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Dáil Éireann debate -
Thursday, 31 Mar 2022

Vol. 1020 No. 4

Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions

Health Service Executive

David Cullinane

Question:

1. Deputy David Cullinane asked the Minister for Health his plans to ensure the recommencement of reports by the HSE pursuant to section 13 of the Disability Act 2005; and if he will make a statement on the matter. [16792/22]

We had some lengthy discussions on this subject while debating a Private Members' motion we proposed on Tuesday night. As the Minister of State will be aware, I take this issue very seriously. The HSE has been found to be in breach of the law in regard to both preliminary assessments of need for children with disabilities and the submitting of section 13 reports under the Disability Act 2005 to the Minister for Health. Will the Minister of State outline when is it expected those reports will be received? Is it the case the HSE will not appeal the High Court judgment? More important, will he assure us there will not be any efforts by the Government to dilute the rights of children by amending the Act?

The HSE has prepared and presented section 13 annual reports for the years 2007 to 2014, inclusive, to the Department of Health and is working on the section 13 annual report for the years 2015 to 2020, inclusive, to bring the process up to date. It is intended these reports will be completed by year end. The HSE and departmental officials are to meet in the near future to discuss the issue of section 13 reports in greater detail.

The HSE acknowledges the current management information system is no longer fit for purpose in the context of technical changes in recent years in policy, operation and practice, and user requirements. It is committed to the development of a new integrated management information system for children's disability services. This system will include a dedicated module on the assessment of needs process. The delay in submitting section 13 reports to the Department of Health has not impacted on the HSE's ongoing engagement with the Department regarding the requirement for additional resources for children’s disability services. These requirements for additional resources are submitted annually to the Department as part of the Estimates process.

I have to say, I find that answer unsatisfactory. Sometimes when I hear responses to parliamentary questions, I have the view the Government does not understand the magnitude of the crisis. I already have that view of the HSE. Moreover, the HSE has broken the law. My job is to hold the Government to account and the Government has to hold the HSE to account, and the Minister for Health, when responding to this issue on Tuesday evening, made the same point.

The Minister of State stated that not submitting these section 13 reports has not impacted on the ability of the HSE to plan. How can that be the case? If it is the case, that means the HSE had the information all along and simply decided it would break the law and would not give the information to the Minister. Section 13 reports, as set out in the Act, relate to the aggregate needs of all children who have had assessments of need where health and education needs have been identified. The logic of the reports is that they go to the Minister, set out the gaps in staffing and allow the Government to respond and fill those gaps. I do not understand how the Minister of State can suggest the Department has all the information, yet the HSE has not provided it with the statutory reports it is legally obliged to provide.

The HSE is committed to the development of a new integrated management information system for disability services, which will include a module on the assessment of needs process under the Disability Act. This will facilitate the HSE to provide a wide range of reports on the assessment of need activity expected in early 2023. The HSE and departmental officials are scheduled to meet shortly to discuss in greater detail the issue of section 13 reports.

I have two final questions, which either the Minister or the Minister of State might address. Are the current preliminary team assessments still being carried out? Some parents have indicated they have received letters to say they have been paused. We have a right to know if they have been paused.

Will the Minister or the Minister of State give us a guarantee that they will not dilute the 2005 Act? A very senior HSE official, when she was appearing before the Joint Committee on Children, Equality, Disability, Integration and Youth, stated the HSE's hands are tied when it comes to preliminary team assessments under the 2005 Act. She went on to state it might be a solution to amend the Act, which many of us took to mean there could be an attempt to dilute the rights of children under the Act for a proper assessment of need. That is not acceptable and it will be fiercely resisted. It is important that either the Minister or the Minister of State offer a guarantee - I have asked twice now - that they will not dilute the rights of children by amending the Act.

I understand a full review is under way to determine the best approach in the interests of the children involved. I hope we can sort out that. The HSE has prepared and presented section 13 annual reports for the years 2007 to 2014, inclusive, to the Department of Health and is working on the reports for the years 2015 to 2020, inclusive, to bring them up to date. It expects to complete these reports by year end.

None of my questions on this issue was answered, which is wholly unsatisfactory.

National Maternity Hospital

Gino Kenny

Question:

2. Deputy Gino Kenny asked the Minister for Health the way he plans to reconcile the requirements for full healthcare for women, including termination of pregnancy, in the new national maternity hospital if it is built on land owned by a Vatican-approved successor organisation to a Catholic religious congregation. [17012/22]

My question relates to the future of the proposed national maternity hospital on the grounds of St. Vincent's University Hospital. Its construction has been something of a saga. People want clarity on its proposed ethos and ownership.

