Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions

Health Services

David Cullinane


31. Deputy David Cullinane asked the Minister for Health the measures he has undertaken or will undertake as part of the winter plan to protect capacity in the health service, to ensure maximum possible uptake of the flu vaccine, secure sufficient staffing levels and bed availability, deliver Covid-19, non-Covid-19 and catch-up care; and if he will make a statement on the matter. [23639/20]

My question relates to the very serious challenge that acute hospitals in our health service will face over the next number of months. We have been hearing for some time from the Minister for Health, Deputy Stephen Donnelly, that he will produce a winter plan. By the way, I want to wish him well and I very much hope that a negative result comes back. He has said that he will produce a winter plan. This is not just about a winter plan but also about Covid, non-Covid and catch-up care and a plan that enables us to do all of that. My question asks how that is going to happen, what supports and measures are being put in place and what funding will be made available.

I thank Deputy Cullinane for his question. As we all know, the Minister for Health has been feeling unwell, has been referred for a Covid-19 test and is self-isolating. We all wish him well.

I will endeavour to answer the questions posed as fully as possible. If any of my answers are insufficient, written answers can also be provided. In reply to the Deputy's very important question, resuming health and social care services and building health sector capacity and capability is a priority for the Government. The coming winter is expected to be particularly challenging due to the presence of Covid-19 and the uncertainty around the level of Covid and non-Covid health care demands. Every winter is challenging but there is no doubt that with Covid-19 this winter is going to be particularly difficult. The HSE is finalising a plan, in line with Sláintecare principles, for delivering services in a Covid pandemic for the period to December 2021 and incorporating winter 2020-21. The initiatives in the plan to mitigate the winter pressures are under three headings, namely, community care, acute care and assistance to support hospital egress. Timely discharge from acute hospital settings is hugely important. Throughflow in hospitals is vitally important so that there will be capacity at the emergency department end. This will include increasing hospital and community capacity, reducing unnecessary hospital admissions by enhancing alternative community care pathways, and enabling timely discharges from acute hospitals, and consequently reduce waiting times in hospital emergency departments. There will be a focus on targeted actions to shift care to home and ambulatory care environments, especially for high-risk cohorts such as elderly patients and those with chronic illnesses.

As the Deputy knows, the pandemic has borne down hardest on our older generation. I have for many years been an advocate for the correct wrap-around supports for our elderly generation living at home, which is what this plan hopes to achieve. Obviously, older people are not in a position to go to day care centres or to be out and about, so they need the supports, rehab and re-ablement at home. Disability and mental health services, e-health and staffing will also be included in the plan.

The resources for the plan will be sought as part of the 2021 Estimates process. In advance of this, the Government has allocated €600 million to support the early roll-out of the winter-specific measures in this plan, with €200 million up to Christmas and €400 million thereafter. This will facilitate the commencement of priority measures from an operational perspective.

A key action will be a comprehensive flu vaccination programme. The HSE has placed orders for approximately 1.35 million doses of the quadrivalent influenza vaccine, as well as 600,000 doses of the live attenuated influenza vaccine, which will be made available to children aged from two to 12 years old, inclusive.

In regard to acute bed capacity, the programme for Government, Our Shared Future, commits to continuing investment in our health care services in line with the recommendations of the health service capacity review and the commitments in Project Ireland 2040. The Minister's Department is working with the HSE to increase both general and critical care acute capacity in hospitals nationwide.

It is very important, as we face into the winter, that we are very conscious of the most vulnerable in our society. We are talking about people with mental health issues, the elderly and people with disabilities, especially those with acute disabilities. I would also like to mention carers, given I hosted a round-table for carers this afternoon. Carers have been to the fore in the past six months, during which they had to cocoon at home with their loved one.

