Other Questions

Hospital Waiting Lists

John Lahart


6. Deputy John Lahart asked the Minister for Health the action that will be taken to reduce outpatient waiting times for neurology consultations in Tallaght University Hospital where 1,276 appointments are outstanding for more than 18 months. [28194/18]

Almost 1,300 people are awaiting neurology consultations and appointments in Tallaght University Hospital for more than 18 months. Neurology includes syndromes like Parkinson's, Alzheimer's, epilepsy and attention deficit hyperactivity disorder, ADHD.

Given that, in the case of Parkinson's, the maximum recommended waiting time for an appointment with a neurologist is approximately six months, what action can the Minister take to deal with these waiting lists? Does he have any plans to appoint additional neurology consultants to Tallaght?

I thank Deputy Lahart for raising this important matter. He has highlighted an issue that we need to get on top of and I think I have some news in that regard today. Improving waiting times for hospital procedures and outpatient appointments is a key commitment in the programme for Government and a key priority of mine. As the Deputy is aware, we increased the National Treatment Purchase Fund, NTPF, budget to €50 million this year. By any objective analysis, that has seen progress in the time it takes to get a hospital operation or procedure. We now need to do the same for outpatients because the outpatient waiting list is still a significant cause of concern. As a result, I recently allocated €3 million from the NTPF to fund outpatient initiatives and my Department, the HSE and the NTPF are in the process of finalising those actions. All hospital groups have been invited by the HSE and the NTPF to bring forward proposals for specific outpatient initiatives for inclusion in this action plan. This plan will support the HSE's compliance with its national service plan targets and will aim to reduce the growth in the size of outpatient lists and, similarly to what we did with inpatients last year, seek to reduce the number over a period.

Tallaght University Hospital advises me that from January to May 2018, there have been a total of 3,925 neurology outpatient attendances, an increase of 18% on the same period in 2017. In fairness to the hospital, it is certainly increasing its level of activity, up 18% on last year with regard to the number of neurology appointments. The good news is that it will take actions to reduce the outpatient waiting times. It recently held a number of improvement workshops to agree these actions and what it will do to implement them to reverse the trends in neurology. I am pleased to say that a new, on-site, general practitioner, GP, led headache clinic is due to be established in the next few weeks at Tallaght Hospital. Registrar and advanced nurse practitioner clinics in neurology will begin in the last quarter of this year. This will enable consultants to increase the numbers of new patients seen at clinics as a number of repeat appointments can be seen by advanced nurse practitioners and registrars. The hospital is also investigating the possibility of launching consultant-led clinics in Naas Hospital and transferring appropriate appointments to that service. There are three practical actions that the hospital is due to commence. The on-site GP-led headache clinic, which will commence in the next few weeks at the hospital, will be welcome to many with regard to trying to triage and reduce the number of outpatients, while one can target those awaiting a consultant appointment.

I thank the Minister. There is some welcome news there. If one is suffering with motor neuron disease, multiple sclerosis, Tourette syndrome or any neuromuscular disorder and is waiting for over 18 months for an appointment with a neurologist, that is very distressing, not just for the individual but for the family. On a political point, it is worth noting, and maybe the Minister will give credit where credit is due, though it is not a cause for smiles, just realpolitik, that the Government abolished the National Treatment Purchase Fund. Fianna Fáil, in the programme for facilitating this Government, asked the Government to reinstate it. The Government has reinstated it and is now telling us that it works, and that when money follows the patient, even in the case of neurology, it works. The Minister never says that publicly, and champions the NTPF as if it was his own invention and creation. Facilitation of government comes at some little price occasionally and I think credit should be given where it is due because it is a practical intervention that makes a difference to people's lives. The people I am talking about are those suffering from these neurological disorders who need interventions. The Minister has said the NTPF works and we would like to see more of it. The Minister did not answer the question relating to the appointment of additional neurologists to Tallaght Hospital.

