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Dáil Éireann debate -
Thursday, 10 Oct 2019

Vol. 987 No. 6

Ceisteanna Eile (Atógáil) - Other Questions (Resumed)

Healthcare Infrastructure Provision

Fiona O'Loughlin


6. Deputy Fiona O'Loughlin asked the Minister for Health the status of a day care centre for Monasterevin, County Kildare; and if he will make a statement on the matter. [41174/19]

The 5,000 people of Monasterevin are playing a waiting game in seeking a new secondary school at St. Paul’s, the amalgamation of two primary schools and an announcement on the blueway which we hope will be made next month. In particular, I refer the Minister to the waiting game on the day care centre which closed five years ago in 2014. Thankfully, one of the local football clubs stepped into the breach, meaning that temporary facilities were provided. It is simply not good enough that nothing has been done. It is not just those who avail of the day care centre who have been affected. The Alzheimer Society of Ireland had a place in the Monasterevin day centre that covers all of south Kildare. It subsequently had to move to three locations.

The HSE recently published its capital plan for the period 2019 to 2021, outlining projects to be progressed which include the day care centre in Monasterevin, County Kildare. This will be welcome news for people there who, rightly, will want to know what happens next.

The HSE is responsible for the delivery of public healthcare infrastructural projects. It has advised me that a design team is progressing stage 1 of the upgrade of the building on Drogheda Street. This will require an application for planning permission to be lodged. There is funding to deliver the project which will be delivered. Obviously, the process is for the design team to progress stage 1 and submit a planning application. I will be happy to keep in touch with the Deputy on this matter as it progresses. It is an important issue for the people of Monasterevin. Access to the original building had to be restricted as far back as 2014 owing to health and safety issues. I thank the local GAA club which stepped into the breach, pending completion of the capital works, in providing temporary facilities. The project is listed in the capital plan and will be funded. It is vital that an application for planning permission be submitted. I am sure the design team is working on the application for planning permission for the upgrade of the day care centre. I will be happy to keep in touch with the Deputy as the HSE advises me as it progresses.

I thank the Minister for confirming that the day care centre project is included in the capital plan. That is welcome news. I have had eight different replies to parliamentary questions on this matter which I have put in the past 12 months.

I have had several in the years since I was elected in 2016. One of the replies I received 18 months ago from the HSE stated that planning permission would be sought by the end of 2018. I am concerned that, 12 months later, the planning permission application has still not been made.

The latest reply I received from the HSE, dated 10 October, states:

The design team for the upgrade of the day care centre building on Drogheda Street, Monasterevin, County Kildare, are now progressing Stage (i) to completion. The programme is subject to the grant of planning permission for the project and the availability of capital funding.

Reference to "the availability of capital funding" is something I noted in every one of the replies. The Minister said that project will be in the capital programme and I accept what that but I am concerned that today's reply states that it is subject to the availability of capital funding.

I thank the Deputy for the follow-up question. I can tell this is an issue she has been pursuing back and forth with the HSE for quite some time. I will certainly engage with the HSE on the timeline for the submission of the planning application and revert directly to her in that regard.

The way the capital planning process works, as she will be aware, is that we need to get through a number of stages and the standard reference to it being subject to the availability of capital is a reference to the fact that this project has yet to receive planning permission. The project is included in the capital plan. That is a commitment from us to deliver the capital to fund that project but, before we get to that point, the project needs to receive planning permission.

The effort must be on getting a planning application submitted as a matter of urgency. Subject to planning permission being granted, I am more than happy to meet the Kildare Deputies to update them on timelines for the delivery.

I accept the Minister's bona fides in this. I also appreciate that his is willing to expedite this and to meet further on this.

I am still concerned, however, that planning permission and availability are two clearly distinct elements within the reply that I received today. I still do not understand why the planning permission application, 12 months later, has not been submitted.

Having said that, the news is positive. It is important for the people of Monasterevin who use this service because the budget reflected an agreement that there would be ten new support staff for Alzheimer's services. The Kildare Alzheimer's services use this and are now in their second temporary building. They have to leave at Christmas and they are at the end of their tether in terms of trying to find another place. While providing supports, we must have places where people can go to. I look forward to a resolution on this. I thank the Minister.

