Ceisteanna Eile - Other Questions

National Children's Hospital Expenditure

Stephen Donnelly

Question:

6. Deputy Stephen Donnelly asked the Minister for Health if a value engineering exercise has been or will be carried out in regard to identifying opportunities to reduce the building costs for the national children's hospital; if so, if changes are being implemented or considered for implementation further to this work; and if he will make a statement on the matter. [12197/19]

When major construction projects go over budget there is commonly something done called value engineering which examines the building, its shape, the way it is built and laid out, the services and all sorts of other issues, to find ways to drive down costs. It is done all over the world and regularly in Ireland and is typically very successful. Has such an exercise been done for the national children's hospital? If it has, what changes have been identified and are being implemented and what savings should they yield?

The National Paediatric Hospital Development Board has confirmed that significant value engineering analysis has been carried out on the project, at each of the stages, namely, pre-tender, pre-contract award and post contract award.

At an early stage in the process, the development board determined that the traditional method of procurement was not suitable or realistic for a project of this size and complexity. Accordingly, the contract is subject to a two-stage process with stage one consisting of a scope refinement and value engineering process, based upon tendered rates, to finalise the phase B works above ground. This value engineering process yielded savings of approximately €20 million.

Following the completion of the second stage of the two-stage tender procurement process, the final cost of the design, build and equipment programme for which the National Paediatric Hospital Development Board is responsible now stands at €1.433 billion, €450 million more than advised to Government in April 2017.

As the Deputy will be aware, in light of the concerns over the major and sudden cost escalation associated with the finalisation of the guaranteed maximum price, the Government also approved the commissioning of an independent review of the escalation in cost at the same time.

The terms of reference require the review to develop recommendations, if possible, which may identify any areas of potential cost savings or reductions which are consistent with the applicable contractual undertakings and the completion of the project to deliver on the vision to improve services for the children and young people of Ireland.

This independent review is under way and PwC has recently advised that the report is now expected to be completed by early April.

It sounds as if one value-for-money engineering exercise was completed and identified savings of €20 million which, in the context of construction costs of €1.433 billion, represents a saving of 1.4%. The national children's hospital is a big glass doughnut with a massive garden on the roof. As anyone who has ever built a wall or an extension or watched a Dermot Bannon television programme knows, curves are expensive while straight lines are less so. That is why most buildings are constructed using straight lines. Doughnuts are not a good use of space, which is why none of us lives in a glass doughnut-shaped house. Such houses are expensive and are not a good use of available space. The design of the hospital looks to be extraordinarily expensive. It is a big glass doughnut with curves everywhere. The whole building is curved; even the roof is curved. Why was no work done to identify design changes that could be made that would save money so that the services provided within the building could be protected?

Obviously, the design has been agreed and planning permission has been secured. The Deputy is now suggesting that we go back and look at the design again. While I cannot say for sure, I think that is unlikely to happen. The points being made by the Deputy will be addressed in the PwC report and it is best to wait for the publication of same. PwC, which has professional expertise in this area, will examine these issues and see if there is merit in doing further analysis on this. However, I do not see merit in looking back at the design at this stage when planning permission has been secured. That said, I am not an expert in this area and do not have a background in design or engineering. If the PwC report makes recommendations on the design and engineering aspects of the project, the Government will certainly be open to embracing them and engaging with a view to securing further savings.

The idea that we would not look at the design of the building when a cost overrun of this scale has happened is not acceptable. It certainly would not be acceptable to people who were spending their own money. The project costs have risen from €650 million to €1.4 billion. That is like getting a price of €250,000 to build a house and then two years later being told that the price is now €650,000. At that point, any individual would call in the architect, quantity surveyor and builder and tell them that it was not possible to build a house for the revised price because he or she does not have a budget of €650,000. They would all sit down and redesign the house to the budget available. They might go over that budget a little. Indeed, that usually happens but nobody would just accept the design as it is and agree to spend the €650,000. That is essentially what the Government is doing.

Does the Minister of State know why, given the massive overrun, consideration was not given to redesigning the building? That is what any individual would do with his or her own money and house.

I am not sure how familiar the Deputy is with the history of this project and the effort, time and expense-----

I am very familiar with it-----

I am not talking about the current position but, rather, the history of the project. I am not sure if Deputy Donnelly knows how long it has been on the go and how long it took to secure planning permission. However, he knows enough about the system to know that if one changes a design, it has planning permission implications. If the Deputy is suggesting that we go back to the drawing board and redesign the hospital and then apply again for planning permission, that is fine but I am making the point that it is unlikely that we will go back to that stage of the process.

I asked if it was considered.

Of course, as part of the PwC review, it will be considered. If a recommendation to that effect is made, the Government will consider it. It is not as simple as saying that we will not change the design. Nobody is saying that but there are implications to doing so.. We would have to go back through the planning process again, which took years to complete. This project was before An Bord Pleanála and went around the houses for a very long time. If we decided to re-engage with the planning process, we would have to put up our hands and admit that this hospital will not be built for another five years or more. That is the implication of what the Deputy suggests. That said, the issue will be considered by PwC in its review.