I am very conscious of the most vulnerable people and I am very conscious they are people we have to protect over the next weeks and months. It is not good enough that the HSE is only finalising a plan. We have an unprecedented crisis facing us. Although we thought we saw chaos over recent weeks and months, unless this Government get its act together, unless a real, aggressive, robust plan is put in place to deal with the challenges facing our healthcare services in the next while, and unless that plan is as robust as it needs to be, then the Minister of State and the Government are failing in their duty.

We have a perfect storm coming at our health services. Our front-line healthcare workers need support. People need to know they will get treatment and that the capacity will be there. I did not hear one word in the Minister of State's answer about how many additional beds or staff will be made available, what capacity will be leveraged in the private sector or how we are going to make sure we can deal with both Covid and non-Covid care. All I got is a statement of the obvious and no plan.

The Deputy is correct we are living in unprecedented times. I do not think it is a statement of the obvious to announce €600 million to support people in the winter plan that runs throughout the winter until after Christmas.

The Deputy is right when he says bed capacity is the most important thing going forward. The whole purpose of this plan is to try to keep as many people in their homes and in the community. The Department of Health is working with the HSE to increase acute capacity in hospitals throughout the country in the context of the current Covid-19 pandemic response. Funding was provided in March for an additional 324 acute beds, which brought the reported acute inpatient capacity to 11,597 beds, excluding critical care beds. This was an average of 11,000 inpatient beds open during 2020 up to the end of July. There were 304 general acute beds and 41 adult critical care beds available in the system on Thursday, 10 September.

The Minister of State gives me a figure of €600 million and no detail of what that will mean. I published a plan in the first week of August and we set out what is necessary. The last figures we got from the National Treatment Purchase Fund, NTPF, showed 610,000 people - record numbers - waiting to see a consultant. They showed that inpatient and outpatient waiting times were up and that, across all of the specialties, people are waiting longer. However, there is no sense of urgency from this Government and no idea what is facing front-line healthcare workers.

As to the planning that goes into putting the extra staff and the extra beds in our hospitals, we know it takes time. However, coming with a plan in the middle of September when we know the crisis is here and now is not good enough, in particular when we have been asking the Minister for months to come forward with a plan. It is not good enough to throw out a figure and say that we will spend a certain amount of money at some point and that we will come in at some point.

We had a plan announced by the Government today on living with the virus but there is no Government time to debate it. I hope that when it announces its winter plan, there will be proper statements in the Dáil so the Minister can be held to account.

I take the Deputy’s point, which is well made, but he has to remember we are living in unprecedented times. We are learning as we go along. When the Covid pandemic hit in March and April, all of our capacity was put into the acute hospital sector because that is what we had learned from seeing what was happening in Europe. Unfortunately, the pandemic bore down hardest on our older generation. We lost 985 people in our nursing home system, and 54% of all those who have died to date were lost in the nursing home sector.

A huge amount of work is being done. Testing, tracing and isolating are the bywords of what we have to face going forward. Even though the Deputy says there is no detail, the detail will follow. I know, for example, that we are looking to double the amount of home care supports for our older generation, and we are looking at rehab in the home and at re-enablement in the home to protect our older generation and to keep them out of the acute hospital setting. While there are many challenges ahead, I believe we have a fantastic front-line service which is well up for the challenge.

Mental Health Services

Michael Lowry


32. Deputy Michael Lowry asked the Minister for Health if a commitment will be given to prioritise increased funding for mental health services in County Tipperary and nationwide in budget 2021 to prevent the Covid-19 crisis from turning into a national mental health crisis (details supplied) [24045/20]

Will the Government give a commitment to prioritise increased funding for mental health services in Tipperary and nationwide in budget 2021? I ask that question in the context that, last week, the HSE head of operations said there has been a significant increase in referrals to mental health services as a result of Covid-19. As we know, mental health services were already overstretched before the pandemic, meaning services now need substantial investment if people are to get the mental health supports they need when they need them.

