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Dáil Éireann debate -
Tuesday, 24 May 2022

Vol. 1022 No. 5

Ceisteanna ó Cheannairí - Leaders' Questions

Tá an stailc atá tógtha ag na heolaithe leighis, agus na himpleachtaí ar na seirbhísí sláinte dá bharr, ag tarlú mar gheall nár dhéileáil an Rialtas leis na fadhbanna ag croílár an aighnis. Tá cothromaíocht i gcúrsaí pá, deiseanna traenála agus coinníollacha oibre fíorthábhachtach do sheirbhísí sláinte nua-aimseartha. Níl aon oibrí ag iarraidh a bheith amuigh ar stailc. Is an rogha dheireanach atá ann. Medical scientists are on the picket lines today, and will be again tomorrow, fighting for fair pay and decent career and progression opportunities. We are seeing significant and widespread disruption to the health service, with up to 30,000 medical procedures and appointments being cancelled. That follows on from the 14,000 appointments that were cancelled last week.

This dispute has been left to fester by successive governments for more than 20 years. The issues at the centre of this strike did not fall out of the sky. Medical scientists are paid 8% less than colleagues who perform identical work in hospital laboratories. Laboratory aids who report to medical scientists receive a higher starting salary than the medical scientists do. Medical scientists have fewer education and progression opportunities than comparable colleagues do. These issues have been raised continuously with governments for more than two decades by medical scientists and their representatives but nothing has been done. Unfair pay and a failure to address poor conditions have led to a chronic retention and recruitment crisis in the profession. We see that 20% of approved hospital posts are currently unfilled and the Medical Laboratory Scientists Association, MLSA, states that the Department of Health and the HSE are ignoring burnout in the sector.

Let the Taoiseach make no mistake about it - medical scientists are on strike today because of a basic lack of respect and recognition of the crucial role they play in delivery of health services. They are among the unsung heroes of this pandemic. Medical scientists essentially designed our Covid-19 testing system from scratch. They suspended industrial action for more than two years. They put aside their grievances for the good of the people and their contribution in the fight against the virus was invaluable. Medical scientists stood up and went beyond the call of duty. Now the Taoiseach's Government has left them standing on the picket line for a second week.

The MLSA says that since the first strike action last Wednesday neither the Department of Health nor the HSE has come to it with a meaningful proposal or an invitation to talks that could resolve the issues. That is incredible. Medical scientists deserve far better than that. The tens of thousands of patients whose medical appointments have been cancelled deserve much better. What we need is a fresh set of urgent talks. We need talks urgently with the aim of getting a resolution. Crucially, these talks must involve the Department of Public Expenditure and Reform, which puts the money on the table at the end of the day. It has to be at the table. Last week the Taoiseach said that he recognised the hugely important work done by medical scientists. He also urged them to engage with the industrial relations mechanisms. That is exactly what they are doing, but there is still no resolution to this issue. It comes down to this: does the Taoiseach accept that medical scientists have a legitimate and fair claim? If so, will he now intervene with the Department of Health, the HSE and, crucially, the Department of Public Expenditure and Reform in order that together they may bring a meaningful proposal to the MLSA to resolve this dispute and ensure it does not go into a third week?

Tá ról faoi leith ag na heolaithe leighis sa chóras sláinte. Bhí an ról sin soiléir le linn na paindéime. Admhaím go bhfuil ceist ann agus go bhfuil siad ag lorg parity idir iad féin agus na clinical biochemists le fada an lá anois. Is í an chaoi is fearr chun na ceisteanna seo a réiteach ná trí cainteanna laistigh den phróiseas atá ann chun ceisteanna den saghas seo a réiteach. I mo thuairim, dá mbeadh cainteanna substaintiúla ann, beimis in ann na ceisteanna seo a réiteach sa deireadh.