I am pleased the Deputy referenced the work of the Alzheimer Society. This is an area of interest she has pursued during her time in the House. I am pleased that in budget 2020 we were able to agree funding, which has been welcomed by the Alzheimer Society, for the appointment of ten additional dementia advisers throughout the country. This means we will be able to ensure that there is a dementia adviser in every county. I want to acknowledge on the record Deputy Butler, Senator Kevin Humphreys and Colette Kelleher and, I am sure, many others who have been working on this issue on a cross-party basis. I hope that will come as welcome news to the Alzheimer's services in Deputy O'Loughlin's county and, indeed, across the country.

I detect and understand her frustration in respect of when the planning application will be submitted. I will further engage with the HSE on that and revert to Kildare Deputies. My understanding is that the centre will be situated in the existing two-storey house that is listed as a protected structure. I can only presume that sometimes it takes a little longer to design planning applications for such structures. The plan is that this house will be renovated and refurbished to ensure that it is fit for purpose. I assure the people of Monasterevin that we will make progress on this, that it is included in the capital plan and that the next phase is planning permission approval.

Mental Health Services Expenditure

James Browne


7. Deputy James Browne asked the Minister for Health when the full allocation for mental health spending in 2019 will be drawn down; and if he will make a statement on the matter. [41185/19]

I tabled Question No. 7 on the Order Paper to the Minister.

Budget 2019 made allowance for an additional €55 million for mental health services. This comprised €20 million continuing cost in 2019 of developments initiated in 2018, combined with €35 million for further new developments. Since 2012, the mental health HSE budget has been increased by almost 40%.

This investment has enabled the HSE mental health services to progress initiatives outlined in the National Service Plan 2019. Initiatives such as e-mental health pilot programmes and clinical programmes in areas such as eating disorders and attention deficit hyperactivity disorder, ADHD, continue to be developed and implemented with this funding. Funding is also provided in 2019 to plan for the opening of the new national forensic mental hospital.

To date, the HSE has drawn down €30 million of the foregoing funding, and an application for a further €10 million is currently being processed. In addition, €3 million has been paid to Pobal for the community mental health fund.

The management of the remaining €12 million funding for 2019 will be agreed with the HSE in the coming weeks.

I reassure the Deputy that mental health continues to be a priority area for the Government. We recognise that mental health service users are often among the most vulnerable in society and, for this reason, in budget 2020 the Government maintained its commitment to mental health with an allocation of more than €1 billion.

A Mental Health Commission, MHC, report published this morning identifies long-term neglect of people with serious and enduring mental illness in the mental health system. It is another in a regular series of highly critical reports from the Mental Health Commission.

I was not surprised by the report. One of the most difficult and common situations I deal with is persons being released from the department of psychiatry without accommodation and without rehabilitation services who end up in a revolving door system where inevitably, a number of months later, they are back in the department of psychiatry - a type of patch them up and show-them-the-front-door approach.

We are in year 13 of a ten-year mental health strategy and yet barely over 50% of the recommended staff are in place and less than 10% for those with intellectual disabilities, with none in some regions.

Fianna Fáil, through the confidence and supply agreement, secured an additional €105 million for mental health. In budget 2019, €55 million was secured. It was secured previously in 2018. The Department of Health knew that funding was coming. The Minister signed a document to that effect. Some €25 million of that expenditure seems to have been withheld so far this year. This is unconscionable. What is the reason for this funding being unspent and where is the ministerial oversight?

I am not sure from where comes this €25 million being withheld by the Government from the HSE. I saw a tweet from Mental Health Reform to that effect yesterday.

A parliamentary reply.

The Government is not withholding €25 million from the HSE. The full €55 million that was an order of Government was made available to the HSE to spend. There is a process under which the Department releases the funding as it is needed. The Department does not merely throw the €55 million onto the table and say, "Spend that." It is released as it is being spent and that is the process to which the Deputy refers.

There is not an issue with withholding funding. Some of it relates to recurring expenditure and one-off expenditure.

A sum of €12 million remains to be spent. We still have two and a half months of the year to spend that. I am meeting the HSE and the Department of Health next week to further oversee the expenditure. When the Deputy referred to ministerial oversight, I have overseen the expenditure of that funding, and, indeed, of the entire €1 billion budget, over the past 12 months.

