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Dáil Éireann debate -
Tuesday, 15 Feb 2022

Vol. 1018 No. 1

Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions

Hospital Waiting Lists

David Cullinane

Question:

58. Deputy David Cullinane asked the Minister for Health when the waiting list plan will be published; and if he will make a statement on the matter. [7839/22]

I think we all accept that waiting lists are dangerously high. At the weekend, figures from the National Treatment Purchase Fund, NTPF, showed almost 900,000 people are on some form of health waiting list. More than 600,000 people are waiting for a hospital appointment, of whom 165,000, including 25,000 children, have been waiting longer than 18 months to see a hospital consultant. We are moving in the wrong direction. I ask the Minister to outline his strategy to tackle, once and for all, these dangerously high wait times.

I thank the Deputy for his question. He has raised one of the greatest challenges in the health service. It is a top priority for me and the Government. Before the Government was formed and Covid arrived, waiting lists were far too high across the board. They are still too high and very significant action is required. The 2022 waiting list action plan, which I will bring to the Government shortly, builds on the successes of the plan in the fourth quarter of 2021, which ran from September until December.

That 2021 plan was developed by my Department, the HSE and the National Treatment Purchase Fund to mitigate the impact of the pandemic and cyberattack on scheduled care and stabilise the resulting growth in waiting lists. Understandably, many more people are coming forward for care.

I am pleased to say that the actions under the plan for last year delivered immediate extra activity, resulting in a 6% reduction in waiting lists last year. Considering the pressure the system was under last year, it is welcome that we were able to reduce the lists at the same time. Obviously, we must go much further. More than 40,000 additional men, women and children treated under the action plan last year no longer have to wait for care.

The short-term plan also incorporated reform actions that will continue to be progressed as part of the 2022 waiting list action plan. This includes revised waiting list management protocols, improved data collection and information and further work towards improving patient pathways of care. Some 37 priority scheduled care pathways across 16 specialties are on track for implementation in 2022. These will ensure the availability of more timely access to care for people in settings closer to their communities and homes.

The problem is that all sorts of promises have been made in the past to deal with waiting lists. When the HSE was established and in 2005, the Taoiseach at the time stated he would eliminate waiting lists. In 2015, the Tánaiste, as the then Minister for Health, said that by the summer of 2015 under his watch no patient would wait longer than 18 months. In 2017, the then Minister for Health, Deputy Simon Harris, said he would halve the time people were waiting for more than 18 months. What has happened? The waiting list has gone in the wrong direction. There are now 165,000 people waiting over 18 months. The number has quadrupled since the then Minister made that statement. That is the reality and it is not all due to Covid.

I received a call earlier today from Ms Phil Ní Sheaghdha of the Irish Nurses and Midwives Organisation, INMO. She is very concerned about what is happening in our hospitals. The number of patients on trolleys is at a critical level in Waterford, Galway, Cork and Limerick. She is calling for the emergency department task force to be convened immediately and for the Minister to take the reins and intervene by putting all options on the table, including leveraging private capacity if necessary. We must understand the scale of what is happening in the hospitals. Ms Ní Sheaghdha's call to me was urgent. She is very concerned because her members across the State are telling her that this is a real crisis.

Phil Ní Sheaghdha and I spoke yesterday about many of these issues. I will visit Limerick on Thursday when I will go directly to the hospital and meet the hospital group. The Deputy is right in identifying the ongoing pressures there in spite of investment, increased resources and a new emergency department. The pressure is still not acceptable in Limerick or in Galway and other hospitals.

I agree with the Deputy's core point on waiting lists. I made similar contributions in this House from where the Deputy is sitting. Waiting lists have not been acceptable for too long. The question is what we are doing about it. I have allocated €350 million this year specifically for waiting lists. Obviously, it will take much more money to build the permanent capacity in the public system because we need a public health service that can deal with total demand for the country. We want a single-tier system. At the same time, we must get help for all of the men, women and children who are waiting. That is what the €350 million plan is for. I look forward to publishing it shortly and discussing it in detail with the Deputy and other Members.

