Ceisteanna Eile - Other Questions

Question No. 6 replied to with Written Answers.

Disability Services Data

Thomas Byrne

Question:

7. Deputy Thomas Byrne asked the Minister for Health the number of young persons with disabilities in County Meath seeking post-school placements at the end of the academic year; and if he will make a statement on the matter. [20917/19]

My question is self-explanatory. It seeks to know the number of young people with disabilities in County Meath who are leaving school this year and will be waiting on placements which are generally organised through the HSE and Department of Health. The issue of Rehab comes into it because it offers placements in County Meath.

I thank the Deputy for raising this important issue. Day services and rehabilitative training programmes for young adults with disabilities who leave school in 2019 are currently being put in place. This is in line with new directions policy and the additional funding provided by the Government in budget 2019. A national school leaver process has been developed by the HSE over the past four years and funding has been allocated based on the outcomes from a standardised profiling process whereby the support needs of each individual referred are identified.

Governance of the profiling process is overseen by the National Disability Authority which does magnificent work for me, as Minister of State with responsibility for disability issues. At a national level, €12 million has been allocated for the provision of day services and rehabilitative training for young adults with disabilities in 2019. In that regard, 1,628 young people were profiled to determine their support needs and identified as requiring a day service in 2019, of which 1,206 placements require funding in 2019 and onwards. The remaining 422 of the overall 1,628 young people will enter vacancies created by rehabilitative training exits and other notified vacancies arising from people progressing onwards to mainstream or other services.

To date, 56 young people who have an address in County Meath have been referred to the HSE for a HSE funded day service once they leave school in 2019. The HSE advises that 23 young people who left school in Meath in 2018 commenced funded adult day services and these service users are in receipt of the quantum of service they requested.

The big questions here are about those who fall through the cracks and, even on the Minister of State's own figures, not everybody is getting a place. The Minister of State, in fairness to him, has met one or two of my constituents who were stuck for a place. They should not be stuck. They are citizens of the country and should be provided with the services to which they are entitled under the HSE new directions policy.

It seems that every year, around this time, there is worry, anxiety and a fight to find placements. This is an annual thing for some families, and the Minister of State knows some of these people, because they have not yet been able to get a suitable placement. All the organisations do fantastic work but some young adults with severe intellectual disabilities find it much more difficult to get placements in my experience. Some of the organisations are not set up to accommodate, provide services and give a life outside of the home to young adults with severe intellectual disabilities and that is a real problem.

Rehab provides significant services in this regard and, if anything went wrong with that, as has been suggested by Rehab, this would only exacerbate the problem. These are young citizens of Ireland who are entitled to be facilitated to enable them to live their best possible lives and go on to pursue other opportunities.

I absolutely agree with the Deputy about the fear factor that many families have each year and I have met the constituents he is talking about. We have put a procedure in place to guarantee that every person who hits 18 in June will be guaranteed a place in September. The debate about people falling through the cracks has to do with issues about geographical areas and locations. It is a worry but the €12 million we will put into this in 2019 is to guarantee a place for every single young person with a disability. The Deputy is correct that those people should have such a place as a right under the UN Convention on Human Rights and that is my objective. The idea is to keep the parents of these young people informed and not to have this worry arising every May, June or July. The families should be getting letters, and some will have them already, from service providers at the moment to ensure that they are told where their young people are going in September.

I do not accept the point that it is acceptable to have any young person with a disability fall through the gaps. That is something I will fight strongly for and I will raise any particular issues the Deputy has.

I want the Minister of State to repeat that every young person who needs a place will have a place next September. Is that something that the Minister of State can absolutely guarantee?

I guarantee it. I have spent three years working on this. The first fire that I had to put out when I took over as Minister of State with responsibility for disability issues was school leavers. All the things the Deputy said were true and it was a nightmare. Families did not know, in May and June, where their 18 year old was going to go in September. The answer is that I can guarantee it. We have guaranteed the funding and resources so that every single school leaver will have a place in a day service in September. I ask the Deputy to come back to me immediately if there are any breaches of that.

Hospital Facilities

Martin Heydon

Question:

8. Deputy Martin Heydon asked the Minister for Health the status of the progression of plans for new endoscopy and mental health units at Naas General Hospital; and if he will make a statement on the matter. [20880/19]

Bernard Durkan

Question:

215. Deputy Bernard J. Durkan asked the Minister for Health when he expects the outstanding phases of the Naas General Hospital development plan to be implemented in full; and if he will make a statement on the matter. [21155/19]

I am raising this question on behalf of my colleague, Deputy Martin Heydon. He seeks to ascertain the progress, ongoing or otherwise, of the development programme at Naas General Hospital which covers mental health units, endoscopy and oncology. I ask the Minister when we are likely to see the serious progress we are awaiting.