I like to think that I am one of the less partisan individuals here. I acknowledge that that was a key demand of the Fianna Fáil Party in establishing this minority Government. If the Deputy searches the Dáil record, I think I have acknowledged that in many questions here. I point out that in the realpolitik world, my predecessors in 2011 would have found it difficult to find any money to put into the NTPF.

My predecessors, when they came to Government, during the greatest financial crash, had to make horrifically difficult decisions, as did Fianna Fáil when in government, with regard to how to spend money and invest in services. I agree that the NTPF works. While the Deputy is not suggesting it, it should not be about just putting money into private hospitals. Deputy Louise O'Reilly and I have this debate regularly. That is why we spent more than a third of its budget on increasing capacity in the public health service last year. While it is not my creation, I like to think that we have tried to tweak and improve it. I agree that it works. There is an unfilled consultant appointment post in Tallaght which the hospital is actively trying to fill and has been for approximately ten months. It is important to give credit to hospitals. This is a hospital that has come up against a difficulty with regard to neurology outpatient appointments. It has come back with practical, tangible actions. I have outlined three today and hope it will see significant improvements.

Disability Services Provision

Michael McGrath


7. Deputy Michael McGrath asked the Minister for Health his plans to address the chronic lack of residential placements for disability services in County Cork [28197/18]

This issue relates to the lack of residential placements for people with a disability. I had a good exchange with the Minister of State, Deputy Finian McGrath, about this issue a few weeks ago during a Topical Issue debate. I am glad that the Minister, Deputy Harris, is here to listen to the exchange. This is not just a Cork issue. It is a national issue but it has been highlighted to me, as is often the case, through individual cases and people in quite a chronic situation. The waiting list is appalling. I would like the Minister of State to update the House about what measures are being put in place to tackle the lack of residential places for persons with a disability, both children and adults.

I thank Deputy Michael McGrath for raising this issue of residential places in disability services in Cork. I take it on board and we recently debated it in the Dáil ourselves. This Government's ongoing priority is the safeguarding of vulnerable people in the care of the health service. We are committed to providing services and supports for people with disabilities which will empower them to live independent lives. As part of its ongoing service provision, this year the HSE will provide over 8,300 residential places to families in need across the country. Residential places make up over two thirds of the disability budget. That is a figure that people often do not know. Our policy is for people with disabilities to be supported to achieve their full potential so that, where possible, they can live on an everyday basis among family and friends in the community. All residential placements for adults with disabilities are considered following detailed clinical assessments by HSE services. Access to places for those with the most complex needs are allocated on a priority basis and the availability of appropriate services.

A significant underlying challenge relates to the unmet need for residential and respite care that arises from the absence of investment during the economic downturn. The HSE national database figures indicate an annual requirement of over 400 residential places per year. As a result, the service is experiencing a high annual demand for emergency residential places to respond to the most urgent cases. In 2018, the HSE national service plan provides for support for 385 persons through 130 emergency places, 135 in-home supports and 120 in-home respite supports. I am informed by the HSE that there are currently 1,093 placements being provided in the Cork-Kerry community healthcare area. The demand for residential places is in excess of places available. I accept questions and will respond accordingly.

Additional information not given on the floor of the House

A residential placement committee made up of all service providers has been established who work collaboratively, and in partnership, to respond to the growing need of service users and their families. This committee is planning for the future, while also reviewing existing services and the varying level of need. Families need support to care for their loved ones at home and the Government is committed to providing a range of accessible respite care supports for people with a disability and their families. There is an absolute need for increased respite care and in 2018 an additional €10 million specifically to enhance respite care was provided. In April of this year, this extra funding enabled the opening of an additional service in Listowel, County Kerry. Up to the end of last month, an additional 108 respite nights were provided to 15 persons. Additional respite is planned towards the end of the year in west Cork, which will facilitate referrals from across County Cork. In the meantime, a range of alternative respite options will begin in the coming weeks across County Cork.

