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Dáil Éireann debate -
Tuesday, 13 Jul 2021

Vol. 1010 No. 4

Ceisteanna Eile - Other Questions

Departmental Funding

Ruairí Ó Murchú


38. Deputy Ruairí Ó Murchú asked the Minister for Health the details in relation to the funding and supports that will be made available for family addiction services; and if he will make a statement on the matter. [37742/21]

I wish to ask the Minister the details of funding and supports for family addiction services. I spoke to the Minister of State, Deputy Feighan, about the matter and he will not be shocked that I am looking for details on supports for groups such as the Family Addiction Support Network, FASN, in Dundalk. He attended the network's events previously. The FASN plays a major role in the provision of family supports and also in drug-debt intimidation reporting, which is a significant issue. The network faces closure, and it needs funding from the State. I would also like to hear about the criteria and timelines.

The national drug strategy, Reducing Harm, Supporting Recovery, recognises the role of families affected by drug use in contributing to the planning, design and delivery of effective addiction services. In budget 2021, I secured €280,000 in additional funding to support family services. This funding will be used to develop and broaden the range of peer-led, mutual aid and family support programmes in accordance with best practice, in line with action 16 of the national drugs strategy.

The development of family support services is listed as a drug and alcohol priority in the HSE's national service plan for 2021. It is intended that the HSE will develop co-ordinated family support programmes in the following four areas this year: Dublin north inner city, Cork and Kerry, Louth and Meath, and Donegal. Each initiative will be allocated €70,000. I am pleased to report that the funding allocated for these services is currently being drawn down by the HSE in line with departmental guidelines. I am aware of the interest in the allocation of this funding in the four regions, including by the Family Addiction Support Network in Louth and Meath. I am confident that these initiatives will make a valuable contribution to supporting families with addiction issues in their local communities.

I welcome the publication of the Drogheda report. Drug activities are affecting individuals and communities in Drogheda and across the north-east region, leading to ill health, premature deaths, damaged family and social relations and drug-related violence and intimidation. I am committed to improving the availability of drug and alcohol services in the north-east region of Louth, Meath, Cavan and Monaghan. There has been an allocation of €150,000 for drug and alcohol services in Drogheda, and a further €150,000 for family support services to improve access to community-based drug and alcohol services across the region.

I seek clarity. The Minister of State can correct me if I am wrong, but I understand two allocations of moneys were provided, one to be drawn down directly by the HSE, and the other that was issued by the North Eastern Regional Drug Task Force. One was to deal directly with family support services for those affected by addiction. We need to hear about the timeline and the criteria. This is an organisation that everybody, including the State services, recognises as doing necessary work but it is surviving on the basis of volunteerism. That is not sustainable into the future. These moneys have been promised for a considerable time. I would welcome some detail on the reason for the hold-up. I want to hear about the timeline and criteria and how quickly this money can be provided for use.

I feel strongly that the families of drug users need to have appropriate, accessible and timely services available to them. I know the Family Addiction Support Network in Dundalk and across the country is aiding people who are often unaware that there is any help available at all. I intend to continue to work with all the relevant stakeholders across the statutory and community and voluntary sectors to achieve better outcomes for problem drug and alcohol abusers. I am aware that FASN, and all organisations providing addiction supports, have adapted to new ways of working during the pandemic. I will work with the Deputy. I encourage the FASN to engage with the HSE regarding the funding announced in budget 2021 for the region. It is the HSE that it will work with, and the Deputy can contact me if any issues arise.

I have arrived in the Chamber directly from a joint policing committee meeting in Dundalk. The Minister of State referred earlier to the Guerin report. Drug-debt intimidation and addiction are major issues. We cannot let organisations like this fail. The FASN is liaising with the HSE, but it is concerned because it has been awaiting the money for a considerable period. We need to get the funding as soon as possible.

I return to the same question on the timelines and criteria for funding. There is no doubt that I will work alongside the Minister of State to deliver the funding because it is far too important to let it go. I am very worried that we are running out of time. We are also running out of time for supports for families. We are dealing with an organisation that deals directly with the Garda. Sometimes it is easier for people to talk to the FASN and then have information on drug debt and intimidation passed on to the Garda. It is vital that funding is provided.

I was honoured to be invited by Gwen McKenna, on behalf of the Family Addiction Support Network, to launch the report, Crossing the Threshold - A facilitator's guide to running developmental and support groups. I understand the Department of Health agreed base funding of €152,000 for the FASN in 2020, delivered in four instalments of €38,000. Funding of €3,000 was also provided for a virtual annual conference, which took place earlier this year. In addition to the base funding of €152,000, the Department provides agreed funding for a drug-related intimidation officer of €52,000 per year for three years, commencing in 2020. Due to delays in filling the post in 2020, only €10,000 was drawn down by the FASN.