The Minister has to understand what causes the problem with waiting lists. It is the same thing that causes the problem in our emergency departments. We do not have enough admission beds in hospitals. Two years ago, in budget 2021, the Minister committed to bring 1,147 additional in-patient acute beds into the system. Some 400 of those have not yet been delivered. Hospitals do not have the beds to admit patients in the numbers they need. That creates problems in our emergency departments. We do not have the enhanced community care that we were promised along with integrated care and step-down beds in communities. This causes late discharges as hospitals cannot discharge people into the community as they do not have the beds. That is a second problem. The third problem is GP capacity, which we will deal with later.

For the first time, we are beginning to see people waiting for access to a GP. Will we get to a point where we have waiting lists to see a GP? People are waiting not just days but sometimes weeks for appointments. These are the problems. When people are unable to access a GP in hours or out of hours they have no choice but to attend our emergency departments. When we have emergency departments overflowing it is a symptom of everything going wrong at the same time. The Minister should convene a meeting of the task force, get the stakeholders together and put all the options on the table, including leveraging capacity in the private sector, because this is so urgent.

I largely agree with the Deputy. I had a high-level meeting with the HSE on exactly this matter in the past few days. There are still some issues related to Covid. One point the HSE raised with me was that about half the nursing homes have Covid outbreaks. We have a protocol in place whereby one must wait 28 days, two full cycles of Covid, before anyone can be discharged. As the Deputy rightly said, there are pressures on discharges. We funded an extra 2.7 million home care hours for last year, which have been carried forward into this year. However, the issue at the moment is not funding but making sure there are people who can deliver the services.

The Deputy is absolutely correct about discharges, more community beds and how we need the nursing homes to be free of Covid in order that people can be discharged. Then there is the issue of home care packages. The Minister of State, Deputy Butler, has done huge work on reducing waiting lists for those looking for home care packages. As the Deputy says, this is end to end, from prevention, GPs, community services and frailty intervention and community intervention teams to the availability of multiple pathways in emergency departments, diagnostics, including acute diagnostics and GP access to diagnostics, acute beds and discharge options.

Hospital Waiting Lists

Duncan Smith

Question:

59. Deputy Duncan Smith asked the Minister for Health the detailed breakdown of child and adolescent orthopaedic and related surgeries waiting lists; his plans to tackle those waiting lists; and if he will make a statement on the matter. [7729/22]

Continuing on the theme of waiting lists, my question relates to the waiting lists for child and adolescent orthopaedic surgeries. These are very complex surgeries which require complex follow-on care and recovery pathways. It is not a case of scheduling X amount of hours in a theatre to get a surgery through. The issue is more complex than that. I want to hear the Minister's plan for the treatment of these young people. With each passing week, month and year, their conditions deteriorate and they become more complex to eventually resolve.

This is one of the most pressing areas of the waiting lists. Children are waiting for orthopaedic surgery, whether spinal surgery or surgery for scoliosis, spina bifida, hip deformities or a range of other conditions. Some are being treated quickly, which is a great testament to our clinicians and health service, but far too many are having to wait for far too long. It is not acceptable now and has not been acceptable for years. Significant progress was being made in the treatment of scoliosis and spina bifida in 2019. The numbers waiting for far too long were coming down.

Obviously, the last two years made that very difficult. Last week I convened a meeting of the three hospitals involved, namely, Crumlin, Temple Street and Cappagh. I met the surgeons, hospital managers and the director of nursing. Some time ago I asked the HSE to put together a comprehensive solution for these children and their families. That is what we met to discuss last week. I then visited Cappagh on Friday, including Cappagh Kids. The hospital has really ambitious, interesting proposals for children and adolescent, and adult services in the from of high-dependency units, more beds and so forth. We have what I think is a very ambitious but very good plan in place. We are putting some final details on that but ultimately we need to ensure the capacity is in mainly Crumlin, Temple Street and Cappagh. Other hospitals can help but they are the three main places that will make sure these children get the care they need very quickly.

