Ceisteanna Eile - Other Questions

Vaccination Programme

Bríd Smith

Question:

82. Deputy Bríd Smith asked the Minister for Health the reason students in the healthcare sector who are working in public hospitals and on the front line of services during the Covid-19 pandemic are being told they must get the flu vaccination shot and must pay the full cost themselves; if he will arrange for such students to be reimbursed the costs; and if he will make a statement on the matter. [42324/20]

We have heard a lot about student nurses and the work they are doing on the front line at the moment. I want to ask specifically why they are being asked to pay for the flu jab. It is perfectly understandable that they would receive the flu jab given that they are front-line workers and working very hard with patients in Covid wards etc. Why, particularly when they are not being paid for the work they do, are they expected to pay for a simple thing like the flu jab? A number of nurses have come to us about this issue. I would like a comprehensive answer from the Minister.

I thank Deputy Bríd Smith for her question. When I received the question, it alarmed me because it suggested something that should not be happening. As a result, I asked for it be looked into.

The flu vaccine is free for all healthcare workers working in our public and voluntary hospitals and to all healthcare workers delivering front-line services. It is also available free of charge to all students on clinical placement. Students can access it in local occupational health clinics, vaccination clinics staffed by their peers or at their local GP or pharmacy. My Department and the HSE are not aware of a situation where students on clinical placements have been charged to receive the vaccine. If the Deputy is aware of individual cases where this has occurred, I want to tell her categorically that it should not have happened. If she would like to revert to me with any individual cases, I guarantee her that they will be followed up.

This year, given the potential for the winter flu season to coincide with a resurgence of Covid infections, and the importance of minimising hospital attendance, the Government expanded the provision of vaccination without charge to all of those in the HSE defined as being at-risk groups, including healthcare workers. The amount of vaccine made available for this winter is almost double the amount of vaccine administered last winter. Healthcare workers are at an increased risk of getting flu. They also have the potential to spread the flu by virtue of their contact with patients. Likewise, they can prevent the spread of flu by getting the vaccine. It is recommended, therefore, that everyone working in a healthcare setting should get the flu vaccine. This includes medical, nursing and allied health students, including those working in residential disability services.

I thank the Minister for his answer. I will provide him with the information I have. Again, we are hearing, in regard to student nurses, that something should not be happening. It should not be happening that they are not getting paid for work they are doing. It should not be happening that they are working instead of studying. It should not be happening that they are not supervised. It should not be happening that they are working instead of learning. However, all of those things are happening. I totally get that workers who work on the front line need to be protected from the flu, but the problem is that they are being asked to pay for it. I will send the Minister the information on that.

Maybe the problem is that they are not defined as workers when they are working. The Minister's reply referred, at the end, to all students, but it also referred to those working in the health sector. At the very least, we need to recognise that student nurses are actually working and we need an assurance that this will not happen in the future. I ask the Minister to clarify that it will not happen. I will give him the information I have.

I thank the Deputy. The two issues are separate. There is the question of vaccinations and the question of students and the allowances they should be paid. I know the Deputy and others are advocating that they become part of the paid workforce. The colleges are strongly opposed to that and are very worried about it. They believe the comparisons with the apprenticeship model could set the profession back decades. Comparisons have been made in this House with Australia, where they run an apprenticeship model and a graduate degree model. The opportunities available to the degree programme graduates are significantly better than those available to the apprenticeship graduates. A lot of the really exciting and important developments in the nursing and midwifery professions happening right now are because they are degree graduate students, including enhanced nurse practitioner specialist roles and so forth.

Specific to the issue at hand, it is clear policy of the HSE that all students get the vaccination for free. I would be very happy to look into cases of individuals who are coming to the Deputy. As Minister for Health, I very much want to know if any of our students, on their clinical placements, are being charged. I will act on it if that is the case.

I appreciate the Minister's answer but the fact is that it is almost like the Government is blinkered to the fact that we are still in a pandemic. That is ignored and we are told that they should be students and they should be training. In fact, they are students and they are working. It is not that we are demanding that they become part of the workforce. We recognise that they are students but we also recognise that they should be paid for every hour they work. It is work that a normal care worker would do, including emptying bed pans, washing patients, taking their vitals and sometimes administering liquids and fluids to them. It is not that they are not working. When one is not being paid for one's work on the front line, being asked to pay for the flu jab is adding insult to injury and it really needs to stop.