Regarding his issue about rehabilitation and the MHC report, I will refer to it in a later response.

Reference to the funding being withheld came in a parliamentary reply. It stated the funding was unspent. There was a year's preparation available to ensure that this funding would be spent.

The funding is desperately needed in mental health services throughout the country and there is no reason to fail to spend it. The Mental Health Act 2001, which was due to be updated years ago, has still not been updated. Unqualified consultants are practising in mental health - a practice condemned by the President of the High Court. The majority of mental health facilities remain unregulated as they do not come under the MHC's remit. Mental health services in St. Luke's were prosecuted this year, the first time ever a mental health facility had to be prosecuted. Suicide remains the greatest cause of death among those aged between 15 to 24. Primary care psychology is a disaster, with patients three years waiting in my county of Wexford. Anti-depressant prescription is increasing at an alarming rate. The expansion of the Jigsaw service has been held up. When I started here, the Tipperary unit was to be opened within a few months. Three and a half years later, it still has not, yet the Department cannot spend funding. In the Department where most Ministers for Finance seem to suffer from financial incontinence, we have a Minister of State with responsibility for mental health who seems to suffer from financial constipation.

Those one-liners might sound good but the reality is that for every challenge in the system, there are many successes.

We have a budget of €1.026 billion this year, up from €711 million when the Government took office in 2012. It represents an increase of almost €400 million in the budget. We also have the refresh of A Vision for Change. In the year to date, we have seen a 20% reduction in the number of children waiting for child and adolescent mental health services, CAMHS. Today we launched a telephone line which will be used to provide an advisory service to direct people to the most appropriate service. It line went live today on World Mental Health Day. The tele-health pilot schemes for psychology and psychiatry services are up and running. We have introduced 134 assistant psychologists and psychiatrists to create a lower level of infrastructure, particularly for young people, which has reduced substantially the reliance on CAMHS as a specialist service. There are many successes in the mental health service. I acknowledge the roles of the HSE and the Department in bringing them about.

Respite Care Services

Michael McGrath


9. Deputy Michael McGrath asked the Minister for Health the reason for the significant fall in the number of overnights, with or without day respite care, accessed by persons with a disability in the Cork South Lee local health office area since 2015; and if he will make a statement on the matter. [41226/19]

This question relates to the provision of overnight respite care beds for people with a disability, both children and adults, in particular in CHO 4, Cork South Lee. The figures which I will outline do not paint a good picture. I seek an explanation for them and to know what will be done to reverse the trend of the number of respite care beds falling.

The Government’s ongoing priority is the safeguarding of vulnerable persons in the care of the health service. We are committed to providing services and supports for people with disabilities which will empower them to live independent lives.

As part of its ongoing service provision, this year the HSE national service plan set a target of over 180,000 overnight and 42,500 day respite care sessions to be provided for families in need across the country. The HSE has advised that there are changes to the models of service, including respite care, being provided in the Cork South Lee area, specifically, the number of overnights with or without day respite care accessed by persons with a disability. The changes to the models of service being provided have not been reflected in data captured for key performance indicator, KPI, returns. The greatest variable in the KPI information relates to children's respite care services provided by the Brothers of Charity. In 2015 a respite care Home Share project was developed as an alternative model to the traditional respite care service. It allows children to spend time with host families in a home from home environment.  This new model of respite care support is proving very popular and a number of children receive more than the 30 nights annual provision, but that is not reflected in the current KPI returns. Home Share was extended to provide significant levels of support for families through a continuum of care provided by an alternative family. This, in turn, has reduced the number of children who require residential respite care to those with higher complex needs.

CHO 4 opened a respite care house in west Cork in December 2018. It accepts referrals from across County Cork.

I thank the Minister of State for the reply. What he seems to be saying is the data Deputy Margaret Murphy O'Mahony received by way of a reply to a parliamentary question do not capture all of the respite care overnights. If that is the case, it is inexplicable. The data I have for the Cork South Lee area are that in 2015 there were 4,084 respite care overnights. In 2018 that number had fallen to just over 2,500. That represents a fall of 38% between 2015 and 2018 and the figure is falling again this year. The Minister of State spoke about a change to the model of care. The provision of respite care in Cork is appalling. It is literally only provided in emergency cases where families simply cannot continue. That is the reality. The hard figures I have in front of me show a 38% fall in the number of respite care overnights. This reply to a parliamentary question does not indicate anything about a change to the model of care and it not being captured in the data. If respite care overnights are being provided in a family setting, it should be set out in the data, but it is not.