I thank the Minister. I am glad there is an ambitious plan and a good plan and that he has met with the three main hospitals in the past week. However, what was reported at the weekend in the Business Post gives all these questions a different complexion. Obviously, all these questions were submitted in advance of that. I heard the Minister of State, Deputy Butler, and indeed the Minister of State, Deputy Rabbitte on the radio. They gave very credible accounts as to how they come up with their budgets and the work that would go into it, which I believe. However, does the Minister now have faith that when ambitious plans for this area or any other in health are put together and he provides the money, it will actually be delivered and will go into the HDUs and the staffing levels? This is not a "Gotcha" question. It is a very serious question because whatever the merits of how that article came to be, namely a secret recording and all the rest which is not great, the fact is it was presented to us. It poses very serious questions about whether what the Minister says is delivered on the ground by the HSE through the Department.

I thank the Deputy. What I asked for from the HSE was an ambitious plan that would get these children the care they need as quickly as possible. I am not interested in solving it over a five-year period; we have got to solve it now. We have paediatric orthopaedic surgeons who do not have the operating theatre time they need. We have operating theatres that are open between 9 p.m. and 5 p.m., Monday to Friday, but not earlier or later and not on Saturdays or Sundays. There is much opportunity there. The HSE worked with Children's Health Ireland, CHI, and with Cappagh and have come back to me with a very ambitious plan. I will shortly be able to share the details. Will they achieve everything set out in the plan, even if it is fully-funded? They are going to try their very best but in a conversation I am having with their surgeons, they are saying that with healthcare, especially at the moment, it is very hard to give definitive guarantees on all of this. Emergency cases come in, theatres get used up, and maybe the neurosurgeons need the theatre that was meant to have a full list of paediatric orthopaedics that day. As such, there is a genuine nervousness and caution when CHI is giving me these figures. I would love all of us to recognise that what I am doing and what the Minister of State, Deputy Butler, is doing is we are setting very ambitious targets and they are not always met by nature of the fact we are asking the system to go beyond what it has ever done before.

On the targets, I am aware the Minister probably cannot give full details. What I am getting from his response is we would be looking at theatres being open at off-peak hours and maybe on Saturdays and Sundays. Is that something he could confirm to the House this evening as part of this ambitious plan? That would be an encouraging sign that there is going to be real energy put towards making a dent in this. Nobody in this House believes something as serious and with such a depth of waiting lists will be resolved in a very short period. Second, regarding the follow-on care such as physiotherapy and all the related multidisciplinary care, does this ambitious plan deal with that level of following the surgeries? If so, is the Minister confident the staffing levels will be in place for the multidisciplinary teams in order that they will be able to provide that follow-up care?

Yes, the plan is for end-to-end care. One of the surgeons at the meeting last week made a related point. He said we are not funding individual surgeries in this regard; we are funding care for children. He said several of these children may have to go in for multiple surgeries and they may need multiple surgeries this year. Thus, the targets are not around individual operations. What we are looking at is child by child, that is, are we putting a plan in place that can get this child, as the Deputy said, the pre-operation support, then the surgical help and then the post-operation recovery as well.

Will that include the off-peak hours for the theatres?

Yes, absolutely. It is something we have discussed - both Monday to Friday and opening earlier and later. It is something that happens in the adult private world. The operating theatres run longer as do the diagnostic suites. The operating theatres are open on Saturdays and sometimes Sundays. In fact, the HSE sometimes uses the private facilities sometimes on a Saturday. It is a "Yes", and not just in paediatric orthopaedic but right across the board.