The Minister wants me to draw attention to specifics but a lot of things happen in the HSE that should not happen. I know care workers in the HSE who have basically been witch-hunted for making any criticism of their employment or their employer. It really is not acceptable that it is like the politburo for workers who work within it. Some of these nurses are nervous about giving their names for that very reason. There is a bad culture there and this is only another example of it. The culture we have to stamp out is the exploitation of student nurses.

We are talking about a different issue now but I am very happy to talk about it. There are two separate issues. One is whether students are being asked to do inappropriate activities while on their clinical placements. Various testimonies have been read out in the Dáil and various students have given testimony in the media and online. As Minister for Health, I take those allegations deadly seriously. I have initiated a full review of all of the allegations. I am meeting with all of the directors of nursing on these allegations. There cannot be a situation where these students are being treated as workers. It is imperative, as part of their degree education, that they are full-time students. In first, second and third year, they spend the majority of their time on campus. The HSE provides clinical placements where they can link theory and practice. I can tell the Deputy that their educators are strongly opposed to the idea that they would become part of the paid workforce in the HSE. In essence, their argument is that they want to protect them as students and protect their learning, and if we start paying them as workers in a system, they could be treated as such.

As the Deputy will be aware, I am seeking a short review, to be finished by the end of this month, in co-operation with the representative bodies, to look at the allowances for student nurses. We want to see if we can increase the allowances during the Covid period to reflect what is a very difficult time. If such a recommendation is made, then I have committed to the students and I have committed to their representative organisations, in writing, that those increases in allowances would happen from January.

General Practitioner Services

Pádraig O'Sullivan

Question:

83. Deputy Pádraig O'Sullivan asked the Minister for Health if consideration will be given to providing an out-of-hours general practitioner care service urgently on the north side of Cork city; and if he will make a statement on the matter. [41268/20]

Mick Barry

Question:

157. Deputy Mick Barry asked the Minister for Health the measures he will take to ensure the recommencement of SouthDoc general practitioner out-of-hours services to the north side of Cork city; and if he will make a statement on the matter. [42429/20]

I want to raise the issue of the urgent need for an out-of-hours GP service on the north side of Cork city. The Blackpool SouthDoc service, which had served residents on the north side, closed in March. According to doctors practising locally, people have had to walk miles for the one operational service, which is situated in an industrial estate off the Kinsale Road roundabout in the south side of the city. While it is accessible by car, many of the people I have spoken to do not drive. The route is difficult for them to access on public transport and the cost of getting a taxi is becoming an issue for them. As the second biggest city in the country, there is an absolute need for a second service. Will the Minister outline whether the HSE has made plans to address this issue or reinstate the service in Blackpool?

I propose to take Questions Nos. 83 and 157 together.

I thank the Deputy for his question and acknowledge his ongoing advocacy on this very important issue for the region and for his constituency. GP out-of-hours services for Cork and Kerry are provided by SouthDoc. The latter is a private organisation with more than 20 locations across the two counties, including a treatment centre in Blackpool that provides for patients on the north side of Cork city. Further to public health guidance and the curtailment of in-person patient consultation, SouthDoc closed a number of treatment centres from 14 March last. This was done in response to Covid-19 in order to protect both patients and staff and to limit the spread of the virus. Other than the Blackpool centre, all centres in Cork city and county have since reopened.

Cork Kerry Community Healthcare has written to, and met with, SouthDoc, requesting that the reopening of the Blackpool centre be prioritised.

Cork Kerry Community Healthcare has also requested a plan for SouthDoc to reinstate services and a timeline for this. While a timeline has not yet been received, the temporary nature of the closure has been confirmed. SouthDoc has assured the HSE that every possible effort has been made and will continue to be made to avoid or minimise any impact of the temporary closures on patients. The Government has supported the continuing provision of necessary out-of-hours GP services during the pandemic through a grant issued to service providers, including SouthDoc.

I thank the Minister for his response. I appreciate the impact Covid-19 has had on all services throughout the health system. It is my understanding that SouthDoc services throughout the city and county were closed at the onset of the pandemic to curtail the spread of the virus. However, as the Minister has acknowledged, all centres in Cork city and county are open except for the one in Blackpool.

I do not expect the Minister to be overly familiar with the north side of Cork city. For his information I note that there is a purpose-built medical centre, St. Mary's Health Campus in Gurranebraher, which could house a new-out-of-hours clinic. A service in this area could also provide for the people of Tower, Blarney, Grenagh and Whitechurch. The demand for this service is greatest on the north side of Cork city. One of the main issues here is the need for access to healthcare among people without transport. I would welcome any further elaboration on the possibility of using St. Mary's Health Campus as a facility for SouthDoc in the event that the Blackpool centre cannot be opened.