I thank the Deputy for his question and I look forward to working with him. I enjoyed my visit to Dundalk. In the time of Covid, we do not get out enough, so I was delighted to be able to see at first hand the work being done there.

Hospital Facilities

Bernard Durkan


39. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the Naas General Hospital extension project is being provided for in the capital budget in the current year; when the project will progress to the next developmental stages; and if he will make a statement on the matter. [37598/21]

This question relates to the urgently required extension at Naas General Hospital, which has been on the waiting list for some considerable time.

I thank the Deputy for his question. There are a number of projects in the capital programme for 2021 at Naas General Hospital. These include the day procedures-endoscopy unit, the oncology and physical therapy unit and a new acute mental health unit. Funding has been allocated to progress the project design for the day procedures-endoscopy unit and oncology and physical therapy unit projects. The procurement of the design team is nearing completion.

The scope of the acute mental health unit has changed considerably and is currently being reviewed. The service area has progressed an extensive exercise to examine the latest delivered mental health projects, including the national forensic mental health service hospital facility in Portrane. Following this review, service requirements have been rescoped to incorporate different room layouts, wider corridors and additional recreational space. Other scope changes have been made, such as the inclusion of a decking car park and seclusion rooms. The schedule of accommodation has just been confirmed and the design team is now working on the stage 1 report.

The delivery of capital projects is a dynamic process and subject to successful completion of the various approval stages as well as the availability of funding. The development of a modular isolation unit providing 12 single isolation rooms at Naas General Hospital is being progressed. The final contract to construct this unit is expected to be agreed within the next two weeks, with off-site fabrication and associated site works commencing in September. Construction of the modular unit is due for completion in quarter 1 of next year.

I thank the Minister for his welcome reply. I ask that particular attention be paid to ensuring that the project goes ahead in a co-ordinated fashion so that everything happens simultaneously, it broadens to include whatever the hospital requires, and we do not have to revisit it in one or two years' time. Will the Minister try to ensure that emphasis is placed on progressing the matter with all possible speed, given the length of time this project has been on the waiting list?

I will. These projects are important for people in the catchment area in the Deputy's constituency and we need to progress them as quickly as possible.

I will offer a quick update on some of the background to the various projects. The day procedures-endoscopy unit and the oncology and physical therapy project were not prioritised to progress by the service area up until now and did not progress in 2020, given the impact of Covid, but I have outlined the progress. I might revert to the Deputy in my final response, as there are some good details around the change in the scope of the mental health project, which the Deputy has raised previously. To me, that change is good news for providing even better mental health facilities. The Minister of State, Deputy Butler, is involved in the detail of all of that.

I agree with the Minister, in that as time goes on, changes are necessary. They are driven by requirements, society and demand. Particular emphasis must be placed on mental health in the aftermath of Covid. Indeed, there will be waiting lists and pressure on all hospitals' facilities, space and staff.

I thank the Minister for the constructive line he is taking. I appreciate that there were difficulties due to Covid, but it is now necessary to proceed with all possible speed lest something else come along to hinder progress. I note the Minister's promise in that regard.

I thank the Deputy for his kind words. In February, he raised the important issue of the scope of the mental health project. Much of it was to be reviewed. The original development proposal comprised the provision of an eight-bed intensive care unit at the existing 30-bed Lakeview mental health unit on the grounds of Naas General Hospital. In 2019, a further revised proposal to deliver 50 bed spaces, a nine-bed intensive care area and significantly upgraded infrastructure was received. In 2021, the scope has again been refined by the service area following a detailed examination of the latest delivered mental health projects to include different room layouts, wider corridors, additional recreational space and the relocation of staff rooms. The Deputy will be supportive of these. The Minister of State, Deputy Butler, is working hard on the delivery of that mental health facility, the mental health facility in Portrane and mental health facilities across the country, which are desperately needed.

I thank the Minister.

Hospital Services

Niamh Smyth


40. Deputy Niamh Smyth asked the Minister for Health his plans for a roll-out of midwifery-led units across Ireland in line with the national maternity strategy. [37476/21]

Will the Minister outline his plans for the roll-out of midwifery-led units across Ireland in line with the national maternity strategy?

I acknowledge the Deputy's ongoing work in terms of advocacy and finding solutions for women's healthcare, including the national maternity strategy and many other issues. As she is aware, achieving a revolution in women's healthcare is a top priority for me and the rest of the Government. One of the cornerstones of advancing women's healthcare is the national maternity strategy. This year, I allocated unprecedented funding to the implementation of the strategy. To put it in context, we allocated five times more money this year than in previous years. The strategy is a great one, the clinical community has bought into it and it has strong support from patients, patient groups and so on across the country. We need to see it happen now. The funding will increase access to community midwifery and to allied and specialist services for women and babies. It will help expand breastfeeding supports in our hospitals, enhance postnatal care in the community and strengthen training and education supports for staff.