I thank the Deputy for his question. There will be a detailed session in the House on this issue this evening, at which I am sure we will get into greater detail.

I reiterate my position since the start of this process. I will bring proposals on the new national maternity hospital to Government only if there are absolute guarantees of full independence for the national maternity hospital and absolute guarantees that all the services prescribed under law will be available there, as they are in Holles Street right now. There will be no religious influence from Catholicism, Protestantism, Buddhism, Taoism - you name it. This hospital will be run according to the law of the land. Under the proposed legal framework, neither the Vatican nor the Religious Sisters of Charity will play any role in the governance of the new hospital or in its operation.

The sisters are transferring their shareholding to the new entity. The public constitution of St. Vincent's Holdings makes no reference to Canon Law. My Department has previously been advised that Canon Law will not impact on anything to do with this new hospital whatsoever.

Regardless of who owns the land on which the new hospital is built, the legal framework is being developed to address both the ownership and, critically, the governance of the hospital. There are several priorities: to ensure that all clinically appropriate and legally permissible services will be available in the new national maternity hospital; to prevent any undue influence, religious or otherwise, on the operation of the new hospital; and to safeguard the State's significant investment in the new hospital.

Is the Minister confident that will happen because this has been an ongoing saga for the past ten years? For the casual observer, it is extremely confusing in relation to the ownership of the land and the ethos of the building itself. I understand the building will be owned by the State but the board will still be run by a private holding, that is, the Religious Sisters of Charity. If that is the case, that may be not conducive to a Catholic ethos - I understand the Minister is probably on the same page as we are - but there is something gone awry in relation to ethos in one guise and the ownership and public money. All that does not add to where we all want to go. There is confusion.

All I can do is repeat the position, which is that when I bring the final structure to the Government for approval, it will have multiple layers of protection in place. The Religious Sisters of Charity will have no hand, act, part, role, influence, board membership or anything else in the new structure. That is simply not going to happen.

The Deputy is correct. There is genuine concern out there. I have spent time talking to the midwives and the doctors in the National Maternity Hospital. These are the women and the men who are treating mums and babies and they are really concerned about what they have described as a campaign of misinformation. It is their lawyers who are writing the contracts and, ultimately, we need to listen carefully to the midwives and the doctors. What they are telling us is that they are absolutely satisfied that the new structures give them all of the independence that they need. They have written publicly on several occasions to ask those who are running what not I but the midwives and the doctors are calling a campaign of misinformation to stop for the reasons the Deputy has outlined.

I will take the Minister's word on that. What the women of Ireland will want to know is when will construction begin. We have seen projects in the State previously that are completely dragged out and, eventually, they may never be built. A modern hospital for the 21st century has to have a modern ethos to fit the 21st century. We live in a different era from when it was established on Holles Street. It was a completely different age in Ireland. I will take the Minister at his word. What I want to get from the last segment of my contribution is the details on when this will be signed off and the work will begin on the St. Vincent's campus.

The work on the enabling structures has already commenced. Much work has already happened on the carpark. Much work has been done on a pharmacy.

On the process, I want to bring this to the Government soon. I imagine we will have a rigorous debate. I am happy to bring it to the Joint Committee on Health to tease it out there as well. There is a great deal of interest. What I want to do is make myself available, the officials available and, probably most importantly, the clinicians from the National Maternity Hospital available to engage with the Oireachtas and to answer some very real questions about the concerns that Members of the Oireachtas have. I hope to bring a memorandum to the Government on that shortly. As soon as that is done, we will move forward with the process in terms of planning, development and design and then getting into building the hospital as quickly as possible. As the Deputy has quite rightly said, genuine concerns were raised last year. We have significantly improved the proposal since then. A significant amount of work has gone on but all of this takes time. The Deputy is right when he says that this hospital has been talked about for ten years. Once we are satisfied that we have the legal guarantees around independence and governance, we need to get on and get this hospital built.

Health Services Staff

David Cullinane

Question:

3. Deputy David Cullinane asked the Minister for Health if he will offer a job guarantee to health and social care graduates; and if he will make a statement on the matter. [16793/22]

The Minister has accepted the reality that we have a real crisis in some of our hospitals and in healthcare generally with overcrowding. Some of this is related to Covid, but it also relates to waiting times, which the Minister has accepted are unacceptable. We also have a challenge in recruiting staff. There is a target of recruiting 10,000 personnel this year and the HSE states that we might recruit 5,500. I ask if the Minister will consider offering a job guarantee to all health graduates.