Medicinal Products Reimbursement

John Curran

Question:

7. Deputy John Curran asked the Minister for Health his plans to provide Spinraza for children with spinal muscular atrophy in view of the decision of the HSE not to provide same; and if he will make a statement on the matter. [12081/19]

The Minister of State will be aware that the HSE did not issue approval for Spinraza to be made available to children suffering with spinal muscular atrophy. However, a period of 28 days has been set aside for the company to engage further with the HSE on the matter. What engagements are under way? What are the Government's and the HSE's plans to make this drug available to this group of children?

The HSE has statutory responsibility for medicine pricing and reimbursement in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013. The Act specifies the criteria for decisions on the reimbursement of medicines. The Minister for Health has no role or powers in respect of such matters.

Following detailed consideration of an application for the reimbursement of Spinraza and lengthy engagement with the company, the HSE recently decided that it was unable to reimburse Spinraza. The HSE concluded that the evidence for clinical effectiveness was still quite limited and that the price proposed by the manufacturer was not a cost-effective use of resources.

On 21 February, the HSE wrote to the company involved and informed it of the proposal to refuse to reimburse Spinraza at the current price offering. Under the terms of the Health (Pricing and Supply of Medical Goods) Act 2013, the company has 28 days from 21 February to respond or make representations to the HSE’s proposed decision.

The HSE remains open to considering any new evidence or information which emerges regarding the clinical effectiveness or price of this medicine during this 28 day timeframe. The Government hopes that the company will use this opportunity to come back to the HSE and that this can result in an acceptable outcome for both parties. Responsibility for progressing this issue is now firmly with the company.

I thank the Minister of State. I am disappointed that the Minister for Health is not here today although that is no reflection on the Minister of State. I know that the Minister is away on St. Patrick's Day business but that would usually be accommodated by a change to the Parliamentary Questions rota. The parents of these children are very disappointed that the Minister is not here to respond, particularly as they were outside the Dáil two weeks ago and presented a petition containing over 100,000 signatures to him.

Most other EU countries have now made this drug available. The Minister of State has very clearly outlined the process involved here but my point is that it is clearly not fit for purpose. There is a major problem when 25 other European countries have a system in place which enables them to make this drug available but we do not. Our system is not working and I call on the Minister to review it because these children cannot be denied this drug indefinitely. This has gone on for too long and we need to find a solution. We have relied on procedure time and again. However, the procedure is failing us and we must change it.

The Deputy may well have a fair point. We are operating under the terms of the 2013 Act, passed by this House, which give the Minister no role or function in the negotiating process. In some other European countries, as I understand it, the relevant Minister is the decision maker. Perhaps Deputy Curran feels that system is more appropriate but that is a matter for this House to decide. We are operating under the existing law.

As already stated, the Minister has no role or function in the process at this point. It is exclusively the job of the HSE and the company to arrive at a solution. We are not aware of the terms or the price secured by other countries. The Government completely accepts that there is a need for this drug and wants to see this process ended as quickly as possible. As Deputy Curran knows, however, we have a responsibility to every child in the State. The drugs budget is finite. We must ensure that we do not pay over the odds for any one drug because this could result in other drugs not being made available to other very sick people.

Maybe the 2013 Act is the problem. We have an issue in this country in that we are not able to provide a drug that most other European countries currently provide. We are an outlier on this. If it means reviewing the legislation, the Minister and HSE need to clearly identify the blockage. Why do we have a problem in this country that most other European countries do not have? Time is not on the side of these young people. I have read the review we got. I have two points relating to the rare disease technology review committee. It states that it supports the use of Spinraza in spinal muscular atrophy, SMA, type 1 patients, subject to STOPP-START criteria, and in SMA types 2 and 3 in patients under 18. The recommendation is quite specific. The report clearly identifies that there is no other treatment. These children grow weaker month by month and they and their families know that a drug is available. It is frustrating for them and I feel so bad for those parents, knowing that there is a solution to the problems they face, when we in this House cannot get our act together. I am not blaming the Minister of State personally but it is appalling that we cannot get our act together when every other European country can. We need the Minister to give a direct response. If that means bringing in amending legislation, please do that.

I acknowledge, as I have done many times before, the consistency and sincerity of Deputy Curran in his genuine efforts and endeavours to keep this issue on the political front. The reality is that the Minister unfortunately does not have the power to instruct the HSE to approve this drug tomorrow. That does not exist under the law. As a House, if we want to address that issue, it is open to any Member to table legislation on it. I take Deputy Curran's point on reviewing it from the Department's point of view to see if there is a difficulty which should be addressed. We are allowing the company to come back to the HSE. The Minister does not have a role or function in that process. That will come to an end in the next few days. We have to await the outcome of that to see if there is a change. We appreciate that very real people are at the other end of this but we also have a responsibility and cannot allow a drug company to demand whatever money it wants for a specific drug no matter how high the demand for the drug is. We unfortunately have a responsibility to the public purse too.

Child and Adolescent Mental Health Services Administration

Jack Chambers

Question:

8. Deputy Jack Chambers asked the Minister for Health the waiting times for CAMHS in the Dublin 7 and 15 areas; and if he will make a statement on the matter. [12018/19]

I want to ask the Minister for Health the waiting times for child and adolescent mental health services in the Dublin 7 and 15 areas, and if he will make a statement on the matter. We have an ongoing crisis in CAMHS, with recruitment shortages, ongoing delays and many children being dismissed and turned away from a service because their diagnosis or presentation does not match the severity which the service can provide for. With Deputy Daly as Minister of State with responsibility for mental health, there has not been any improvement in the quality of the service. Children continue to be admitted to adult units and there is not a 24-7 call service, which is shocking in the context of a €17 billion budget.