I propose to take Questions Nos. 8 and 215 together.

I thank Deputies Durkan and Heydon for asking these important questions about Naas General Hospital. I was delighted to visit the hospital on a number of occasions with Deputies Durkan and Heydon.

There are, as the Deputy said, two distinct capital development proposals for Naas General Hospital at present. The first development consists of accommodation and ancillary services to support the new endoscopy unit, physical medicine unit, physical therapy unit, oncology unit and day procedure department. Planning permission has been received and I understand the project is currently at tender stage. I say clearly that I want this project to progress. We are finalising our capital plan in our discussions with the Department of Public Expenditure and Reform but this is an absolute priority, not only for the people of Naas but for the people of Kildare and elsewhere. It has the ability to transform our endoscopy services for the people in that region.

In addition, as the Deputy rightly said, there is the development of a new mental health unit at the hospital. The original development proposal comprised the provision of an eight-bed intensive care unit at the existing 30-bed Lakeview mental health unit on the grounds of Naas General Hospital. Following a review of the proposal, I am pleased to say that a significant expansion of the project scope is now proposed, with an associated and significant increase in project value. This has meant the original design team’s engagement had to be terminated and a new procurement process undertaken. I understand that the HSE has now appointed a new design team for this much expanded project. This is an exciting project for our mental health services in Kildare because the revised proposal is expected to deliver 50 bed spaces, including a nine-bed intensive care area, and significantly upgraded infrastructure. The timeframe for the completion of the new acute mental health unit project will be informed by the work of the new design team and this work will be undertaken in conjunction with Naas General Hospital and the HSE.

My Department is continuing to invest significantly in this important hospital for the people of Kildare and, as the Deputy is aware, under the winter initiative we provided an additional 11 beds in Naas General Hospital which came on-stream in the last quarter of 2017. All this means more beds and more capital investment for Naas General Hospital.

I thank the Minister for his comprehensive reply. To what extent can the Department remain in contact with the authorities at Naas hospital to ensure continuity of dialogue to identify issues before they become emergencies, with a view to putting in place the necessary measures to ensure adequate provision is made for the hospital to meet the challenges posed by the rapidly expanding population in the area?

The Deputy is entirely correct and I assure him that not only will the Department take an interest in this but I will take a personal interest in it. I know that Deputies Durkan and Heydon will continue to monitor this issue in the House.

It is important for people to know exactly what the mental health unit will involve. The Kildare and west Wicklow mental health service proposes building a new three-storey, 50-bed acute mental health unit in the car park of Naas General Hospital with four units between the first and second floors. The facility will have state-of-the art observation areas, en suite facilities for each bedroom, which is very important, Health and Safety Authority, HSA, approved interview rooms, improved recreational and therapeutic facilities, a Mental Health Commission tribunal room and a legal representative interview area. The expectation is that the overall environment will be much more conducive to the service users' recovery as stepped levels of care will be provided in four ward areas, tailored to specific levels of acuteness.

This is a much bigger project that we are now planning in the mental health services. I am particularly pleased today to tell Deputy Durkan that the mental health directorate has advised his community health organisation that it will now provide additional funding of €300,000 towards the cost of preparing for planning and design this year.

I welcome the mental health investment in the area. The crunch question, however, is whether there is a timetable for the delivery of the services as envisaged in the development programme. At what stage can we expect all the phases to be completed?

Development phase three, which is the exciting new development for Naas hospital, including the endoscopy unit but much more than that, is, I understand, at tender stage. This consists of accommodation, ancillary services to support the endoscopy unit, a physical medicine unit, a physical therapy unit, an oncology unit and a day procedure department. It will also include a duplex reverse water filtration system and two lifts. Planning permission is in place. In the next few weeks, I will finalise the HSE’s capital plan which will provide certainty of funding for many capital projects. It is an absolute priority to try to green-light the project within that timeframe.

I thank the Minister.

Home Care Packages Provision

Bernard Durkan

Question:

9. Deputy Bernard J. Durkan asked the Minister for Health the extent to which home care packages are being made available to patients who might otherwise need hospitalisation; the number to date approved in each of the regions; the extent of the funding given, required and-or pending; and if he will make a statement on the matter. [20879/19]

Peadar Tóibín

Question:

15. Deputy Peadar Tóibín asked the Minister for Health the overall number of persons waiting for home help services by county; and the average and longest wait. [20920/19]

My question seeks to ascertain the availability of home care packages which are a useful development to provide home care services, thus alleviating the burden on hospitals and accident and emergency departments.

I propose to take Questions Nos. 9 and 15 together.

