Ceisteanna Eile - Other Questions

Misuse of Drugs

Aodhán Ó Ríordáin

Question:

96. Deputy Aodhán Ó Ríordáin asked the Minister for Health the position of his Department on the decriminalisation of drug users; and if he will make a statement on the matter. [51980/21]

I tried to put this question concerning the decriminalisation of drug users to the Minister for Justice, but it was redirected to the Department of Health, which I am sure will be of interest to those who have criminal convictions for possession of controlled substances for personal use. I will be interested to know the Department of Health's view of the potential for the decriminalisation of the drug user.

I offer the apologies of the Minister of State with responsibility for public health, well-being and national drugs strategy, Deputy Feighan. He cannot be here because of Covid-19 restrictions. I am taking the question on his behalf.

Under the national drugs strategy, the Government established a working group to consider alternative approaches to the possession of drugs for personal use in December 2017. The working group examined the option of decriminalising drugs and did not deem this an appropriate option in the Irish context due to legal difficulties, which could lead to the de facto legalisation of drugs and operational problems for An Garda Síochána. The Government published this report in 2019. We cannot be complacent about the risk to health posed by illicit drugs. The Government is committed to a public health approach to drug use that will lead to better outcomes for individuals and society. There are no plans therefore to decriminalise or legalise drugs.

In line with the working group’s recommendations, the Government agreed a health-led approach to the possession of drugs for personal use, namely, the health diversion programme. This approach will offer compassion and not punishment to people who use drugs. It will connect people who use drugs with health services and a pathway to recovery, thereby avoiding a criminal conviction, which can have far-reaching consequences for people, particularly younger people. The implementation of the health diversion programme is being finalised in conjunction with the Department of Justice, An Garda Síochána and the HSE.

One of the strategic priorities of the Minister of State, Deputy Feighan, for the remaining four years of the national drugs strategy is to promote alternatives to coercive sanctions for drug-related offences. As well as the roll-out of the health diversion programme, other initiatives to be supported include the drug treatment court and the drug treatment services of the Probation Service. A particular emphasis will be placed on the exchange of best practice on alternatives to coercive sanctions in EU member states, under the EU drugs strategy and action plan.

There are several issues with the response from the Minister of State. The use of language in this debate is extremely important. I referred to the decriminalisation of the "drug user", while the response from the Minister of State refers to the "decriminalisation of drugs" and continues with a reference to the legalisation of drugs. Decriminalisation and legalisation are completely different issues, as are decriminalisation of the drug user and decriminalisation of drugs.

I am talking about the person, and the decriminalisation of the person. If the Minister of State had come in here at the beginning of the pandemic and said that the solution to Covid-19 was to arrest everyone who gets it, everybody would have thought she was out of her mind. People at the start of the pandemic would have regarded people working on the front line or living in poor conditions, for example, as victims of this virus, not as people who should be penalised by the State. It would be a ridiculous response from the State to arrest people because they have Covid-19, but that is exactly what the State does in respect of people with addiction issues. We arrest them for possession of something they are addicted to. It does not work. We have the fourth highest overdose rate in Europe.

People are dying and the response-----

I thank the Deputy. We are out of time.

The health-----

-----must be much more compassionate than misinformed answers on the floor of this House.

I do not accept that it is a misinformed answer. The health diversion programme will connect participants with health services and it will provide a pathway to treatment and recovery where there is problematic drug use. It will also allow participants to avoid a criminal conviction. An interdepartmental group, chaired by representatives of the Department of Health, is considering legal advice from the Office of the Attorney General and the formal views of the Garda Commissioner. The group, as the Deputy may know, is chaired by the former Minister of State and Deputy, Kathleen Lynch, who is doing an excellent job. I have been working closely with her in that regard, as has the Minister of State, Deputy Feighan. Certain legal procedures and logistical issues must be clarified before this roll-out can commence. However, we are not burying our heads in the sand on this issue. We are acutely conscious of the linkages between mental health, dual diagnosis, addiction and court proceedings, and much work has been done in this regard.

I am sorry. The Minister of State's proposal is that people will get a criminal sanction if they are caught a third time. What is the difference? If someone is acutely and profoundly addicted to something, surely the hundredth time that he or she has an intervention because of that addiction should have the same response as the third time. What is utterly heartbreaking about this is that the people affected are powerless. If they had more power and more value in society, we would not be treating them like this and they would not be ending up in graveyards at the rate they are. It is because they are disproportionately poor that they are treated by the State in this fashion.

I suggest to the Minister of State that the proposal for a citizens' assembly on drugs be fast-tracked, she put to one side her current proposal on how to deal with people in addiction and look instead to the Portuguese model, which is much more humane and has successfully reduced the number of people in addiction programmes by 50%. Crucially, it has also reduced the number of people dying from overdoses by 75%.

We have the fourth highest overdose rate in Europe. The Minister of State should please understand the difference between decriminalisation of drugs and decriminalisation of the drug user.

They are completely different things, and the Minister of State needs to understand that.

There is no reason for the Deputy to shout across the floor at me. I am taking this question on behalf of the Minister of State, Deputy Feighan, who cannot be here due to Covid-19. A little respect would go a long way.

I want respect for those dying as a result of this issue. I also want a citizens' assembly on drugs.