I wish to restate that this is an unacceptable situation for people on the north side of the city and beyond who have to travel to the other side of the city for out-of-hours care. Someone with a car might be able to deal with the situation. Someone without a car who faces an emergency with a young child must spend €40 on a taxi. That is completely and totally unacceptable.

I note that in reply to Cork Kerry Community Healthcare, SouthDoc has stated that this is temporary. The question is how temporary it is. Can we have a guarantee that if and when facilities are reinstated, this will not be a skeleton service with someone on the phone taking notes but no cars going out to visit people in the community? The people of the north side of the city and beyond deserve a comprehensive and fully staffed out-of-hours GP service. Can the Minister guarantee they will get that?

I thank both Deputies for their responses. As Members will know, all of the relevant services were closed during the Covid-19 pandemic. I have no doubt that the fact that the Blackpool centre remains closed is very frustrating for the people of the north of the city whom the Deputies represent. Reopening it is a priority. The HSE has engaged with SouthDoc to ask for the centre to be reopened and to request a timeline. It is frustrating that a timeline has not been provided. I undertake to follow up with the HSE to get one.

In response to Deputy Barry's question around the nature of the services to be resumed, I can say that nothing has been brought to my attention to suggest that a smaller or more limited service will be opened. I can revert to the Deputy with a statement to that effect from the HSE.

I thank the Minister for his response. The service closed in March. Other out-of-hours services reopened in June but the people of the north side of Cork city are still without a service in December. I urge the Minister and the HSE to make this a priority. Despite commitments to resolve the issue, months have passed and the situation is unchanged. People are becoming increasingly frustrated with the fact that this is the only unit that has not reopened. I stress the urgency of this matter and I hope the Minister can prioritise it as soon as possible.

The Minister says a timeline has not been provided but he will undertake to discover one. If the House does not mind me going into a rabbit hole, I must ask what the timeline is for the Minister to tell us the timeline. We do not want to know about this in January. We want to hear about it in the Dáil. Can we hear it tomorrow? If not tomorrow, can we have it early next week? The idea that the timeline will be kept secret from the people of the north side of the city until the Dáil reconvenes in January and the Minister has the chance to give us a timeline for a timeline is not acceptable.

I heard the Minister say he has heard nothing about the centre eventually reopening with a skeleton workforce providing a skeleton service. I advise him very strongly to put his ear very close to the ground on that. It is a very real danger here. That would be unacceptable to me and more importantly, to the people of the north side of the city and beyond.

I thank the Deputy. He asks a very fair question about timelines for timelines. I can make a commitment to both Deputies that I will have a response from the HSE in a matter of days. That does not mean SouthDoc will have provided the timeline that has been requested of it. I will re-emphasise the importance of this and revert to both Deputies on both issues in a matter of days.

Disabilities Assessments

Richard Bruton

Question:

84. Deputy Richard Bruton asked the Minister for Health if he has undertaken a review of the system for early assessment and prioritisation of therapies for children with special needs, which despite extra resources seems to continue to struggle to provide time supports; his views on whether the success on the pilot integrating therapies into the school provided model offers an opportunity of a different approach; and if he will make a statement on the matter. [41603/20]

First I wish to congratulate the Minister of State, Deputy Rabbitte, on her appointment. An earlier question noted parents' frustration with long waiting lists for both assessments and therapeutic intervention. They are waiting for admission to services like Beechpark Services. Frustratingly, the transfer from infant services to school-going services creates another blockage. These are sources of stress, uncertainty and fear of irretrievable loss of time. Can a different model be considered to better deliver for parents?

I thank Deputy Bruton for raising this vital question. As I said in my earlier contribution, one of my key priorities is finding a model that actually works. Let us have one list so that when a child reaches early years education or school and needs an assessment, it is done in a timely way and an intervention can be accessed. The intervention should follow all the way through. Children should not age into and then age out of the catchment of early years intervention without ever accessing a service. That is what I hope to achieve. The €7.8 million package was intended to form a basis for timely intervention.

A pilot scheme was set up in community healthcare organisation, CHO, 7 as part of the school inclusion model, which envisages the provision of a certain number of therapists. That proved very successful. The pilot was not completed because of the Covid-19 pandemic but funding has been secured by the Department of Education to ensure that therapists are part of the education system. When children are diagnosed and given therapy and a further follow-up is needed, services can continue until all therapy has been completed. No child would end up on a list.