I take the Deputy's point and also the point about the data. We have to get to the bottom of that matter and I give a commitment that I will do so. Also, if there are particular needs in the Cork area, I will absolutely deal with them. The reality is that we have been investing in respite care services for the past three years. I will travel to Naas in two weeks' time to open our 12th respite care house, just to let Deputy O'Loughlin know. I have not yet picked a date.

We have been waiting for it to be opened.

Nationally, the investment in residential, respite care and home services in the past three years has been amazing, but if there are particular gaps in counties, I will listen to the position on them. At national level, the HSE received funding of €5 million to support the development of respite care services. That funding was subsequently allocated among community health organisations in the form of 12 respite care houses. As I mentioned, a new respite care house run by Kerry Parents and Friends Association was opened in March 2018. The one in west Cork was opened in December 2018. On alternative respite care services, Cork Kerry Community Healthcare received in the region of €220,000. I accept the Deputy's point that we first need to get the data right. If there are particular gaps in Cork, we need to look at them also.

There certainly are particular gaps. Looking at the text of the reply, in addition to the data provided in the table, it acknowledges that there has been reduced provision of respite care overnights. It refers to unmet needs and growing demand. It states beds that had been available to provide respite care in some cases have been transferred for use as long-term residential placements. That is the reality. The numbers are falling. There has been a 38% drop in three years in CHO 4. I raise the wider issue. If we look at all of the metrics and all of the waiting lists, particularly for disability services, the waiting times for assessment for children with special needs and the lack of therapy interventions, CHO 4 seems to be an outlier. Does the HSE and the Minister's Department carry out any performance measurement of the way different CHO areas are performing because to me CHO 4 does not seem to be a strong performer? Again, this is borne out by the evidence given in the reply to a parliamentary question.

I mentioned respite care services. In the context of the budget announced yesterday, in 2020 we will spend approximately €2 billion on social care services. There is a fundamental question to be asked. If there are particular parts of the country - the Deputy is talking about CHO 4 - that are not receiving the relevant services, that is an issue I will examine and monitor closely. I will come back to the Deputy with more details, but the bottom line is we have to see the money invested to deliver respite care services. We cannot have a situation where that is not the case in some counties. I am aware that in Dublin hundreds of letters are sent to parents every day offering extra respite care provision.

The Minister of State could send a few to Cork.

That is happening in Dublin. To answer the Deputy's question, the position in CHO 4 has to be looked at and I will do so.

Question No. 10 in the name of Deputy Jonathan O'Brien will be taken by Deputy Buckley.

Hospital Consultant Recruitment

Jonathan O'Brien


10. Deputy Jonathan O'Brien asked the Minister for Health when a new endocrinologist for the paediatric diabetes service in Cork University Hospital will be appointed; and if he will make a statement on the matter. [40957/19]

I ask the Minister for Health to indicate when the new endocrinologist for the paediatric diabetes service in Cork University Hospital will be appointed and if he will make a statement on the matter.

I thank the Deputy for the question he asked on behalf of Deputy Jonathan O'Brien. As the Deputies will be aware, Cork University Hospital is the centre for the treatment of paediatric diabetes for the south-west region. It treats approximately 400 children with diabetes, with an average of between 45 and 52 new children being diagnosed each year. I assure the Deputy that the Government is committed to further developing and strengthening paediatric diabetic services.  The HSE has advised me that an additional permanent consultant paediatric endocrinologist is due to commence duties in Cork University Hospital in January 2020, which will greatly enhance the paediatric diabetic service. We provided funding in the HSE national service plan for 2019 for recruitment to fill that post and I am pleased that the recruitment competition has been successful. We have approximately 125 additional consultants working in the health service already this year. I am pleased to see that the consultant paediatric endocrinologist post has been filled and that the person concerned will commence work in January 2020. It will make a significant difference to the paediatric diabetic service we can offer children in the south west.