Why did the Deputy not do that when he was Minister of State with responsibility for the national drugs strategy?

Is that the response? This over and back and "Why did you not do it"?

Why did the Deputy not do it?

Where is the citizens' assembly?

It is in the programme for Government. Is that the Minister's response?

Why did the Deputy not do it then instead of shouting down others now?

The Minister of State, Deputy Butler, is on her feet and I would be glad to hear her answer.

Could I request, when I am on my feet, that the Deputy's microphone might be turned off so I can get the opportunity to reply? The report of the working group on alternative approaches to the possession of drugs for personal use published in 2019 noted difficulties with decriminalisation in the Irish legal context. In Portugal, personal possession of drugs carries an administrative sanction. The concept of administrative sanctions for a criminal offence is not compatible with the Irish legal system. Therefore, in Ireland, drug use will remain a criminal offence but people will be diverted from the criminal justice system to avoid criminal conviction.

Question No. 97 replied to with Written Answers.

Covid-19 Pandemic

Catherine Connolly

Question:

98. Deputy Catherine Connolly asked the Minister for Health his plans to extend the validity of the digital Covid-19 certificate to nine months for persons who have recovered from Covid-19 infection, particularly in view of HIQA's recommendation that the period of presumptive protective immunity following infection with Covid-19 should remain at nine months post infection; and if he will make a statement on the matter. [59481/21]

My question is very specific. I ask the Minister about plans to extend the validity of the digital Covid-19 certificate to nine months for persons who have recovered from Covid-19 infection, particularly in view of HIQA's recommendation that the period of presumptive protective immunity following infection with Covid-19 should remain at nine months post infection.

I thank the Deputy for the question. Many people look at this and wonder if it is consistent. With the EU Covid-19 certificate we have a recognised recovery period of six months and as the Deputy has said, we have recent advice from HIQA that has been endorsed by National Public Health Emergency Team, NPHET, that the presumptive period is nine months. It is a reasonable question as to why we do not adjust the Covid-19 certificate accordingly.

The EU digital Covid-19 certificate regulation creates a framework for the issuing, authentication and validity of certificates to facilitate the safe and free movement across the EU during the pandemic. Certificates are proof a person has been vaccinated against Covid-19, received a negative test result or recovered from Covid-19. This initiative has been adopted by countries around the world, confirming its status as a robust international standard for Covid-19 certification. To date, 24 third countries have joined the initiative and a further 32 are in the process of joining. This really demonstrates how Europe can set global standards through decisive and co-ordinated action.

The Irish Government has successfully delivered the EU digital Covid-19 certificate to the Irish public, and to date more than 4.5 million certificates have issued nationally, with more than 25,000 also issuing to the Irish diaspora, which is very welcome. Across the EU, in excess 600 million certificates have been issued.

The wide implementation of this tool for accessing indoor hospitality and services has supported the reopening of our economy and society nationally. The scope and parameters for issuing the certificates has been agreed at EU level and is standardised to allow for complete interoperability. That gets to the core of the Deputy's question. Currently, the agreed maximum validity date for recovery certificates is 180 days after the date of a positive PCR test result, as set out in the EU regulation.

We put down questions to be answered and this question is very specific. It is whether the Minister plans to extend the period. I had to ask this way because I failed to get an answer up to now. I know the Minister is extremely busy but this is a very specific matter. We have seen HIQA's report and a letter to the Minister from Dr. Tony Holohan in November, and I believe there was one before that. He sets out in a paragraph that based on the advice provided from HIQA, which I have already read, the NPHET further accepted HIQA's advice and so on. The letter set out that NPHET endorsed the recommendation that the period of presumptive protective immunity following infection with Covid-19 should remain at nine months post infection at this time. Will the Minister just deal with that? I have been obliged to bring this question. I know somebody who had Covid-19, as we all may have, and the period in question is six months. NPHET has endorsed the HIQA recommendation of a nine-month period. What is the Minister telling me?

I am telling the Deputy the standard is set at an EU level. HIQA has made its recommendations and they have been endorsed by NPHET but the EU regulation sets the six-month period. I am advised the EU is not actively considering reviewing that six-month period at this time.

Will the Minister direct me to the regulation because I have not seen it? That is my own fault, I suppose, if the regulation is there. If he has it to hand, he might just quote the regulation and indicate when it was introduced and effected? Who has the Minister been advised by that the regulation will stand and not be changed? Who is making that advice? All the time we have endorsed NPHET and HIQA and, by and large, we go by their reports. Why are we ignoring the advice on this occasion? What evidence is there that has led the EU to indicate a six-month period? Could the Minister point me to the scientific evidence on this?

I have tabled a question so I expected an answer, if not from the Minister, then at least through him from the Department, which has all the expertise at its fingertips. Now we will ignore NPHET and HIQA when it suits us. We will talk about a regulation I do not know about. There is no scientific evidence whatever in the reply. This goes to the basis and the heart of trust so that when I go into the community I can advocate such trust in the system.

To be clear, the Deputy's question is "to ask the Minister for Health his plans to extend the validity of the digital Covid-19 certificate to nine months" and I am answering that directly. I am saying the digital Covid-19 certificate is based on an EU-set regulation.

I heard that. The Minister's plan is not to extend that period.