I am taking these questions on behalf of my colleague, the Minister of State, Deputy Jim Daly, who is at a dementia conference today. Improving access to home support is a priority for the Government. Over the past four years, we have seen a considerable increase of nearly €140 million in the budget, which has grown from €306 million in 2015 to almost €446 million this year. This year the HSE intends to provide 17.9 million home support hours to 53,000 people and intensive home care packages to 235 people.

The Deputy is right to highlight this issue because despite this significant level of increased investment in service provision, demand for home support continues to grow and will only go in one direction as, thankfully, people continue to live longer. The allocation of funding for home supports across the system, though significant, is finite and services must be delivered within the funding available. This is the challenge we need to grapple with. Preliminary data indicate that at the end of March, there were 52,360 people in receipt of home support. During the first quarter of the year, 4.2 million hours were delivered nationally, 4,411 new clients commenced the service and 6,238 people were assessed. I will arrange to have the specific information requested by both Deputies forwarded in tabular form.

I acknowledge that in some cases access to the service may take longer than we would like. However, the HSE has assured my Department that those people who are on a waiting list are reviewed, as funding becomes available, to ensure that individual cases continue to be dealt with on a priority basis. If Deputy Durkan comes across cases which he believes have not been assessed in that manner, he should let me know.

We need a new statutory home support scheme. We all talk about wanting to provide care for people in their homes and communities. The only law we have passed is the fair deal, the nursing home support scheme. We need to do a fair deal 2.0, a version of the scheme for home care. My colleague, Deputy Daly, who is leading out on that, has just concluded a very substantial public consultation where many thousands of submissions were made. He intends to develop that scheme and the system of regulation to try to improve access on an affordable and sustainable basis because, as our population ages, that is the way we need to deal with this.

Would it be possible to intervene in the usual way in the health services to move this forward? It seems to have stalled or somebody has hit the pause button on the availability of home care packages in all constituencies but particularly in north Kildare where there seems to be a considerable backlog. Will it be possible to energise the system such that we might see an improvement in the numbers on waiting lists for that service?

Absolutely. The Minister of State, Deputy Jim Daly, and I are keeping in very regular contact with the HSE on this issue because apart from the societal impact of not providing home support and the impact on a family, it can have a significant knock-on effect on hospital admissions, the use of hospital beds and delayed discharges, to use a phrase I do not like. The Minister of State continues to monitor this and work with the HSE to ask that it come up with new and innovative ways to do this.

I need to provide some context. In 2015, we were providing a budget of €34.1 million for home care in community health organisation area 1, CHO 1. That is now €44.3 million. In CHO 2, where it was €30.6 million, it is now €47.6 million. In CHO 7, which I think is the Deputy's area, it was €28.7 million and is now €54.5 million, which is nearly a doubling of the budget. We are substantially increasing funding to every CHO every year. Thankfully, our population is ageing and we need to consider a new scheme to supplement this. The work the Minister of State is doing, which is a part of Sláintecare, on a statutory home care scheme will be key to reforming the delivery of this service.

Does the Minister remain satisfied that adequate staffing can be made available throughout the service to ensure its workability, having particular regard to what he correctly identified as hospital and accident and emergency department overcrowding, and thereby alleviate the serious burden on the hospitals and on patients who are concerned about having to wait on seemingly never-ending waiting lists? As one who has repeatedly raised this question on waiting lists, I wonder if we could come to a stage in the not too distant future where we address the waiting lists in advance in order that they become much shorter than they are now.

I have no doubt we could do that. In advance of the introduction of the fair deal scheme, the question of significant delays in accessing nursing home care was a very persistent one in this House, probably tabled by Deputy Durkan, who is known for his parliamentary questions, and by many other Deputies. The fair deal scheme, which was landmark legislation, brought through by the former Minister, Mary Harney, put in place for the first time a statutorily based scheme, a legal entitlement, guidelines, rules and the like. We do not have that for home care. We have an ad hoc system that works well in some parts of the country and not so well in others. Providing more certainty about how something works will help to attract more people to work within that sector too. I am confident that increased investment coupled, crucially, with reform and the introduction of a statutory home care scheme, we can significantly reduce waiting lists for home care and provide people with certainty about the supports they receive.