I thank the Deputy for his question. I will be engaging in detail with the Estimates process and seeking additional funding for all mental health services. The challenges of Covid and living with the virus have caused huge problems for those with mental health issues and challenges. In line with the programme for Government, promoting positive mental health and reducing the burden of illness can have benefits for everyone. Mental health service users are among the most vulnerable people in Ireland.

I know the Deputy has been a long-time advocate for mental health service users in Tipperary. As he knows, I have visited Tipperary on three occasions since I became Minister of State with responsibility for older people. I first met with Oireachtas Members. On a second occasion, I met again with Oireachtas Members and with different support groups in Tipperary which are trying to support people with mental health issues. On a third occasion, I visited South Tipperary General Hospital and stayed there for three hours. Further to that, I also visited St. Luke's Hospital in Kilkenny, including the department of psychiatry, to see the exact situation in regard to inpatient beds. People with mental health issues from south Tipperary who need inpatient supports go to St. Luke's in Kilkenny and those from north Tipperary, the Deputy’s own area, go to Ennis Hospital for those supports.

I am acutely aware of the challenges in the area and that the Deputy is very concerned there are no inpatient beds in Tipperary itself. However, I believe the bed capacity is there at Ennis and at St. Luke's. For example, last year, the capacity in the department of psychiatry in St. Luke's was at 85% for the whole year.

I appreciate and acknowledge the Minister of State's commitment to improving mental health services in Tipperary and all of us recognise that. The problem is whether she has a budget to deliver. I have no doubt the Minister of State is well meaning, but I remind her that Tipperary is a large county with a population of 160,000 people.

The distance from Lorrha at the northern end of the county to Carrick-on-Suir is 130 km. The mental health strategy and the policy enforced on Tipperary by the then Minister of State, Kathleen Lynch, deprived our patients of access to vital services. The people of the county who have mental health issues are at a disadvantage. The county is left without a single acute mental health bed. There are no proper respite mental health beds. Access to crucial services is split between Ennis and Kilkenny. The system has not worked for Tipperary. It is a failed policy. The neglect of our mental health patients is indefensible. The extent of the deficit in services is bordering on irresponsible. The Minister of State needs a budget to correct it.

I will refer to the budget first. Budget 2020 saw the Government continue its commitment to mental health by increasing funding by €39 million to €1.026 billion. This represents an increase of over €315 million or 45% since 2012. Admittedly, we have a long way to go, and I am very conscious of that. I have three priorities for Tipperary. My first priority and commitment is to have Jigsaw open in Thurles before Christmas. I have given that commitment and I will follow through on it. The second commitment I gave previously, and this is where the budget Estimates are involved, is to seek €2 million in those Estimates to redo the crisis house in Tipperary which I believe is not fit for purpose. Third, under Sharing the Vision I will task the national implementation monitoring committee with completing a review of mental health bed capacity throughout the country. There are major issues in the south east, not only in Tipperary. Waterford and Wexford have the same issues relating to capacity. The first thing I want the committee to look at is bed capacity, and then we will work from there.

The reality is that the mental health budget has remained at 6% of the overall health budget for many years. There are fewer staff working in mental health services than there were in 2008. In January 2020, there were 10,642 individuals waiting for 12 months or more on waiting lists. There were also 2,000 children and young people on the waiting lists. In regard to Tipperary, at a time when there are dramatically increased levels of stress, anxiety, depression, isolation and loneliness, the lack of access to mental health services is inexcusable. At a time of great vulnerability, mental health patients in Tipperary are reaching out to an empty space. The lack of access to professional care, guidance and support is unacceptable. It must be seen as a priority for the Minister of State and this Government.