General Practitioner Services

David Cullinane

Question:

60. Deputy David Cullinane asked the Minister for Health his plans to address the crisis in general practice and general practitioner out-of-hours services; and if he will make a statement on the matter. [7840/22]

I spoke earlier about the crisis we have in GP capacity. There are so many crises in health and I think the Minister will accept we have a real problem in this State. I am getting calls from people who are telling me that for the first time, they are having real difficulties getting an appointment to see a GP. It is not just Covid-related. It is a problem in rural areas but also in parts of Dublin as well. Many people cannot get registered with a GP. The HSE has said there is a deficit of up to 1,600 GPs. That is even before the 500 GPs it is anticipated will retire over the next five years is taken into consideration. That means 2,100 GPs will be needed over the next five years. What is the plan to make that happen?

I thank the Deputy very much for the question. It is a hugely important issue. I pay tribute to GPs and everyone working with them in general practice for the extraordinary work they have done through the pandemic and of late in stepping up around the Christmas period for the booster vaccines. They have been absolutely incredible.

There are capacity challenges facing general practice. There are access challenges for patients. As the Deputy rightly said, it can be quite variable in different parts of the country. One of the areas I am particularly concerned about is that the waits are especially bad in some lower-income areas. That is something that must be looked at as well. Steps we have taken recently in co-operation with general practice include the chronic disease management programme, which is going very well, and GP direct access, which is going very well and is helping with a lot of access. They are having a transformative impact in the delivery of quality care in the community that general practice is able to provide. However, as the Deputy quite rightly said, much more must be done.

The 2019 agreement with GPs was an important step in restoring general practice as an attractive option for medical graduates. What impact has there been so far? The number in training has increased quite a lot. In 2009, there were 120 coming out of training; last year, there were 233. We have further to go but it is a significant increase. The transfer of responsibility for training to the Irish College of General Practitioners, ICGP, was completed last year. That is a really important step.

We are also committed, under the 2019 agreement, to undertake a strategic review of general practice. This should have started before now but it was delayed by Covid. Work on the review is going to commence this year. The review will examine a wide range of issues affecting general practice and set out the measures necessary to deliver a sustainable service in the coming years.

The Minister's response sets out the scale of the challenge because we are talking about 233 training places. I engaged with the ICGP on this and approximately 30 places over the past two years were not available to allow some of those training places to be taken up. That is one of the problems. We need 2,100 GPs over the next five years to simply stand still. That is on a no-change basis.

We are all committed to universal GP access, but we are only training 233 people. Not all of them will go into the public system, not all of them will sign up to the GMS contract and not all of them will become GPs. Some will go into hospitals and stay there and some will leave. We have a real crisis and unless we ratchet up the number of training places and have a much more joined-up approach between the training body, the acute hospitals to make sure people are trained, and the actual need, we are in real difficulty.

Yes, I agree. We have to continue with the graduate training posts but we have to go much further than that. I talked to a rural GP from the Deputy's neck of the woods in Waterford a while ago, and she estimated that her maternity leave, which she totally funded herself, will cost her approximately €60,000. This is a brilliant young GP in Waterford. She was considering splitting a GMS list as she wanted to change the balance and pull back, but the rules are not in place to allow her to do that. As a result, she was thinking about moving to Australia. That is just completely unacceptable.

Yes, we need to increase the number of training places, but what I want from the review this year is for us to listen carefully to GPs, at various stages of their lives, to hear what they need to make this a job that would attract them, they would stay in and where they would continue to develop and work with others in a multidisciplinary way.

The example the Minister gave of a GP in Waterford is very important, and he has listened to what she had to say, but he is the Minister and he can effect change. If I was in his shoes, I would establish a working group on the future of general practice and I would look at a new model of GP and primary care, including the option of directly hired GPs, if that is what we need to do.

We need a new GMS contract. The Minister is right that many GPs who are coming out of training all of a sudden find they are entrepreneurs and businesspeople and they need practical supports regarding that. There are issues relating to staffing subsidies, which are based on an archaic view of how practices work, when we know general practice has completely changed. The GMS contract needs to reflect a modern, primary care service. All the other supports the Minister mentioned also have to be put in place. It is all of that.