Health Screening Programmes

Stephen Donnelly

Question:

10. Deputy Stephen Donnelly asked the Minister for Health the implications for the National Screening Service of the recent High Court judgment in a case (details supplied); and if he will make a statement on the matter. [20743/19]

Louise O'Reilly

Question:

34. Deputy Louise O'Reilly asked the Minister for Health his views on the future of the CervicalCheck screening programme and other screening programmes in view of the High Court judgment for screeners to have absolute confidence in their finding before giving the all-clear when reading a test slide, even though every screening test has an intrinsic error rate. [20834/19]

Any conversation about the recent judgment in the case of Ruth Morrissey should start with an acknowledgement of the very brave stand she took. That is something we need to consider in the future when citizens seeking justice are faced with a wall of lawyers employed by the State. The State appears to use the law as a weapon in many of these cases. There is a great deal of concern about a particular element of the judgment and the phrase "absolute certainty" when telling someone a screening or test is clear. Does the Minister have an update on the potential implications of that judgment for the screening services and the wider healthcare services?

I propose to take Questions Nos. 10 and 34 together. I thank Deputies Donnelly and O'Reilly for their important and timely questions. We began to discuss this issue last week and it is quite right and important that we keep it on the agenda in the House. On the State and lawyers, it is very important that the State accepts liability in regard to non-disclosure in any of these cases, does not contest the matter and has set up an ex gratia payment scheme.

My officials and I, in conjunction with the State Claims Agency and the Office of the Attorney General, are carefully studying the recent High Court judgment in the relevant case. It is important that there is careful legal analysis of the judgment as an input to the proper assessment of its implications for the health service. Many well-intentioned people have commented on it, but very few of them are legal experts, as I am not a legal expert.

My Department has received correspondence from the HSE which sets out its concerns relating to potential implications arising from the judgment for screening services in particular. I am aware that concerns have been publicly expressed by some in the clinical community in recent days.

I ask that those in leadership positions in the medical profession work with me and this House during this time as we reflect on the judgement and form a fuller understanding of any potential implications. This will give us the necessary time and space to consider what actions might be required. I want the clinical community to know that I, as Minister for Health, the Government and, I am sure, the Oireachtas are committed to addressing their concerns and that we will work with them to so do.

I am conscious that decisions in regard to this case will impact individual women as well as having wider implications. I wish to reassure women, as will all Members, that the Government and Oireachtas are committed to ensuring that our life-saving cancer screening programmes can continue to operate to a high standard. I have no doubt that objective is widely supported across the House.

There has been much recent comment on this case. On many occasions since the CervicalCheck debacle of more than a year ago, I, the Government, the Oireachtas, the media and many others have been accused of a knee jerk response. Such accusations were made for good reasons by those who made them, including Opposition Deputies. Now is the time for us to take a deep breath and put forward a calm, cool and collected response on this issue. I am happy to work with Opposition Members on it.

I wish to get a sense of the legal implications. What does "absolute confidence" mean? The Deputies and I may think it means one thing, but that may not be its legal meaning. What approach is taken in other jurisdictions in such cases? Mr. Justice Cross in his judgment and comments in the High Court on Friday referenced the fact that other jurisdictions have this stipulation and he specifically referenced Britain in that regard. He stated that he does not believe he has added a new test but, rather, that this is the law as it stands. Many others have refuted that claim. Deputy Donnelly articulated it well last week in the House when he asked how one can have absolute confidence when there is always a degree of clinical judgment.

I am conscious that although the debate to date has been about screening, it could have wider implications, such as its impact on diagnostics and so on. I am happy to keep in close contact with Opposition spokespersons on health on this issue. Although I am not asking for a significant amount of time, I suggest that we take the next couple of weeks to determine legally what this means, to see if there is a need for the State to seek legal clarity and, if that is necessary, how the State can do so in a way that does not have an adverse impact on Ms Morrissey, which none of us wants.

I thank the Minister for his reply. This is certainly an issue on which we need to work together. I presume the Attorney General is providing advice on it. I acknowledge that such advice cannot be shared directly, but I ask that it be repackaged into a report and that the Minister endeavour to get it to the Oireachtas and the health committee as quickly as possible. It should include the views of the HSE if they are not especially sensitive in order that we can start considering its viewpoint, which would be useful.

The judgment may be appealed, changed or overturned and the Minister will revert with legal advice in the coming weeks. In the meantime, there is widespread fear and concern among clinicians. As the Minister rightly stated, they are asking questions that go beyond screening and pointing out that the same issues exist with any diagnostics. Will the Minister consider as a matter of urgency convening a stakeholder forum with the professional bodies, the State Claims Agency, the clinical indemnity scheme, to provide reassurance to clinicians in the interim period while we are awaiting legal views on this in order that they are safe to continue practising, screening and diagnosing as they are today?