The network disability teams have been reconfigured under the HSE. Some 91 of these teams will be geographically spread throughout the country. They will be fully populated. As of my most recent information, only seven team lead positions remained to be filled. A lot of reconfiguration is going on to put speech and language therapy, occupational therapy and physiotherapy services in place.

The model is coming together really well. We now have the opportunity to work through the school inclusion model. The network disability teams and the school and modular teams can work together so children can get the intervention they need in the appropriate setting and no appointments are missed. This is all about intervention. A new model is in place to allow for collaboration between education and disability services.

I would like to draw the Minister of State's attention to some of the features of the school-led model. It is far less reliant on assessment. The Minister of State mentioned the development of an assessment industry and the avoidance of the loss of a lot of very valuable time in those assessments. Parents previously had to spend €500 or €600 on private assessments, which serve only as a gateway to further treatment.

Perhaps there should be less reliance on assessment and more collective delivery of service, whereby both the resource teacher and the SNA within the school could supplement the professional therapies in order that, even between intermittent therapeutic interventions, there might be continuity for the child and less withdrawal of him or her from the group in the way these needs are handled. I think there are in that model the seeds of a better approach than the one embedded in the HSE. I worry that while huge money is being put into attempts to improve the HSE model, it might in its structure have elements that are not best practice and some of that money will not deliver the opportunities we hope it will.

Deputy Bruton has pulled together in his comments where we want to get to. The child should at all times get the necessary intervention. We should also equip the people who spend eight hours per day in classrooms in developing the skill sets they need to support the child in his or her pathway through education. We need to crack this nut - I used that phrase earlier - for the simple reason that there are too many lists and too many people responsible for them. We need a clear pathway. I see the value in the school inclusion model because we have the therapists who are dedicated to supporting the children all the way through their education as long as they need that support. Nobody should need to time out after six weeks of speech and language therapy while waiting again and wondering whether he or she needs another assessment to continue when he or she is part of the education system. I do not wish to speak on behalf of the education sector but I see completely the value in this.

I also see the value in the 91 network disability teams, which are geographically spaced and which work in collaboration. If children in schools need further intervention at a more complex level, the network disability teams will be able to support them. It is all about using the resources collaboratively and together, cutting out the assessment and getting to the intervention at whatever level the child and the family need it. The frustration of families at present is that they get letters back telling them it could be two years before their child will have his or her initial therapy. Then the child has to get further therapy and is put on another waiting list for that. These children are ageing out of their early years and going to secondary school without having got the other intervention they needed in the beginning. That is where we need to get to.

The frustration I think people feel is a little like when Secretary of State Kissinger asked, "Who do I call if I want to call Europe?" One does not know who to ring. I think parents have the same experience. Who do they ring when they want to find out from one of these 91 teams where their child stands? This is a very frustrating element and it needs to be sorted out.

I welcome the Minister of State's commitment to meet the Minister of State, Deputy Madigan, and her work with the Oireachtas committee. For those of us Deputies who do not have the privilege of attending those meetings or being on the Oireachtas committee, could the Minister of State, Deputy Rabbitte, perhaps include at least me in some of this work in order that I might get an insight into the way in which the Department sees this developing? I would like to contribute in some way.

Absolutely. I would welcome more involvement of people with experience for the simple reason that I think we all want the one thing: we want the families to get their interventions. We do not want lists upon lists. I look forward to working with the Minister of State, Deputy Madigan, on this. I believe in the network disability teams, coupled with the school inclusion model so we can have just one list so that families know when their children have gone on a list. The reason I need the school inclusion model, and I hope it will work, together with the network disability teams, is that schools operate for 38 weeks per year and that for the other weeks of the year children need to continue with their therapies in order that the network disability teams are able to support them through term time as well.

Medicinal Products

David Cullinane

Question:

85. Deputy David Cullinane asked the Minister for Health if the drug dupilumab for the treatment of severe atopic eczema will be approved; and if he will make a statement on the matter. [42338/20]

Richard Boyd Barrett

Question:

452. Deputy Richard Boyd Barrett asked the Minister for Health when dupilumab for persons with eczema will be made available in Ireland; and if he will make a statement on the matter. [42807/20]

I am raising with the Minister the issue of dupilumab, which is a drug for people with severe eczema. I know that the drug approval process is an apolitical one, and so it should be and I fully support that, but my understanding is that this drug was discussed at a meeting on Tuesday of this week within the HSE. Can the Minister provide an update to the House on this drug?