I thank the Deputy for raising the issue. I acknowledge and pay tribute to the dedication, professionalism and commitment of medical scientists throughout the country. They were instrumental and crucial in respect of our response to Covid-19 and the pandemic and are clearly an intricate part of the delivery of care within our health service. The MLSA wants pay parity between medical scientists and clinical biochemists. It was recommended by an expert group in 2000 or 2001. That was broken by benchmarking between the two grades at the time of the 2002 benchmarking process. There is a clearly defined grade structure with promotional opportunities for medical scientists within the HSE. The Building Momentum public service agreement provided for sectoral bargaining within that overall framework. In addition to that, we believe it is particularly important that this gets into a proper process either in the Labour Relations Commission, LRC, or within the Labour Court. In my view, optimal use must be made of the industrial relations machinery of the State - whether that be the Workplace Relations Commission, WRC, or the Labour Court - in order to resolve this issue. Significant informal contact occurred over the weekend on the issue of getting all sides into the process at the WRC or the Labour Court to get this resolved within a broad industrial relations framework.

At the end of the day, the Government wants a resolution of this. I am sure the MLSA wants a resolution on behalf of medical laboratory scientists. However, such a resolution must always be conscious of potential implications and relativities and so on. It must be clearly and transparently done and signed off in respect of the processes in play. The objective of all the informal contacts over the weekend has been to get people comfortable about going into a process, in terms of a proper outcome for all concerned. We are anxious to get this resolved. There has been overall growth in the number of medical scientists of about 6% since 2019. I acknowledge there have been increases at the higher level but not at the basic grade.

We want to improve that. The HSE is embarking on a recruitment campaign. Additional funding is being made available in the Estimates for 2022 to facilitate that. Approximately 160 development posts are being recruited in addition to replacement posts.

The resolution of this lies in the full utilisation of the labour relations machinery of the State.

Medical scientists have been waiting for 20 years for the Government to turn up and deliver. They do not need plaudits. They do not need applause. What they need is a government to step up to the plate, recognise the invaluable work they do in the health service and recognise all the work they have done over recent years. They have been waiting 20 years for a government to hear their legitimate grievances and act. They are out on strike today because they have had enough.

We cannot allow this to go into a third week with the disruption that that will cause to the health services with three more strike days next week. The Taoiseach says we need to use the industrial relations mechanisms. I agree with that, but all parties need to turn up. The Department of Public Expenditure and Reform needs to be at the table. The people who will pay at the end of the day need to be involved in these talks. I am asking the Taoiseach, again, if he will direct the Department of Health, the HSE and the Department of Public Expenditure and Reform to get around the table with the medical scientists to come up with some sort of resolution.

First, the health sector management has engaged with the Medical Laboratory Scientists Association, MLSA, through the WRC over the course of 2021 and, more recently, through the sectoral bargaining process under Building Momentum 2021-2022. The Public Service Agreement Group, PSAG, recommended that the parties re-engage at the WRC. That is where it has been over the past week or so - endeavouring to get back into the process. There was further engagement with the MLSA in that regard. Unfortunately, no resolution was reached last week in respect of that, but I am hoping. I urge all parties to use either the WRC or, potentially, the Labour Court to bring about a resolution to this. The full arm of Government, in terms of the full continuum of the Government through its different Departments and agencies, then would be involved in that process to get an outcome, once and for all, on this particular issue.

We understand the role that the medical scientists play. We understand the impact of this disruption of patients as well. We are very concerned about that.

The time is up.

That is why we want to get this resolved. We believe it can be if we can get a proper basis for engagement with the WRC or the Labour Court.

I too want to raise the issue of the medical scientists' strike this week. The health services are under severe strain and this is really showing that. It is reported that 30,000 procedures will be cancelled this week due to the two-day strike, but the reality is that the disruption is much greater than that. Another 14,000 outpatient appointments will be cancelled each day as a result of the strike. Thousands of inpatient procedures, day-case elective procedures, maternity appointments and all the routine GP testing appointments will also have to be cancelled. The strike is completely disabling the health service. It just shows the importance of this particular profession.

We must be clear that the dispute is doing that and it is having serious consequences for patients right across the country. To give an indication of how serious it was, this morning, on "Morning Ireland", Mr. Tony Canavan, the CEO of the Saolta group, said he was concerned that deteriorations in the conditions of inpatients in hospital would not be detected because of the lack of regular testing. We cannot go on with this. Certainly, we cannot countenance another three days of strike action next week.