If we are to have any chance of expanding free GP care, and delivering on the promise that was made, all of this needs to be done. If it is not, a legacy of the Minister and the Government will be that of another party that promised to deliver reforms in healthcare to transition to a single-tier health service and universal GP access, but failed. They will only fail if they do not grapple with these issues. While the Minister is listening to GPs, I do not see any evidence of any concrete changes so far.

As the Deputy quite rightly said, the ambition is very serious. The ambition is ultimately for free GP access to be the norm in our country, not just for children. That is where we have to go and we have to get there quickly. To do that, there has to be massive investment in general practice, including in the numbers, as we have discussed, and in the supports around them, such as eHealth, where there are some good initiatives but which is not rolling out quickly enough. The GMS contract will have to change. It will not work for the level of ambition of what we have in mind and, as we know, it does not work in some parts of the country anyway. In many parts of the country, some people are struggling to get onto a GMS list and that is not acceptable.

The Deputy said he would set up a working group this year. We are doing that. It was promised under the 2019 agreement. For reasons we can all accept, it was not possible over 2020 and 2021, but we are doing that this year. It is important to me that the starting point will be to listen to GPs very carefully and hear what they need to develop general practice.

General Practitioner Services

Róisín Shortall

Question:

61. Deputy Róisín Shortall asked the Minister for Health if his attention has been drawn to a proposal from an organisation (details supplied) to establish a working group on the future of general practice in order to address the serious challenges facing general practice and patient care; if he will undertake to meet with the organisation in this regard; and if he will make a statement on the matter. [8386/22]

To stick with the issue of the shortage of GPs, we know there are major recruitment and retention problems right across the health service. The Minister described the problems well but we need to talk about what exactly will be done about them. General practice is central to our health service, to its future, to Sláintecare and to the aim of having the right care in the right place at the right time. Will the Minister tell us exactly what steps he will take to deal with the shortage of GPs?

I thank the Deputy for raising this issue. We are doing several things. We have to first recognise there is a serious issue. I know the groups met with the Oireachtas Joint Committee on Health and the figures it gave them were very stark in respect of future shortages. Let us all agree this is a major issue that needs to be dealt with. What do we do? We need a very significant increase in training places. As the Deputy referenced in her question, we are setting up a working group on the future of general practice. Under the 2019 agreement, that should have happened either in 2019 or 2020.

I do not want to pre-empt what that working group will come up with. I have various views. A serious gender analysis is required. Certainly, the conversations I have had with GPs suggest the system simply does not work structurally for many women. There are very serious issues with access, especially GMS access. It is more serious in lower income areas where it is a real problem so we need to look at how a future GMS contract interacts with the future of general practice. We moved training to the ICGP. That happened last year and was a very positive move. We are funding roles through the ICGP, for example, the role of women's healthcare in general practice. There is a dedicated resource looking at that issue.

An issue the Deputy has raised many times, where there has not been sufficient progress, is eHealth in the community. Some good things happened during the pandemic, but much more is required in terms of remote monitoring of patients, including practice nurses, GPs, remote sensors and home care workers being able to bring their patients in through the chronic disease management programme.

The ICGP has done a lot of work in this area. It is great that it is now responsible for training, but the people in that organisation are the ones who provide the policy basis for general practice. They have identified four areas: workforce, workload, IT and data, and bricks and mortar. It is very important that we address all of those. Part and parcel of that is accepting the current business model for general practice works for some people, especially existing GPs, and maybe some in the future, but it does not cater for all GPs.

The important thing is to ask newly qualified GPs why so many of them are leaving this country and going abroad. They have already been asked that in various surveys and it is not about money. Everybody wants a decent income, but GPs do not want to be businesspeople. They want to be doctors practising medicine, they want to work as part of a multidisciplinary team, they want support in their practice and they want a better work-life balance. Does the Minister accept that all those issues are key to ensuring we keep people here after their training?

