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Dáil Éireann debate -
Friday, 3 Dec 2021

Vol. 1015 No. 3

Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions

Health Services

David Cullinane

Question:

91. Deputy David Cullinane asked the Minister for Health his plans for addressing the problems in paediatric orthopaedic services; and if he will make a statement on the matter. [59111/21]

The provision of paediatric orthopaedic services has been a long-running issue. The Minister will be aware of all of the issues that stem and flow from it, including the impact it has on children with scoliosis, spina bifida and other hip deformities and orthopaedic conditions. We need to get to a space where the capacity is in the system. The issues have come into sharp focus again over the past number of weeks because a number of children have had to go public and talk about their experiences. It should not take that to put the pressure on the political system to provide the services people need. What additional capacity will be provided in this area over the next number of weeks and months?

I thank the Deputy for the question. It is such a critical issue and it has to be solved permanently. We are all very aware that waiting times for hospital procedures and appointments are unacceptably long. This applies to paediatric orthopaedics, as he rightly said. It is of particular concern to me when it comes to procedures that are time-sensitive, such as scoliosis and others mentioned by the Deputy. I remain acutely aware of the impact that delays are having on children and their families. We remain committed to improving access to these critical services and to ensuring that orthopaedic procedures can be accessed, in good time, and that the complex patient needs remain at the forefront of all service provision.

Since 2018, Children's Health Ireland, CHI, has been provided with an additional €9 million in funding to address paediatric orthopaedic waiting lists. One of my first official engagements as Minister was to meet with the orthopaedic team in Crumlin children's hospital and to see the great work that they do and the challenges that they face. This visit highlighted to me the improvements that need to be made, as well as the impact that timely orthopaedic intervention has on a child and their family.

The additional funding provided has supported the recruitment of a significant number of people. Approximately 60 whole-time equivalents, WTEs, were recruited in 2018 and 2019. Accessing capacity in order that children can undergo the procedures remains a key priority, especially for those children who require time-sensitive procedures. To this end, CHI has been working with the HSE to source additional capacity to reduce waiting times. For example, as the Deputy is aware, Cappagh Kids at the National Orthopaedic Hospital at Cappagh provides additional theatre capacity for non-complex, age-appropriate orthopaedic procedures. Not only do those children get seen, but it frees up freeing up much-needed space at central CHI sites for the more complex work. I will come back with more in my response.

Earlier this week, I visited Crumlin Children's Hospital. I met with the CEO of CHI and the full clinical team, and I heard, first-hand, the very exciting plans they have for the National Children's Hospital, which will be a game changer in increased surgical capacity, staff and beds. It will also provide protected beds for scheduled care, which is most important. The team also outlined some of what they need in the next number of years to deal with the here and now. One of the asks that they had concerned the €200 million access to care fund, most of which, as the Minister will be aware, is used to outsource to the national treatment purchase fund, NTPF, and the private sector. They are saying that is not a solution for them. What they are looking for is €8 million or €9 million in revenue funding to recruit staff that they need to provide the additional services to staff the beds, which are also very important. The surgeon there told me that the issue of the provision of recovery beds is a problem. There are problems with the provision of ICU beds, but the lack of recovery beds is an impediment. I ask the Minister to give a commitment that this €8 million or €9 million of revenue funding will be provided.

To be clear, it is not either-or. It is not revenue funding or the access to care fund. They are for different purposes. The revenue funding is to build up the permanent capacity in the system so we never see waiting lists like this again. While we are doing that, the access to care fund is used to ensure that the people who are currently waiting are seen. Cappagh Kids and the National Orthopaedic Hospital at Cappagh have submitted several applications under the access to care fund. They are using it. They received just over €1.5 million this year and they have more proposals in. They have submitted a proposal for around €2.6 million for next year. The access to care fund is not just for private care; in fact, the majority of it goes to the HSE. Indeed, approximately two thirds of the NTPF money also gets spent in the HSE and one third in private provision.

On the important question asked by the Deputy, all of the applications under revenue funding, including those submitted by the National Orthopaedic Hospital at Cappagh and Cappagh Kids, are being looked at very seriously. Indeed, there is more than the €9 million funding provided. We have told the HSE that there is funding available for critical care, diagnostics and capital proposals. What we need to do is to ensure that those proposals are assessed quickly and are acted on. Other capital proposals have been submitted, for example by the Crumlin and Temple Street children's hospitals, that we are looking to push along. I will share the details of them at another time.