Developing all aspects of mental health remains a priority for Government, reflected by the additional €55 million provided in budget 2019, bringing overall HSE funding this year for this key care programme to €987 million. Demand for CAMHS has had an increase in referrals of over 20% since 2012. All aspects of CAMHS nationally are being improved by the HSE under its annual service plans. This includes better out-of-hours and 7-7 day cover, progression of day hospital care, developing specialist teams such as those for eating disorders, and improved prevention and early intervention services. There are now 70 CAMHS teams and three paediatric liaison teams. Approximately 18,100 CAMHS referrals are expected in 2019. Cases assessed by professionals as being urgent are seen as a matter of priority.

There are 76 CAMHS inpatient beds in four acute units nationally, with plans for additional beds in the new children's hospital, and the new forensic mental health hospital which is being built at Portrane and is due to open next year. Additional funding allocated to mental health services since 2012 has provided for the recruitment to more than 1,500 posts in mental health, including a significant number relating to CAMHS. There were 2,523 children on the HSE CAMHS waiting list in January 2019. In community healthcare organisation area 9, which covers the areas of Dublin 7 and 15, there were 193 on the CAMHS waiting list. There is currently no waiting list for the north inner city CAMHS team, Grangegorman, which covers the Dublin 7 area.

There is currently a waiting list of 68 for the Dublin 15 area, primarily due to a consultant on leave which has resulted in delays in routine appointments. A locum consultant psychiatrist has taken up duty with the Castleknock CAMHS team since 5 February. This will see a return to more normal levels of activity and a reduction in the waiting list. Prior to this date, cover was being provided via an arrangement between existing CAMHS consultants across other CAMHS teams in Dublin north city and county.

I regularly meet with the HSE to review progress on all aspects of CAMHS. In addition, I recently wrote to all executive clinical directors concerning recruitment and retention issues with a view to improving staffing levels on CAMHS teams thus improving access and reducing waiting lists.

We have received the classic response that more funding is being allocated. We accept that but one problem is that the Government throws money at issues without getting service delivery. We have the second highest health spending per capita in the OECD but what parents and children care about is actual delivery. It is not about how much the Government is allocating or how many more consultants it is talking about, but how people can see a consultant as quickly as possible. The figures are worse, with 193 now versus 186 in November. The Minister of State mentioned a consultant being out and nobody being in an area to cover a population in Dublin 15 that is the size of some cities. There is nobody to see someone and the burden of care is on other consultants who already have significant waiting times. I am aware of children who have a particular diagnosis, have been referred by general practitioners, GPs, and are told by CAMHS that their diagnosis does not match the level of severity that it can deal with, despite it being within the diagnostic guidelines for its own service delivery. That is a serious issue. If someone presented to an emergency department with a significant acute physical problem-----

Go raibh maith agat.

-----he or she would not be triaged and turned away on the basis-----

We will get an answer. I call the Minister of State to respond.

-----that the issue was not serious enough. We have a deep underlying issue here.

I am not sure if the Deputy has ever heard me speak on this before because if he had, he would not make some of the statements that he has made. I have always said that throwing money at it is not a solution. It is interesting to hear that from Fianna Fáil because it has always looked for more money in this area and everything else relating to health. I do not agree that additional moneys are required. Additional, real reform is needed. I have a serious issue with the referrals to CAMHS. In many cases, the referrals are not appropriate and I am glad to hear that CAMHS teams are pointing to the fact that they are not appropriate.

If the Deputy does not want to listen, that is fine. He asked the question.

We will move on if the Deputy does not want to listen.

With respect, the Minister of State made a political charge in his response relating to a very serious matter, the diagnostic management of patients with severe mental illnesses. As Minister of State with responsibility for mental health, I have heard him talk more about rural taxis and telepsychiatry to get headlines in the Irish Independent than I have heard about solutions for mental health services. It is a disgrace that the Minister of State has made a political charge. I was trying to be constructive. I agree that it is not about throwing more money at the HSE. It is about delivering services and that is what the Minister of State is in an executive position for, to deliver mental health services. It is not about making political charges and talking about Fianna Fáil. We are trying to be constructive and to provide solutions, but the Minister of State is not doing that. He is not delivering. He has not made any positive changes relating to CAMHS in my area, where we have seen worsening of waiting lists and where his Government has allowed vacant consultant positions to leave behind children with particular diagnoses. It is the Minister of State's responsibility to act, not to get headlines about Ruxi, coalitions with Sinn Féin or telepsychiatry.

I call the Minister of State to respond.

The Minister of State should deal with his own responsibilities which he is in government to deal with.

I would be delighted to answer the Deputy's questions if he is prepared to listen. I was about to inform the Deputy, while I did not realise he was so sensitive to politics, that I have built a lower level of infrastructure across the country over the past 12 months. We have recruited 114 assistant psychologists, 20 psychologists and ten advanced nurse practitioners for young people across the country, including in the area that Deputy Chambers represents. An independent evaluation that was produced by the University of Limerick for me last week has shown that it will reduce the waiting list for primary care psychology by 1,350 young people this year.