That is right. It is not being considered at an EU level at this point. Of course I will ask the Department to provide the Deputy with a detailed briefing on the EU regulation concerned.

I would also like to see the advice the Minister referred to. He said he has been advised the period will not be changed. I am sorry because I am breaking the rules.

It is no problem at all. The advice I have is from the Department, which engages with the EU.

The Minister might get back to me with that.

Question No. 99 replied to with Written Answers.

Primary Care Centres

Joe Carey

Question:

100. Deputy Joe Carey asked the Minister for Health if he will report on progress to provide a network of primary healthcare centres in County Clare; and if he will make a statement on the matter. [59225/21]

I seek an update on the provision of a network of primary care health centres in County Clare.

I am very pleased to inform the Deputy that a number of primary care centre developments are being progressed in County Clare. In addition to the existing primary care centre in Westbury, the site at Station Road, Ennis, is under construction and is expected to be operational by mid-summer 2022. The HSE is also continuing to work with a developer on another centre in Ennis on the Tulla Road and is awaiting the outcome of a planning matter currently with An Bord Pleanála. A further project in Ennistymon is progressing, with HSE's estates division working directly with the promoter of the top-ranked proposal following a review of priced offers.

The HSE is also engaged in a review of the current facilities and the overall accommodation requirements for the Kilrush area, while expressions of interest have been received for the site at Sixmilebridge. In addition, the people of Killaloe will be served by a primary care centre currently in development at Ballina, Killaloe and Newport. I understand some of these projects have been delayed due to planning issues or other factors and that is undoubtedly frustrating for the local population and their elected representatives, but the Government’s commitment to the continued development of primary care services in Clare should be in no doubt. These facilities are an essential part of the investment in enhancing capacity in the primary and community sector to deliver high-quality integrated care to people in their own communities.

I thank the Minister. The previous Fine Gael-led Government laid the foundations for these primary health care centres in County Clare and I thank the Minister and the HSE for continuing that work. The Ennis site on Station Road is a really striking building and is a state-of-the-art facility. I have been in touch with the Minister, his officials and the HSE throughout its development. When is it expected that the doors will open in this facility? Will the Minister give some more detail on the Tulla Road site? I know the project is currently with An Bord Pleanála and that has been the position for quite a long number of months. Has the Minister any update on that?

I do. Station Road in Ennis is under construction and planning permission has been sought to increase the floor area of the building to provide for additional services. A decision is awaited from An Bord Pleanála on this additional application. Subject to the decision, which we all hope will be in the affirmative while we obviously full respect the independence of the process, the timeframe for completion of the additional floor space can then be established. In other words, we will not know until we get a ruling from An Bord Pleanála.

It is anticipated that the primary care centre will be operational from mid-summer next year. The Tulla Road project in Ennis is delayed due to an ongoing planning matter. It is with An Bord Pleanála. The HSE continues to seek progress updates from the developer on this.

Sixmilebridge is a really important project. It has met with some hitches and has been re-advertised. Can the Minister give a detailed explanation of the next steps and when we can expect movement on that site? Will he give more detail on the sites that are planned for Ennistymon and Kilrush? Kilrush has experienced a number of glitches over the years. I would appreciate an explanation and a path forward.

With Ennistymon, a number of price proposals have been received and the HSE's estates division is engaging with the promoter of the top-ranked proposal. It is hoped that a firm proposal to meet HSE requirements can be agreed and progressed. On Kilrush, a review of the current facilities and the overall accommodation requirements for the area is due to be undertaken. We will seek a more detailed update as it comes in. In Sixmilebridge, an issue with the sale of the land at Ashview Drive halted the development. The HSE is currently reviewing expressions of interest from developers with a view to progressing the development as a matter of urgency.

Question No. 101 replied to with Written Answers.

A number of Deputies are not present. We will move to Deputy Carey.

I am stepping in for Deputy Haughey.

I had not been informed of that. With Deputy Carey's agreement we will move to Deputy Calleary.

Legislative Measures

Seán Haughey

Question:

102. Deputy Seán Haughey asked the Minister for Health the status of the Mental Health Act 2001; and if he will make a statement on the matter. [59234/21]

My apologies; I thought a message had gone to the Chair. The mental health Bill which the Minister of State is working on will be the first in two decades. I seek a progress update on it. What are the Minister of State's thoughts on the legislation? I would like information on the resourcing plans to go with it.

In 2015, Government decided to draft a general scheme of a Bill to amend the Mental Health Act 2001 in line with the 165 recommendations of the 2015 expert group review report.

Among the expert group recommendations were proposals on revised criteria for detention, updated definitions of mental disorder and voluntary and involuntary patients, the introduction of guiding principles, statutory individual care plans, a greater role for authorised officers in involuntary admissions, improved safeguards for service users, shorter intervals for tribunals, a presumption of capacity for young people aged 16 and 17 years to consent or refuse treatment unless proven otherwise, and the introduction of guiding principles for the care of children under the Act. I thank the Deputy for his question because when I came to the post I was concerned to learn that the general scheme was drafted in 2015 and we had not made a lot of progress. The original Act was introduced in 2001 by the Taoiseach, Deputy Micheál Martin, who was then Minister for Health and Children. A lot of progress has been made in the last 18 months.