Choice of care for women is essential. Important for ensuring that choice is providing access to comfortable, low-tech and suitable birth rooms for women and families. This is recognised in the strategy and is central to delivering on the goal of enhanced midwifery care. That is why funding of nearly €200,000 is being allocated to the development of three additional home away from home suites this year in Sligo, Letterkenny and Portiuncula, adding to the nine sites already in service. The suites effectively replicate the environment and birthing infrastructure available in the midwifery-led units in Drogheda and Cavan, which will help support the full implementation of the supported care pathway and provide enhanced experiences and choice for women, which is essential.

I thank the Minister. I compliment him on his advocacy for this initiative. He mentioned Cavan general hospital and the midwifery unit there. It would be remiss of me not to acknowledge and compliment its staff on the magnificent and pioneering job they do in that flagship midwifery-led unit, the first of its kind on this island. After it came the one in Our Lady of Lourdes Hospital, Drogheda.

The pandemic has given us an opportunity to put a new focus on midwifery-led units and home birthing. We have seen a magnificent increase in the number of women and families looking to deliver their babies at home. That is welcome. Such an holistic approach is important if women are to have a choice. The Minister invested in that, which is welcome. Is there an opportunity to find ways to expand upon our midwifery-led units?

The short answer is "Yes". We need to put as much funding into and political and administrative focus on these services as possible. We must push on. That is why there is so much focus on getting the national maternity hospital, the home away from home suite strategy and the national maternity strategy moving as quickly as possible.

With regard to the home away from home suites referenced by the Deputy, it is a similar environment to the birthing infrastructure of the midwife-led units, MLUs. There are nine sites, in Drogheda, Cavan, the Coombe, Mullingar, the National Maternity Hospital, Wexford, Cork, Waterford and Limerick. Four sites in Kerry, Sligo, Portlaoise and Letterkenny are developing services as well. Some €195,000 was allocated this year. Some 19 services have antenatal midwifery clinics which is really important. Some 74 midwifery-led clinics are being held every week, which is fantastic to see. The national average of 24% of women are in a supportive care pathway at this point.

From my experience in terms of the Cavan midwifery-led unit there, what I have found important and crucial to the further expansion, development, growth and promotion of that unit is buy-in from GPs. As I said, the one in Cavan not only provides a service for Cavan-Monaghan, but is a more regional midlands service for women across the area. Does the Minister have any input in terms of how GPs are buying in? Those types of midwifery units are dependent on women having that engagement with their GPs when they are making that decision for their pathway of care on maternity services. There is much to be garnered and gained from our GPs and those primary care services in communities throughout the country. If there is buy-in from those, we will see exponential growth in our midwifery-led units. I often find, from talking to women, they are not that aware of the service available. What can we do to encourage and nurture that?

It is a great question. There is no doubt there is more opportunity to improve the services in the community and in primary care. One of the things I have recently funded is a women's health lead with the Irish College of General Practitioners, ICGP. That is the first time we will have a lead person whose job it will be do exactly that, with regard to figuring out whether more communication is needed with GPs, what other work, services and healthcare provision GPs can lead in the community and whether more training is needed in terms of core training for GPs, continuous professional development and so forth. Part of the answer is that and part of the answer is ongoing engagement with the GP community and its representative group to prioritise these. The Deputy will have seen there are some things we are doing which are acute-based but which will help. We have funded an endometriosis service specialising in advanced cases in Tallaght which will give more referral pathways to GPs as well.

Cannabis for Medicinal Use

Martin Browne


41. Deputy Martin Browne asked the Minister for Health the status of the medicinal cannabis access programme; and if he will make a statement on the matter. [28321/21]

I ask the Minister for Health the status of the medicinal cannabis access programme and if he will make a statement on this matter.

I thank Deputy Browne for his question. The provision of the medical cannabis access programme is as a result of recommendations by the Health Products Regulatory Authority, HPRA, in its review, Cannabis for Medical Use - A Scientific Review.

The review stated that if the policy decision is to make cannabis available for medical purposes, the HPRA advised it should recognise patient need but be evidence based. It was advised that treatment with cannabis be only permitted under a controlled access programme for the treatment of patients, with the following medical conditions, who have failed to respond to standard treatments: spasticity associated with multiple sclerosis, intractable nausea and vomiting associated with chemotherapy and severe, refractory, treatment-resistant epilepsy. Subsequently, the former Minister for Health established an expert reference group to advise on the development of a medical cannabis access programme. This group developed detailed clinical guidelines for the MCAP to be followed by clinicians, which contained inter alia guidance on ingredient combinations recommended for each of the three indications included in the programme.

The programme is a five-year pilot programme. The purpose of the programme is to facilitate access to acceptable cannabis-based products for medical use that are of a standardised quality and meet the requirements outlined in the misuse of drugs regulations 2019. It is an important and positive step forward for those individuals who are suffering serious ill health but for whom conventional treatments are not working. There are currently four products assessed by the HPRA for inclusion in schedule 1 of the regulations and more products are being assessed by the HPRA.

