 2012 to develop mental health overall. Funding for the service in 2018 amounts to €910 million. The standardised operational procedures of HSE CAMHS support timely access to services. This is based on professional clinical assessment and prioritisation to address the mental health needs of all children presenting to this specialist service.

Despite increasing demands overall on CAMHS, irrespective of the source of referrals, individual cases assessed as urgent receive priority. There are currently 69 CAMHS teams and three paediatric liaison teams, while ten CAMHS teams are in place in CHO 4. Staffing levels in the CAMHS teams vary in Cork-Kerry community healthcare but are below the levels recommended in A Vision for Change. CAMHS teams in CHO 4 are at 52% of the recommendation. It is difficult to determine an exact timeframe for bringing staffing in line with A Vision for Change, but efforts are under way to achieve it.

I would like to assure the Deputy, as would the Minister of State, Deputy Daly, that funding is not the reason posts remain unfilled. At present, there is a European shortage of appropriately trained CAMHS consultant psychiatrists. This is having an impact on the provision of services. On average, there have been two consultant vacancies in teams at any one time in CHO 4. The HSE is striving to recruit and retain suitably qualified CAMHS consultants in the Cork-Kerry region. In addition, it is difficult to replace all clinical CAMHS staff going on maternity leave in Cork-Kerry, a challenge it is addressing.

Recruitment challenges are also experienced in respect of nursing and psychology professionals. A CAMHS medical recruitment task force has been established to review efforts to recruit and retain medical staff. An additional 7.5 posts have been approved for the area in line with programme for Government development funding. These have been allocated to fill posts in teams with low staffing levels and the longest waiting lists, with new staff starting between April and July of this year. Clear action plans have been put in place for each team where waiting lists are over 12 months.

The CAMHS enhancement project commenced at the end of September 2017 in the Cork-Kerry community healthcare area. As a priority, the initial focus has been on reducing waiting times in excess of 12 months. However, in the longer term, the project will address practice changes to improve access to CAMHS to maximise efficiency. The development of CAMHS services in CHO 4 will be progressed in the context of the ongoing review of mental health policy to succeed A Vision For Change.

The Minister of State, Deputy Jim Daly, met the chief officer of CHO 4 on Friday morning last to review what CAMHS service improvements can be delivered in the short and longer terms. This includes reducing waiting lists and enabling better access to the Eist Linn acute unit in Cork. He will continue to closely monitor CAMHS service improvements overall in CHO 4. I will also ask him to correspond directly with the Deputy on the outcome of his meeting with the chief officer last Friday.

The issue is really the level of funding that is available and the level of services. Everybody who is affected across the region has great difficulty, particularly in getting young people seen. The fear in families and the damage done by not having them seen on time cannot be underestimated. There are two patients in particular who I have been trying to get seen and the damage that has been done to them and their families must be acknowledged. I note what the Minister is saying about April to July. There is not enough energy or drive to tackle the mental health issue and I feel very strongly about people who cannot get appointments.

Deputy Moynihan is right to highlight this as an important issue and I know he will welcome the new staff starting between April and July of this year in his CHO area. This is an area in respect of which the Minister of State, Deputy Jim Daly, also has concerns. The Deputy will accept that it is not a funding challenge. The funding is in place for a number of unfilled posts and there is a recruitment and retention challenge. I know the Minister of State is very conscious of this in respect of CHO 4, which is why he met with the chief officer last Friday. I will ask him to update the Deputy directly.

Written Answers are published on the Oireachtas website.