The CEO of CHI knows the difference between the access to care fund and ongoing revenue funding, as do I. I believe the Minister is to meet with the CEO and her team next week. The point the CEO was making, and asked me to relay back to the Minister, is that this particular fund is not the solution for them. It is not a sustainable solution. Yes, they can use some of it, but the CEO told me that €30 million to €40 million of that can be used for revenue funding. They would prefer it if they could get €8 million or €9 million of revenue funding. Whether it comes from that fund or from somewhere else is immaterial. They need to recruit the staff. Given all of the concerns that we have had on this particular issue, I think it should be done and the commitment should be given.

On the surgical theatre space, we heard again, earlier this week, from Mr. Connor Green, a consultant orthopaedic surgeon at Temple Street, that the cancellation of procedures causes real difficulty for families and children. We need to avoid that as much as possible. Surgical theatre capacity, staff, paediatric ICU beds are all part of the solution.

There is no lack of funding available under the access to care fund. If Eilísh Hardiman and the team are looking for money for short periods, which is what the access to care funding provides, there will be money left at the end of December. The HSE has not been able to spend all the money. That is not from want of desire to do so. Given all of the various issues that the HSE has been dealing with this year, it has made incredible progress. There is funding there. In Temple Street, for example, part of the permanent solution is a the construction of a fifth operating theatre. CHI has put in a proposal for that. We are looking that that urgently as part of the capital plan for next year. I am very positively disposed to it. I have spoken directly with the CEO about it.

As the Deputy will be aware and as we have discussed previously, there are different requirements in different hospitals and children's hospitals.

Crumlin hospital needs an MRI machine. There are various issues. All of this is being looked at within the capital plan for next year. We allocated more money than the HSE drew down this year so the issue is not funding. The issue is making sure that these critically important projects are processed and put in place as quickly as possible.

Health Services

Peadar Tóibín

Question:

92. Deputy Peadar Tóibín asked the Minister for Health if his Department has conducted a study on the impact of lockdowns on cancer services including diagnostic and treatment services; and if he will make a statement on the matter. [59767/21]

I read the annual report of National Cancer Registry Ireland, NCRI, during the week. I am sure the Minister has also read it. It stated that there would be a shortfall of between 10% and 14% in the number of cancer diagnoses for 2020. As somebody who had cancer during the first wave of the Covid pandemic, I am deeply worried that there is a significant problem with people not getting a diagnosis and treatment and, as a result, having more advanced cancers when they approach the health service in the future. What is the Minister doing to address this crisis?

I share Deputy Tóibín's concern, as do the team running the national cancer control programme, NCCP, the Department and the HSE. The Department and the national cancer control programme are systematically studying the impact of Covid-19 on cancer services through data monitoring and monthly review meetings. I am sure I would be able to get the Deputy a detailed note on that if he wishes. During the first wave, from March to May 2020, in line with international experience and as the Deputy has quite rightly pointed out, there was a significant drop in the number of people presenting with cancer concerns. From the outset of the pandemic, great focus has been placed by the cancer services on providing safe patient pathways and encouraging people to come forward. That is very important. The HSE deserves great credit for maintaining urgent cancer services throughout the pandemic.

By the time of the second and subsequent waves, the degree of resilience built up in the cancer services through staff commitment, revised treatment guidelines, social distancing and infection prevention and control measures instilled confidence in people that they could come forward and access diagnostics and treatment. Services were much less impacted, which is very good news.

As indicated, we are continuing to closely monitor trends in the number of people coming forward to the diagnostic services and the level of attendance for appointments for treatment. The most recent figures are as follow. The total number of GP e-referrals to rapid access clinics for January to October of this year stands at 127% of the number for the corresponding period in 2019. I have been discussing this with the NCCP. The figure is higher for this year than for last year. I hope that some of that relates to people we would have loved to come forward last year. The total number of patients seen across all rapid access clinics for January to September 2021 stands at 99% of the number for the corresponding period in 2019. I am out of time but I will give the Deputy the rest of the figures as we go.

Today, 480 people will be diagnosed with cancer and 24 people will die of cancer. It is one of the biggest threats to human life in this State. Timely diagnosis can and will make all the difference for many people. The Irish Cancer Society says that it is worried that many people have cancer and do not know it. This will impact on their outcomes. The Marie Keating Foundation anticipates a tsunami of cancer diagnoses. Perhaps the figures the Minister has just given show that those delayed cancer diagnoses are starting to come into the system. Research that we in Aontú recently carried out showed that there is a significant drop in the number of patients who are starting anti-cancer therapy treatments. In 2019, 8,252 patients started chemotherapy, hormonal treatments or immunotherapy. In 2020, this figure had decreased to 7,683. So far in 2021, it is down to 5,703. The numbers attending BreastCheck, BowelScreen, CervicalCheck, skin cancer clinics, chemotherapy and radiotherapy are all down. We need extra capacity to be put in to deal with this right now.