The Department shared the initial draft heads of Bill with the Mental Health Commission, the HSE, the Office of the Ombudsman for Children, the College of Psychiatrists of Ireland and the Departments of Justice and Children, Equality, Disability, Integration and Youth for their consideration and input. Earlier this year, I launched a public consultation on the legislation which ran over March and April because I was conscious that the expert panel review had reported in 2015 and I felt we needed an update. Therefore, an independent legal review of the Bill was also completed.

The general scheme of a Bill to amend the 2001 Act was approved by the Government on 13 July and was published on the Department’s website on 23 July 2021. Pre-legislative scrutiny of the general scheme commenced on 2 November.

I want to acknowledge the Minister of State's work on this and in the whole area since she took up the role. Since 2001, there has been a sea change around the understanding, treatment and acceptance of mental health issues. We still have a long way to go but let us hope that the legislation reflects that sea change, the change in treatments and the fact that people have greater power and capacity.

The Minister of State mentioned those aged 16 and 17 years. During the week at the subcommittee on mental health, Mental Health Reform highlighted a particular lacuna between the heads of the Bill and the assisted decision-making capacity Bill. The heads of the Bill say that the assisted decision-making capacity Bill would apply for the purposes of conducting capacity assessments, but there is no decision on supports for those aged under the age of 18. Has that been highlighted to the Minister of State? Why are we still talking about leaving an opening to admit those under 18 years into adult units? I am very wary of that. Hopefully we can move away from it.

A formal Bill will be drafted by the Office of the Attorney General. I expect to introduce the legislation to the Oireachtas as early as possible in 2022. Updating the Mental Health Act is a priority for the Government and for me. I am glad that the Deputy mentioned detention for those under 18 years. I understand that 27 people under the age of 18 have been admitted to an adult psychiatric unit this year. I have recently visited all the child and adolescent mental health service, CAMHS, units in Ireland. Some 95% of those who were admitted to an adult unit were aged 17 years or over. It is very difficult when, for example, a young girl of 11, 12 or 13 years with an eating disorder is on the same unit as a male of 17 and a half - a man - who may be psychotic. It is in the best interests of the patient to take the best advice at that time, which may be to put him or her into an adult unit.

I welcome the Minister of State's clarification but I think it should be specific to particular scenarios and not a general policy.

We have all seen Bills pass through with the best of intentions. Will the money go with the Bill? I know the Minister of State secured huge investment in mental health through the Minister, Deputy Stephen Donnelly, in last year's budget. Have those positions been put in place? It is my concern that we will create an expectation around this legislation as a Bill that is relevant to the 21st century in the way we treat mental health, but that the resources will not be behind it and, more importantly, there will be no way of finding out if the resources are actually going into the system and making a difference to services on the ground.

To conclude on the previous point, each case will be taken on a case-by-case basis. I will give another example. A young adult, under 18 years, was admitted to a psychiatric unit in Donegal one night because it was not possible to transfer him to the CAMHS unit in Merlin Park in Galway. Sometimes a decision like that has to be taken. A person might only be admitted to an adult unit for six or seven hours overnight until he or she can be transferred, but it still goes down in the figures. In some instances, a person can have multiple admissions to a unit. However, one person is one person too many. The national implementation and monitoring committee is examining the issue. Jigsaw, for example, looks after young people between the ages of 12 and 25. There is a mood change that we might have to expand the CAMHS age group from 18 years of age up to 21 or 23 years of age.

The Deputy made a specific point about the funding. It will be vital to implement the Bill next year. We will have short-term, medium-term and long-term goals but a lot of revenue will be required.

Question No. 103 replied to with Written Answers.

Hospital Overcrowding

Joe Carey

Question:

104. Deputy Joe Carey asked the Minister for Health if he will report on efforts to address severe overcrowding at University Hospital Limerick; and if he will make a statement on the matter. [59224/21]

I seek an update on the ongoing overcrowding at the emergency department in University Hospital Limerick and on the efforts by the Minister and the HSE to address the situation, particularly as we face into a very difficult winter period.

I am acutely aware of the scale of the challenge facing our emergency departments across the country this winter and the extra demands Covid is placing on them. Our front-line staff are exhausted from 20 months of dealing with Covid yet continue to deliver a high standard of care to all. I wish to thank them and acknowledge the distress that overcrowded emergency departments cause to patients, their families and the incredible front-line staff who have to work in those difficult conditions.

UHL of course has one of the busiest emergency departments in the country and more than 63,000 individuals have attended so far this year. Increased attendances and Covid-19-related patient safety protocols are contributing to slower progress of patients through the system, and this impacts on waiting times and patient experience in the emergency department. However, despite an increase in attendances of 7% up to October of this year compared with the same period in 2019, the number of patients on trolleys is 35% lower. That is despite an increase in patients and all the additional pressures of Covid-19. Huge thanks and acknowledgement goes to our frontline healthcare workers right across the system, including those in acute, primary and community care, for putting in so much effort to make that possible.

I published the HSE winter plan on 15 November. The Government already allocated an additional €1.1 billion in additional funding to support health services and this is being maintained into next year. The winter plan is designed around a whole-system approach involving acute hospitals and the community and primary care sectors. It has three key objectives: emergency department avoidance; patient flow; and hospital egress. It is aligned with the Sláintecare principle of "Right Care, Right Place, Right Time". Specific measures for UHL include an extension of the National Ambulance Service pathfinder initiative and paediatric patient flow initiatives to ensure timely discharges.