I do not believe the people who are on the picket line want to be on the picket line. They want a resolution to this.

Patient safety is clearly being put at risk. That is having a hugely negative impact on patients, some of whom have been on waiting lists for many years, seeing long-awaited procedures being cancelled. The strike will cause further chaos with delayed diagnosis, delayed treatment, avoidable patient pain and suffering, and expanding waiting lists, with which we already have a problem.

Medical scientists are the hidden heroes of the health service, the people whom patients never get to meet, but patients' treatment and care are dependent on their hard work.

Despite this, and as has been mentioned, they are paid 8% less than biochemists and they do broadly the same work. They are paid less than laboratory aides, who have much less responsibility.

What is the Government proposing as a means to resolve this dispute? We were told last week the public service agreement group had recommended that the dispute be referred to the WRC. The MLSA has agreed to engage with the WRC but not to lift the strike action. However, the union has said that neither the HSE nor the Department of Health has approached it with any meaningful proposal or invitation to talks. There must be some talking in order to get the two sides engaged. What can the Taoiseach say he can do to bring these two sides to the table? Why has neither the HSE nor the Department of Health approached the MLSA with meaningful proposals they can talk about? The apparatus of the State is fine as long as there is something on which to engage. Will the Taoiseach tell us how he sees this being resolved?

I thank the Deputy for raising the matter and I acknowledge the disruption being caused as a result of strike action. It is having an impact and will continue to affect patients. I do not think anybody wants that and the MLSA does not want it either, to be fair, but this is having an impact. There is a very strong desire to get this matter resolved. What has been going on through informal contacts is to get a basis for participation now, following failed attempts in recent weeks through the WRC and the public service agreement group. It is about getting the basis right, if you like, for all parties to participate either in the WRC or in the Labour Court, which could be the way forward in getting a resolution to this dispute.

It is a dispute of long standing, but in these cases there are always further implications. The broader consideration of this must be within that context also. In other words, people must be fully aware of all the implications of any particular agreement on a specific matter, particularly in the health service. Anybody involved with the health service knows that to be the case historically. Experience informs us that a deal in one particular location of the health service can have repercussions across the entire service that may not have been envisaged at the outset. The best way to resolve an issue of that kind is to use either the WRC or the Labour Court so the details can be hammered out and ring-fenced to ensure we can get a resolution to this in the best interests of all concerned. That includes medical scientists, patients and the public at large. It is what the Government is endeavouring to do here.

There is no dispute about the need to get this resolved and we have provided funding to expand the numbers working. Currently we have approximately 2,135 whole-time equivalents in the sector and we want to expand that through additional posts. We want to create a framework and basis to have a lasting resolution to this dispute.

Approximately 20% of medical scientist posts are currently unfilled. It appears the pharmaceutical sector is finding no difficulty in attracting people with these qualifications but there is a reluctance to take up positions because of poor pay and a lack of parity and respect. There is also an issue with career progression. Will the Taoiseach ensure there is a formal invitation issued by the HSE and the Department of Health to the MLSA and that there is a realistic basis for a resolution to this?

We all understand there is industrial relations apparatus and it must be used. There must be a basis, nonetheless, and we must have a formal invitation in place.

Will the Taoiseach make sure a formal invitation is issued? Will he make sure there is a basis for a resolution? There is no way the other side will engage if there is not a basis for a resolution.

I take the Deputy's point but, as she knows, before a formal invitation issues one would like to know there is a basis for it to be accepted. A lot of informal work and contact goes on all of the time between parties with a view to getting the right basis to facilitate participation in these mechanisms at the Labour Relations Commission or the Labour Court. Each year approximately half of the graduates from the colleges go to the health service. There has been a significant increase in senior posts and specialist posts over the past three years and that is the way it should be. We want to continue to invest in the service. We are working to make sure we can get a proper basis and an invitation process in place that would lead to participation by all concerned in the labour relations machinery of the State to get this dispute settled.