That is real progress and it is the future. It is not about reacting and throwing more money at CAMHS to deal with waiting lists. Rather, proactive investment in lower-level interventions will prevent people escalating to that level of acuity.

Questions Nos. 9 to 11, inclusive, replied to with Written Answers.

Hospital Overcrowding

Jim O'Callaghan

Question:

12. Deputy Jim O'Callaghan asked the Minister for Health his plans in place to increase capacity at St. Vincent’s University Hospital; and if he will make a statement on the matter. [12217/19]

My question concerns St. Vincent's University Hospital, which is in my constituency. What are the Minister of State's plans to increase capacity at the hospital in the light of the increase in demand for services there?

The Minister for Health recognises that hospitals are increasingly operating at or above capacity, with year-round demand pressures that are further challenged in the winter months.

It is against this background that the health service capacity review of 2018 recommended an increase in acute hospitals beds of more than 2,600 by 2031 to support the projected increase in demand for services in the years ahead. The National Development Plan 2018-2027 provides for the full 2,600 beds over its lifetime.

In the past 18 months, an additional 241 beds have been opened, which included 22 acute beds in St. Vincent’s University Hospital.

In addition, the national service plan provides for the preparation of 202 additional beds, to be operational in the first quarter of 2020, including 12 inpatient beds in St. Michael’s Hospital, Dún Laoghaire, which is part of the St. Vincent’s Healthcare Group.

In addition to capacity, the HSE winter plan seeks to ensure that the health system is as prepared as possible for the increase in demand for services in the winter months, within existing capacity and financial parameters.

St. Vincent’s was identified as one of nine sites requiring additional focus, investment and support as part this year’s winter plan. Important enhanced measures to be provided include additional home support packages, enhanced access to diagnostic testing and additional bed capacity in St. Vincent’s Private Hospital.

The Minister of State is correct that St. Vincent's hospital requires additional focus. When one considers the figures for the hospital, however, one can see that it requires much more focus and attention than the Government has given it to date. According to the Irish Nurses and Midwives Organisation, the number of people on trolleys in St. Vincent's hospital in 2018 was 3,773, which was up by 1,276 in comparison with the figures for 2017, or a jump of more than 50% in one year. Some 3,906 people have waited more than a year for outpatient appointments at St. Vincent's hospital, but when the Minister of State's boss, the Minister for Health, took office, the number was just over 1,400.

The Minister recently published a waiting list plan. When will the 215 people on the inpatient day-case list in St. Vincent's be treated? They have been on the list for more than 18 months. While I acknowledge the provision of the 22 acute beds that the Minister of State outlined, further intervention by the Government is required.

The point I was making was that the need for additional capacity has been recognised and identified and is being addressed, although the speed with which it is being addressed may not satisfy everyone. Capacity is only one aspect of the waiting lists for people in day care and inpatient care, and there are a number of other issues to be addressed. Delayed discharges, for example, is an area on which we must put increased focus and we have recently carried out a report on the matter. As I noted, an implementation team is being established within the HSE to address delayed discharges and ensure that there are more timely discharges. There is also an increase in the focus on the provision of step-down and transitional care, which will free up many beds at the acute hospitals. In addition to that suite of measures, there has been an increase in the National Treatment Purchase Fund this year, rising to €75 million, which should also help to reduce some of the lists. A cross-suite of initiatives and measures is being introduced, rather than capacity alone being addressed, notwithstanding the Deputy's points.

I acknowledge the suite of measures that the Government has introduced but it is clear that it is not sufficient or appropriate for St. Vincent's hospital. The Minister of State referred to 22 acute beds being opened in the past 18 months in St. Vincent's, which is welcome but it does not take into account the extraordinary increase in demand for services at the hospital and the necessity for the Government to ensure that it increases the hospital's capacity.

There are a couple of other points about St. Vincent's that are worthwhile noting. More than 1,000 of people over the age of 75 endured a wait of more than 24 hours in the hospital's emergency department before a decision was taken to admit them. That is not helped by the fact that 11,950 bed days were lost at the hospital owing to heavily delayed discharges. It is important to recognise that there must be an increase in step-down bed capacity at the hospital and throughout south Dublin to deal with capacity. Will the Minister of State do more in respect of St. Vincent's hospital to ensure that the increase in demand is met with an increase in capacity?

I certainly accept the Deputy's points and will ensure that there is an increased focus on what he seeks for St. Vincent's. I was addressing the matter on a more global scale but the measures, vis-à-vis step-down care and transitional care, will also apply to St. Vincent's. I am delighted to hear the Deputy's interest in view of the fact that local Deputies of all parties and none can have a role in ensuring a more proactive approach with their local HSE management teams to provide increases in facilities for step-down care and transitional care beds.

Question No. 13 replied to with Written Answers.

Child and Adolescent Mental Health Services Staff

Question No. 14 will be taken by Deputy Quinlivan on behalf of Deputy O'Reilly.