There is a serious issue with respite provision but this question focuses on residential placements. It surprised me when I did some digging that the HSE could not provide any data on the number of people on a waiting list for residential placement nationally, so I started to probe the issue locally. In Cork alone, between the Cope Foundation and the Brothers of Charity, two outstanding service providers, there are 252 adults and children on a waiting list for a residential placement. The Cope Foundation has 175 of those and 27 of them are deemed to be priority 1. They are critically urgent cases.

There are situations where elderly parents, who are not getting any younger and who have medical needs themselves, are caring for adult children who, in some cases, have very high dependency needs. It is becoming incredibly difficult for them and they are just about coping day by day. They need to know there is light at the end of the tunnel but they are being told by their service provider there is no hope. They might be 30th or 40th on a local waiting list and the service is not even getting enough funding to clear the emergency cases. That is what they are being told.

I am sorry to hear they are being told that there is no hope. We gave one of the services mentioned, Cope Foundation in Cork, increased funding in the last two weeks. I have already visited and met the management team there, and I will be going back in the future.

I take the point on the issue of residential places, where we have a particular problem. The Deputy mentioned the Brothers of Charity, who are providing 184 residential places, Cope Foundation is providing 437 residential places and the Cork Association for Autism is providing 16 places. There is work going on, although I accept we have a hell of a lot more to do. With regard to funding for disability services, we have to prioritise residential services, particularly those where older parents are taking care of adults with an intellectual disability but have no residential care available.

With regard to the HSE budget, in 2018 we are spending €1.7 billion, an increase of €92 million on last year. The figures are as follows: there were 182,500 respite over-nights, 42,552 day respite sessions, 135 new home supports for emergency cases, 130 residential places and 120 in-home respite supports for emergency cases. There was also the additional €10 million to provide respite services.

The bottom line, when we break down all the figures, is that in budget 2019, as I and the Deputy know and as I have said to the Government, we need 400 emergency residential places.

Ireland’s Eel Management Plan (EMP), including the closure of commercial fishing, was approved, in 2009, by the European Commission under EU Regulation 1100/2007. Fishing for eel was by way of public licence and therefore the issue of compensation does not arise. However, I directed my officials to engage with the European Commission in relation to Ireland's proposals to fund a support scheme for former eel fishermen. The outcome of that engagement confirmed that funding for the proposed measure is not eligible for support under the European Maritime and Fisheries Fund. However both Minister Naughten and I have secured Exchequer funding to support the measure and our position that this does not constitute State Aid has been confirmed to the Commission. Consultation with the Revenue Commissioners is at an advanced stage. Until consultations are completed, it is not possible to elaborate on the terms and conditions for, or the prospective number of participants in, any potential support measure.  Once completed it is intended to publish the relevant details in the coming weeks

I appreciate that support and I know that the Minister is on the same page. Health and disability are key issues for our society.

To add a little hope, additional respite is being planned for towards the end of the year in Cork, which will have referrals from all over the Cork area. In the meantime, a range of alternative respite options will be beginning in the coming weeks across County Cork.

To return to the core issue, we need to ensure that this year's budget contains support for these emergency places. As I said, last year we managed to have 135 new home supports for emergency cases and there were also other home supports. The bottom line - and the figure for which I am pitching - is that we would ensure 400 residential emergency places are available every year to ensure we deal with these priority cases. There are a lot of families doing fantastic work but, as they get older and sometimes themselves have disabilities, they need support. It is up to us, as a compassionate Government and a compassionate Opposition, to ensure we prioritise the funding and supports for these people. I would try to give a message of hope to the many people with disabilities and their families. We are improving the services every day.

National Dementia Strategy

Deputy Butler has been given permission to take Question No. 8, which was tabled by Deputy Niall Collins.

Niall Collins


8. Deputy Niall Collins asked the Minister for Health if he is considering the appointment of a dementia care adviser in each CHO area; and if he will make a statement on the matter. [28212/18]

Each day, 11 people are diagnosed with dementia. There are currently 55,000 people living with dementia. There are eight dementia care advisers in the country, providing services in 11 counties only. Is the Minister considering the appointment of a dementia care adviser in each CHO area?