Reimbursement of the products, prescribed by approved medical consultants and supplied through community pharmacies for a specified therapeutic indication in line with schedule 2 of the misuse of drugs regulations 2019 will be on an individual named patient basis, aligned to the patient's eligibility under the community drug schemes. It cannot be assumed that reimbursement approval will be forthcoming on submission of applications. A reimbursement decision will be communicated with the prescribing consultant in writing.

The HSE has indicated that the medicinal cannabis access programme is rapidly progressing and I hope to be in a position to update the Deputy shortly.

The Minister will not be surprised to hear I am again highlighting the plight of Ms Vera Twomey and her daughter, Ava, who suffers from Dravet's Syndrome. This family and other families still have to fork out €9,500 every three months to get Bedrocan and they have to wait as long as five to six weeks to get reimbursed. I know the Dutch authorities will not allow the commercial export of the oil-based cannabis products to pharmacies or wholesalers. That is its decision, but being unable to apply to the Health Products Regulatory Authority, HPRA, to have it included in the medicinal cannabis access programme, like other products, is something the Minister is in a position to influence.

As the Minister said, he is due to announce funding for the MCAP and he has asked his official to find a way to ensure patients will no longer need to pay upfront for Bedrocan. Yet Ms Twomey and other families are constantly told the Department is working on it and they have to patient. How patient must these families be? Ms Twomey told me this week she is exhausted from the pressure she is under. Can the Minister tell Ms Twomey, Ava and the other families throughout the country Bedrocan will be funded at source and when that funding will be announced?

I am, of course, aware of the case of Ms Twomey and Ava and many other families around the country. Can I just make a few points on Deputy Browne's reasonable question? I have funded the medicinal cannabis access programme, MCAP, for the first time. While the programme existed previously, there was never any money allocated to it. We have now allocated money to it. It will be fully funded. It will cost a significant amount of money. We will be able to make an announcement and I look forward to being able to share that with Deputy Browne shortly. An awful lot of work has gone on this year to bring it to this point.

The Deputy will appreciate I cannot talk about any specific families for data protection reasons, obviously. For many families in this situation, what is currently happening is the products are being delivered to their front doors from Holland. That is something the Government and the State is doing. The Deputy will be-----

The Minister will get a chance to come back in.

I appreciate the Minister has made the moneys available. It is there now. I am talking about the Twomey family because I know Ms Twomey well. I have been in her house and have seen the way Ava has responded to medicinal cannabis and Bedrocan. Families such as the Twomeys and others have a worry every three months in terms of coming up with the €9,500. All they are asking for is a level playing field and for the Minister to give them an assurance the €9,500 has stopped and there is no more of that kind of pressure. It is enough having a child sick, like Ava was. We all know the case. I walked to Dublin with Vera. I saw the pressure she was under and saw her raising the issues.

It is about going from 30, 40 or 50 attacks per day down to one or two per week and seeing that child being able to go to mainstream school. I know the Minister is new to it, but the previous Government and Ministers have dragged their heels on it. I am asking the Minister to give assurance to those families that, from now on, there is no more having to worry about €9,500 being there every three months to access Bedrocan.

To the first question, Ms Twomey and others were having to go to Holland to secure things. The first thing I wanted to make sure was that stopped. I have given a commitment directly to Ms Twomey and I am happy to repeat it here on the floor, that would not happen again. We have a system in place whereby the pharmaceuticals are being hand-delivered to the door. That is the first thing and it is important. As the Deputy said, these things are not cheap. Using the Deputy's figures, if it were €9,000, for example, every quarter for any family, it would be nearly €40,000 for the year.

That cost gets covered by the State. Second, there should not have to be a prepayment for it. I can assure the Deputy, and Ms Twomey has been assured, that significant work has been going on in this regard. It is my intention that Ms Twomey and other families will not have to pay up front. We needed to establish why it was happening in the first place. There were technical reasons, which I can share later with the Deputy. However, I can give a commitment that we are moving as quickly as possible to stop the prepayment requirement because I do not believe it is acceptable. It is my intention to solve it.

Hospital Services

Réada Cronin


42. Deputy Réada Cronin asked the Minister for Health if he will liaise with the Minister for Children, Equality, Disability, Integration and Youth in the best interest of the child to urgently examine the lack of electronic records at St. Louise’s unit, Our Lady's Hospital for Sick Children, Crumlin, for those children who have reported sexual abuse and are waiting months for specialist interview regarding same; and if the delay in providing the number on the lists to members of Dáil Eireann will be examined (details supplied). [43078/20]

Will the Minister for Health liaise with the Minister for Children, Equality, Disability, Integration and Youth in the best interests of the child to urgently examine the lack of electronic records at St. Louise's clinic in Our Lady's Hospital for Sick Children in Crumlin for those children who have reported sexual abuse and are waiting months for specialist interview regarding same, and the delay in providing the number on the lists of Members of Dáil Éireann.