I welcome the clarification provided by the Minister and have no difficulty with the sentiment expressed about the need for cool and calm heads. I wish to take this opportunity to pay tribute to Ruth Morrissey, who has been to hell and back. The judgment raises concerns and has had a chilling effect across the clinical community. I am particularly thinking of Dr. Ailín Rogers, the chair of the Irish Surgical Training Group and a general and colorectal surgeon, who stated that the calls from outside the medical community for greater sensitivity in screening, although well meaning, are not necessarily going to advance things. The information should be shared not necessarily with Deputies, although that would be helpful, but with the clinical and medical community at the earliest possible juncture because I am concerned about the chilling effect the judgment has had. There may be an opportunity to address any consternation that may have arisen in the time between now and when the certainty or legal advice is made available. I echo the call for a stakeholder forum, which would be most welcome.

The Deputies' suggestions are very helpful and constructive. I concur that this is an issue on which we must all work and pull together and I have no doubt that we will do so. "Yes" is the short answer to Deputy Donnelly's question as to whether I will endeavour to find a mechanism to brief health spokespersons or the health committee on the legal advice or rationale behind any approach I may take. We will work out an appropriate way to so do. This is an issue on which I believe in sharing the maximum amount of information such that we can make informed decisions because there may be a need for this House to do something. There may be a need for legal clarity from the courts, legislative change or reassurance. We need to carefully tease through those questions.

I absolutely accept that there are concerns. I have heard them clearly. It is understandable that a person working on the front line of the delivery of our health service would have concerns on reading the judgment. I reiterate the call for time to seek a legal opinion. I make the point to all patients, particularly women, that our screening programmes are continuing and are safe to use. All Members would echo the fact that people should continue to use them.

A stakeholder forum is a very good idea. I have been considering it in consultation with my medical advisers and we have been trying to work out from a sequencing point of view the appropriate time to do that. The Deputies can take it as given that I will do that and will endeavour to do so quickly.

I thank the Minister for that commitment, which is very welcome. What is his advice for clinicians today? A significant number of nurses, midwives, doctors, radiographers, radiologists and others across the system will today carry out screening and diagnostic testing. We will await the legal advice, but is the Government's advice to them in the interim period to carry on as usual or is there any additional advice or information such as that they should do things differently?

In the absence of the advice of the Attorney General, which I appreciate takes time and, obviously, will not be fully shared with the House, although some version of it can and should be shared, the chief medical officer may have a role in engaging with the clinical community because, as has been pointed out, there is a vacuum and those in the medical and clinical community would greatly benefit from some direction. We are all very conscious that we do not want any knee jerk reactions.

We want to be measured. However, when someone like Professor Donal Brennan states that a woman with an entirely normal cervix could end up having a hysterectomy for no apparent reason other than nobody will say that the sample is normal, that is going to cause an issue, perhaps not in the short term but certainly in the medium term. That is a plea from the medical community for support and assistance. There may be a role in this for the chief medical officer.

I thank the Deputies again. My guidance to all those working in the health service is to continue providing the services we provide to women and men. Those services that have saved lives since we introduced CervicalCheck screening programme during the time in government of Deputy Donnelly's party. The mortality rates relating to cervical cancer have decreased by 7% each year. This is a programme that saves lives. For all the imperfections in screening, transparency and the like in recent years, it continues to do so. I ask those providing the services to continue with their work. I make that appeal in the context of last week's comments by Mr. Justice Cross to the effect that his judgment was being misinterpreted by some people. I do not believe that anybody out there is endeavouring to misinterpret what he said for any reasons other than good ones. I accept the bona fides of parties in this. We need to ensure that those analysing the legal impact are lawyers and legal experts. I will work out a way of sharing information with colleagues.

I wish to say to the medical profession, our clinical leaders and people working in the health service that we will engage with their colleges. That was and is our intention and I thank the Deputies for raising the matter. The chief medical officer will play a role in this regard. Dr. Holohan has shown leadership and has brought people together at difficult times in the past. I have no doubt that he will do so again.

Question No. 11 replied to with Written Answers.

Drug and Alcohol Task Forces

Maureen O'Sullivan

Question:

12. Deputy Maureen O'Sullivan asked the Minister for Health the way in which he can address the immediate funding requirements of drug and alcohol task forces; if his attention has been drawn to the valuable contribution these task forces make particularly in areas of disadvantage; and the way in which he will continue to support them [20853/19]

My question relates to the drug and alcohol task forces and their funding requirements. The task forces are making a valuable contribution, particularly in areas of disadvantage. I wish to discuss the ways in which they can be supported, particularly in light of drastic reductions in their budgets in recent years.

I thank Deputy Maureen O'Sullivan for this question, which relates to an area in which she takes a keen interest. I am answering the quesiton on behalf of my colleague, the Minister of State, Deputy Catherine Byrne, who is unavoidably detained.