I thank Deputy Butler for the question. Dementia adviser services are provided at eight demonstrator sites across Ireland, supporting approximately 1,700 people with dementia and their carers and families in 14 counties. Dementia advisers offer a highly responsive and individualised information and signposting service.

The national dementia strategy was launched in December 2014 to meet the challenges faced by the 55,000 people living with dementia in Ireland and to provide services to meet growing demand in future years. The strategy contains 35 priority and additional actions to be undertaken by the HSE. As the Deputy will be aware, one of these actions is for the HSE to consider the provision of dementia advisers, based on the experience of demonstrator sites.

In order to fully capture the experience of demonstrator sites and inform the future development of this service, the HSE’s national dementia office has commissioned an external evaluation of the service. The evaluation, by University College Cork, UCC, began in November 2017 and is expected to be finalised by September 2018. Initial results indicate that a majority of people with dementia are satisfied with the information, advice, support and signposting provided by dementia advisers. The service has brought normality to their lives, provided understanding about dementia and given people with dementia the confidence to ask questions. The Department is awaiting the final evaluation report. The appointment of additional dementia advisers will be considered when the results of this evaluation are available.

I thank the Minister of State. He referred to the external evaluation that is under way. As he knows, I am chair of the all-party Oireachtas group set up to raise awareness of dementia. There has recently been a mid-term review of the national dementia strategy. Those involved came to a meeting of our group and talked us through the current position. They told us people with dementia and their families are still dealing with inadequate services and supports, and stated that additional funding is required. Access to community dementia-specific services across Ireland is not equal and, as the Minister of State will know, the mapping document prepared recently showed there are huge gaps across the different counties. The level of service varies depending on where one lives and we need more equity of service. I thank the Minister of State who, on three different occasions, has engaged with the all-party Oireachtas group, which is much appreciated.

I appreciate the Deputy's comments. I am happy to continue that engagement, given the group is very constructive in its approach to these issues.

The question asks about the appointment of one dementia care adviser for each of the CHO areas, of which there are nine in the country. As the Deputy will know, given she knows so much about this issue, there are already eight dementia care advisers so that would only mean the appointment of one more. However, as the service is only serving 14 counties, that highlights the issue we needed to evaluate. If I was to answer by saying that I would provide one in every CHO area, I would be confirming the appointment of one more adviser, whereas I know that is not what the Deputy is seeking.

I am awaiting the results of the UCC research, which will be on my desk in September. Hopefully, that will be in time to inform the budget. We are acutely aware of this issue. At every meeting we have around budget issues for the coming year and our priorities, dementia is top of the list because we know it is an enormous challenge for society that is coming down the road. I intend to keep that focus.

The question is probably incorrectly worded. Our plan is to grow the dementia adviser network from the current eight to 33 throughout the country. A dementia adviser costs €70,000. We had this conversation with the Minister of State before the budget last year. I know money does not grow on trees and the Department has a specific budget that it has to work with. However, as I said to the Minister on the previous occasion, the ask is €2.31 million in order to have 33 dementia advisers in place. I ask the Minister of State to consider an incremental pathway. If we had eight a year for the next four years, we would reach the target and that would make a major difference.

As I have told the Minister of State previously, I understand that there are budgetary constraints, but we must start somewhere. We have eight advisers in place, but we need 33. If another eight could be provided this year and a further eight the following year, that would be helpful.

That is appreciated and understood. The other challenge that I must consider in the overall picture is that, while having advisers in place is a wonderful support, assurance, point of contact and human interaction for families, the services to which people will be directed are insufficient. In terms of funding, I must try to get the balance right between developing services in the community and having people to signpost individuals to those services. I am trying to study that balance and to get not just the geography right, but also the structures in terms of which parts of the HSE they will sit in and to whom they will be accountable. I need to find a few more answers, but I will have them by September. I look forward to working with the all-party Oireachtas committee on developing this service and signposting.