I propose to take Questions Nos. 85 and 452 together.

The HSE has statutory responsibility for decisions on pricing and reimbursement of medicines under the Health (Pricing and Supply of Medical Goods) Act 2013.

I am informed that the HSE received two applications for the reimbursement of dupilumab for the treatment of moderate to severe atopic dermatitis in patients who are candidates for systemic therapy: first in November 2017, for treating adult patients, and then in December 2019, for treating adolescents 12 years and older. The National Centre for Pharmacoeconomics, NCPE, conducted a full health technology assessment of the application for the adult population and in December 2019 recommended that dupilumab be considered for reimbursement if cost-effectiveness could be improved relative to existing treatments. The NCPE conducted a rapid review of the application for the adolescent group and in January of this year advised that a full health technology assessment was not proposed and that the drug should not be considered for reimbursement at the submitted price.

Having reviewed the NCPE's recommendations, the patient group submission and the outputs of commercial negotiations, the HSE drugs group recommended that the HSE executive management team not support the reimbursement of the drug for either the adult population or the adolescent population. On 21 August the applicant was notified of the proposed decision not to support reimbursement. On 18 September the applicant submitted representations concerning this proposed decision. Last month the HSE reviewed the applicant's representations and met with representatives from the company.

The HSE has advised that the process is still ongoing and that the matter will be included on the agenda for the HSE drugs group's meeting in January 2021. The HSE executive management team is the decision-making body for the reimbursement of medicines under the Health Act 2013 and will, on receipt of the outcome of the drugs group's deliberations, make the decision as to whether the drug will be reimbursed.

I hope we will see movement on this issue in January. The drug is a treatment for severe eczema, which causes inflamed, dry and broken skin, which is exhausting to treat, painful and intensely itchy. I have met many people who suffer from this unfortunate disease and many healthcare professionals who are campaigning on the issue. While the issue is apolitical, we all get lobbied on these issues from time to time and I am very clear as to what our role is. Equally, however, when I listen to healthcare professionals who say there is something profoundly wrong with the drug approval process in this State, and very often we find ourselves the last EU state to approve drugs, I believe it is an area we need to review on an ongoing basis. I have asked the Oireachtas health committee to examine this and to work with Deputy Donnelly as Minister for Health. If we can make improvements in this area while still keeping in place the apolitical process that is in place, we should consider doing so.

I agree with everything the Deputy has said. The health committee of the previous Dáil spent a lot of time considering this. The good news is that there are some amazing, life-changing and lifesaving new drugs out there. A lot of them are so-called high-tech drugs, which are very expensive, and the HSE has been paying a lot more for such drugs. In recent years, for example, the amount spent on the high-tech drugs alone has gone up from €400 million to €700 million per year, a very significant increase. Part of the frustration for this calendar year is that there was no allocation in the service plan for new drugs. That has been part of the reason that some of the drugs have been held up. I say this without prejudice to this particular drug because, as the Deputy says, this is an independent assessment process. What I can say is that I have allocated €50 million for 2021 to new drugs. I agree with the Deputy that Ireland in some cases is behind the curve and he and I have been given evidence that sometimes we are late to the party in allocating new drugs. We are all the time trying to balance making as many of the new and exciting drugs available as possible for as many people in Ireland as possible with the very real cost constraints. As the Deputy will be aware, negotiations take time and, in fairness to the HSE, at least in several examples I have seen, it does succeed in securing a lower unit price for the drugs which, given any budget, means we can make more and more drugs available.

I thank the Minister for his response. I recently met with Professor John Crowne. We had a good discussion on cancer care and one of the issues he raised with me was, again, these high-tech drugs to which the Minister referred in the field of cancer. He was very supportive of and enthusiastic and excited about a lot of these new drugs.

However, he pointed out that many of them are not available to patients in this State because, as he and many others who work in this area have observed, the unfortunate slowness of the drug approval process.

I wish to also raise the issue of the drug, Patisiran, which is a life-saving treatment for hereditary ATTR amyloidosis. As the Minister will be aware, that is a disease that is peculiar to people on this island. The drug is available in the North but it is not available to patients in the South, which is problematic.

My point is that we can all celebrate these drugs when they come on stream. Significant advances are being made all the time. However, if patients cannot access the drugs in a timely manner, then we have a difficulty. I genuinely believe it is an area in which we can make improvements. I certainly wish to work constructively with the Minister, as does the Joint Committee on Health, to make advances in this area.

There have been several conversations and representations about Patisiran, the second drug the Deputy referenced, and I will revert to him and colleagues with an update on it.