Louise O'Reilly

Question:

14. Deputy Louise O'Reilly asked the Minister for Health the staffing levels for CAMHS teams, by community healthcare organisation, CHO, and local health office, LHO; the way in which this compares with the necessary full complement of staff as outlined in A Vision for Change; the number of vacant posts in whole-time equivalent terms in CAMHS, by specialty, by CHO and LHO; and if he will make a statement on the matter. [12175/19]

Will the Minister of State provide the staffing levels for CAMHS teams, by CHO and LHO? How do the levels compare with the targets set out in A Vision for Change? In whole-time equivalent terms, what is the number of vacant posts in CAMHS, by specialty, by CHO and LHO?

The Government is strongly committed to developing all aspects of HSE mental health services, including CAMHS, as envisaged in A Vision for Change. Significant progress has been made in recent years, underpinned by additional funding since 2012 to develop mental health services overall, which was reflected by an additional €55 million in budget 2019.

Improvements to various aspects of CAMHS are delivered by the HSE under its agreed service plans.

CAMHS have standardised operational procedures to support timely access to services, which is based on professional clinical assessment to address the mental health needs of all children presenting to this specialist service. Despite increasing demands overall on CAMHS, individual cases that are assessed as urgent receive priority, irrespective of the source of referrals.

At present, there is an acknowledged shortage of consultant psychiatrists and allied mental health professionals, including CAMHS. This, rather than funding availability, is the main difficulty facing the HSE, but steady progress has been made in recent years in filling the type of posts needed to modernise the service. There are approximately 600 whole-time equivalent posts approved for CAMHS.

In January 2019, there were a total of 222 CAMHS posts with the HSE national recruitment service at various stages of recruitment. The latest available data from the HSE personnel census indicate that consultant posts have increased nationally by approximately 14 in the past year.

In conjunction with the Department of Health and the HSE, I am progressing various initiatives to enhance CAMHS by alleviating pressures on the specialist CAMHS service. These include maximising the impact of primary care assistant psychologists recruited in 2018 to relieve pressures on CAMHS, the roll-out by the HSE of various e-mental health pilot projects; additional mental health nurse training places coming on stream to help fill existing vacancies, and a review of CAMHS under the refresh of A Vision for Change.

There is also regular monitoring of CAMHS activity and staffing data. In addition, I have held meetings with, and recently sought further information from, the chief officers and executive clinical directors of the community healthcare organisations of the HSE, specifically on CAMHS vacancies. I have received more detailed information from the HSE in respect of this question, which I will furnish directly to the Deputy.

CAMHS are in utter disarray. At the end of 2018, approximately 2,560 children and young adults were on the CAMHS waiting list and almost 300 of them had waited for more than a year to be seen. In my CHO area, which includes Limerick, approximately 245 children and young people are on waiting lists for assessments, while 60 of them have waited for more than a year. As the Minister of State will know, early intervention is crucial but early intervention in mental health cases is not possible when there are extensive waiting lists and a sheer lack of capacity within the system. Children and young adults desperately in need of care and help, who are reaching out for same, are not receiving in a timely manner the appropriate support they need.

The current situation is totally unacceptable. We cannot approach every year in the same vein by paying lip service to mental health services rather than properly funding them or, more crucially, staffing them properly. Will the Minister of State commit to tackling the issue and providing the funding and staffing for CAMHS teams to meet at least the target set out in A Vision for Change?

The funding for all CAMHS teams is available and, therefore, it is not an issue of funding where there are gaps. I strongly disagree with the Deputy's description of the CAMHS system as being in disarray.

That is very disrespectful to those who work in it, those who avail of its services and those we are encouraging to reach out and avail of the system. It is not helpful for someone to make such a statement.

The Deputy referred to 300 people waiting for more than a year to access CAMHS. There are a number of reasons for those 300 people waiting for more than a year. Most of them relate to issues-----

There are not enough staff.

I ask the Deputy to let me finish; this is a two-way thing as far as I know.

Allow the Minister of State to speak.

Much of it relates to people being inappropriately referred. If someone who is acutely sick and is referred to a CAMHS team, no psychiatrist will say they must wait 12 months. They will see people who are seriously ill. Some people with lower levels of illness are left waiting longer. There are gaps in the system and areas where we fail to recruit consultants for myriad different reasons. It goes across all disciplines in health. It is a worldwide issue. I agree with the Deputy that we need a lower level of intervention.

An independent evaluation done by the University of Limerick projects a reduction of 1,350 in the waiting list for primary care psychology as a direct result of the actions I took last year to recruit 114 assistant psychologists, 20 psychologists and ten advanced nurse practitioners, ANPs, into community primary care specifically for younger people. That is the future of CAMHS. We will solve the issue relating to CAMHS by reducing the number of people going up to it. That is a proactive approach that is working.

Deputy James Browne is not here.

Question No. 15 replied to with Written Answers.

Drug and Alcohol Task Forces

Louise O'Reilly

Question:

16. Deputy Louise O'Reilly asked the Minister for Health his views on whether the funding provided to local and regional drug and alcohol task forces is sufficient to meet the aims of the national drugs strategy; and if he will make a statement on the matter. [12172/19]

As the Minister of State knows, funding for local and regional drug and alcohol forums and task forces is vital in the fight against drug and alcohol addiction, which has had a devastating effect in many of our communities. Is the funding provided to these task forces sufficient to meet the aims of the national drugs strategy which we all want to succeed? I have grave concern that it will not succeed owing to lack of funding.