This is an important question that relates to a very sensitive area. St. Louise's unit in Children's Health Ireland, CHI, at Crumlin is a specialist unit dealing with sexual assault trauma, offering therapeutic interventions to children and families. Timely access to the therapeutic services offered at St. Louise's unit is essential for families, and I note the extraordinary work of the staff in these services, providing a high standard of care to these vulnerable children, and by association their families, who have been through horrific situations.

CHI advises that since January 2021 it has seen a twofold to threefold increase in the number of referrals for assessment and therapy services. This has impacted on waiting times. The referral process has an average waiting time of six to eight weeks for the assessment and of up to five months for therapy services. The service is provided by a multidisciplinary team and the limitations on its availability can also impact on follow-up and longer-term therapy. CHl advises that a waiting list initiative, including face-to-face consultation and telephone support, is in place. I do not believe that the current wait time is acceptable, however, and I have asked my Department to engage as a priority with the HSE to seek viable solutions.

In response to the Deputy's question on the provision of the waiting list data, CHI has confirmed it expects to be in a position to provide timely waiting list data for any future requests received within the normal 15-day period for such requests.

I thank the Minister for his reply. He will appreciate that getting clarity on this is very important. I have been raising this matter since last autumn. I first raised it on Questions on Promised Legislation with the Tánaiste and I have sent several letters to the Minister and his Department as well as tabling parliamentary questions. I have been trying to help a family in my constituency. It is not a waiting list of six to eight weeks as the Minister mentioned. This particular family, and the child was under seven years old, was waiting several months when I first raised the matter in the Dáil. The Department of Children, Equality, Disability, Integration and Youth tells me that this is an issue for the Department of Health, but the Department of Health has sent me back to the Department of Children, Equality, Disability, Integration and Youth. St. Louise's unit in Crumlin has been referring me to both Departments as well. These children need specific specialist help, so I am a little perplexed by the Minister's reply.

I wish to make clear that there are two different times. One is for assessment, which is the six to eight weeks, but the other, critically - and this might be the situation for the family the Deputy is involved with - is the waiting time for therapy, which is five months. Having looked at this, I do not believe that this is an acceptable amount of time for a child to wait when it is therapeutic intervention in the case of sexual assault. I have instructed the Department to work directly with the HSE to find ways to quickly bring that five-month period down.

The Deputy referred to a delay in sending waiting information. I will come to that in my final reply.

Perhaps the Minister could examine the lack of electronic records. With paper records, it is very difficult to find out exactly where one is on the list. It is hard to cross-check between different Departments and it is hard to know the number of cases. It is hard to believe that we are still relying on paper records at this stage.

I wish to thank the Minister and his staff, in the last week of this session, for the help they have given me on this and other questions. I know the Department has been extremely busy. It must be the busiest Department during the pandemic. However, it is time to move away from paper records so we can at least know how bad the situation is. It is horrific to think that cases have increased two- to threefold during the pandemic. It is horrendous.

I thank the Deputy for her kind words. It is good to hear that the Department and my team have tried to help, so I thank her for that.

With regard to the paper records, I take the Deputy's point. The current patient management system in St. Louise's unit uses dedicated charts which are separate to CHI at Crumlin medical charts, due to the very sensitive information involved, coupled with electronic records which are held on a secure server with controlled access, for reasons we all appreciate. It has not been possible to establish a reason for the delay in providing the information to the Deputy, but CHI has assured officials that it is in a position to provide such information within 15 days. Due to the recent cyberattack and its effect on documentary records, including email, CHI is unable to advise of the circumstances which led to the delay. I apologise to the Deputy for any delay she encountered.

Mental Health Services

Claire Kerrane


43. Deputy Claire Kerrane asked the Minister for Health the reason funding was not provided for a service (details supplied) to ensure that it is fully staffed; and if he will make a statement on the matter. [28726/21]

This question relates to the funding of the e-Mental Health Hub in Castlerea, County Roscommon, in my constituency. While events have superseded this given the fact that this funding has now been announced, halfway through the year, which I acknowledge and welcome very much, I want to know why the funding did not come into place last January, rather than halfway through the year as it is now.

I propose to take Questions Nos. 43 and 48 together.

The Government is committed to the ongoing and future development of the Castlerea Mental Health Hub in Castlerea, County Roscommon. The project is one of three child and adolescent mental health services, CAMHS, Connect initiatives planned. The others are in Limerick and Cork. This project was announced in June 2020 with two main elements identified for development - a new child and adolescent mental health service Connect day hospital and a psychiatry of later life day hospital. In 2020, €800,000 was invested in development capital works, refurbishment and staffing recruitment by the HSE. For 2021, 14 posts have been approved and €1.4 million allocated from within the overall allocation for mental health. Release of funding is imminent, and local services have approval to proceed with further development this year.