The HSE has further advised me that while Cork University Hospital awaits the appointment of this permanent consultant, a locum consultant paediatrician is in place, alongside a part-time consultant paediatric endocrinologist to support additional clinics to target long waiters and patients who had appointments cancelled in the past. This is a very welcome development not only for people in Cork but also in quite a large catchment area which includes the whole of counties Limerick, Clare, Tipperary, Waterford and Kilkenny.

We provided approval to recruit these additional posts. It was not only approval for the extra consultant who will be in place from January. The national service plan also provided funding for a new psychologist, social worker and dietitian to work as part of that wider paediatric diabetes service in Cork. These posts will also support the delivery of the model of care. I hope this is welcome news and I look forward to people taking up these posts at the start of the new year.

I thank the Minister and welcome the news. It is to be hoped such provision will progress. I welcome that there is an increase in the number of psychologists and dietitians because key findings were made recently and staffing deficits were also identified across other disciplines with a national working time equivalent percentage deficit of 95% in psychologists, 74% deficit in dietitians and a 19% deficit in specialist diabetes nursing. Any improvement in the Cork-Kerry region must be welcomed.

There probably are more than 100 teenagers making the transition to adulthood. Has HSE management done any forward planning to progress their access to services?

I thank the Deputy for his detailed questions in this regard. I do not disagree with him that there is a further body of work we need to do to make sure we increase capacity in all of these teams. I very much welcome the fact that when the Deputy spoke about this issue, he referred to a range of healthcare professionals. Sometimes, in the media and political commentary, people tend to talk about consultants and nurses. While both are important key staff within the health service, the way we are delivering health services now and the way we must do so in the future is very much around a multidisciplinary team where the roles of a dietitian, social worker, psychologist and all the different roles coming together is what will lead to the best possible outcomes and to shifts in the model of care.

On the Deputy's question on children transitioning from childhood to adulthood, I will have the HSE or my Department revert to him on it directly. We have developed a new national clinical programme in paediatrics and neonatology, called the new national model of care for paediatric healthcare services in Ireland. We talk a great deal in this House about the building of the children's hospital in terms of bricks and mortar but this will transform the delivery of healthcare for children and I will send the Deputy a copy of that also.

I welcome the Minister's commitment to addressing provision for teenagers transitioning to adulthood. I look forward to receiving a reply on behalf of Deputy Jonathan O'Brien and Cork University Hospital.

Health Services Provision

Mick Barry


11. Deputy Mick Barry asked the Minister for Health if he will report on the implementation of the recommendation by the Oireachtas Joint Committee on the Eighth Amendment of the Constitution for the availability of free contraception; and if he will make a statement on the matter. [41358/19]

Richard Boyd Barrett


72. Deputy Richard Boyd Barrett asked the Minister for Health if he will report on the implementation of his plans to provide free contraception; and if he will make a statement on the matter. [41365/19]

I heard the Minister mention earlier that he would have a contraception report in the next few days and perhaps it is timely to ask him to report on the implementation of the Oireachtas Joint Committee on the Eight Amendment of the Constitution for the availability of free contraception. I look forward to hearing his comments on that matter.

I propose to answer Questions Nos. 11 and 72 together.

Deputy Barry was up early this morning as well. I thank him for his timely question regarding contraception. I reiterate on the record of this House my view that we need to make contraception free for all women in our country. We have made very significant progress regarding male contraception in terms of condoms. We have very significantly increased the amount of condoms being distributed. We are putting vending machines into a number of locations throughout the country and our sexual health strategy very much aligns with this both in terms of reducing crisis pregnancy and in terms of reducing sexually transmitted infections, STIs, which are at a worrying level in our country.

The question of access to contraception is an important one. That is why, following on from the recommendations of the Joint Committee on the Eighth Amendment of the Constitution, I established a working group within my Department to examine the range of policy, regulatory and legislative issues because there are issues in each of those areas which arise with respect to improving access to contraception. I established the group in April and it has overseen a public consultation exercise. It received many public submissions and submissions from stakeholders. It has undertaken a review of research and met a number of stakeholders directly. I am pleased to say the group has just finalised its report and it has submitted to me in recent days for consideration.