The Department of Health allocated funding of almost €100 million to the HSE for addiction services in 2019. The HSE national service plan for 2019 sets out the type and volume of addiction services to be provided, having regard to the funding allocated.

In addition, the Department provides a further €28 million to drug and alcohol task forces through various channels of funding, including the HSE.

Measuring the overall effectiveness of the response to the drug problem is an important objective of Government policy. To this end, the national drugs strategy commits to operationalising a performance measurement system of drug and alcohol task forces by 2020.

I announced additional funding of €1 million for implementation of the national drugs strategy last week.

The funding, which will be provided on a recurring, multi-annual basis, will address the priorities set down in the strategy including early harm-reduction responses, emerging trends in substance misuse and improving services for at-risk groups.

The funding will complement enhancements in drug and alcohol treatment services relating to mental health and homelessness under the 2019 HSE national service plan.

Working in partnership with statutory, community and voluntary sectors is central to this response. I will be consulting the drug and alcohol task forces and the HSE on how best to target this new funding. I have issued an invitation to the task forces to a meeting in the Department of Health at the end March to begin this process.

I thank the Minister of State for his reply. As a member and director of the mid-west region drug and alcohol forum, I appreciate the incredible work done by the groups we support and which are funded by task forces in the mid-west region and across the State. I note the additional funding announced in advance of the motion Sinn Féin tabled last week on the topic, but it is not enough. It only works out at about €41,000 for each of the 21 task forces, which is very little for the incredible work they have to do. I appreciate the invitation the Department made to task forces for a meeting. However, I plead with the Minister of State to make that easier. It was difficult last year when there was a funding announcement. I know it diverts the front-line staff from the work they need to do. Much of the bureaucracy that has come in is bogging them down in what they have to do.

Since 2008 my local task force has experienced cuts of more than 50%. Over the years these cuts have impacted dramatically and prevented the delivery of the urgently needed drug and alcohol services in Limerick and the mid-west region. If funding is not increased substantially, the aims of the national drugs strategy will not be met. Does the Minister of State intend to increase funding for local and regional drug and alcohol forums in addition to what was announced last week?

I concur with the Deputy on the good work being done within the finite budgets. I thank him for acknowledging exceptional work done by people in his area and throughout the country. I will pass on his concerns and hopes for increased funding in this area to my colleague, the Minister of State, Deputy Catherine Byrne, who has ultimate responsibility for securing that. I will ensure that his views on the issue are made quite clear to her.

Question No. 17 replied to with Written Answers.

Mental Health Services

James Browne

Question:

18. Deputy James Browne asked the Minister for Health when the review of A Vision for Change will be published; if the new policy will be costed; and if he will make a statement on the matter. [12199/19]

I put the question on the Order Paper to the Minister of State.

A Vision for Change reached the end of its ten-year term in 2016 and preparations for a review and updating of policy have been under way since early 2016.

As a first step in this process, an expert evidence review was completed in February 2017. This provided both domestic and international evidence to determine the policy direction for a refresh of A Vision for Change.

In October 2017, the Department of Health established an oversight group to review A Vision for Change and to update the existing mental health policy having regard to the expert evidence review. This group is independently chaired by Mr. Hugh Kane.

The group focused on developing measurable outcomes within a patient-centred care framework. It engaged in a major national stakeholder process and collected additional information from stakeholder statements made to the Joint Committee on the Future of Mental Health Care. These national consultations concluded in August 2018.

Additional research was completed and relevant policies from other Departments were coded and incorporated into the refreshed A Vision for Change document.

The oversight group is in the process of editing chapters and it is anticipated that a final draft report will be finalised in the coming weeks. Once the final draft is received by the Department of Health, it will be reviewed and submitted to Government for consideration. There are several proposals recommending additional supports and these will be costed by officials in the Department. The views of other Departments will be taken into consideration prior to submission to Government. It is intended that this process will be completed in the coming months when the revised policy will be launched.

We await the review of A Vision for Change that will set out the future direction for our mental health services. A Vision for Change was a very important and progressive document that set out a pathway for providing mental health services. Probably 90% of it is still extremely relevant but it needs to be updated. I look forward to the review.

Obviously many aspects of A Vision for Change have been successfully delivered and in other areas it has under-delivered. In particular, child and adolescent mental health services and mental health services for people with intellectual disabilities are both significantly under-resourced. Will the review have full costings when it is published or will that be left to a future date?

I concur with the Deputy over the success of the first A Vision for Change document. It was probably one of the most ambitious documents launched in healthcare in modern times. Its success or otherwise can be debated, but it has transformed mental health care. It was an extraordinarily ambitious document published at a time when the country was awash with resources. The country entered into recession during that ten-year period and many challenges arose in implementing some of the ambitions. It may have been overly ambitious, but notwithstanding that it has had incredible achievements to its name over that ten-year period. If Sláintecare, which is also an ambitious ten-year plan, achieves half the success of A Vision for Change we can look forward to enormous successes in healthcare.