For the CAMHS Connect day hospital, provision has been made for staffing to include a consultant psychiatrist, a non-consultant hospital director, an advanced nurse practitioner, a senior social worker, a clinical nurse specialist, a senior psychologist and an occupational therapist. The consultant psychiatrist and non-consultant hospital director are in place and the advanced nurse practitioner and social worker are scheduled to start at the end of the summer. Recruitment for the other posts will start immediately.

I thank the Minister of State, but I must ask the question again. I appreciate that a large amount of money went into developing this centre last year. It was opened in June 2020 and funding was made available for four posts. The remaining funding was to be put in place from 2021. The four posts were put in place and people were hired. Then the funding was pulled or ended in some way at the end of 2020. It is only now in July 2021 that funding has been put in place. These are critical services for young people throughout the western region, even beyond County Roscommon.

They are critical services for older people. It is not good enough that I have had to raise this issue repeatedly. I have sent several emails and I have met the head of mental health services. I have raised this repeatedly. I have not received a reply to an email I sent to the Minister of State in May on this funding, which is regrettable and disappointing. I do not want to see us here next year looking for this funding again. Why was it not put in place in January?

There is no story here. This is a fantastic initiative that was put in place by my predecessor last year when the Rosalie nursing home, which dealt with many people with dementia, had to close. Castlerea mental health hub was put in place. It is a fantastic initiative. Last year, €800,000 was made available, with €400,000 for refurbishment and €400,000 for staffing expenditure. There is no story here. The Castlerea hub will be extended. It will be an absolutely fantastic initiative. From the point of view of what it will do, the roll-out nationally of the three CAMHS e-mental health hubs in Castlerea, Limerick and Cork will significantly enhance overall CAMHS provision, including improved early intervention and monitoring of cases. In this region, the Castlerea hub will operate in partnership with a day hospital in Galway on a seven-day basis, which I have discussed with the Minister of State, Deputy Rabbitte. This will provide young people in counties Galway, Roscommon, Mayo, Sligo and Leitrim with a real alternative to inpatient care.

Health Services

Pearse Doherty


44. Deputy Pearse Doherty asked the Minister for Health when respite care services will recommence in their full capacity; when services provided in locations (details supplied) in County Donegal will recommence; and if he will make a statement on the matter. [28645/21]

As the Minister of State is aware, Covid-19 has presented a particular hardship for those caring for a loved ones. They have been without a break and respite. It is heartbreaking to speak to mothers and fathers who are finding it difficult to cope. In particular, I want to ask about two respite facilities in Donegal. When does the Minister of State plan for these facilities to resume the provision of respite care services? The first is Drumboe Respite House and the second is Seaview Respite House. As the Minister of State knows, the facilities are crucial and critical for carers in Donegal and they need to reopen as a matter of priority.

I thank the Deputy for raising this question and giving me the opportunity to address it. Seaview Respite House was closed until January 2021 but it has reopened and Rehab has the contract to deliver care there. It is open only five days a week and I would like to see it open seven days a week in the future because respite is such a crucial part and cornerstone of supporting families. Drumboe Respite House is a centre based in Stranorlar, County Donegal. It provides services including respite for adults and children with disabilities. It is run by the HSE. The service operates at capacity but provides ongoing emergency residential care.

Before I arrived, I made contact with the HSE in the community healthcare organisation, CHO, 1 area to discuss respite services. With regard to Drumboe Respite House, I am assured that accommodation for some of the residents who were there long term, as opposed to in a phase of respite, residential accommodation is being sought. This will be looked after during the week. The service will become a full-time respite centre. Until now, some people stayed longer than on a temporary basis. This is being addressed as we speak.

A review was carried out of respite services in the CHO 1 area. In budget 2021 it was determined we would open one new respite centre in each CHO area. It was determined as part of the review of the CHO 1 area that this would not happen in Donegal because there was no need. What was needed were time savings and the allocation of funding. The properties are there but the services need to be delivered differently. A respite house is being placed in the Sligo and Leitrim area for children with disabilities. This is to ensure the CHO area in its entirety has a decent complement of respite to support the families the Deputy is speaking about.

I assure the Minister of State there is no decent complement of services for families in Donegal. We have been aware of the realities of Covid-19 for well over a year. Notwithstanding the fantastic job many staff are doing in facilities such as Drumboe Respite House, Stranorlar, which is being used as emergency accommodation for a number of vulnerable adults, children and families are being asked to forego respite care services. There is no end in sight for them.

If it is the case that contingency plans for accommodation or respite care in other facilities need to be put in place, then so be it. I ask the Minister of State to put in place a plan to reopen Drumboe Respite House as a matter of urgency. It would be welcome were she to provide a date for when this will happen. I ask the Minister of State to bear in mind that the children who use this facility are familiar with it. They know it intimately and they feel safe and secure there. This is an important consideration. After the year these children and families have faced, they deserve that the Department acts with urgency to resolve the situation and get Drumboe Respite House reopened for respite care services.