I thank the Deputy for the question. I was not sure from the question, as initially tabled, whether the Deputy was talking about medical graduates or health and social care graduates. I will try to cover all of them in line with his introductory remarks. As he has quite rightly said, recruitment of qualified health and social care graduates, medical graduates, and nursing and midwifery graduates is an absolute priority for me and for the Government. The HSE has a process in place to offer newly qualified nursing and midwifery graduates permanent positions managed through the hospital group and CHO networks. All nursing and midwifery graduates were offered permanent contracts in 2020 and 2021 and the same is planned for 2022.

The HSE provides opportunities to graduates on an annual basis for occupational therapy, physiotherapy, speech and language therapist and dietetics directly through the colleges prior to their final examinations. Following interview, the successful applicants are placed on a panel. Any approved vacancies that arise are notified to this panel. Candidates indicate their interest in specific jobs, and this covers all locations and different care settings. Since the start of 2020, 1,123 of these posts have been filled. This is encouraging. A breakdown of these is as follows: occupational therapists, 356; physiotherapists, 354; speech and language therapists, 335; and dieticians, 78.

To date, there are 365 posts that have remained unfilled - we need to be cognisant of these - after being offered to the panels on multiple occasions. These unfilled jobs are across all settings and locations. I have asked the HSE and the Department to look further at this. Essentially, we still have fantastic qualified professionals on panels. We have several hundred jobs we are trying to fill. I am advised by the HSE that offers have been made on all of them. It is clearly not working in every case. We want to try to get those filled as well. If the Deputy likes, in my next response I can give him similar detail on the medical graduates.

The Minister might submit that to me or email me the full response. That is useful.

We have to be more proactive and energetic in engaging with health and social care professional graduates and medical graduates when they are graduating. We should have HSE officials working with them in their final years. That would be really important. A job guarantee for all professionals would be important. All of this is in the context of the crisis in hospitals.

The Minister will be aware that today there is a call from some healthcare trade unions and advocate groups that more needs to be done in terms of public health restrictions. Can I ask what is the current position in relation to public health measures, for example, mandatory mask wearing? I signalled I would ask the Minister this question because it is important for him to update this House on what advice he has received from the Chief Medical Officer, CMO. Will the Minister and the CMO attend the next meeting of the emergency department task force? The Joint Committee on Health has asked for a briefing from the CMO. My understanding is, as of today, that still has not been arranged. It is important that we hear what the message is.

The public health advice is that you wear a mask in certain settings. I encourage people to do so but it is important for the Minister to set the message out.

Not only are we over time, but we are raising many issues that are not in the question. The Minister has one minute.

I thank the Deputy for the questions. Our hospitals are under very significant pressure. As of this morning, we have 1,610 patients in hospital with Covid.

It is putting significant pressure on our hospitals, our patients, their families and our healthcare workers. I am conscious of, and fully understand, the calls that have been made through emergency medicine and the Irish Nurses and Midwives Organisation, INMO, this morning. Our workers - their members - are exhausted. This is yet another Covid wave. It has been going on for a long time, people are tired and the pressure is relentless.

I might be able to revert to the Deputy after his next supplementary question. In short, we have taken away the legal requirements around masks but the advice remains: if people are on public transport, they should wear masks; if people are visiting a healthcare or nursing home setting, they should wear masks; if people are in a crowded space indoors or outdoors; they should wear masks; and if people are more susceptible to Covid or are meeting others who are more susceptible, they should wear masks.

I wish to restate my position, which is that people should abide by the public health advice and wear masks in all of the settings where they have been asked to do so. Is there any advice from the CMO to return to the legal mandate for mask wearing or any other public health measure? Will the CMO engage with the Oireachtas Joint Committee on Health - that would be important - and the healthcare trade unions? As the Minister mentioned, there is frustration and fatigue in the healthcare system and there are many pressures on staff. We must do everything possible to relieve those pressures.

Any public health measure has to be underpinned by public health advice and it is important that we hear what that advice is, not from second or third parties, but directly from the public health experts themselves, which include the CMO. It is not unreasonable to ask the CMO to engage with the Opposition and the healthcare trade unions.