On standing for election I gave a commitment to the people of Waterford city and county and the south east that I would do my utmost for our regional hospital, University Hospital Waterford, and the patients it serves. Yet again, I have to bring the issue of the hospital's under-resourcing onto the floor of the Dáil. Recent work on heart attacks by the National Office of Clinical Audit using data from 2017 to 2020 demonstrates that no patient from the south-east region is getting to alternative cardiac care when the cath lab at University Hospital Waterford is closed. In addition, in 134 blue-light emergency transfers from Waterford to Cork in the years from 2019 to 2022, the average time elapsed was three hours and 15 minutes. The national clinical protocol for heart attack requires cath lab access within 90 minutes from first responder. Every heart attack patient from the south-east region is exposed to additional heart damage and medical trauma and increased morbidity because of the lack of treatments available in the location where it is required, which the Taoiseach promised he would provide.

I have watched the Government walk through walls to build a hospital that is largely for the people of south Dublin. I have watched the Government parties whip their Deputies furiously to get them to support the national maternity hospital project despite misgivings as to its ultimate ownership. I heard the rationale offered by the Tánaiste, our next Taoiseach, in the debate in this House when he stated the maternity hospital needs to be in Dublin because if a woman has a cardiac arrest she can be in ICU within 20 minutes. The Hippocratic oath extends to the people of Waterford and the south-east also.

Over the past two years I have seen the Taoiseach in action. I would say he is a formidable operator. He gets his way. He can build a new runway in Cork in less than six months from a standing start. He can green-light the Dunkettle interchange. He is certainly a man of his word to his electorate and the people of Cork. On behalf of my electorate and the people I represent, I need a simple "Yes" or "No" answer from the Taoiseach today. Will he keep his promise to the people of Waterford and the south east? Will a 24-7 emergency cardiac care service be in place when he leaves the Taoiseach's office in December?

I thank the Deputy for raising this very important issue and generally for his consistency in raising these issues in respect of Waterford University Hospital and the broader constituency. He referenced the national maternity hospital. That was first announced in 2013. It is now 2022. It is questionable as to whether too many walls have been gone through. It took seven years to get to a point where a decision was taken to build it. In the case of Waterford the issue in recent years has been the cath lab. Work on the construction of the second cath lab commenced in March 2021. It will be completed by the end of August. The second cath lab will be available for operational use from the end of October this year. This is in the context of Covid-19, with the shutdown in construction. The second cath lab will mirror the existing cath lab and will be able to undertake the full range of diagnostic, interventional and non-interventional cardiac procedures available in the existing upgraded cath lab.

All consultant cardiology posts are currently filled in the hospital. There is an issue with the recruitment of an additional registrar to support the 8 a.m. to 8 p.m., Monday to Friday service. That position is being recruited as a matter of urgency. A total of 24 whole-time equivalents were approved by the South/South West Hospital Group in November 2021 for the staffing of the second cath lab, which is a significant commitment to the undertakings we gave the Deputies and representatives of the south east. We are awaiting the presentation and publication of the national review of specialist cardiac services. The overall budget of the hospital has increased by about €60 million since January 2020, which is a 20% increase and a significant commitment to University Hospital Waterford.

I accept the Deputy's point about timely care and that having the right care at the right time in the right place is critical. More generally, we want to develop further services at University Hospital Waterford in addition to the second cath lab. In terms of the capital programmes, in particular, as the Deputy knows, a report is expected to be finalised in the coming weeks. That review has been strategically examining the current and future capacity requirements of University Hospital Waterford to ensure that proper planning is in place for the next 15 years to invest in the hospital. The South/South West Hospital Group will work with HSE estates to make the relevant capital submissions for new developments that are required at the hospital. HSE estates has confirmed that a submission will be made at the capital steering committee for the development of additional bed capacity for the hospital. There has been significant investment across Waterford but I do not have time to go into that now. Perhaps it could be given as a supplementary response.