I need to correct the Deputy on a fact. He said it is not open. Of the three residents living in Drumboe Respite House at present, the plan is that two residents will move to Slieve Sneacht, Letterkenny. A technical assessment will be completed this week and a programme of minor works will be completed on the house. This has been prioritised in the programme of work and the move will be facilitated as soon as possible to do so. One resident has been identified for a joint placement with an external provider. Compatibility assessments are under way and this will be progressed on completion of compatibility and the engagement process with the external provider. Should the joint placement not be feasible, an alternative provider will be resourced. Drumboe Respite House will be used for respite, freeing it up completely for the families the Deputy is speaking about.

It is not open for respite services and the families would like to know a date. Seaview Respite House in Mountcharles is another facility that provides a lifeline for many families in south Donegal and further afield. I have been raising the issue of this critical service for many years. The Minister of State said it is open for five days a week and she would like it to open seven days a week. There is no reason this cannot happen bar a budgeting reason. Will the Minister of State give a commitment to make the funds available to allow this service to open for seven days a week? It is slowly reopening but it only ever provided a five-day service. What the families are calling for, and what I am asking for today, is the Minister of State to act urgently to reopen Seaview Respite House on a seven-day basis. The need is there and it is very clear. If the Minister of State does not believe me, I invite her to come to Donegal to speak to the families who contact my office in desperation every week. They tell me in no uncertain terms that the facility is crucial. They need this support and I urge the Minister of State to look at this demand to open Seaview Respite House. She has said she would like to see it open on a seven-day basis. Let us do it. Let us make the funds available to Rehab to provide the two extra days.

Seaview Respite House was closed until the budget became available in budget 2021. The Minister for Agriculture, Food and the Marine, Deputy McConalogue, has brought to my attention the need for it to be open seven days at week. Conversations have started in the HSE to ensure a funding application will be put forward to expand the service from five days to seven days. The Deputy can reassure the families this is a priority in the Donegal area.

Mental Health Services

Johnny Mythen


45. Deputy Johnny Mythen asked the Minister for Health the plans in place to deal with the waiting lists for autism spectrum disorder assessments in County Wexford. [28071/21]

I submitted this question originally following a reply to a parliamentary question I received in April which showed that 503 children in County Wexford were waiting for autism spectrum disorder, ASD, assessment. The incredible number of 436 children have been waiting for more than 12 months. This is an increase of 142 children who have been waiting for more than a year since September 2020. These families are desperate for help but it appears the situation is getting worse. I ask the Minister of State to outline what will be done to address this acute situation in County Wexford.

I thank the Deputy for raising the question. The first quarterly HSE assessment of need report for 2021 indicates that as of 31 March 2021, the commencement of four assessments and the completion of 85 assessments were overdue in the Wexford area. Children who applied for an assessment of need after January 2020 will receive a preliminary team assessment. In some cases, these assessments will identify a requirement for a diagnostic autism spectrum disorder assessment. In the first quarter of 2021, 27 children in the south-east community healthcare area, which includes Wexford, were referred for follow-up assessments. This is the latest information available for individual counties in light of the recent cyberattack on the HSE's IT systems.

I was in Carlow and Kilkenny yesterday with Deputy Murnane O'Connor. I met representatives of the Holy Angels Day Care Centre to discuss the query the Deputy has raised on early intervention for children who need to access preschool services. I have taken it on board and I will meet the HSE on Friday morning to address this vital issue regarding early intervention assessments.

It is not good enough that these continuing assessments would be ongoing while we are rolling out the progressing disability services, PDS, model. This factors into the question the Deputy asked and which Deputy Murnane O'Connor raised with me yesterday regarding the Holy Angels service. While I do not have access to the data because of the cyberattack, I need to be sure that no child is being denied a service because an early intervention is not being done to get him or her into preschool, whether an ASD preschool service or a preschool catering for complex needs. I will have an answer on that point on Friday.

I thank the Minister of State. As she is aware, when a family receives a diagnosis of autism for a child, there are changes that may need to be made in terms of education, healthcare and other supports to ensure the continued heath, well-being and happiness of the child. These appropriate supports cannot be put in place if a family is left waiting for an assessment. This is highly stressful for the children, parents and siblings involved. It also affects school allocations of special needs assistants, SNAs. Some of these parents are in a state of desperation, trying to scrape together enough money to get a private assessment for their child. It appears that the cost of an assessment that would be accepted by the HSE is between €1,450 and €1,850. We cannot and should not have a situation where money is a factor in whether children receive the supports they require. That is wrong. These children and their families must be made an immediate priority for assessment. They cannot wait any longer. Can the Minister of State offer an remedy for the growing waiting lists for ASD assessment in Wexford?