National Dementia Strategy

Dara Calleary


9. Deputy Dara Calleary asked the Minister for Health if a new national dementia strategy is being prepared; and if he will make a statement on the matter. [28235/18]

My question is similar and aims to tease out an update on the preparation of a new national dementia strategy. The current strategy is due to be completed this time next year, having missed most of its targets. Given the increase in dementia rates across our community, what are the Government's plans for a properly funded strategy that can be implemented?

The national dementia strategy was launched in December 2014 and seeks to increase awareness and understanding of dementia, ensure timely diagnosis and intervention, and provide enhanced community-based supports and services. The strategy was developed to meet the challenges faced by the 55,000 people living with dementia in Ireland and to provide services to meet growing demand in future years. The number of people with dementia is expected to almost treble by 2046.

A mid-term review of the implementation of the strategy was published on 23 May. It indicates that half of the strategy's 35 actions have been substantially progressed, with preliminary work done on the other half. The mid-term review also contains an action plan for the work of the National Dementia Office over the next year.

A number of priority actions in the strategy were co-funded by the HSE and The Atlantic Philanthropies through the €27.5 million national dementia strategy implementation programme. These include the establishment of the National Dementia Office within the HSE, upskilling and training of GPs and primary care teams, an awareness campaign and intensive home care packages. Actions within the strategy that did not receive funding through the national dementia strategy implementation programme are also being addressed. These projects include the development of a diagnostic and post-diagnostic support pathway, the roll-out of a national network of memory technology resource rooms, the mapping of dementia-specific community-based services, and the development of a job specification for the role of key worker. Funding for some of these actions has been secured through the Dormant Accounts Fund, with the Department securing €2.28 million through the 2016 and 2017 action plans.

A large-scale external evaluation of the strategy is being conducted, the results of which will be available during the first quarter of 2019.

The Department is committed to the full implementation of the national dementia strategy and will continue to work with the National Dementia Office and stakeholders to progress the actions contained in the strategy. Until satisfactory work has been completed on actions contained in the current strategy, and because the external evaluation of the strategy has not concluded, it would not be appropriate to begin work on a new strategy.

For each of the 55,000 people who suffer from dementia, at least three others are affected by it. They need certainty and consistency in the delivery of services, but that is not happening. We are putting these people on an appalling health journey, and the blockages and inconsistency in services throughout the country are making that journey even more difficult. It took the Minister of State's personal intervention to resolve a service issue in Mayo that Deputy Lisa Chambers and I raised at the end of last month, when the HSE was going to cut services to dementia sufferers. Families need more than ministerial intervention to give them certainty in services, though; they need a break. The lack of a properly resourced strategy is not helping.

Apart from the 55,000 dementia sufferers we know of, how many more will receive that diagnosis? People are developing dementia at a younger age. Specific cohorts within the 55,000 have additional needs, for instance, the 700 with Down's syndrome. They are all being left in abeyance because of the lack of a properly funded and deliverable strategy and the inconsistency from CHO to CHO. People with dementia should get the same level of high service no matter where they are in the country, but that is not happening.

I thank the Deputy for his acknowledgement. I agree that it should not have been necessary for him to reach out to a Minister to have the issue in his county resolved.

Regarding the wider question on a new national dementia strategy, the strategy itself is not the issue. It is ambitious, and one of the key elements underpinning it is a change of culture in society so that, rather than believing that people should be locked away just because they have dementia, they should instead be accommodated in their own communities. Such a shift in attitudes highlights the significant challenges facing a strategy like this. It is not something that will happen overnight, which resources would not allow for anyway.

I want more resources to be invested in dementia services. There are no two ways about it, but dementia is the challenge of our time. We as a political body must respond in kind and up our game when it comes to resourcing the provision of services for the significantly increasing number of people affected by dementia on a daily basis, as Deputy Butler stated.