I thank the Minister. I join him in complimenting our frontline staff at UHL. They are under extreme pressure. We are unfortunately a permanent fixture at the top of the Irish Nurses and Midwives Organisation's Trolley Watch figures. Today there are 47 people on trolleys in the accident and emergency department of UHL. It is a frightening figure. The next highest figure is in Cork University Hospital where there are 26 people on trolleys. I recognise the work, including the addition of 98 more beds to the system over the last year, since the advent of Covid, to help us fight it. There is also a critical project planned there. It is a 96-bed permanent ward block. It is important this project is fast-tracked. We only have 533 inpatient acute beds in the mid-west region. It is important this project is brought online as quickly as possible. I ask the Minister to take a personal interest in this to drive it on because we just do not have enough bed capacity to deal with the admissions to the hospital.

I thank the Deputy. As he rightly acknowledges, very substantial additional capacity has been added in UHL but as he also rightly says, still more is required. We are still looking at patients waiting on trolleys at a level we must move away from. In 2017 a new €24 million emergency department opened. Since the start of last year, 132 additional beds have been provided, which is a very significant number. As the Deputy referenced, 98 of those beds are in recent developments. On top of that, there is full planning permission for the 96-bed development and the project is currently out to tender. UHL is also accessing private hospital capacity as well.

I thank the Minister, including for his commitment to the 96-bed unit. It is a really important project. However, with respect to the short and medium term, will the Minister explain what efforts are being made to deal with this in the coming weeks to avoid the really chaotic scenes we have seen in recent times, when there were 98 people on trolleys at UHL? What measures are going to be introduced to ensure that situation is not replicated in the coming weeks and months?

Deputy Griffin is going to come in with a supplementary question.

I thank the Acting Chairman. Many of the issues facing UHL are also being faced by University Hospital Kerry, UHK. Almost a month ago we had senior HSE officials coming down to visit the hospital and meet stakeholders, yet there is still no plan. There is a dearth of feedback from the HSE about what is happening or what is going to be done to address the massive problems we have at UHK. Will the Minister please update the House on what is happening and what has resulted from those meetings? A month ago I signalled my concerns in the House that this would be yet another visit and yet another box-ticking exercise. I am starting to fear I was right, and that should not be the case.

I thank Deputy Griffin. He was not right but I must take advice from the Acting Chairman on this. The Deputy's question is a fundamentally different one. The question posed is about UHL. The Deputy is asking a completely different question. It is a very valid one about UHK and I would like to answer but it is not supplemental to this question. I can send him a detailed note. He and I have obviously discussed this. The Minister for Education, Deputy Foley, and I are in regular communication on this. As the Deputy will be aware, the national director of acute operations has been in UHK and there is a very comprehensive review going on. For example, a figure I think I shared with the Deputy recently was there has been a 33% increase in the consultants added to UHK. At the same time as we have had a one third increase in our doctors, fewer patients are being seen. We need to understand what is going on there, whereby we can substantially increase our medical workforce-----

When will we have a plan?

-----and fewer patients get seen. With the Acting Chairman's indulgence-----

When will we have a plan?

-----I do not know if it is possible-----

Will the Minister please tell us when there will be a plan?

-----to get 60 seconds to respond to the Deputy.

Quite a bit of latitude has been given in terms of putting the question in the first place, Deputy Griffin, to be fair. I am afraid our time for that question has elapsed. Perhaps the Minister will reply to Deputy Carey in writing, if he can.

I apologise to Deputy Carey.

Question No. 105 replied to with Written Answers.

Healthcare Infrastructure Provision

Thomas Gould

Question:

106. Deputy Thomas Gould asked the Minister for Health the status of the new elective hospital in Cork. [59419/21]

I ask the Minister what the status is of the new elective hospital in Cork.

We have skipped a question and are on to No. 106.

I apologise to the Deputy. He might bear with me. There are not as many people turning up on a Friday.

I thank the Deputy very much for his question. It is an essential one on an essential piece of infrastructure for Cork and indeed the entire region. The provision of additional elective care delivery capability in Cork, Galway and Dublin is, as the Deputy will be aware, stated Government policy. The purpose of elective care centres is to initially provide high volume, low- to medium-complexity procedures and a range of related diagnostic services as well. There will also be outpatient facilities. The range of specialties in the initial scope of the elective care centres-----

I apologise to the Minister but I am looking for the status. I am looking to see where we are.

The Deputy has put his question. Perhaps we can allow the Minister to give his answer. The Deputy will then have two further opportunities to come in.

It is recognised that the current elective care capacities do not meet current demand and there will be even greater demand for elective care services in the future. Incremental refinements to the current public hospital network will not, I think we can all agree, be sufficient to meet this demand by themselves. The electives proposal has guided the work of the elective hospitals oversight group, under the governance of the HSE and the Department of Health. The development of three elective care centres will require significant infrastructural investment and therefore the oversight group is following the process outlined in the updated public spending code. This sets out value for money requirements for the evaluation, planning and management of large public investment projects, that is, those costing in excess of €100 million. I think we can all agree these will be investments exceeding €100 million.