I recently met the oversight group for the new vision document. The group is concluding its work. I think it will be a very interesting and welcome document. The costings will not form part of that review; they will be considered by Government on an ongoing basis because some of them will be cross-departmental and cross-sectoral as we go along the way.

Is there a timeline for the costings following the review? It will be important to have costings set out so that the document is not purely aspirational. It will have more teeth if costings are provided. Will the review be a follow-on document? In other words will we be able to trace the steps from A Vision for Change into the review document, rather than being a total reset? It would be important to be able to continue to trace the successes and the absence of delivery in different areas in the current A Vision for Change document. Will the Sláintecare report be incorporated into this review?

The answer to the last two questions is "Yes". Sláintecare is very much in the background. This document is very much a progression from the first document.

The team that is putting it together has an eye to the first document. The members of that team realise that progress has to be made. It is not possible to do costings. Much of this document will be more outcome-orientated and less prescriptive. The last document was very prescriptive. It suggested that there should be a certain number of members on each team, that certain disciplines should be represented on each team and that there should be a certain number of teams. This document does not involve the same level of prescription. It focuses instead on what the outcomes should be. I do not think the costing of those outcomes can be done in a straightforward scientific manner. The best way to do that will have to emerge over time. This document is essentially looking at how we do what we do. It is ensuring best practice is involved all the times. Its predecessor was probably more prescriptive.

There are no Members here for Questions Nos. 19 to 31, inclusive. Approval has been given to Deputy Quinlivan to take Question No. 32.

Questions Nos. 19 to 31, inclusive, replied to with Written Answers.

Hospital Overcrowding

Louise O'Reilly

Question:

32. Deputy Louise O'Reilly asked the Minister for Health if ward 1A in University Hospital Limerick is to close in a number of weeks, which would result in the loss of 17 inpatient beds and add further pressure to the overcrowding situation in the hospital. [12171/19]

This question follows on from Question No. 2, which was taken earlier. Having spoken to nurses' unions, I understand there is a concern that University Hospital Limerick will lose 17 inpatient beds in the coming weeks due to the closure of ward 1A. The Minister of State announced earlier that five additional beds are being provided under the winter programme. He also mentioned that 17 beds have opened in another ward. My understanding is that ward 1A is to be closed. The Minister of State might confirm whether this is the case.

I outlined earlier that "an additional 23 beds have opened in Limerick, including five as part of this year’s winter plan". As the Deputy has said, 17 beds have been provided outside of that. I do not have the details of the closure to which the Deputy has referred.

This question relates to the closure of 17 inpatient beds.

Is it okay with the Deputy if I come back to him on the particular question he is asking?

The next available question is Question No. 36, in the name of Deputy Calleary.

Questions Nos. 33 to 35, inclusive, replied to with Written Answers.

General Practitioner Services Provision

Dara Calleary

Question:

36. Deputy Dara Calleary asked the Minister for Health the measures he will take to secure the viability of rural general practitioner services; and if he will make a statement on the matter. [12204/19]

I understand that the Minister of State, Deputy Finian McGrath, is back in his spiritual home of Cuba as we speak. I have spoken to him previously about rural GP services. The Minister of State, Deputy Jim Daly, knows from his local area that the offer has to be changed to make it far more attractive for GPs to come to work in rural areas. We also have to support our existing GPs. Since I raised this issue a few weeks ago, I have been inundated with calls from all over the country from existing GPs who are about to throw in the towel because of the pressure they are under, the lack of backup and the lack of understanding. I ask the Minister of State not to give me the standard answer about the GMS contract because that is not good enough anymore. We need a whole new response and a whole new focus. Perhaps the Minister for Rural and Community Development needs to be involved in this as well.

I thank the Deputy for the question. I know he does not want the standard answer which mentions that the contract is very central to the future of GP practice. Whether we like it or not, the existing contract has been in place since 1971 or 1972. The renegotiation of that contract is a central aspect of the development of GP practice into the future. In recent years, we have invested in and significantly increased the GP allowance for rural practices. However, such practices continue to face many pressures. I take the Deputy's point that all these issues will not be solved by contract renewal alone. Much of this relates to the implementation of Sláintecare, a reduction in our reliance on GPs and better management of GP practices. Into the future, initiatives like nurse-led practice and nurses seeing more people will be features of GP practices as we seek to make sure such practices are sustainable. There has been a significant increase in the number of training places for GPs. I think the number has increased to 193 this year. There has been a big percentage increase. I do not have the exact figure to hand. That will help with availability. Many GPs find it difficult to get replacements when they are under pressure and cannot manage, when they need time off and when they are putting together rotas and rosters.

It is absolutely crucial that the discussions are finalised immediately. The Minister of State met 500 GPs outside the gates of Leinster House recently. They are fed up and are about to walk away. While the increase in training places mentioned by the Minister of State is welcome, the irony is that the places being provided are not being taken up. I would love to see the figures. In recent years, there have been vacancies in the west of Ireland training scheme for the first time. A career that used to be seen as a great one is no longer seen in that light. The Government needs to address the core issue of why general practice is not seen as an attractive profession. The Minister of State has spoken about the increased GP allowance, but it has not kept up with costs like insurance and equipment. It has not kept up with the demand on patients. It has not kept up with rural depopulation, which is affecting the ability of GPs to make a sufficient income from their existing lists. The allowance has to be changed. The Government needs to go back to the way things used to be done. It needs to provide surgeries and facilities on an ongoing basis so that people can locate in these areas. The financial model needs to be completely changed. Most of all, the Minister cannot allow the current situation, in which there are no respondents to GP vacancies when they are advertised, to continue. Surely that in itself is a wake-up call for the Government. It shows that there are problems with GP services. The Government needs to act to provide a better on-call service. Rural GPs need better backup for on-call. A range of issues are being put on the long finger while the flight from the profession continues.