An external evaluation of the strategy is about to be concluded and I look forward to its conclusion. Once that happens, we need to continue with our current strategy and ensure its implementation.

We do not need to change the culture, as communities are leading the response to dementia on an organic basis throughout the country. The HSE is behind the curve. It comes along and tries to shut down community-led initiatives.

A new strategy will have to be prepared without the participation of The Atlantic Philanthropies. Since there will be no rich sugar daddy anymore, the money will have to come from the taxpayer. The Minister of State should commence that work as soon as the external review is concluded. He should not be behind the curve. Most important, it must be ensured that those suffering from dementia and their families are consulted and central to the writing of the strategy and that it is not left to some HSE official who does not get the situation. It is clear that many officials do not understand what families and patients are going through, and the cross being borne by people around the country. The Minister of State needs to involve families and the organisations. They need to be central to the new strategy.

We are effectively saying the same thing but, to be fair, I am not sure that people do not understand the situation. Given dementia's unfortunate and increasing prevalence, the incredible number impacted includes people who are making decisions at senior levels within the Department and HSE.

However, I take the Deputy's point that this must be a priority for resourcing. The battle is on for the budget, which I hope will be before the House in October. I accept full responsibility for the need to ensure that dementia will be a top priority in next year's health budget. I look forward to whatever support comes from the Deputy's party. Strength and leadership has been shown by Deputies Butler, Calleary and Lisa Chambers and other Members who have a stake in ensuring that we get this right. I will play my part and co-operate in full.

Home Help Service Provision

Lisa Chambers


10. Deputy Lisa Chambers asked the Minister for Health the reason CHO 2 was 45,000 home support hours behind target in the first quarter of 2018; and if he will make a statement on the matter. [28190/18]

Home support hours allow loved ones to be cared for in their homes and save the State a considerable amount. That should be rewarded and respected.

I thank the Deputy. This year, the HSE consolidated the funding for home help and standard home care packages, which now operate as a single home support service. This new approach will provide significant benefits: the services will be easier to understand; the application and decision-making processes will be streamlined; and it will be easier for people availing of home support to move to changed levels of service as their assessed needs change without the need for an additional application process.

Home support services were a particular area of focus in budget 2018, with an additional €18.25 million allocated. This brought the total funding for home support services to €408 million. As a result, the HSE has been able to increase the provision of home support services. Its national service plan provides for a target of just over 17 million home support hours to be provided to 50,500 people. This represents an increase of 754,000 hours and home support for 500 more people compared to last year. In addition, 235 intensive home care packages will provide 360,000 home support hours for people with complex needs. Earlier this year, a further initiative saw 324 people being provided with home support services in the context of the recent adverse weather events.

The overall budget for home support services for people living in the CHO 2 catchment area increased in 2017 and 2018 and is now just over €43 million. This funding will deliver more than 1.9 million home support hours. During the first three months of this year, 430,832 hours were delivered against a target of 475,893 hours, which is 45,000 hours below target.

Some parts of the country, including CHO 2, are experiencing capacity issues relating to the availability of home care staff. I have been advised by the HSE that CHO 2 is working towards increasing capacity and is committed to providing its targeted hours by year end. With that in mind, CHO 2 is increasing its monthly spend on home support services to ensure delivery of full year service plan targets.

At the end of March, 6,458 older people were on a waiting list for home support nationwide and 1,482 were in CHO 2, which is Mayo, Galway and Roscommon. Almost a quarter of those waiting are in those three counties alone. Across the three counties, 5,791 were receiving home care or home help and for the first three months of the year, there was a target of 475,893 support hours. According to figures released to our health spokesperson, Deputy Donnelly, just 430,832 hours were provided in those three months. That represents a considerable shortfall by any measure, heading towards 10% in the first quarter.