It is a reasonable request and one I will bring back to the Department. That is not a problem at all.

For various reasons, there is no advice coming to me at the moment in terms of the reimposition of any measure. One reason is that the sublineage BA.2, which accounts for approximately 95% of cases, is so contagious that using population-based measures to push the curve down would need to be very serious. The advice remains that masks should be worn, people should stay at home if they are symptomatic and, critically, people should get vaccinated or boosted. Approximately 700,000 people are now, or shortly will be, eligible for their booster shots. To give a sense of just how important that is, of the 1,610 people in hospital with Covid, approximately half are there because of Covid and fewer than half of those are fully protected. Only 370 of the 1,610 are there because of Covid and are also boosted.

We are over time, Minister.

I beg the Leas-Cheann Comhairle's pardon. I just wish to re-emphasise that-----

It was not actually part of the question and we are over time.

Okay. I will stop.

I know it is an important matter, but we are over time.

Covid-19 Pandemic

Denis Naughten

Question:

4. Deputy Denis Naughten asked the Minister for Health the steps that are being taken to provide long Covid services across the country; and if he will make a statement on the matter. [16430/22]

Based on research that I commissioned from the Oireachtas Library and Research Service, we have somewhere between 145,000 and 300,000 cases of long Covid in Ireland, with a surge of these cases presenting to our already overwhelmed health service as a result of the spread of the Omicron variant late last year. I am concerned that our health service is sleepwalking into a potential avalanche of chronic illness cases as a result of long Covid.

I thank the Deputy for this important question. I acknowledge his ongoing advocacy and work on the issue.

The Government is committed to ensuring that those suffering from long Covid receive the full support they need. A few months ago, I met patients attending a long Covid clinic in Tallaght University Hospital. Hearing first hand from them about the significant deterioration in their ability to live their lives and the symptoms they were dealing with was sobering. According to the advice I have been given, we know that long Covid can be experienced through approximately 50 symptoms, the most common being fatigue, weakness, breathlessness, anxiety, difficulty with memory and concentration, and musculoskeletal pain. These are serious symptoms.

Anyone concerned with long Covid is advised in the first instance to attend his or her GP, who can refer him or her for specialist care where needed. There are services in place. Critically in the context of this question, we are expanding those services. The HSE has developed and is implementing an interim model of care to provide long Covid services nationally. Some €2.2 million has been allocated directly for that. It involves services across a number of healthcare settings, including GPs, communities and hospitals. The initial priority is to establish post-acute and long Covid clinics within each hospital group. The HSE has advised that the post-acute clinics are managing patients between four and 12 weeks after initial onset of infection and the long Covid clinics are managing patients 12 weeks post onset of infection. The clinics are established as part of a new interim model of care. They are operational in four of the hospital groups and work is ongoing to establish the additional clinics and links with the other hospital groups and clinics to ensure that we have a national network, which we need and for which the Deputy has been calling.

I welcome that these post-acute and long Covid clinics are being established, but we have been a long time waiting for that. I was promised last September that they would be put in place. We are being told that, until they are put in place at hospital level, there will not be a network back to the GPs.

The Minister has provided advice this morning that people experiencing long Covid should go to their GPs. GPs are overwhelmed and it is impossible to get an appointment. When someone goes to a GP, the GP does not have the data. When the GP sends someone for a test, the test is not showing any indication of long Covid. There is not a proper referral pathway into the acute hospital system, and even when people get into it, there is no testing or procedure in place. The clinics are only available in a handful of hospital settings.

I accept that the Deputy was told this last September. Since then, a great deal has happened and clinics have been set up. The Deputy will appreciate that, given the immense pressure that our hospital system is under, our healthcare professionals are working as quickly as they can.

The interim model of care focuses on two different aspects - post-acute clinics and, after that, long Covid clinics. As the Deputy rightly stated, we need the clinics in all of the hospital groups. We have them in four and are establishing them in the rest as quickly as we can. The Deputy is also right about the need for more engagement with GPs, primary care and the Irish College of General Practitioners, ICGP, to ensure that resources, protocols and training are available to GPs and that, in those instances where GPs are able to provide care, there is a specialised service available when their patients are referred onwards.

The difficulty is that we are experiencing an avalanche of these cases. Somewhere between one in ten and one in five people who have Covid end up with long Covid. They are presenting at GPs' surgeries at the moment but there is no referral pathway in place for the majority of them. We are looking at a minimum of 145,000 people added on top of the 1,610 people already within hospitals suffering acute Covid today.