Drug and alcohol task forces play a key role in assessing the extent and nature of the drug problem in local communities and in ensuring that a co-ordinated approach is taken across all sectors to address substance misuse based on the identified needs and priorities in their areas. The Department of Health is committed to supporting drug and alcohol task forces and provides in the region of €28 million to them annually 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, Reducing Harm, Supporting Recovery, commits to operationalising a performance measurement system for drug and alcohol task forces by 2020.

In March I announced additional funding of €1 million for the implementation of Reducing Harm, Supporting Recovery. This funding, which will be provided on a recurring and multi-annual basis, will address the priorities set down in the strategy including early harm reduction responses to emerging trends in substance misuse and improving services for groups with complex needs.

Recently the Minister of State held a consultation with drug and alcohol task forces and the HSE to hear their views on how best to target additional funding. She will shortly be notifying task forces regarding the allocation of this additional funding. This will include information on the guiding principles and the application process. I will also ask the Minister of State to write to the Deputy with more information in that regard.

I thank the Minister. We can all agree that the task forces have provided, in a very challenging drug environment, crucial support to communities with complex needs. The drug scene changes several times a year. The task forces are a great partnership involving the community, the voluntary sector, the statutory authorities and public representatives. However, the cumulative reductions made in the austerity budgets from 2008 to 2014 were significant. The task force projects experienced a 20% funding reduction and local youth services were affected by a 31% reduction. That meant cuts in respect of crucial interventions and key services and support for such services. We have particular difficulties in the constituency I represent. There is blatant drug dealing on the streets and high levels of intimidation, yet so much really good work goes on. The chairs and co-ordinators provided a pre-budget submission just a couple of months ago. They sought restoration of previous funding levels in order to enable them to do the work. Returning project funding to 2008 levels would cost €5 million. The submission also sought €10 million from the emerging needs fund for the areas most affected. We will see what will happen with the Minister of State's review, but I hope those requests can be taken on board.

I take what Deputy Maureen O'Sullivan says very seriously. I know from her constituency what a very positive impact the task forces can have in a community with rampant drug problems. I very much appreciate that point. I will indeed ask Minister of State, Catherine Byrne, to take the Deputy's comments on board as part of her review on additional funding. We all agree that this is an area for which we want to see more funding. The Deputy will agree that we must make sure to align additional funding with the priorities set out in our relatively new national drug and alcohol strategy. The funding model for the additional €1 million has three tiers. I may not get time to list all of them. The first tier will provide an agreed amount of resources on a priority basis across all task forces. The second tier will provide funding of up to €60,000 a year for 12 strategic initiatives which reflect all of the six guiding principles. The third tier will provide funding for a national awareness campaign on drug-related violence and intimidation and a reporting programme on those issues. Drug and alcohol task forces will receive additional funding this year. I accept this is an area in which we want to do more. We will ensure that the review takes Deputy Maureen O'Sullivan's comments on board.

Everybody welcomes additional funding, but without restoring the original funding it does not make sense. I refer to the recent report by the Health Research Board into drug-related deaths. I know these figures are from 2016 and I know why there is a two-year delay before figures can be ascertained, but it is really very significant that drug-related deaths are on the increase. Alcohol-related deaths increased by 18%. Prescription drugs were implicated in 258 deaths. Some three in four of all 354 poisoning deaths were from overdoses. Two thirds of poisoning deaths involved a cocktail of drugs and hangings had trebled among drug users. Benzodiazapines are implicated in the majority of overdose deaths. Three quarters of the 736 drug-related deaths in 2016 involved males. That is the kind of scenario with which the drugs and alcohol task forces are dealing. They have also had alcohol added to their work. Everybody agrees with that but the implications have not really been considered. We know that alcohol is very significant in drug-related deaths.

I do not disagree with what the Deputy says and I take her comments about funding on board. I would also make the point that it is about more than funding. It has to be about the way we treat people with drug addiction. For a country that likes to consider itself progressive, tolerant and inclusive, the way we only treat people with drug addiction through the criminal justice system is regressive and belongs in a different era. The idea that the first point of contact of somebody who finds themselves in difficulty, and there but for the grace of God goes any of us, is the criminal justice system rather than the health system makes me quite annoyed and frustrated and somewhat embarrassed. We need to look at best international practice in this regard. We need a compassionate, health-led response to drug addiction. That is why and the Minister of State, Deputy Catherine Byrne, and I set up a group to look at exactly that. That group is due to report to us very shortly. The first support the State provides to a young person in Deputy Maureen O'Sullivan's constituency or in mine who is suffering from a drug addiction should not be a knock on the door from An Garda Síochána. It should be help from an addiction service or a health-led approach. That is now Government policy under the national drug and alcohol strategy, but we may need to start changing the law in that regard. I look forward to working on that with the Deputy.