Almost one in four of those waiting is in Mayo, Galway or Roscommon and these people are waiting for basic supports. Many families are making do with what they have and are struggling at home. They are in great difficulty and are making a choice to stay at home and not put an extra strain on an already overburdened health service. If people are pushed too far, they will eventually break. What is going on? Why are the targets being missed when we know demand will increase? The Minister of State said we are experiencing capacity issues. That is as plain as day. What action is the Minister of State taking to ensure that those capacity issues will be dealt with swiftly?

I thank the Deputy. There are local and national issues. As the Deputy will be aware, I published the results of a public consultation which I launched after taking office last October. I have stood over my commitment to bring about the scheme for home care to mirror the fair deal scheme and ensure people will be guaranteed access to the home care they require under statute, in a similar manner to the fair deal scheme, which we developed and which has grown and been committed to. Nobody has to wait for more four weeks under the commitments in the fair deal scheme. It is guaranteed by statute that everybody who wants to avail of it will get it, and will not have to wait any more than four weeks.

I want a similar scheme to be established to allow people to continue to live in their homes. I have put a timeline of two to three years on that and we are about nine or ten months into the process. It will take another two years to bring about the scheme and ensure it is delivered by statute and properly funded, as well as to address the issues the Deputy has raised, which are affecting Mayo and west Cork. The issues include the availability of staff to fill posts and their terms and conditions. Home helps having to travel a 14-mile round trip to deliver half an hour of service does not make sense to anybody. I have said on the record that the current system is not fit for purpose and that is why I want to design a properly funded, equitable, fair, transparent and efficient service for home help.

CHO 6, which has 4,290 waiting on home support, was some 45,000 hours ahead of target. Why, for the purposes of reporting home care and home help, are they being counted together as there is a significant difference between the two? Despite pledges in the programme for Government and the Fine Gael manifesto, there has been no increase in home help provision. Have the two categories been merged to disguise the lack of an increase?

I am glad the Minister of State touched on the provision of half an hour of help. Many families are being given half an hour per day, which is of no use to anybody. By the time a person gets to a house, says hello, makes the person who is there a couple of tea and gets him or her dressed the half an hour is gone. It is a waste of hours to cut them into such small portions. A wait of two years is too long for those affected. We cannot allow families to languish in what I can only imagine are the most difficult circumstances and let them continue to care for their loved ones without the proper State supports they need and deserve.

I fully support what Deputy Chambers has said. I have raised the issue in respect of the constituency of Roscommon-Galway numerous times.

I have had families cry in my office, not just on one or two occasions but at least 12 different families. What is going on in the CHO 2 area with home care is shocking and appalling. Will the Minister of State examine our area on the strength of what Deputy Chambers has said today? Something is not right. I have been told it involves resources but the Minister of State said that is not the case. I do not believe it is a staff issue. I ask the Minister of State to examine the issue because what is happening is not correct.

I can assure the Deputy that there are not enough resources but the particular issue he is experiencing in his area is a capacity issue involving staff availability. It is the same in my area of west Cork, as I mentioned. There are 45,000 hours which have been paid for but not used in CHO 2, which is a management issue for the HSE to address. It has assured me that it will up the ante in that regard and spend every euro it has been given on home help by year end. I will continue to monitor the situation. We spent €409 million on the provision of home help hours and increased funding by €18.25 million this year. We hope to increase it again next year; we have increased it every year.

Deputy Chambers asked about the two-year timeline. It took seven years to bring about the fair deal scheme, from conception to implementation. I do not intend to spend seven years on this but it will take time to address the myriad issues and faults which exist, many of which are structural such as standards, inspection, funding, availability, qualifications, complaints procedures, standardisation, equity and transparency.

Deputy Chambers asked about the coming together of the two funding models. That has been done for a very progressive and positive reason, that is, to ensure people do not have to apply a second time when they move to a more intensive home care package and to ensure increased transparency.

Question No. 11 replied to with Written Answers.