A preliminary business case for the new elective facilities, including in Cork, is currently being reviewed within the Department of Health. If it is technically compliant and approved by the Department of Expenditure and Reform, the preliminary business case, PBC, will then be further developed by that Department. If approved, it is envisaged a memorandum for Government will be brought by me, seeking approval to proceed to the next stage.

The Minister is saying he received a proposal in September. This is December and it still has not been approved. This is urgent. A site should be specifically set out in the PBC. Why is there a delay in announcing it? It should say where the potential site is. Where is the information for people? I ask that this hospital be based on the north side of Cork. The people of the north side have no hospital. Fianna Fáil closed down the North Infirmary. Fine Gael closed down St. Mary's Orthopaedic Hospital. I am asking for a full elective inpatient surgery hospital open 24-7 and not the part-time hospital that is being suggested. There are 75,000 people on waiting lists in Cork city and county.

We were promised this hospital before the general election, before the by-election, in 2018 and in 2017. We are being promised and promised. I am asking the Minister a straight question. When will there be an announcement regarding this hospital? Will it be located on the northside of Cork city?

I assure the Deputy that no one is proposing anything that would be described as a part-time hospital. He might elaborate on what he means so I can address concerns, if he has them, but I assure him that there is-----

What is being proposed is 8 a.m. to 8 p.m. from Monday to Friday.

The Deputy should allow the Minister to answer.

I assure the Deputy that no one is proposing a part-time hospital. To answer his exact question on when we will be able to announce where the hospital will be built, with details on its configuration, the number of operating theatres, the number of patients we hope to see, the timelines and so forth, I would like nothing more than to come to the Chamber and, indeed, meet representatives from the region, to give that information. However, following the national children's hospital situation, a review of large capital investment was done. It was agreed that there would be a multi-stage approach to this project to ensure value for money and to ensure it was done right. The downside is that it takes time. While I acknowledge the Deputy's frustration, and we are all frustrated by this, a set process has to be gone through to evaluate and approve the business case. We are moving through that as quickly as it can be done.

We know the figures in CUH and Mercy University Hospital are at crisis point. We have people on trolleys and waiting lists. This is not just about Cork wanting or needing a hospital. Hospital services are at crisis point in Cork. This hospital has to happen. It was proposed that it would be operational by 2024. There is no way I can see that happening. I am asking the Minister a direct question. Does he believe that this hospital will be operational by 2024? This is a commitment given by his Government, his party and Fine Gael, who all made a promise to the people of Cork. This is not about making election promises. This has been specifically identified under health needs as a requirement for the Cork area. This hospital is needed and the Minister knows it is needed, as do the HSE and the people of Cork. When will it be delivered? Will it be delivered on the northside? Will there be beds to go with it? We are talking about delivering elective hospitals, but we need a 24-7, seven days a week hospital, with the beds to support it.

This is a very important issue that the Joint Committee on Health should focus on in the new year. Its members should have a discussion on exactly what these elective-only hospitals should or should not be. I have an open mind on it, but my understanding is that elective-only hospitals will be for the regions and for addressing waiting lists for elective procedures. I support its location on the northside of Cork, as it makes sense. I spoke to Deputy Gould on this issue and we understand that these hospitals will be for people throughout the regions. I hope that these hospitals, in whatever form they come, will address the critical mass of elective care that needs to be done, will take it out of acute hospitals, if possible, and allow more complicated work to take place in the acute hospitals, which will continue. The debate about what elective hospitals are is an important one. We need to bring as many people with us as possible, which is done through consultation with those in the constituencies who might be affected and engagement with Members. Engagement with the Oireachtas health committee on this particular issue would also be helpful.

I wholeheartedly agree with Deputy Cullinane. There needs to be engagement with the health committee and elected representatives from the regions. To answer his question, these will be regional elective hospitals that will not just serve Cork city, County Cork or Galway city. They will be incredibly useful. I suggest to both Deputies that elected representatives from the regions and members of the health committee consider arranging a trip to one of these hospitals, which I would be very happy to facilitate. We have one such hospital, the Reeves Day Surgery Centre in Tallaght University Hospital, which has four operating theatres. It is modest by comparison with what we are looking at building in Cork, but it is going incredibly well. The Reeves centre has no inpatient facility. I am very aware that there are strong views in some parts of the clinical communities in Cork and Galway that there should be inpatient beds as part of this. That is actively under consideration and consultation.

I have very strong advice from the expert group that these hospitals should be day case only. It might be worthwhile if Professor Frank Keane comes in to talk to the health committee about that. All I ask of the Deputies is to keep an open mind until they have an opportunity to engage with the experts on the rationale for it. It is quite a compelling argument but no decisions have been made on that. I strongly recommend a trip to the Reeves centre to talk to the surgeons there about how useful they are finding it for medium and lower complexity work. Their lists are scheduled, they know they are coming in at 7 a.m. or 8 a.m. on a Monday and nothing stops that. The volume is going very well. In fact, more and more hospitals throughout Dublin are expressing interest in using it. I would be very happy to facilitate a trip to the Reeves centre in addition to broader consultation. Both Deputies are exactly correct. There has to be engagement with those in the Dublin, Galway and Cork regions so that this is received well and understood as the best possible response and solution.