Yes, I do. I accept all those issues. Certainly, the conversations I have had with GPs and members of the Irish Medical Organisation reflect all of that. We need to be flexible. From the conversations I have had with GPs, many of the younger GPs, and some of the more urban-based ones, are very interested in being in primary care centres, multidisciplinary teams and a lot of the innovation around eHealth. Interestingly, some of the older GPs I have spoken to who might be in more rural areas are quite happy with their situation. They want to keep going, but there is flexibility they do not have, such as splitting GMS lists.

The Deputy talked about the business model. There is a real issue with the GMS. GPs say to me that in many cases they lose money on the GMS list. It is income that comes into the practice, but where they make their profit and get to pay their wages is on private patients. If we are moving towards more and more people being able to access GP care for free, that is something we will have to deal with. If we are asking GPs to come into areas, which we must, where the majority of patients are GMS patients, we need to think about that. It cannot be more profitable for GPs to work in well-to-do areas than in lower income areas. That just does not work because lower income areas will not have enough GPs.

That is the situation at present. That has to change and we have to stop talking about it. We need to move ahead and take action on this. It is understandable that existing GPs who have invested heavily in their practices and premises should be protected, but it does not mean that should be the standard model for everybody.

The Minister needs to introduce that flexibility. That can be done quickly. The contract is very much out of date. We need to start the work to update the contract, but that should not hold up other progress. There is a need for facilitation of GPs to come into primary care centres. Currently, that is not being facilitated because of ridiculous rows about paying rent. We should be bringing in as many GPs as possible. We should also have salaried GPs and contracts where GPs, especially women, can work part time. These are all issues that need to be dealt with quickly. The Minister can deal with them quickly. Will he undertake to meet with the ICGP within the next two to three weeks to discuss its proposals for the working group which will be representative of all stakeholders? Will the Minister please do that? They have plenty of good ideas. They know the issues thoroughly. Will the Minister sit down with the ICGP?

I would be delighted to meet the ICGP. It is an excellent organisation. It is doing the training now, but there is an awful lot of innovation and constant thinking about the future of the profession. I agree with regard to the need for salaried GPs. I have no issue with that. I would like to see more of that. It is something of an anomaly in a public health service where the vast majority of GPs are private contractors. That suits many of them and that is fine. Like the Deputy, I have spoken to GPs who would much prefer not to have to be entrepreneurs or businesspeople. They are doctors and they would love to be able to come into the system. There are a lot of primary care centres out there. Many more were added last year. If the Deputy has examples or evidence of situations where the State or the HSE is making it too difficult for them to go in on contract, I would be very happy to take a look at it.

Will the Minister meet the ICGP within the next two to three weeks?

Yes, no problem. I will do so within the next few weeks.

I thank the Minister.

Mental Health Services

Pa Daly

Question:

62. Deputy Pa Daly asked the Minister for Health the status of the implementation of the south Kerry CAMHS review recommendations; the status of the State-wide review and prescription audit and of a review into north Kerry CAMHS; the supports provided by the HSE to parents and children affected by the CAMHS scandal since the launch of the look back review; and if he will make a statement on the matter. [7841/22]

The recent review of the south Kerry CAMHS comprised 74 pages and 35 recommendations and it proclaimed the contact it had with parents, patients and former patients who are now adults. However, many of them have been in touch with me and told me that there has not been much contact with them, that there is no care plan in place, that they have not seen a psychologist who must be independent of the current team and that they feel their questions are not being listened to, heard or answered.

In regard to those parents who have not been contacted, what does the Minister propose to do with regard to contacting them, giving them what is needed and extending the review to the parents in north Kerry who feel just as aggrieved?

I thank the Deputy for the question. We have discussed this matter several times in the past three and a half weeks.

Six of the 35 recommendations in the Maskey report have been implemented, with 13 currently being implemented. Having read the report, the Deputy will know that some of the recommendations can be implemented straight away but others will take time. The HSE has committed to implementing them all as quickly as possible. I have sought fortnightly updates from the HSE on progress. I will continue to do that.