As I said, this time last year, funding amounting to €7.8 million was made available through the Sláintecare initiative to address the backlog of assessments of needs. Since then, more than 80% of that funding has been delivered and we have managed to move forward with the PDS initiative. I have a concern in regard to CHO 5, however, in terms of ensuring all assessments are continuing.

We are really having two different conversations here. When I talk about health, I am talking about an interventions-based and needs-based model. The education side is about diagnosis-based assessments. There is a conversation that needs to happen between the Departments of Health and Education to ensure all children can access all services, including education. While they are receiving an intervention, they should not have to be waiting on a diagnosis. An intervention should happen the minute a therapist meets a child, whether it is speech and language therapy, occupational therapy or physiotherapy. Children should not have to wait for a piece of paper showing an assessment to determine which strand of education they can access.

Between parents coming into my office worried sick about the time it is taking to get an ASD assessment and school principals contacting me in desperation about their SNA allocations for the coming year, it is clear that the issue of supports for children is growing more urgent by the week. The response to a parliamentary question I put down last September showed that 294 children had been waiting more than 12 months for an assessment at that time. When I submitted the same question at the end of April, that figure had increased to 436. I do not want to put the question forward again in September and be told there has been another increase. These are real children with skills and talents to offer the world. We must do all we can to ensure they can flourish in their full potential. They must not be left behind. I hope I have convinced the Minister of State that an intervention in County Wexford is urgently needed.

It is not just in County Wexford that this issue arises; the entire CHO 5 needs to be addressed. For every child that is presenting through CHO 5, I need to ensure that an early assessment is taking place and, thereafter, that an intervention is happening while we are waiting for the roll-out of the PDS framework. No child and no family should have to access private services. The whole purpose of my seeking funding to clear the backlog last year was to ensure we get to an intervention-based model, not an assessment process. An assessment should mean getting access to a place where we have interventions and services being delivered to families. That would cut down on the frustration people are feeling. The most important point in regard to the Deputy's question is that progress really hinges on people having the piece of paper that enables them to access either preschool facilities, such as the Holy Angels service I referred to, or national schools. I will be addressing this matter on Friday.

Hospital Procedures

Jennifer Carroll MacNeill


46. Deputy Jennifer Carroll MacNeill asked the Minister for Health if he will support a child (details supplied) in obtaining urgent and life-changing surgery as soon as possible. [27631/21]

There is only time for Deputy Carroll MacNeill to introduce her question.

My question concerns a two-year-old boy in Cork who came to my attention because of an initiative I am doing around the cost of having children in long-term hospital care. The boy's urethra is in the wrong place and I cannot understand what the delay is in providing surgical treatment for him. May I come back in, a Cheann Comhairle, after the Minister has responded?

Given the urgency of the issue the Deputy is raising, will it be possible for the Minister to give a brief response and perhaps liaise with the Deputy afterwards?

I can give a one-minute or two-minute response if that is helpful.

I thank the Deputy for her question. I sincerely regret, as we all do, that patients can experience a long waiting time for hospital appointments and treatment. I am very conscious of the burden this places on patients and their families. No situation is harder than when it is children who need hospital care.

It is recognised that prior to the Covid outbreak, many adults and children were already waiting too long for appointments and procedures. Unfortunately, as we know, the pandemic and, more recently, the cyberattack have had a significant impact on the provision of scheduled care services and a further backlog has arisen. Waiting lists for public hospital services remain unacceptably high. I do not believe they are defendable. The Government, with, we hope, the support of the Oireachtas, needs to do everything it can to tackle these waiting lists. It is one of the big focuses for the Government and for me as Minister for Health.

I cannot discuss a specific case on the floor of the House but I am very happy to continue to discuss it privately with the Deputy.

Is that acceptable, Deputy?

May I make on comment, a Cheann Comhairle?

This is very important. The issue has been going on since the boy was born. I raised it with the Department in March after meeting the family for the first time. I have seen very different experiences in regard to surgical emergencies in Crumlin hospital. The decision in this boy's case cannot be about waiting lists. I have brought a child in with septic arthritis, which is an orthopaedic emergency, and surgery took place four hours later, at 11 a.m. on a Sunday morning. In this instance, there is a child with his urethra in the wrong place. He is nearly two years old. Apart from the medical side of it, the developmental impact for that child in terms of growing as a human being and being able to participate in Montessori school and other things as he grows is surely of an equivalent measure to other emergency cases. I cannot understand how the hospital has not acted.

I will speak about this case privately with the Minister but it is important to state here that it is not just about broader waiting lists. This boy is at a delicate developmental stage. His case has to be a developmental emergency as much as a medical emergency. I thank the Minister for the offer to continue the discussion privately. It should not have to get to the stage where we are raising individual cases but I thank him for his response and the offer to engage.

I thank the Deputy and the Minister. I hope other Members will accept that in the unique circumstances that the Deputy outlined, we had to give a little flexibility. Let me again lament the fact that something of that nature would have to be raised here at all.

Written Answers are published on the Oireachtas website.