When I visited the emergency department, ED, in South Tipperary General Hospital, I was delighted to meet the team operating there. All mental health patients attending the ED are triaged in accordance with assessed clinical need with the objective of referring them as soon as possible to the HSE mental health service when they are discharged from the ED. The ED has a 24-hour mental health nurse liaison service for mental health patients, seven days a week. This was put in place in 2012 when St. Michael's closed down. Many other areas in Ireland would love to have similar supports. I spoke at length to the mental health liaison nurse on duty, who is one of three who deliver this 24-hour service. We discussed many issues that were raised with me previously, including voluntary and involuntary admissions, transfer of service users, assessment and the department of psychiatry. There are two rooms dedicated for that purpose. One is for the nurses and the other is for the patient as soon as he or she enters the ED and has been triaged. I will give the commitment I gave previously, which is that I will continue to work with all Deputies in Tipperary to try to improve the mental health services there.

Covid-19 Tests

David Cullinane


33. Deputy David Cullinane asked the Minister for Health the steps being taken to ensure a proactive and robust testing and tracing regime to support the plan for living with Covid-19; the way in which Ireland compares with the EU and other comparator states such as New Zealand in terms of testing and tracing capacity and performance by tests per capita; and if he will make a statement on the matter. [23640/20]

This question relates to testing and tracing. Testing and tracing are the foundation of getting everything right over the next number of months. We have been asking the Government for some time to ramp up testing and tracing. In fact, the calls we made were rubbished and dismissed by the Taoiseach and the Tánaiste in the past. We now see that we were right and we are paying the price for the fact that we do not have enough capacity. What action is the Government taking to ratchet up capacity in testing and tracing?

This is a very important question because the entire premise of Covid is test, trace and isolate. A comprehensive, reliable and responsive testing and tracing operation is central to our public health strategy.

Capacity has been in place since early summer to test 15,000 people a day. While the system came under pressure in recent weeks, overall the system is working well and is proving central to our public health response. Rigorous contact tracing, automatic testing of close contacts, serial testing in high-risk environments and large-scale testing in outbreak situations mean we are proactively finding more cases than we would have found previously. Today, we learned that there are 357 cases and, unfortunately, three people have lost their lives. I offer my sympathies and condolences to their families.

In recent weeks we have needed to flex resources up significantly as demand has increased. We are testing more people than ever before, with over 71,000 tests completed in the week ending 12 September. Community testing has increased in line with a steady increase in the prevalence of the disease and the HSE has deployed additional resources to meet this increased demand.  This included the opening of additional community testing centres and mobile pop-up testing units, significantly increased contact tracing teams and increased laboratory testing.

Our testing strategy and infrastructure compare well internationally. We are in the top third of EU countries in terms of tests completed as a percentage of the overall population and capacity levels and turnaround times are similar to those of many countries. We are also going further than many other countries in pursuing a robust testing strategy, which includes testing of close contacts and serial testing in nursing homes and food processing facilities.

That is not to say we cannot improve further. We can always improve. I acknowledge that the system has come under strain in recent weeks. The HSE is now finalising a future service model for testing and tracing. The plan includes the recruitment of a permanent workforce, which has already commenced, and a range of other service improvements which will be rolled out quickly. Transition to the new model is under way and will continue throughout the autumn.

The plan announced today will only be effective if we get testing and tracing right. It will not be worth the paper it is written on if the failures of recent times continue. That is not to say testing has not been happening because it has, but it has not been happening at the rates at which it should be happening and it is not quick enough, despite all the promises that were made. We have been calling for this for some time, but those calls have fallen on deaf ears. We saw what happened in meat plants and we see what is happening in Dublin. Testing and tracing must be used to hunt down this virus. The Government said it could reach 100,000 tests per week by the middle of May. It has not done so. Now the Minister of State talks about hiring more staff. Why were the staff not hired last month, two months ago or three months ago when we were raising these concerns in the Dáil? My party leader raised them directly with the Minister of State's party leader. She also raised them with the Tánaiste when he was Taoiseach, with the Minister for Health and with the previous Minister for Health. It is only now that the Government is getting around to providing the extra capacity. It is not good enough and it undermines confidence in the Government.