It goes without saying that I intend to fully consider the detail of the report but, in doing so, I do not intend to sit on it. I would like to publish it and will do so this month. It might be very helpful for the Joint Committee on Health to see it also and to be able to consider some of these issues. We know, however, that there can be barriers to accessing contraception and that cost can be an issue. Most forms of contraception, including long-acting reversible contraceptives, LARCs, are provided free of charge to those with medical cards, so we are not starting from a point of nobody having free access. Many people already have free access to contraception. I have already mentioned the national condom distribution service, which supports free access to contraception among those who may be at increased risk of negative sexual health outcomes. The working group examined other means by which the costs involved in accessing contraception can be reduced and it has come up with a range of recommendations as well.

I intend to publish the report shortly. I suggest we will have a body of work to do in terms of legislation and policy options and we should get on and do that.

The Minister stated that the report will be published in the month of October. I would have liked to have seen it published before the announcement of budget rather than after it, which brings me to my first supplementary question. Has the Minister made provision in the budget arrangements for 2020 to provide the funding necessary to provide free contraception for all in this State in the year 2020. As he is aware, Ireland is an outlier in terms of maintaining a cost barrier for women to have access to contraception. I am sure he will agree that the sooner that cost barrier is removed the better. Is there funding in the budget to provide free contraception in this State in 2020?

I agree with the Deputy that it would have been useful to have the report published in advance of the budget. However, I remind the House that we are framing a budget in the context of a no-deal Brexit where there is a range of priority issues we needed to address, including making sure we address home care services, mental health services and a number of other issues that have been raised in this House this morning. When people see the report, I think it will become very clear to the Deputy that if we as an Oireachtas were to press "go" on this, and I hope we do, much of 2020 would be taken up with the need to legislate in this area, as well as the need to engage with the healthcare professionals involved. They may need engagement regarding fees as well. I suggest that the cost in 2020 would be minimal because, if we are being honest with each other, this will really arise as a 2021 issue, but I would like this Oireachtas and Government to set the policy direction shortly. I would like to publish the report this month.

The Deputy referred to our county lagging behind in this area. The European contraception atlas for this year ranked Ireland 12 of 46 countries and gave the Government a rating of 65% for our policies and access to contraceptive supplies, family planning counselling and the provision of online information on contraception, so we are making progress in this regard. A third of our population hold a medical card. That means 124,379 clients availed of contraceptive drugs and special services through the General Medical Services, GMS, scheme last year.

My view is that it would have been best if we had free contraception available in 2020. I take it from the Minister's reply that is not the intention of the Government. He seemed to indicate it is his intention for 2021. Specifically, is the Minister saying that he aims to see the introduction of free contraception in this State in 2021? I ask him to comment on that. Currently, in terms of free contraception, there are prescription costs and GP fees. GP fees and prescription costs need to be removed from the equation. It should not be necessary to go to a GP to get a prescription to avail of contraception in many cases. Is it a definite aim to have free contraception in 2021? What about the question of GP fees and prescription costs?

My position on this is not in any way ambiguous. I signed up fully to all the recommendations of the Joint Committee on the Eighth Amendment of the Constitution and applied rigour to trying to progress a number of them working across this House and I will continue to do so. I believe contraception should be free for men and women. We should talk about men as well. It is not just a woman's issue. Men obviously have a role to play in reducing crisis pregnancies and in helping around these issues as well. We have made progress on the national condom distribution service this year.

When it comes to the female side of contraception, it will require dealing with regulatory issues, legal issues, policy issues and, possibly, fee negotiation. When the report is published, and it will be published this month, I will be very happy to debate it in this House and to talk about it at the health committee. It is my policy objective to make contraception free in 2021 and that is what I would like to see happen.

The Deputy talked about our record on some of these issues. We are also making PrEP available from 4 November. These are real, concrete steps that are taking place in regard to sexual health in our country. When it comes to female contraception, a woman's choice will be important because, as the Deputy knows, there are a variety of methods available.