Any opportunity we can find to accelerate access to these new and exciting drugs should be taken. I had a conversation with medical oncologists just this week on access to new cancer drugs. On the €50 million that has been allocated for new drugs, although there is no set amount yet and the budget does not get sliced up per care pathway, it would be quite reasonable to think that €15 million or up to one third of that €50 million will end up being allocated towards some of the really exciting new drugs. I asked the medical oncologists whether there is an opportunity for us to save money within the existing amount. We should remember that we spend €2 billion per year on drugs. Their clear view was that there is an opportunity to make savings in biosimilars and prescribing practices. What I would love to do is to protect the drugs budget, add the €50 million to it, and find ways of reducing costs within that €2 billion and reinvesting the saved money back into further drugs. That certainly seemed to be something the medical oncologists wished to discuss further. I will be delighted to continue the discussion with the Deputy and the joint committee on the issue.

Child and Adolescent Mental Health Services

Michael Moynihan

Question:

86. Deputy Michael Moynihan asked the Minister for Health the number of persons on the child and adolescent mental health services, CAMHS, waiting list in community healthcare organisation, CHO, 4; and if he will make a statement on the matter. [42302/20]

How many people are on CAMHS waiting lists in CHO 4? I ask the Minister of State to make a statement on the matter.

I thank the Deputy for his very important question. The development of all aspects of mental health services nationally, including those for children and young people, remains a priority for me and the Government. This is reflected in the current programme for Government and in the significant additional funding allocated to mental health in budget 2021.  As the Deputy will know, an additional €50 million was secured, which will bring the overall budget to €1.076 billion. Of that €50 million, €23 million has been allocated to commence the implementation of many of the short-term recommendations of Sharing the Vision, including the expansion of CAMHS hubs.  It is expected that 148 additional staff will be recruited in 2021 by the HSE, of whom 29 will be in CAMHS.

As the Deputy will be aware, CAMHS admissions are prioritised by clinical need. CHO 4 continues to take a proactive approach, with a focus on reducing CAMHS waiting times to improve access to a safe and effective service.  In the past eight months, even with Covid, much progress has been made. The waiting list in the CHO 4 area, which covers counties Cork and Kerry, was 352 in October 2020, a reduction from 573 in October 2019. Of those, 78 had been waiting to access CAMHS services for longer than 12 months, a reduction of 49% since January 2020.  In October 2020, 93% of all accepted referrals were offered a first appointment within 12 weeks and, of those referrals, 96% were seen within 12 weeks. I will address the issue further in subsequent replies.

It is vitally important that we get this sorted out and that we keep challenging the system in respect of CAMHS. All Members, as public representatives, meet families in distress and know challenges that exist and the difficulties accessing services. There is a growing acceptance that there is a mental health crisis on the back of Covid. In terms of the figures being provided to the Department by the HSE, does the Minister of State see a significant challenge, particularly in respect of CAMHS in CHO 4 and the rest of the country? Are there still vacancies within CHO 4 for psychiatrists and other trained staff to help to alleviate the crisis that exists in communities?

The Deputy has raised a valid point. Since I came into this role, I have had several discussions with the Minister, Deputy Donnelly, regarding CAMHS waiting lists. There are currently more than 2,230 children waiting for such services. However, in the past seven months or eight months, CHO 4 has taken a proactive approach. Part of the waiting list, especially on the Kerry side, was associated with a key consultant vacancy. The CHO put in place a Saturday clinic facilitated by local CAMHS consultant cover to target the waiting list. Having spoken to the chief officer of CHO 4, which covers counties Cork and Kerry, in the past week, I can confirm it has secured a second consultant psychiatrist in CAMHS in Kerry on a temporary basis. The CAMHS teams in Cork and Kerry are both now fully populated in terms of psychiatrists and they are working at full tilt. We are working with them to reduce the waiting list as a matter of priority. From what I can see, CHO 4 has always been problematic in terms of it always having quite a high number on the CAMHS waiting list. I am adamant that I will have that waiting list reduced.

I admire the Minister of State for her determination and I thank her for her work to date. Is there a shortage of psychologists in CHO 4? Is there a challenge in recruiting psychologists there? On the issue of primary care, what is her view on how it is being rolled out to alleviate some of the stress within communities and address the enormous challenges coming down the line?