I agree with all of that. In terms of treatment, the numbers are as follows. The number of patients receiving chemotherapy this year is 95% of the number for 2019. The number of patients receiving radiation oncology in the period from January to August is 85% of the equivalent number for 2019. The equivalent figure for surgical oncology for January to August is 80% of the 2019 figure. Critically, these figures do not include the private hospital activity being used by the public system, so the overall figures are higher. I could not agree with the Deputy more with regard to the need to invest very seriously and very significantly. As the Deputy will be aware, €12 million was made available to restart cancer services to deal with Covid-19. This funding is being used to address backlogs, extend clinic times, provide additional clinics and increase diagnostic capacity. Last year, I allocated €20 million for the national cancer strategy. I am allocating another €20 million for next year.

I understand this is a difficult situation for the Government. Nobody expects it to be able to deal with the issue 100%. We talk about capacity ad nauseum in this Chamber but there is a difference of 260 between the number of ICU beds there should be and the number there are. There are 112 to 117 people in ICU beds with Covid at the moment. The lack of capacity is a bigger threat to ICU capacity than those patients. There is a difference of 8,000 between the number of beds there should be in the hospital sector and the number there are. That is 16 times the number of people with Covid in hospital beds. The lack of capacity arising from Government's lack of investment in hospital beds is 16 times worse a threat to hospital bed capacity than Covid is. We need to set out a significant plan of major investment in capacity. There are 1 million people on hospital waiting lists. Even outside of Covid, there is a necessity to build capacity. It is hard to believe that the Government is looking to close down ICU beds and accident and emergency department beds in hospitals such as my own in Navan at such a time of need. I ask the Government to say here today that there will be a radical step change in how it invests in hospital capacity to deal with Covid and other health issues.

I am very happy to give that commitment. That step change is already under way. In the last year, there was a record increase in the number of hospital beds. Very shortly, we will have added approximately 1,000 hospital beds. To the Deputy's point, there are more than 500 Covid patients in hospital at the moment. We have added twice that number of beds in the last year. We are in the middle of the biggest increase in critical care capacity on record. This year and last year were the top two years with regard to increasing the workforce and the number of clinicians since the HSE was established. There is another question on critical care coming up very shortly and we can get into the detail at that time. I absolutely agree with what the Deputy is demanding. I am demanding exactly the same thing. We need an unprecedented and historic increase in capacity and we are in the middle of one. We need the same kind of targeted investment in cancer services. That is why the national cancer strategy was fully funded for the first time this year. It will get full funding again next year. Approximately one third of the €50 million for new drugs this year will be spent on cancer drugs. There is an awful lot of catching up to be done but we are moving and investing as quickly as capacity can be added.

Where are the hospital beds the Minister referred to?

They are all over the country. We can get the Deputy a breakdown of where they are.

Hospital Procedures

David Cullinane

Question:

93. Deputy David Cullinane asked the Minister for Health the number of hospital appointments including but not limited to elective surgeries which have been cancelled due to capacity constraints and particularly the lack of critical care beds; and if he will make a statement on the matter. [59112/21]

This question relates to the cancellation of outpatient hospital appointments and scheduled care and treatment. I am specifically looking for the number of hospital appointments, whether for consultations with a consultant or procedures, that have been cancelled over the course of the last year.

I thank the Deputy. I looked into this and was advised that the HSE does not collect that specific information centrally. When I was preparing for this session, I noted that the Deputy's direct question had not been answered so I asked the Department to see if that information could be collected. The HSE collects data on cancellations locally but not centrally. Arguably, that is something that should be done. Capacity is obviously one of the big issues. There is an acknowledged deficit in critical care capacity in the country. We came into this pandemic with 255 beds. The capacity review says that we should have in excess of 400 beds. The target for the end of next year or early in the following year is 340 beds. This would represent a 33% increase in our permanent standing critical care stock since the start of the pandemic last year. That is a very significant increase.

One of the big constraints is critical care staff so highly specialised nurses and doctors are required. There is a lot of investment, building and recruitment to build up critical care capacity and, indeed, the entire patient flow so that we do not have these cancellations, which obviously are absolutely awful for the patients and their families. Indeed, it is awful for the healthcare workforce who are trying to provide these patients with the best possible care.