Hospital Services

Martin Kenny


12. Deputy Martin Kenny asked the Minister for Health the status of the diabetes service in Sligo University Hospital; and if he will make a statement on the matter. [41165/19]

We are back here again. This is the umpteenth time I have asked this question around Sligo diabetic services, particularly with regard to people with type 1 diabetes and access to the insulin pump. I gave the Minister a letter earlier which stated that, back in June, 30 adults were waiting to get access to this service, but they cannot get access to it because there is no specialist diabetic nurse in place to train them or to provide them with the service. It is over a year since I began raising this and I have raised it with the Minister umpteen times. I had a Topical Issue on the matter and the Minister of State, Deputy Catherine Byrne, came in and read out a pile of waffle to me one night. I got angry with her and I said that the people who were blocking the service should be sacked. I do not think anyone has been sacked since and I do not think the service has been put in place since.

I have always had a good relationship with the Minister and always found him to be an honourable person. However, in this case, he is letting people down hugely. It is outrageous that there are up to 40 people who cannot get access to this service in the north-west.

I thank Deputy Kenny and, in fairness, I acknowledge and understand his frustration in this regard because it is an issue he has pursued on multiple occasions in this House. I accept his sincerity and bona fides in this regard.

The diabetes service at Sligo University Hospital, as the Deputy knows better than I, is a well-established integrated service, operating on a multidisciplinary team basis in the hospital and the community. This shared care approach is supported by a team of specialist diabetic nurses and an advanced nurse practitioner in both the hospital and the community, as well as a full range of support staff. In addition, there is a pregnancy diabetes service, inpatient ward-based consultation service and inpatient and outpatient podiatry service. The adult diabetes service at Sligo University Hospital is currently led by two consultant endocrinologists and includes an insulin pump service. There is also a paediatric diabetes specialist service which provides a regional insulin pump service for children across the north-west region. Both the adult and paediatric pump services have experienced considerable growth in referrals - which is a real challenge in regard to diabetes - both from new patients commencing treatment, as well as repatriation of patients from national tertiary centres.

We are committed to the further development of services for people with diabetes. A project funded under the Sláintecare integration fund only in recent weeks will give diabetes patients across Sligo, Leitrim and west Cavan expanded access to diabetes services through their GP and primary care settings, and I will send the Deputy information in that regard. We also see that the development of the diabetes day unit is now proceeding to build stage, with contractors appointed and building due to start next week. The project is expected to take 12 months and will meet the needs of the paediatric and adult diabetes services for patients from Sligo University Hospital.

I accept the Deputy's point on the need to do more in this regard. He has given me a letter this morning from the chairperson of the Sligo branch of Diabetes Ireland. In recognition of the fact that the Deputy has raised this on multiple occasions, and in an effort to resolve the matter, I suggest that I would happily host a meeting here with representatives of the Sligo branch of Diabetes Ireland, Deputy Kenny and his Oireachtas colleagues, a manager from the hospital and the HSE. I will arrange that within the next month.

I appreciate that offer of a meeting and, undoubtedly, that will be taken up. I also gave the Minister a letter from Grainne McCann, the manager of Sligo University Hospital, in response to a young woman of 18 years who has been recommended to use the insulin pump. Her letter stated:

Unfortunately, we do not have the resources to facilitate commencement of the pump therapy at this time. In order to do so, the person involved will need to attend a specific programme and have follow-up support by a nurse specialist dietician in order to safely manage the patients on insulin pumps. We have a number of patients awaiting this programme and we are trying to identify funding streams for this service requirement.

The issue is that the specialist diabetic nurse is not in place. The diabetic nurse is there and still works in the hospital but was seconded away from service to another part of the hospital and was not replaced. This has gone on for almost two years now. I understand that, when talking about the national children's hospital, it is a situation that involves huge money. However, this situation in Sligo is not a big one to resolve, which is why I and these patients are so frustrated. It takes so little to solve it, yet it seems to be impossible.

Every time a Deputy raises the issue of the national children's hospital and suggests in some way, shape or form that it is a hospital for Dublin-----

I did not suggest that.

-----I am going to make the point, and it is not particular to Deputy Kenny, that children from Sligo will benefit from this massive investment we are making in children's healthcare, which was promised years ago and debated but about which nothing was done. We are now getting on with delivering it.

In regard to the adult insulin pump services, in fairness to Deputy Kenny, he and Grainne McCann, the manager in Sligo University Hospital, have highlighted an issue. The issue is that, in order to run an adult insulin pump service, there is a requirement for a dietician and for a clinical nurse specialist. We are in the process, after budget 2020 this week, of preparing the HSE budget, service level agreements, allocations to hospital groups and the like for 2020. Therefore, it could be timely to engage with the Oireachtas Members for Sligo, the hospital and the HSE to see if this is something we can progress.