On the current situation, I meet the chief officer, Michael Fitzgerald, three or four times a week. I met him last Thursday morning on the very issues raised by the Deputy. The consultant psychiatrist post at south Kerry CAMHS is, unfortunately, still vacant. That has not changed just because the report was issued. The HSE does not expect to have a permanent consultant in the short term and on that basis it has put additional support into the team. A dedicated consultant lead is in place and additional support is provided by other consultants. Online consultant appointments have been offered. In the long term, the HSE will establish a clinical support team in Killarney to provide a point of contact and support in the future. This will take a little time to do. The HSE will be in direct contact with the young people and families shortly with details of that clinical support team. The HSE has been working over the past couple of weeks to get this clinical support team in place.

As the Deputy will know, the 227 families were invited to a meeting. To date, 198 have taken up the invitation to that meeting for the purposes of open disclosure. They have been informed of the situation in regard to each young person. As rightly stated by the Deputy, some of them are now over 18 and they are getting support in adult services. We can put in place supports such as talk therapies, cognitive behavioural therapies and the psychosocial supports that these people need. We are working towards that. I will come back on the other issues in my next slot.

I thank the Minister of State. There is an obvious problem with recruitment. Things are going to have to change. At one stage, we received a glib reply to the effect that this is a €200,000 per annum post and so there is no reason people would not want to travel to Kerry and stay there. It is not just about psychiatrists. Consultants who go to the general hospital need support staff, resources, equipment and, in many cases, an office. That has to change as part of the recruitment strategy.

The Minister of State mentioned that the Killarney team will be in place "shortly". What is meant by "shortly?" On the cases in north Kerry, we need an extension into all of those families. What is happening with them? We need a State-wide review and an audit of medication and medicating practices, which are the issues at the root of 90% of the problems here.

In regard to north Kerry, we addressed this again last Thursday. There will be an audit in north Kerry, similar to the audit in south Kerry. The chief officer has informed me that he is currently trying to get a consultant of the calibre of Dr. Seán Maskey to do the north Kerry audit. He is looking outside of Ireland in that regard. Dr. Maskey will not be carrying out the audit in north Kerry. To make sure the audit is independent, the chief officer will seek a consultant from outside of Ireland.

On the national audit, I met with the Mental Health Commission yesterday. It is also doing a review. Dr. Susan Finnerty, the chief inspector, will oversee this review. She has already secured a consultant psychiatrist from Scotland and one from Ireland to ensure the review will be completely independent.

On the HSE audit, we are still finalising the details in that regard. It will commence in quarter 1. I expect it to commence in the next couple of weeks.

I thank the Minister of State. They are all good proposals, but I cannot stress enough the urgency and the importance of communication with the patients and their families. I was contacted by one family whose daughter suffered from chronic fatigue and experienced social anxiety going into secondary school, in respect of which she was put on antipsychotic medication which is used to treat schizophrenia, mania and other types of serious illness. Those who are already aggrieved, damaged and hurt by the system that is in place need answers and they need them now. I urge the Minister of State to ensure there is communication with them, and to tell them what is happening and when a care plan will be place. There are many more families out there. This is only the tip of the iceberg. There are at least as many families in north Kerry subject to the same practices that we heard about in regard to south Kerry.

As the Deputy will know, it is very important that these reviews are conducted independently. It is for that reason the chief officer is seeking a consultant from outside of Ireland to do the review in north Kerry, which is really important. My complete and utter focus at the moment is on getting the supports for the young people who need them.

The Deputy knows as well as I do that there are challenges. The post has been vacant since 2016 even though it was funded. Prior to Christmas and the publication of the report, I travelled to Tralee to meet the team there. There are some really good people working there, but there are vacancies on the multidisciplinary teams in north and south Kerry. That is the purpose of putting in place the clinical support team in Killarney. As soon as I have more details, I will revert to the Deputy. My focus at the moment is on getting the supports for those children and young adults as quickly as possible. They have suffered enough. They need the talk therapies, cognitive behavioural therapies and psychosocial supports as a matter of urgency.

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