Will it be delivered by 2024?

We are already well over time on this question.

A commitment was given to 2024. I am looking for an answer on that.

I am preaching to the converted, but I note we are fully half an hour ahead of our anticipated time. Questions are now being reached, which the Deputies who tabled them would have reasonably expected not to be reached, given the timeframe. Deputy Ó Murchú is first up. I will give the Minister of State a little time to get organised. We are skipping ahead to Question No. 112.

Questions Nos. 107 to 111, inclusive, replied to with Written Answers.

Home Care Packages

Ruairí Ó Murchú

Question:

112. Deputy Ruairí Ó Murchú asked the Minister for Health the details of engagements regarding the need to increase the number of staff delivering home supports; the steps that can be taken to remedy the shortage of staff in the home support sector; and if he will make a statement on the matter. [53104/21]

I have had a number of engagements, both public and private, with the Minister of State on this issue. All of us in this House understand the difficulties that exist regarding families who are looking for home care packages that will ensure their family members can stay at home as opposed to needing to go into long-term nursing care. We need to deliver that, while accepting there are difficulties because of pay scales and other issues. The Minister of State's task force has met a couple of times and is considering incentivising people who work in this sector and ensuring that we get more people into it. I would appreciate it if she will go into a little detail on that.

I acknowledge the Deputy has raised this issue with me on several occasions.

Work is ongoing in the Department of Health to progress the development of a new statutory scheme to support people to live in their own homes. Recruitment for 130 posts to support the national roll-out of international resident assessment instrument, interRAI, as a standard assessment tool for care needs is scheduled to commence this quarter. A national home support office is in the process of being established and a home support pilot commenced this month in one site, with the other pilot sites to be fully operational by January 2022. I was disappointed that the four sites did not commence operation in October. The only reason was the recruitment of staff. It was not due to lack of funding. We have started in one site and the other three sites will commence. This is to test the statutory home care model in four sites to provide us with information as we go forward.

On home care specifically, last year, I secured an additional €150 million for home support, which provides for an additional 5 million hours. My budget for home support this year is €666 million, which is a vast amount. The HSE target is to deliver 24 million hours of home support this year. It is estimated that, by the end of September, 15 million hours had been provided to more than 53,000 people. Notwithstanding the challenges we have, this is approximately 2.2 million more home hours compared to the same period last year. The funding secured in budget 2021 to provide these additional 5 million hours has been maintained for next year.

Significant progress has been made overall on reducing waiting lists for people awaiting funding approval for home support from 7,800 in January 2020 to just under 400 in September. I will conclude in the next part of my reply.

I appreciate that. I accept the added difficulties with the pilots the Department was looking to put in place in the context of the wider issue we have that an insufficient number of people are working in this sector. I know that a lot of things are being considered. We have to look at pay scales and any incentivisation we can provide. We know of the difficulties of people, some of whom were contracted staff, who would state that they were not going to get paid expenses for travel. Every obstacle possible was being put in their way. I think the Minister of State told me that the task force has met, or at least had met when we spoke last, three times and that it is examining every avenue to deal with this problem. Could she go into a little detail in that regard? We all know that the big issue is weekend support. Could she provide a general timeline for getting those pilots up and running? Where is the pilot that is under way operating? Where are the other three? Will the Minister of State provide a timeline, with all the caveats necessary?

To go back to the point, the funding of home care is not the issue. We are all aware of the €666 million available. Delays are occurring at the moment because we have delays in providing home care workers into specific areas. As the Deputy said, weekends and rural areas, especially, can be very problematic. Notwithstanding that, the number has come down significantly over recent years. Home care in Ireland is delivered with a 50:50 split, that is, 50% public and 50% private, but it depends where someone lives. Up in County Donegal, for example, only 19% of home care is delivered on a private basis, with 81% of care provided publicly. In CHO 5, which includes Waterford, where the Acting Chairman and I come from, it is a 26:74 split, whereas in the Dublin area, for example, all home care is provided both voluntarily and privately. That has been going on for many years.

I have put in place a cross-departmental strategic workforce advisory committee. It has met informally on a couple of occasions, but the inaugural meeting will be held very soon. We want to look at the challenges of private providers.

The Deputy referred to the difference in the rates of pay. I will come back to that in a moment.

Obviously, we need to look at the issue of the rates of pay. Again, I accept the difficulties in providing a timeline, but we need that task force to have its inaugural meeting. I accept that considerable work has probably been done, but we need the task force to put the priorities that are required in place and on the agenda, to be enacted by the Government as quickly as possible. We are all dealing with families coming to us who just do not have sufficient care. Could the Minister of State detail, as I said, the pilot schemes and a general timeline as to when they will be up and running? I have referred to the proposals on the agenda regarding improving the numbers of people in the sector.

The pilot scheme in the Galway area is operational. The pilot schemes in west Cork, Mullingar and the Dublin area are not. I will get the Deputy a note on that because it will outline exactly the areas being covered.

That would be brilliant.