As I said, I accept the Deputy's sincerity and he has raised the issue many times. There are 30 adults who could benefit from this and I will work with him constructively to see if we can assist Sligo University Hospital to make progress on this in the coming weeks.

Question No. 13 replied to with Written Answers.

Hospitals Building Programme

Stephen Donnelly


14. Deputy Stephen Donnelly asked the Minister for Health if a design team has been appointed for the relocation of the Coombe Women and Infants University Hospital to the St. James’s site; if so, the progress made to date including the funding has been allocated in 2019; and if he will make a statement on the matter. [41263/19]

In line with best international practice, it is Government policy, as set out in the National Maternity Strategy 2016-2026, that stand-alone maternity hospitals should be co-located with acute adult hospitals. The national maternity strategy, the first ever national maternity strategy in Ireland - it baffles me that we never had one before - reaffirms the commitment to tri-location of maternity, paediatric and acute adult hospital services on the St. James's site campus by relocating the Coombe Women and Infants University Hospital to the campus following the development of the new children’s hospital. The development of the maternity hospital on this site is acknowledged as a key service objective by the principal stakeholders in order to provide the infrastructure to support implementation of the national maternity strategy.

All capital development proposals, including the relocation of the Coombe Women and Infants University Hospital to the St. James’s site, must progress through a number of approval stages, in line with the public spending code, including detailed appraisal, planning, design and procurement, before funding for each stage can be confirmed.

A site capacity study was undertaken to demonstrate in general terms that the overall St. James’s campus has the ability to accommodate the proposed maternity hospital facilities and achieve the intended configuration. This capacity study was included in the planning application documents for the children’s hospital. It identifies a location on the campus for development, and the likely decant and enabling works requirement.

The recently published HSE capital plan provides for the project brief to be progressed as part of the strategic assessment stage. The appointment of a design team will be considered on completion of the project brief and the assessment stage.

To cut through all of that, although Deputy Donnelly and myself go hammer and tongs at each other on some issues, he made a valid point on this, namely, that we should be doing some of the preparatory work for the Coombe to move to St. James's while the children's hospital is being built. I do not disagree with that. In the HSE capital plan that was recently published, we decided to go ahead and appoint a project brief team. Once it concludes its work, we should then be in a position to consider the appointment of a design team. I am very favourably disposed towards this. When the project brief is concluded, I will come back and interact with Deputy Donnelly further on it.

I thank the Minister. It is a sensible suggestion from Deputy Donnelly that the preparatory work would be put in place so that, when the Coombe proceeds to move to the St. James's site, it would be ready to proceed as quickly as possible. The national maternity strategy is a good strategy but there are concerns there is a lack of progress in the implementation of that strategy.

Question No. 15 replied to with Written Answers.

Hospitals Building Programme

Eamon Scanlon


16. Deputy Eamon Scanlon asked the Minister for Health the status of the allocation of funding for additional and urgently needed medical beds at Sligo University Hospital; and if he will make a statement on the matter. [41173/19]

I want to ask the Minister the status of the allocation of funding for additional and urgently needed medical beds at Sligo University Hospital, and if he will make a statement on the matter.

Just minutes ago, I was talking about the works on the new diabetes facility for Sligo which is starting next week, and I know that is news the Deputy will welcome.

The HSE recently published its capital plan for the next three years, outlining projects to be progressed over the three-year period. The capital plan includes a new ward block development and additional bed capacity at Sligo University Hospital and this is currently at design stage. The HSE is responsible for the delivery of infrastructure projects and it has advised me that preliminary design work and site investigations have been carried out for this new development at Sligo University Hospital. Planning approval was granted in July 2019 and the project is currently at the detailed design stage. I will be happy to keep the Deputy informed as it progresses further. I visited Sligo and I very much see the need for this facility. It is included in the capital plan and its current status is that it is at the detailed design stage.

I thank the Minister for his response. As he knows, our hospital is one of the worst in the country at this stage for patients on trolleys. It is important, therefore, that the issue be followed up as quickly as possible.

Written Answers are published on the Oireachtas website.