In terms of the private capacity, we have used about 65,000 private hospital bed days this year so far and that is about 20,500 patients. In critical care units, surge plans remain in place and are being activated, as needed. The latest information that I have from the HSE is that we have surge capacity, if needed through the winter, for about 380 critical care beds. Obviously that is not a surge capacity that we hope to activate.

The cancellation of hospital appointments and scheduled care is not sustainable. It now happens routinely. Covid has exacerbated the problem but it happened long before it for which there are a number of reasons. Obviously there is the lack of capacity, as the Minister mentioned, in terms of ICU. There is a lack of recovery beds so surgeries cannot be scheduled. There is a lack of specialist staff, as the Minister mentioned. Finally, there is a lack of stepdown beds in the community.

I wish to raise an issue with the Minister that was raised with me in Letterkenny recently when I met representatives of the Lifford Hospital Campaign Group. It is a community hospital that provided long-stay beds. HIQA advised that the hospital be closed temporarily and it is still closed. My understanding is that the HSE may have funding to provide for short-stay beds, which would a great use of the hospital. I do not presume that the Minister has the information to hand and ask him to provide me with a detailed note on exactly how much funding will be provided to the community hospital and give a timeframe for delivery. It is crucial that we get all of these elements right. There are many reasons treatments and care are cancelled. Some of it is because of capacity and late discharges in hospitals, and the reason for that is that there are not enough stepdown beds.

Yes, I agree with the analysis by the Deputy. It is not about simply providing more home care, outpatients, operating theatres or diagnostics. We have got to look at the entire patient pathway. Can they get to the GP quick enough? Can the GP refer to a consultant or, better still, is there an intermediary, like an advance nurse practitioner scheme that we have seen treat and discharge between 70% and 80% of patients who, in many cases, would have had to wait to see a consultant? Do the consultants have the outpatient facilities that they need? Do the consultants and GPs have access to the diagnostics that they need?

When someone is scheduled for a procedure we must ask the following. Can we get the operating theatre space? Can we get the day space? Can we get the diagnostics on the day? Can we get the recovery bed? Is the critical care capacity there, if needed? Are the ward beds there? Is there an option to discharge? Are there stepdown or rehabilitation beds? Can home care packages be put in place? We have found that in different parts of the country it is different things. We have a very comprehensive level of investment right across all of that to make sure that more and more patients get seen.

On that note, in the last number of months I have visited 17 hospitals. I have met 17 hospital managers and all of their clinical teams. I have met the CEOs of hospital groups. I have also met people who work in primary and community care settings. While some good work has been done through the enhanced community care programme there is still an awful lot more to be done so that we can have admission avoidance in acute hospitals, which is one of the things that we need to do to reduce the cancellation of surgeries and hospital appointments because that is not sustainable. I will draft a report on all of my visits. I will do a synopsis of what I have been told and what I have learned from GPs. There is an issue in terms of GP access. We know that we need more GPs. There are problems in terms out-of-hours GP access for patients. For far too many people, such as people who suffer chronic pain, respiratory illnesses or other illnesses, care management in the community is not happening quickly enough. The infrastructure does not exist so the integrated care piece is critically important. If we get that right then we can reduce wait times and increase hospital avoidance, which is important.

If the Deputy is willing to share his note then I will be delighted to take a look. There is no better insight that I get, no more than the Deputy, than meeting clinicians, healthcare providers, social care providers, patients and their families and seeing what is going on. An awful lot is working and people have done incredible work but, as the Deputy has quite rightly said, more is needed.

While we have seen record recruitment into the HSE this year and lasts year, and record acute beds, the community care side of things has proven more challenging. While we are broadly on target for adding acute beds that is not the case for community beds or community recruitment. We have very ambitious targets.

I ask the Minister to give me a note on Lifford Community Hospital.

I will. We have put in a vast amount of funding to significantly increase the community-based workforce and therapeutics. It has proven very difficult. There is a lot that we are doing, working with the HSE, to see what more we can do to train up, attract and retain people to work in community care.

Deputy Mattie McGrath has sent his apologies regarding his question.

Question No. 94 replied to with Written Answers.

Disability Services

The next question is in the name of Deputy Pauline Tully and her substitute is Deputy Thomas Gould.