There are many challenges in primary care for under 18s. The waiting list is at all-time high of 10,500. It is an issue I have inherited. I met the Minister on this issue recently and I have met the HSE primary care team. The team and the section of the Department that deals with mental health are aware that more than 5,000 under-18s are currently on that waiting list for more than 12 months and we are looking at a targeted intervention to reduce the waiting list next year. A process is being put in place to see where we can get the capacity to so do. The Deputy is correct that there are psychologist vacancies. We are looking at a targeted approach. I will visit Cork in January or February, Covid permitting, to meet the teams there. Significant good work has been done, but we have to do more.

Covid-19 Pandemic

Éamon Ó Cuív

Question:

87. Deputy Éamon Ó Cuív asked the Minister for Health the number of persons involved in testing and tracing as part of the Covid-19 response who transferred to that work from elsewhere in the health service; the work from which they were transferred; and if he will make a statement on the matter. [41113/20]

I am inquiring about the number of persons involved in testing and tracing as part of the Covid-19 response who were transferred to this work from other sections of the HSE. People who previously provided therapies and so on have been transferred to testing and tracing. I ask the Minister to explain why it was not possible to leave those workers in their positions and hire other people to do this necessary testing and tracing work.

Since the beginning of the pandemic, we have pursued a robust testing and contact tracing strategy. The HSE has worked intensively to put in place a comprehensive, reliable and responsive testing and tracing operation in a very short timeframe.  The redeployment of existing staff from other areas of the HSE, including front-line services as the Deputy pointed out, was an essential part of this response.

Since the height of the pandemic there has been a significant return of staff to non-Covid front-line roles. This has been facilitated by an ongoing recruitment process through which the HSE has recruited 675 new contact tracers and 565 swabbers to date. Recruitment in these areas will continue until the targets of dedicated staff of 800 in contact tracing and 1,000 in swabbing are met. This will allow the remaining redeployed staff to return to their original roles.

I have been informed that there are 411 staff currently redeployed to swabbing operations, made up of both healthcare workers and non-patient-facing administrative and management staff. Of the staff currently redeployed to contact tracing, none is from patient-focused roles. Areas such as complex contact tracing will continue to require some level of redeployed community staff. Where these staff remain in Covid-19 services, it is intended that their substantive posts will be back-filled. While we remain cognisant of the potential for future demands associated with surges in Covid-19 transmission, the aim is to return redeployed staff to their substantive posts as soon as possible and to ensure that posts are back-filled when this is not possible. I have asked the HSE to expedite this process.  At the end of September, I also announced plans to double the workforce in our public health departments by hiring more public health doctors, public health nurses, scientists and support staff. That hiring process has commenced.

Can the Minister say how many redeployed people, and particularly non-administrative staff, are engaged in testing, not in complex tracing? How many are involved in the routine tracing that was being done, for example, by Army personnel and so forth and, therefore, can be done by competent people who are not necessarily required to have a medical background? I understand the people who carry out the test do not need that background either. It appears the HSE has a total inability to recruit speedily. It is difficult to understand how it took so long to replace necessary HSE staff with people recruited for this purpose. Can the Minister explain how long it takes the HSE to make an appointment from the day it receives an application for a job? What are the processes that take such a long time for such a clearly defined purpose?

To answer the Deputy's direct question on the number of people in contact tracing, there are now no therapists or front-line community therapists working in contact tracing. They have all been redeployed. There is a current workforce of 736 in swabbing. Of those, 411 are redeployed staff. That combines both the therapists we are discussing and those with non-patient-facing roles. From memory, and I am open to correction, I received a report ten to 14 days ago that the number of therapy grades in swabbing was at 279, but I will revert to the Deputy with the most up-to-date figure on that.

I have engaged repeatedly with the HSE. We should remember that the HSE, to its credit, has created from a standing start one of the most comprehensive testing and tracing regimes anywhere in the western world. That required pulling in therapists. I agree with the Deputy, and the HSE is cognisant of getting the therapists back to their front-line roles as quickly as possible.

The Minister said that over 200 therapists are involved in swabbing. That means 500 of the staff are not therapists. It also means that if there had been quicker recruitment, and there is a massive number of well-qualified and competent people who are unemployed because of Covid-19, the therapists could have been allowed back into their jobs. Can the Minister give an estimate of the increase in the waiting lists for many types of therapy that has occurred due to the fact that there has been a long, non-crisis redeployment? I can understand that during the first lockdown, the HSE had to do something fast. However, I do not understand why, at the end of the year, we still have over 200 therapists involved in swabbing. I would be interested to get some idea as to why it was not possible to employ non-therapy people. Can the Minister give an indication of the effect this has had on various waiting lists in the community healthcare organisations, CHOs, around the country?