Mental Health Services Staff

Deputy Eugene Murphy has lucky number 13.

Eugene Murphy

Question:

13. Deputy Eugene Murphy asked the Minister for Health if a number of senior staff members in Roscommon community mental health services have been transferred to County Galway; the reason for these positions being vacated; his plans for the replacement of these positions; and if he will make a statement on the matter. [20493/19]

I want to ask the Minister about the community mental health services in County Roscommon. Specifically, I want to ask if some staff have transferred to County Galway, why those positions have been vacated and whether there are plans for the replacement of those positions. I look for ward to the Minister's reply.

I thank Deputy Eugene Murphy for this important question on Roscommon community mental health services, the reason for their transfer to County Galway and plans for the replacement of these positions.

Community healthcare west has confirmed to me that three senior clinicians in the Roscommon area are in the process of leaving their roles. They are leaving to pursue career opportunities elsewhere in the mental health service of community healthcare west. The three clinicians, a consultant psychiatrist, an area director of nursing and a senior nurse, worked in the adult mental health services and are expected to move to their new posts by the beginning of June 2019. There is currently a process in place to offer the consultant post to candidates on a national panel established for the filling of consultant psychiatrist posts. In the interim, a locum consultant psychiatrist will be engaged. A community nurse manager in the area will take on the role as acting director of nursing until a permanent replacement can be recruited. Nursing management in Roscommon is currently in the process of filling the acting director of nursing and senior nurse positions on a permanent basis.

The Deputy's question was asking me whether the staff were moving from Roscommon to Galway and not being replaced. I am pleased to inform Deputy Eugene Murphy that is not the case. The case is that for individual personal and career reasons, staff have decided to take up job opportunities elsewhere, as is their right, and we wish them well. It is the HSE's active intention to fill those posts, and we will fill the consultant post on an interim basis with a locum consultant. There will be a process in place to fill the post permanently, and we will see the permanent filling of the acting director of nursing and senior nurse positions. Let me assure the Deputy of the HSE's and my own commitment to recruiting these staff. My Department has requested regular updates as part of this process, and I would be happy to share them with Deputy Eugene Murphy and keep in touch with him in this regard.

I thank the Minister for his reply and for the reassurances given in relation to mental health services in County Roscommon. We well remember the external report into the Roscommon mental health services in September 2017, and those services were rightly condemned right across this House and across this nation. Indeed, there is a report out today showing the concerns young people have about the importance of mental health services going forward. While the Minister has confirmed that those three people are leaving the services in Roscommon, it is crucial that those positions are filled as quickly as possible. We cannot have any gap, and while I have total respect for locums, we need people in permanent positions. As the Minister can imagine, people build up a rapport with their psychologist, nurse, or psychiatrist, and if that is broken it can cause a lot of difficulty for the individuals concerned. I know these cases personally, and some of those people are living with regret. Again, I would appeal to the Minister because it is so important that we get those positions filled as permanent roles as quickly as possible.

I again thank Deputy Eugene Murphy and appreciate his very sincere interest in this. As a constituency Deputy, he has rightly come across families who are interacting with these services and who are dependent on them. He is entirely right that people build up a rapport, a personal relationship, a trust, and a bond with people working in our mental health services. It can be upsetting for people when they hear that staff are moving, but it is even more upsetting when that then develops into a worry that those staff will not be replaced or that services will be transferred to another county. I hope Deputy Eugene Murphy and his constituents can take some comfort today from my assurance that is not the HSE's intention. The HSE's intention is to fill these posts, and in fairness to it, it has taken proactive steps to make sure they are filled on an interim basis. However, I accept absolutely and could not agree with the Deputy more that they need to be filled on a permanent basis. That is the intention of the health service. I have asked to be kept personally informed of this through regular updates from the HSE to my Department and I would be very happy to share them with Deputy Eugene Murphy and to keep him informed.

I am very happy to put on the record today that some of those who are helping and interacting with people who need their assistance and help are doing a fine job. I know of a number of cases personally where the patients concerned are extremely happy and in many cases their lives have taken a new road or twist and many of them have come out of the deep depression they were in. The loss of staff like this is obviously going to affect them.

Going back to the external report and review from September 2017, which I said was damning, there were 27 recommendations in that. I am not going to fire the question willy-nilly at the Minister now, but I would ask him to check on that again to make sure those 27 recommendations are implemented as quickly as possible. A number of them have been implemented but I understand that a number have not. While some of them will of course take longer than others, I ask the Minister to please ensure that those 27 recommendations are all put in place. The mental health services, as the Minister and the Minister for State are well aware, are crucial and so important to society nowadays.