Pauline Tully

Question:

95. Deputy Pauline Tully asked the Minister for Health his plans to address the slow pace of implementing Progressing Disability Services and children’s disability networks; his plans to address the challenges this has presented for parents of children with disabilities; and if he will make a statement on the matter. [59113/21]

As the Minister will probably know, today is International Day of Persons with Disabilities. I want to know how he plans to address the slow pace of implementing and processing disability services, and children's disability networks. I want to know how he plans to address the challenges this presents for parents of children with disabilities. Finally, I ask him to make a statement here on the matter.

My colleague and fellow Minister of State, Deputy Rabbitte, sends her apologies as she is currently in the Seanad and was not in a position to take this question.

The implementation of Progressing Disability Service for Children and Young People, PDS, programme is an agreed Government and HSE policy. This policy supports the reconfiguration of children's disability services to provide equitable child and family-centred services based on need rather than diagnosis. The PDS programme will ensure that services are provided for children with complex needs regardless of where they live or go to school.

In line with the PDS model, resources assigned for children's disability services are allocated to the birth to 18 years disability network teams rather than a dedicated early intervention team or dedicated school age team. No longer will a child age out of the services. Before, when one reached the age of six, one was transferred to different services. With this new PDS model, services will be allocated from birth to age 18 years, which I am sure everybody will welcome. There are now 88 network teams in place and the remaining three will be in place by the end of the year. This constitutes the most significant re-organisation of health and social care services ever undertaken in the State.

The reconfiguration of network teams has been challenging, particularly in regard to staffing issues. Currently, there are a number of vacancies on children's disability network teams in each community healthcare organisation, CHO. Recruitment is being progressed, as a matter of urgency, by HSE national recruitment services, and directly in the case of section 39 lead agencies, in order to support network teams to optimise service delivery. There are recruitment challenges due to the significant availability of new posts across the wider HSE in areas such as primary care and services for older people.

Last month, figures were released to me that show the following: 853 children await occupational therapy in Cork north Lee in my own constituency; over 200 children have waited two years or more; and some children have waited three and four years. I have also had it confirmed for me that out of the three funded occupational therapist positions in Cork north Lee 1.5 persons have been on maternity leave since June 2020 and 0.5 of a person has yet to be recruited. This means that for the past 18 months one occupational therapist has had to deal with over 850 children.

Even if we did have three occupational therapists they would not be able to deal with the more than 200 children who have waited over two years and the other 650 children. It is scandal that there is only one occupational therapist to look after 853 children. I wish to emphasise to the Minister of State that parents are at their wits' end because they cannot get services for their children. What can she tell me to tell those parents?

My colleague, the Minister of State, Deputy Rabbitte, has put enormous work and energy into reducing the number of children who are overdue assessments of need. Nationally, 6,558 assessments of need were overdue in June 2020 under the old process. At the end of October 2021, through a combination of different measures, approximately 6,100 children had their assessments completed, reducing the backlog to 460 cases. That is a reduction of 93%, and by anyone's metric that is some reduction in the number of children who require and deserve their assessments of need to be done in a timely manner. This has led to children being put on further waiting lists, and the Minister of State, Deputy Rabbitte is working hard to get those therapies in place.

The Minister of State made a point about a reduction in the backlog of assessments of need for children. They are getting their assessments of need done, but then there are no services. I am dealing with families who have had no services for their children for years. We are talking about the children's disability network teams. I am dealing with a mother who is doing a 12-week course to educate herself to enable her to provide occupational therapy to her son. The course is a good idea for that parent, but not as a replacement for the service. That is what this Government is standing over now - trying to educate a parent in six weeks to do something it takes years for a professional in college to learn and develop the required skills. It is not good enough. These vulnerable children are being failed by the Government and State. I need answers for parents now. Telling me about waiting lists being cleared so that children will have no services is not good enough. The way children with disabilities are being treated is a scandal.

By anyone's metric, achieving a reduction of 93% in a waiting list in 12 months must be acknowledged. Since 2019, some 285 new posts have been allocated to children's disability services across the country. The diversity of posts recruited include dieticians, occupational therapists, physiotherapists, psychologists, speech and language therapists, nurses and some administrative support staff. These posts have been assigned based on several factors, including the existing ratio of staff to the number of children with disabilities in each area.

To return to the children's disability network teams, they will provide a continuum of care for children with special needs from birth to 18 years, reducing the need for onward referral and allowing different professionals to work as one team. This will be a fairer system, but it will have to bed down. It will cover all parts of the country so we will no longer have areas with good services and other pockets where there were effectively none.

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