Primary Care Centres Data

Louise O'Reilly


12. Deputy Louise O'Reilly asked the Minister for Health the status of all primary care centres under construction or opened or both; the healthcare and medical staff working in each operational primary care centre by centre and occupation; and if he will make a statement on the matter. [27851/18]

My question is fairly simple and relates to primary care centres. We have had this conversation many times. I have said that if the Minister is serious about primary care he would employ staff. I have asked about staffing in primary care centres and have been told repeatedly that the services will be provided from within existing resources, which is HSE code to the effect that no new staff will be provided. I ask the Minister to outline whether there are plans to adequately staff the centres.

The development of primary care centres supports the shift from acute care to primary care. This is a key priority for the Government and accords with the vision of a reformed health service set out in the Sláintecare cross-party report. These modern facilities provide a setting in which a wide range of health professionals can deliver better care, closer to people's homes in their local communities. The centres are also a key enabler of care delivery on an interdisciplinary basis. When I visit them I see health care professionals working in a multidisciplinary capacity.

There are currently 120 primary care centres operational throughout the country, 12 of which opened in 2018. A further seven are expected to open before the end of the year while another 65 centres are either being developed or in the planning process. I am arranging to provide the Deputy with the details in tabular format.

Data on the number of staff working in individual centres are not compiled centrally by the HSE. There is a good reason for this. The Deputy and I have visited primary care centres. The staff work across centres and in communities and are not employees of an individual primary care centre. I have asked the HSE to provide what information is possible to Deputy O'Reilly. I can assure her that the number of staff working in primary care is increasing quite significantly. This year, for example, we have provided additional funding for 20 additional psychology posts and 114 additional psychologists in the area of responsibility of the Minister of State, Deputy Jim Daly. Some €4 million has been provided for 83 additional full-time speech and language therapists to come on stream. There will be 40 additional occupational therapists working in our community this year. I can assure the Deputy that we are increasing the number of staff.

I was in a primary care centre in Celbridge, County Kildare, recently. It is being opened alongside a new community intervention team and podiatrist. When I opened a new primary care centre in Carnew, a new wound management clinic was located there. As we open primary care centres, we are not just opening new shiny buildings. Rather, we are looking at the additional services which can be provided, as well as people working on a multidisciplinary basis. The number of staff working in primary care this year has increased on last year, which in turn increased on the year before. It will continue to increase as we reinvest in our health services.

JobPath is one of a range of activation supports which includes schemes such as TÚS and Community Employment (CE), catering for long-term unemployed jobseekers. Activation services are also provided by departmental case officers in the Intreo Centres, or by contracted companies and organisations such as Local Employment Services (LES), Job Clubs and the JobPath providers.

The JobPath service is being delivered through a payment by results model and the Department was careful in designing the service to ensure that payments to contractors are conditional on people not just finding a job, but finding sustainable employment. If a person secures a job and sustains that job, the contractor may be able to claim a job sustainment fee. JobPath is an activation service and not a placement agency and as such clients are assisted to secure their own employment. Depending on the nature of that employment it may be beneficial to the client to make use of Recruitment Agencies to help them secure a position. However the JobPath providers continue to work with the client until such time as they have found sustainable employment.

I hope this clarifies the matter for the Deputy.

I did not say that we are not counting the numbers. Rather, I said the figures are not compiled centrally. The Deputy wanted to know about each individual primary care centre. As she knows from her time as a Member and her previous life, the staff working in primary care centres are not employees of individual primary care centres.

Many of them work across areas. Many of them work in communities. Many of them are visiting people's houses in the Deputy's constituency and in mine. However, the number of people working in primary care is increasing year on year.

In April 2017, we had 954 medical-dental staff working in primary care; that is 981. In nursing, we had 2,857 in 2017 and that is 2,940 this year. In health and social care professionals we had 2,504 in April 2017 and this had risen to 2,598 by April 2018. There has also been an increase in patient and client care. I will provide the Deputy with this information. The number of staff working in primary care is increasing each year and we will continue to roll out a network of top-class primary care facilities throughout the country because our staff deserve them and it also changes the way they can care for patients in the community, working on a multidisciplinary basis.

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