It is lovely to hear such positive feedback about the really important impact our front-line staff are having on the Deputy's constituents in Roscommon, and I will make sure that is passed on to the people working in the mental health services in community healthcare west. I will indeed seek an update on the recommendations from that review, and I will ask the Minister of State, Deputy Jim Daly, to correspond with Deputy Eugene Murphy directly on it. My understanding, similar to the Deputy's, is that much progress has been made on some recommendations but it is certainly important that we keep a focus on this and I will ensure that takes place.

Question No. 14 replied to with Written Answers.
Question No. 15 answered with Question No. 9.
Questions Nos. 16 to 21, inclusive, replied to with Written Answers.

Primary Care Centres Provision

John Curran

Question:

22. Deputy John Curran asked the Minister for Health if his attention has been drawn to the long delays in the delivery of a primary healthcare centre (details supplied); and if he will make a statement on the matter. [20646/19]

My question relates to the provision of a primary care centre in Lucan, County Dublin. This has been promised for quite some time, by means of a public private partnership through the HSE. That being said, little or no tangible progress has been made and I understand the HSE is now re-advertising the project. Could the Minister engage with the HSE to be more proactive, and to deliver something that is way overdue at this stage in Lucan?

I do not think I have ever gotten to Question No. 22 during my Oral Parliamentary Questions.

I very much welcome Deputy Curran's important question, and this is something about which he has corresponded with me over the last number of months as well. I am well aware there have been delays in developing a primary care centre in Lucan. The HSE has informed me that an advertisement for the development of such a centre was placed in the Lucan Gazette on 6 April 2017, and a letter of intent was issued in August of that year to the preferred bidder selected by the HSE based on the submissions received. The proposed location for the centre was on the grounds of St. Edmundsbury Hospital. Unfortunately, due to a lack of progress on the project by the joint proposers, which was very disappointing, the HSE decided to withdraw the letter of intent which had, in any case, expired. There was a real willingness, and there remains a willingness, from the HSE to provide this primary care centre. In fact, the HSE has confirmed to me that it is still very committed to delivering a primary care centre in Lucan. Indeed, the project was included in an advertisement published in the national press only this month, on Friday, 3 May 2019. This advertisement seeks submissions of interest from parties that wish to develop primary care healthcare facilities under the operational lease mechanism. I understand from the HSE that one of the parties in the original joint submission has indicated that it intends to resubmit a proposal in response to the new advertisement, and that will need to be considered by the HSE in the appropriate fashion. I am certainly happy to take a proactive interest in this and, if it is of use to the Deputy, I would be happy to meet with Dublin Mid-West Deputies on this in the next month or so and to see what progress has been made.

I thank the Minister for his reply. It is important that both he and the HSE are proactive. The reason I say that is that this public private partnership in relation to St. Edmundsbury Hospital has obviously run into difficulty, but this is the second time it has happened. A previous location had been identified, went through the planning process, and was refused by An Bord Pleanála. The problem is that the period of time from the refusal of that planning to the next advertisement by the HSE was quite long, taking at least 12 months. It shows a complete lack of urgency in the project and that is why I raise it today, namely, that the Minister might engage proactively to ensure there is an urgency attached to this project and that we deliver a primary care centre.

I would make the one point that in my constituency of Dublin Mid-West, there will be three primary care centres. Two will be by means of a public private partnership and one direct build, but none has turned a sod yet.

I thank the Deputy for that. From memory, I think we have 129 primary care centres operational around the country, but I will certainly inquire into the Deputy's constituency.

That makes me feel very bad.

I accept and appreciate Deputy Curran's very real interest in this. We want to see a primary care centre in Lucan, and that has been the HSE's position for quite a period of time. We advertised, as I said, back in 2017 and it was highly unfortunate what happened in relation to the selected preferred bidder. If the Deputy wishes to contact my office, I will certainly convene a meeting with Deputies from Dublin Mid-West next month to monitor progress now that the new advertisement has been placed.

I will show the Deputy around the one in Coolock.

I thank the Minister for his response, and in particular for stating that he will follow up with me. I acknowledge that primary care centres have opened around the country but it is a fact that in my own area the three that have been promised - two by public private partnership and one direct build - have not materialised. There are obviously reasons for that, but the Minister might stay in touch with me about the Lucan one in particular. I appreciate his response.

We are certainly going to build a primary care centre in Lucan and I hope the advertisement placed on 3 May yields interest. I am encouraged by what the HSE informs me in relation to one of the parties to the previous joint bid expressing a view that it will resubmit an application. As I said, we will meet with the Dublin Mid-West Deputies next month and monitor progress together.

Written Answers published on the Oireachtas website.