The role of the cross-departmental strategic work force advisory group will be to facilitate the views of stakeholders and to examine workforce challenges in home support and nursing homes. Potential areas will be recruitment and retention, training and the career development of home supports. I was updated by the chief officer yesterday on CHO 4, which comprises counties Cork and Kerry. They are strategically looking to hire 300 healthcare workers in the next three months. They have gone out on a very strong recruitment campaign, which is happening all over the country. The challenge we have, however, is that many people have left the home care sector and gone into nine-to-five jobs and into retail. Some have gone to work in factories, where the terms and conditions for some are more favourable.

They are family-friendly.

We are, therefore, challenged but we are working with the Department of Public Expenditure and Reform to look at different things to see that people on social welfare, for example, might be able to work a certain number of hours and students in receipt of the SUSI grant might be able to work enhanced hours. We are trying to throw the kitchen sink at this to resolve it.

Questions Nos. 113 to 116, inclusive, replied to with Written Answers.

Vaccination Programme

Duncan Smith

Question:

117. Deputy Duncan Smith asked the Minister for Health the status of the roll-out of the Covid-19 booster programme; the issues that have been identified with the early roll-out; and if he will make a statement on the matter. [59244/21]

Wow, anything can happen during Question Time on a Friday, including getting through the list of questions.

I would like an update on the booster vaccine campaign. GPs seem to be getting on well, but I would like the Minister's view on the mass vaccination centres and the pharmacies and how they are being used for the campaign. Could he also speak to the staffing levels to provide the vaccine compared with the levels during summer? Have there been changes in the staffing levels and resources we have at our disposal?

I will caveat my response. I do not think anybody expected to get to Question No. 117, so the note I have does not include everything I would like. I will therefore go from memory, so if some of these figures are off, I apologise ahead of time.

Between boosters and third doses for the immunocompromised, approximately 900,000 vaccines have been administered at this stage. The highest priority groups were nursing homes and other long-term residential care residents, those over the age of 80 and those who are immunocompromised. They have been either substantially done at this point or have been offered appointments for boosters or third doses. The next group is healthcare workers and those in their 70s. Approximately a little over two thirds of healthcare workers and a little over two thirds of those in their 70s have now had their boosters, and many more have been scheduled. That is moving very quickly. The next groups are those in their 60s. One group I asked the HSE to accelerate vaccinations for was those who have underlying health conditions. These comprise the vast majority of people in ICU, Covid patients or people with underlying conditions. Good progress is being made on those in their 60s, and there are walk-in clinics this week. There are walk-in clinics for healthcare workers as well in the vaccine centres. Those with underlying conditions have started this week and, to begin with, they are being contacted. What I am talking to the HSE about now is whether we can expand access to those with underlying conditions, for example, by walking into a pharmacy or contacting a GP, who may well have given them the vaccine last time, or by having walk-in centres for those with underlying conditions. We are moving through those as quickly as we can. The next group is those in their 50s. I am advised that the plan for them is to start in approximately two weeks, so mid-December is the provisional date for that group.

Neither of us expected to get to this question, so I appreciate that the Minister does not have detailed notes with him. However, it has been reported that we do not have as many vaccinators or staff as we had in the summer. Is he able to speak to that? I am not looking for numbers, but is that an issue? It may not be a big one; it may be a small one.

Second, we are following a similar vaccination pathway by prioritising older people, healthcare workers and so on, as we did initially. Has there been any kind of judgment or indications as to whether there has been any drop-off in booster take-up as opposed to the first vaccine? I would be interested to hear if there are early indications or data on that. Let us be honest: we are benchmarking our booster campaign against a very successful initial vaccination campaign. The vaccination campaign and what it has done to keep people alive cannot be overstated. We all want the booster campaign to be a success. I would be interested to hear from the Minister on those two points.

I will respond first to the Deputy's second point, which was what the level of demand is like. As the Minister of State, Deputy Butler, was just saying to me, the demand in the nursing homes has been huge. There has been no drop-off. We saw over the weekend very long queues. Obviously, we do not want anyone waiting many hours for a booster, particularly in the winter, but it is at least indicative that there is a very high demand, and we have seen it grow. In fact, we have seen another big wave of interest since we found out about the latest variant. The good news is that there is strong demand and we are seeing high take-up levels, as I said, for the initial groups who have had that little bit longer, namely people in nursing homes, those in other long-term residential care, the immunocompromised and those aged over 80.

The Deputy's second question related to recruitment, which is one of the issues we are focusing on a lot on the task force. We had a great many people in the vaccine centres. There was a period between broadly the end of the vaccine programme and the start of the booster programme when we could not leave very large numbers of people with nothing to do, so many were redeployed back into-----

I might come back on the supplementary-----

I am happy to cede whatever time I have to the Minister. Do I have 30 seconds?

Perhaps I will just finish up on this, Acting Chairman.

We are right up against the clock. Go ahead.

Many staff were redeployed into primary and acute care. Some went back into retirement. An amazing number of people had come out of retirement. Students went back to college. In recent weeks, the HSE has been successfully asking people to come back and has been deploying, where possible, from acute settings. However, the acute settings are under severe pressure and one of the areas we were able to bring staff from last time was PCR testing. We now have capacity of approximately 225,000 PCR tests per week. The students are back in college so it is more difficult. We are calling out to everyone we can to come in to allow us have as many people as possible available. Regardless of that, between third doses and boosters, approximately 210,000 vaccines were administered in the past seven days, which is good. We are looking to increase that all the time.

Written Answers are published on the Oireachtas website.