It would be easy for us to say that Covid should be a fully stand-alone service line within the HSE and that we should be able to run one of the most comprehensive testing and tracing systems in the world independent of the existing HSE workforce, but that would not be a realistic request to the HSE. The HSE has pointed out repeatedly that while it is redeploying and is back-filling posts as fast as it can, it is a difficult recruiting environment generally. It has also said that the swabbing centres and swabbing service are a serious clinical activity. It has people there who are managing teams. These are experienced clinicians and it is simply not possible to remove all that clinical and therapy experience and all the experience of people who have been involved from the start and have a stand-alone service. There has to be continuity and senior clinical supervision, and the HSE is maintaining that. However, it has committed to redeploying as fast as possible but also as fast as is appropriate to maintain the safety and quality standards in swabbing.

I fully agree with the Deputy that there is a cost to these therapists not being in their front-line roles. We have testimony from people across Ireland, particularly children, who have not been able to get the access they normally would get because of this. Unfortunately, one of the things we must deal with in the HSE and the healthcare system during the Covid pandemic is the same system, essentially, having to fulfil both roles. We must fight Covid-19, and Ireland is doing very well by international standards in that fight, and we must run the full healthcare system at the same time and try to alleviate issues such as the trolley crisis, which we experienced in previous years.

There are only three minutes remaining for the next question.

Nursing Education

Gino Kenny

Question:

88. Deputy Gino Kenny asked the Minister for Health if it will be ensured that all student nurses receive payment for the work they have put in across the health service during the Covid-19 pandemic; and if he will make a statement on the matter. [42363/20]

I will listen to the Minister's reply before I contribute, to expedite matters.

As I mentioned to Deputy Cullinane earlier, I recognise the importance of student nurses and midwives completing their essential clinical placements in a safe environment.  During the first surge of Covid-19 it was not possible to facilitate student placements from April onwards. This was due to redeployment of staff, including senior nurses who would ordinarily be supervising the students. There was a particularly high rate of absenteeism and the HSE’s directors of nursing said they could not ensure clinical placements were protected. There were fears hospitals could be overrun. At the time, there were up to 900 Covid patients in hospitals. Thankfully, the situation has improved. As of Sunday, 6 December, there were 232 Covid patients in hospital.

In April, students were offered healthcare assistant, HCA, contracts to work and contribute to the national effort.  Approximately 1,350 of the 3,200 first to third year students took up HCA roles and contributed to the national effort. All fourth year students were also paid at the HCA pay rate. Given that working as a healthcare assistant does not provide student nurses and midwives with the structured educational outcomes that are part of a graduate programme, it was important to have the students revert to their educational placements as quickly as possible. The HSE’s directors of nursing have said that all student placements have now fully resumed. It is imperative that educational placements are protected for education. Payment at the HCA rate was made during the first Covid wave solely because the student nurses were working as HCAs.

We do not want the student nurses and midwives working as healthcare assistants, but to be full-time students on educational placements. The colleges, which have primary responsibility for these students, have not contacted me or the Department of Education to seek payment for them as healthcare assistants. In fact, I understand that the colleges, which are fully responsible for the students' education, are firmly of the view that these placements are clinical education placements and must be protected as such.

I thank the Minister.

They do not want to their students to be paid as healthcare assistants.

There has been a lot of commentary about and criticism of the Government regarding the treatment of student nurses, even prior to Covid-19. If anything can emerge from this situation, particularly in terms of the review, it is how student nurses and nurses are treated. They are extremely dedicated to their vocation. The last nine months have been unbelievably challenging, not only for the student nurses and their families but the people that they care for. I hope the review will identify a number of issues. I was a healthcare assistant for a long time prior to being elected so I understand about student nurses being on placement and that it is an educational environment, but it is also an environment where the healthcare assistants do a significant amount of work and they should be compensated and remunerated for that. The retention of nurses is so important in this environment. When nurses graduate, they want to stay in this country. They are so proud of their job, but they will not stay here if they are constantly exploited and not respected.

I thank the Deputy. We are out of time.

I plead with the Minister that following the review student nurses would be properly paid for the work they do.

We are way over time. The Minister should make just a brief comment. I am sorry but we are moving to Leaders' Questions. The Minister is welcome to make a brief comment.

I will need 60 seconds to respond, but if I do not have that, it is okay.

We do not have 60 seconds. We are moving on to Leaders' Questions. I thank the Minister. Leaders' Questions take precedence. I am sorry about that.