I was hoping for a "Yes" or "No" answer but I understand that the Taoiseach feels he cannot give it. With the additional money put into University Hospital Waterford, it still remains the most underfunded of nine model 4 hospitals in the country. That is the first issue. Second, the Taoiseach talked about the provision of additional services to the cardiac care suite. What he is offering us is an aeroplane with no pilots, baggage people or transportation on the ground to operate it. Without the people, we cannot operate it.

We need a 24-7 service, which the Taoiseach and his party committed to in 2016. The lack of care, attention and interest in following up on this promise over the years is quite evident now. The people of the south east will have their say. Either the service will be in place in December and the Taoiseach's word will have demonstrated its worth or it will not. I apologise to him for saying that but I have to keep the promises I made to fight for this vital service.

We are past reviews. We had 134 blue-light transfers over three years. Not one of them could get out of Waterford to Cork in under three and a quarter hours. It is no longer a clinical case. It is a political decision. It is up to the Government to either follow through on what it promised to do or else not follow through and leave it to the electorate to decide how it appreciates and takes that.

Some 250 new staff, of whom 25 are consultants, have been appointed to the hospital since January 2020. All consultant cardiology posts are filled. I do not know whether the Deputy is equating the consultants to the pilots.

It is not enough.

The consultants might have an issue with that. In any event, there are a fair few pilots there and we want to do more for the hospital.

I have been discussing this issue with the Deputy since January 2020. His issue with me, along with the other Deputies from the south east and Waterford, was to get the second cath lab up and running, and that is happening. We have to get this done step by step. The second cath lab is there. Some 24 whole-time equivalent posts-----

(Interruptions).

Hold on. Please let me finish. Some 24 whole-time equivalent posts were approved by the South/South West Hospital Group in November 2021 for the staffing of the second cath lab. Therefore, it is not without pilots. It is ridiculous to say it is without pilots.

It is a political decision. It is no longer a clinical decision.

The start dates for two senior radiographers have been agreed. The start dates are awaited for three cardiac physiologists. Recruitment campaigns for ten staff nurse posts and two healthcare assistants are ongoing. Recruitment campaigns for the position of certified nurse midwives, CNM, 1 and 2 are ongoing. The recruitment of four administrative posts and two porters is under way through the national recruitment process for the second cath lab.

I thank the Taoiseach. His time is up. We must proceed to Deputy Joan Collins on behalf of the Independent Group.

There is an ongoing crisis in our mental health service for children and young adults. There are 3,900 young people on waiting lists, up 40% in the past year. One would imagine that for the HSE, this would require an urgent response to increase services but, quite incredibly, the HSE has announced a national cut in services, with the closure of almost half the beds in the Linn Dara facility in Cherry Orchard. Linn Dara is a key facility for child and adolescent mental health services, CAMHS, nationally, and for the greater Dublin area and counties Wicklow, Kildare and Louth, in particular. The HSE has stated these bed closures, a reduction of 11 beds, from 24 to 13, is a consequence of shortages of qualified staff. The CAMHS unit in Cherry Orchard should have 51 nurses. It has only 24. There is an ongoing problem with recruitment and retention in the health service as a whole. We have heard this from the medical scientists. The Psychiatric Nurses Association, PNA, has described the bed closures at Linn Dara as a consequence of poor planning by the HSE. The PNA has pointed out that similar closures took place five years ago in 2017, but it seems nothing has been learned since then.

Mental Health Reform, a national coalition of groups concerned with mental health issues and services, has called for the reinstatement of a national director on mental health to report directly to Mr. Paul Reid, the CEO of the HSE. It has stated this post is essential to ensure proper oversight and leadership in the improvement of mental health services nationally.

In 2006, A Vision for Change was adopted as a Government policy to transform these services. A Vision for Change called for 100 beds to be available. We now have just 56 beds nationally following the closure of the Cherry Orchard facility. Mental Health Reform has also pointed out that these reductions in beds could mean that children may end up being admitted to adult mental health treatment units, which would be in contravention of their human rights. The reductions will mean young people will face increasing difficulties in accessing care in a situation where long delays can have a devastating effect on families and children in need of early intervention.