The on-call issue is a significant one for rural GPs. I think it is one of the biggest causes of stress. GPs in more built-up areas do not face the same demand with regard to on-call as GPs in rural areas. The number I have given in respect of training places might not be correct. I will get the correct figure for the Deputy. I have given a number from my head, but I cannot rely on my head. I will come back to the Deputy with the exact figure. There has been a significant increase in the number of training places. I take the Deputy's point that they are not being filled. We have to make sure they are being filled to continue the flow of people. We are aware of the stresses being faced by rural GPs. As the Deputy has acknowledged, I represent a rural area. I know many GPs who have brought these issues to my attention. I am sure our colleagues, Deputies Margaret Murphy O'Mahony and Michael Collins, are well aware of the issues in rural areas as well. There is a significant investment attached to the renegotiation of the rural GP contract. I think that will go a long way towards addressing some of the issues that are significant for GPs. As I have said, work practices have to be looked at. We will do this. We will continue to engage with the representative bodies on the wider range of issues affecting GPs, particularly in rural areas.

I appreciate the Minister of State is aware of this issue, but I ask him to do something about it. The contract talks have been going on for longer than the Brexit talks. It seems to be easier to resolve Brexit than to resolve the GP contract. I have mentioned the specific case of Bangor in my constituency. When the position there was advertised previously, there was just one applicant. A local solution has been put forward. We are engaging with the HSE, which will have to engage with the local solution. I ask the Minister of State, who is responsible for primary care, to give his attention to the Bangor situation. All the political representatives from the constituency are working collectively on it. We cannot allow the people of Bangor to be left without a GP again. People must not be allowed to stick their heads in the sand when a local solution is on offer. This is an urgent matter. We are losing very good and qualified people to Canada, Australia and the United States because of something small. There are small things that can be done to fix this problem, to make general practice an attractive career again and to provide and essential rural service. We cannot put the contract negotiations on the long finger. They have been delayed for long enough.

There is nobody who would like to see the contract negotiations brought to a conclusion more than me, the Minister, Deputy Harris, everyone in the Department of Health and the other Ministers on this side of the House. As the Deputy will appreciate, there are two sides involved in the negotiations. It is not just within the Government's remit to end the negotiations. Both sides have to reach satisfaction. The Irish Medical Organisation, which is the representative body of the doctors, must also get agreement from its members up the line. We are very anxious to see this process brought to a conclusion. We are prepared to provide the additional significant resources that are required to bring that about. Many issues are still being teased out by both sides. It takes two to tango, but it takes two to agree as well. Those of us on this side of the House, like the Deputies opposite, really want to see agreement. I do not think there is any political disagreement on this issue. There is no difference between the positions of Deputies across the House on issues like GP contracts and the sustainability of GP services. The primary care sector is an area of medicine that works very well. GP practices are crucial for rural and urban areas. They are delivering superb services. We recognise their value and want to see it recognised. I will take an interest in Deputy Calleary's local area. I am quite happy to see whether anything can be done in the Bangor area, which he has mentioned.

We will move on to Question No. 39, in the name of Deputy Calleary.

Question No. 37 replied to with Written Answers.
Question No. 38 answered with Question No. 28.

Dental Services Provision

Dara Calleary

Question:

39. Deputy Dara Calleary asked the Minister for Health the initiatives in place to improve dental services in County Mayo; and if he will make a statement on the matter. [12203/19]

If Deputy Calleary introduces this question briefly, the Minister of State will have time to respond before we move on to Leaders' Questions.

I will let the Minister of State respond.

I do not have the question to hand. I can provide the answers, but not without the questions.

The Minister of State is good, but not that good.

Are we on Deputy McLoughlin's question?

Deputy McLoughlin is not here. The question before the House seeks details of the initiatives in place to improve dental services in County Mayo.

Can the Minister of State answer that one?

I will have to come back to the Deputy on this matter. I do not have the reply to hand.

We have been inundated with representations from constituents, particularly parents of teenagers, who are being made to wait inordinate amounts of time for basic assessments for orthodontic services. Early intervention in this area can prevent a significant amount of physical pain, as well as financial pain down the line. Unfortunately, waiting lists seem to have gone beyond the two-year mark.

We need a specific intervention in the county to reduce those waiting lists. As I stated previously, rather than sticking things into CHO areas, we could instead have a range of professionals who can be moved around to where waiting lists have gone out of sync. We could in that way address waiting lists that are way above the national profile. Instead of continuing to adhere to geographical rules, let us address where there are specific problems. We have a big problem in Mayo with treatment for dental and orthodontic issues, particularly for those aged under 18 years of age.

I will come back to Deputy Calleary on this matter.

Written Answers are published on the Oireachtas website.