As I said, 71,000 people were tested last week. We have had to ramp up testing considerably in the last four to six weeks because Covid has changed and is changing. It is more prevalent in communities now. In March, April and into May we were testing many people, but we managed to flatten the curve. The lockdown worked. People stayed at home and did not move further than 2 km from their location. However, as soon as we started to reopen society, Covid returned. Covid is not going anywhere. It is lying dormant and is in our communities. Some 30 community testing sites are open and three pop-up testing sites have been mobilised in Limerick, Tallaght and Carlow-Kilkenny. The Deputy is right that we cannot rest on our laurels. Testing, tracing and isolation are the way forward. It is the only way to flatten this virus. I have no doubt that the Minister will make every effort to ensure we will ramp up capacity wherever it is needed. However, 71,000 people were tested last week.

Testing and tracing are the way to stay ahead of the virus.

Of course, when people were in lockdown the numbers were going to go down. My point is that it was pointed out that when the economy started to reopen we would see more community transmission and the virus would look for places to spread. That is what happened. The way to prevent that, because prevention is what we need, is to ratchet up testing and tracing. The Government failed to do it in nursing homes originally, and it failed to do it in meat plants.

The Minister of State may have heard of a cluster in a meat plant in our constituency. She might have seen stories in a local newspaper of a bus packed to the rafters with people going to work. This is what is happening. Testing was not being carried out in these areas. I am holding the Government not to my standard but to the standard it set for itself. It has never done 100,000 tests a week. It is only now telling us that it is recruiting staff on the same day it launched a plan on how to live with the virus. That is simply not good enough.

Testing of staff in nursing homes has been ongoing for the past two months and has proven very effective. As regards the meat factory the Deputy mentioned, I have two family members who have worked there for a very long time and they were tested last Thursday. There was a hullabaloo that there was no testing in meat factories last week, but in Dawn Meats in Grannagh over 800 people were tested last Thursday. We have to deal with the facts. The HSE is adding swabbing capacity in Dublin, Wicklow, Kildare, Louth and Galway. Pop-up testing centres remain in place in Limerick and Carlow and there is additional staffing and longer opening hours in many sites. We must remember that at the start of the pandemic, many front-line workers were redeployed to the test, trace and isolate service because the ordinary person did not understand it. People needed to have a medical background. We know so much more now and permanent people will be put in place. As the virus was suppressed and the curve was flattened, these medical people had to go back into the acute system to deliver non-Covid services.

Question No. 34 is in the name of Deputy Cullinane again. He was very lucky in the draw.

That is what happens when a party wins 37 seats.

Budget 2020

David Cullinane


34. Deputy David Cullinane asked the Minister for Health if promised medical card eligibility expansions and reductions in prescription charges made in budget 2020 will be commenced in 2020; the reason for the delay; if funding is being made available for same in 2020; and if he will make a statement on the matter. [23641/20]

In last year's budget, the Government announced that it would extend the medical card to seven and eight year olds and extend medical card eligibility for the over-70s by changing the eligibility criteria and the thresholds for entry. It also promised that all people with a terminal illness would have a medical card, and examining that issue was in the programme for Government. We passed a Bill on this matter in this House a number of weeks ago. There has still been no progress on these issues and my constituency office is inundated with people asking when this is going to happen. The Minister of State now has the floor and has the opportunity to provide clarity.

I thank the Deputy for keeping me on my toes today.

First, I acknowledge the difficult year older people in our society have experienced as a result of Covid-19. They have shown tremendous resilience in helping to fight the spread of Covid-19. The issue the Deputy raises is one that is very close to me as Minister of State with responsibility for older people and mental health.

Budget 2020 provided for an increase in the medical card thresholds for persons aged 70 and over. The threshold is currently €900 for a couple but would increase to €1,050.  While it was intended that this measure would be implemented from July, it was not possible to legislate for the necessary amendments to provide for this measure until there was a fully constituted Dáil and Seanad. The Deputy is quite correct. The Minister for Health, Deputy Stephen Donnelly, was very pleased that his first piece of legislation was the Health (General Practitioner Service and Alteration of Criteria for Eligibility) Act 2020, which provides for the increases in the income thresholds.