In the numerous responses that I have received from the HSE, it has stated that it will build on the existing level of service provision. Anyone who has suffered from myalgic encephalomyelitis, ME, or chronic fatigue syndrome, will tell you that the services are not there at the moment, so we will be building on dangerous foundations.

Regarding the clinical approach, the HSE is using the UK's National Institute for Health and Care Excellence, NICE, guidelines in defining long Covid. The HSE says that long Covid is characterised by symptoms that develop during or after an infection consistent with Covid-19, persist beyond 12 weeks and are not attributable to a different diagnosis. As the Deputy is aware, there is a great deal of uncertainty in the international literature about how many people experience prolonged symptoms, but as he has consistently and rightly stated, the initial indications are sobering. While the published international reports vary, our best current understanding is that between 10% and 20% of Covid-19 patients experience lingering symptoms for weeks or, sometimes, months.

As the Deputy rightly said, it is a very significant number of people. The clinicians are at present working through what portion of those people will require ongoing clinical supports. The HSE is now putting a patient registry and an epidemiological survey in place to help with that.

Disability Services

Pauline Tully

Question:

5. Deputy Pauline Tully asked the Minister for Health his plans to ensure access to services for children with disabilities; his plans to fully staff children’s disability network teams and to fully establish family forums; and if he will make a statement on the matter. [16794/22]

Will the Minister outline his plans to ensure access to services for children with disabilities, in addition to his plans to fully staff children's disability network teams and establish the family forums associated with those teams?

The Government is committed to the development of children's disability services through the implementation of the progressing disability services programme. The High Court judgment on standard operating procedures for assessment of need, AON, is being examined by the HSE, which is engaging at all levels to address the judgment while ensuring the availability of therapy supports. AON reports will no longer be issued on the basis of a preliminary team assessment. Where appointments have already been scheduled with children, these will form the first steps in their AON process.

All 91 children's disability network teams, CDNTs, were established by the end of 2021 to provide services for children with complex needs within a defined geographic area. Since 2019, 475 development posts have been allocated to children's disability services throughout the country assigned based on factors including the existing ratio of staff to children with disabilities in each area. A staffing census of CDNTs has been undertaken and is being verified. It is envisaged that this information will become available in early April.

There are recruitment and retention challenges regarding the filling of posts due to the availability of opportunities across the wider HSE and the private sector. Work continues on establishing family forums, with the HSE advising that approximately 40 forums have either been established or are in train.

I was contacted yesterday by a parent who said that numerous parents had contacted her to say their AON appointments had been cancelled due to the High Court ruling. They are being told by CDNT staff that they are not reverting to the previous AON model covered by the Disability Act 2005. Staff have also told these parents that they have received no guidance from the HSE on how to proceed with assessments. All assessments have ceased, no guidance has been issued and children have been moved to a new waiting list until further guidance is given. That needs to be addressed immediately because we cannot have another delay in assessments being carried out.

A long-term plan and a short-term plan are needed regarding staff. A short-term plan is needed because there are children who are waiting for, and need, interventions immediately. We need to look at the critical skills lists and how to entice clinicians and therapists back, but the main problem is to do with the HSE panel.

I appreciate the Deputy's concerns and I will bring them to the Minister of State, Deputy Rabbitte. I understand that she is working with the HSE to try to get this moving as quickly as possible.

As I said, the biggest problem is with HSE recruitment practices. They are cumbersome and archaic. Just before I came to the Chamber, this issue was discussed at a private meeting of the Joint Committee on Disability Matters. Several of its members said they know highly qualified people who were not refused and were put on panels. They were placed third, fourth or fifth on a panel a year ago and still have not been offered a position. That is something the HSE needs to address immediately. We have highly qualified people who could be induced into the services.

We also need to look at the number of third level places that are being offered to study these various therapies. By increasing the number of third level places we can reduce the points required to get into these courses. Many people are interested in them but they cannot get the points, which are very high because the places are so few. We need to talk to and entice all these young people to take on these courses by ensuring they have jobs guaranteed at the end of them for a certain period.

I understand there are recruitment and retention challenges regarding the filling of posts. The Minister and the Minister of State, Deputy Rabbitte, are working with the Higher Education Authority and the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Harris, to try to resolve these issues. There are issues regarding office supports and I understand all the various Departments and stakeholders are working to resolve that.

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