What has happened makes a mockery of the Sharing the Vision policy, which followed A Vision for Change. There is a need for urgent action. The reduction in beds and overall service at the time of an escalating crisis is simply unacceptable. What action does the Taoiseach propose to take? It is not good enough to say that there is a problem with recruitment and retention. The situation requires urgent action.

I thank the Deputy for raising this most important issue. The issue of CAMHS and bed capacity is a serious one, particularly the decision in relation to Linn Dara and the reduction of beds there, due to a range of issues, as the Deputy has said. In the first instance, the Minister of State, Deputy Butler, is working with the HSE intensively to ensure this is a temporary situation and to get it reversed. As the Deputy has said, a number of beds are now not in operation in Linn Dara. The same applies to Merlin Park University Hospital for different reasons. Ten out of 12 beds are operational in St. Joseph's Hospital, and all of the 16 beds in Eist Linn are fully operational.

The regrettable situation in Linn Dara has come about because a number of nursing posts have become vacant simultaneously for various reasons. It is not a resources or a funding issue but a staffing recruitment issue. The nursing complement available through the use of permanent and agency staff is no longer sufficient to continue to provide a full 24-bed inpatient service to a safe standard. That was the basis and the rationale for the decision taken. There are still seven beds available at Linn Dara specifically for the treatment of eating disorders. No young person was discharged early from the unit as a result of the reduced bed numbers.

The reduction in beds at Merlin Park is due to the reconfiguration of two shared bedrooms to single rooms because of Covid, nursing staff vacancies and physical risks associated with some rooms. The two-bedroom reductions in St. Joseph's are due to staff vacancies and physical limitations of the unit, as advised by consultant psychiatrists.

The HSE explored all options prior to making the decision. For example, it looked at redeploying staff from other CAMHS units or teams. It was not in a position to do that, and it did not want to impact negatively on CAMHS community care and the CAMHS community teams, which are a key part of the broader CAMHS programme.

All four CAMHS units nationally will work collaboratively to maximise the use of national CAMHS bed capacity over the coming while. The Minister of State and the HSE will work to intensify efforts to recruit the specialist skills and people for the vacancies that currently exist. To the end of March 2022, there have not been any admissions of under-18s to adult facilities. In 2021, there were 25 such admissions, down from 50 in 2019. That is something that we do not want to see happening within our mental health services, particularly in respect of young people.

Some 91% of urgent CAMHS referrals are now seen within 48 hours. Record funding of €1.149 billion is being provided for CAMHS, which again is up significantly on last year, but it is an issue of recruiting the specialist nursing staff.

I repeat that there are 3,900 young people on waiting lists, which is up by 40% on last year. Covid-19 has had an impact on the mental health of many young people and adults over the past two years. To see the HSE cutting beds rather than maintaining them is completely incredible.

The Taoiseach said the HSE has been looking to bring in teams from other areas. The issue that arises is that where any child is brought to an adult care facility, it will be breaking their human rights. They should be cared for within CAMHS. It is not good enough for the Taoiseach to stand up and say what he has just said there. This should have been well planned for. The Minister of State with responsibility for mental health and older people launched the implementation of the Sharing the Vision policy and it should have been well flagged if there was a problem. It should have been addressed a long time ago if we were having staffing problems in the area six or eight months ago. This happened in 2017 and it has to be resolved immediately.

It has to be resolved but the level of service is also expanding all of the time. The level of referrals is also going up exponentially. Covid-19 without question had an impact on the number of young people contacting their primary care services and their community teams in respect of mental health issues arising out of the pandemic. This has been a feature across the health service in the past six months as we emerge from the emergency phase of the pandemic where there has been an exponential growth in activity and in referrals, which is exacerbating the problems and issues we have. The funding has been provided to recruit as many people as we possibly can in all of the different disciplines, and that will continue. In the meantime, the Minister of State will work with the HSE to see what we can do, especially in respect of the Linn Dara facility. There is an urgency attached to that and I thank the Deputy for having raised it.

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