When that measure was proposed in the budget last year, it was set to be introduced if sufficient savings were made in the health budget this year. As we are all aware, that is not possible at the moment. Those savings have not been realised as the pandemic has placed a significant demand on public finances, a substantial proportion of which have been allocated to the health system. In that context, decisions on the associated funding and a potential implementation date are being actively considered. I have sat down with the Minister on this matter because it is something we need to move on. I want to see it happening and it will be discussed in the context of the budget. I am hopeful that we will be able to bring this in. It would mean that for those over 70 who have an income of €900 and have missed out on a medical card, the threshold would increase to €1,050. I will be pushing this issue hard.

I do not think those over 70 will take any comfort from the fact that this might be addressed again in this year's budget. I do not doubt the Minister of State's sincerity or her association with this issue. The problem is that last year, in my constituency and around the State, Government Deputies were going around saying that this was one of the great things they had in the budget. They said that more people over 70 would get medical cards, as would seven and eight year olds, but that has not happened. We are now hearing that it might happen and it might be in this year's budget again. The fact is that the money should be provided to make it happen. Parents have contacted me whose children have passed the age of six and are now seven or eight. They say that they were promised this and were told it was in last year's budget. They are asking what is happening. The negotiations with the Irish Medical Organisation on this matter have not even occurred. The Minister has not even started discussions with the medical organisation to see what can happen. We need more answers and more clarity than "may" or "might", given that this was in last year's budget and was voted on by this House.

Can I ask something?

On the next round, not during priority questions.

As the Deputy will be aware, I am here representing the Minister for Health. I am glad the Deputy accepts my bona fides on this matter because I have spoken to the Minister about it and we are very anxious to make progress on the medical cards. Currently, 75% of persons aged over 70 have a medical card and if the potential beneficiaries, which could be up to 56,000 people, materialise then an increase in the income thresholds would result in over 88% of this cohort being eligible for a medical card. It is an important health measure which will provide medical card eligibility to a greater proportion of people over 70. All I can say here today is that I will continue to push this issue with the Minister. We are in an unprecedented times. Over €600 million has been allocated today for supports which will be seen in the next week or two. The Deputy has a guarantee from me that I will continue to push this.

I will make the point again that this was voted on in last year's budget. I do not think there is a Deputy in this Chamber, whether Government or Opposition, who has not been lobbied or received correspondence from parents of children and from older people about this.

I also raised the issue of cancer patients and other patients with terminal illnesses who were promised that medical cards for them would also be examined. When Fianna Fáil was involved in the confidence and supply agreement and was taking credit for all the good things it saw in the budget, but not the bad, the extension of eligibility for the medical card was one of the good things. Deputy after Deputy on the Government side took credit for it. Deputies from Fianna Fáil were falling over themselves to claim credit for the fact that children were going to get medical cards when they were seven or eight years old and more older people would get medical cards, but it has not been delivered. It is a broken promise. We are now being told it might be included in this year's budget. If that is the best I can bring back to the people in my constituency who have contacted me, I do not believe, on their behalf, that it is good enough.

I can certainly say that I was not one of the people who said this was a done deal because it was always contingent on there being a surplus in the budget in 2020 to deliver it. That was the small print that was written into it but who bothers with small print?

That is not what the Government says at budget time.

I was very clear on that. This was always dependent on a surplus. We are in unprecedented times. There is a pandemic. The Minister for Health has gone home because he is sick and he has to have a Covid test. We need to be very careful where we are. Some 357 people died today and our focus has to be on Covid. I want to see the threshold extended and I will be pushing hard for that during the Estimates and the budget. I have given that commitment on the floor of the Dáil. I have spoken to the Minister and he wants to see the same thing happen.