Vol. 1022 No. 7
1. Deputy David Cullinane asked the Minister for Health his plans to tackle emergency department overcrowding and long waiting times; the number of scheduled patient care appointments that were cancelled due to complications with unscheduled care in 2021 and to date in 2022; and if he will make a statement on the matter. [26375/22]
I ask for an outline of the length of time people are waiting in emergency departments. Are the Government's targets for the maximum wait times being met? Yesterday I received a response to a parliamentary question which stated that the average time to admission for patients aged over 75 through emergency departments across the State was 13.75 hours. That is a long time. Unfortunately, the data across the board are not good.
It is too long and completely unacceptable. I have personally, as no doubt the Deputy has, seen the distress in overcrowded emergency departments - distress to patients, their families and our healthcare professionals across the country. I have visited some of the busiest sites including Limerick and Galway. Later today I will be in the Mercy Hospital in Cork and tomorrow I will be in Cork University Hospital, CUH. I will talk to senior management and clinicians about what is going on and what needs to change.
We invested an additional €1.1 billion in the budget for last year to expand capacity, increase services and support reform. We maintained this level of investment this year with an additional €77 million in the winter plan for the winter that has just gone by. The plan sought to address the causes of long waits in the emergency departments. It targeted attendances, patient flow and better egress or discharge.
The approach is to allow emergency department staff to focus on those most urgently in need of care or most in need of urgent care. We have provided 850 additional non-ICU hospitals beds since January 2020.
Despite this unprecedented investment and increase in capacity, patients still face unacceptably long waits. What patients face in some, not all, of our hospital emergency departments is simply not acceptable. It is mainly due to increased attendances and admittances especially of those aged over 75, as outlined in the response to the parliamentary question the Deputy received. Many are sicker than before, have comorbidities and stay longer. As the Deputy will be aware, Covid impacted bed availability and facilities in hospitals. It has also significantly affected discharge options, including taking out about two thirds of nursing homes in terms of being able to discharge patients to them.
In one of the hospitals the Minister will visit tomorrow, Cork University Hospital, the average wait time for over 75s in April was 28.8 hours which is staggering. These are people over the age of 75, who the Minister admits have comorbidity and other challenges. The average wait time in the Mercy Hospital was 26.8 hours and University Hospital Limerick was 22.2 hours. We have major problems in all our acute hospitals. The Minister is right in saying some hospitals are getting it right. I will get to the solutions in my next round of questions. Our Lady of Lourdes Hospital in Drogheda and Cavan hospital are two examples of hospitals that have put in place in a zero-tolerance approach to emergency department waits and it seems to be working. Why is this not being replicated across the State?
I fully agree that the operation in Our Lady of Lourdes Hospital in Drogheda is fantastic. I think it has five separate pathways when patients come in, including the use of advanced nurse practitioners who are doing a phenomenal job in being able to see, treat and discharge about 70% to 75% of the patients coming into that hospital. The challenge the Deputy posed is exactly the challenge I posed the HSE. What are we doing about it? We now have a group that is looking at every emergency department throughout the country and doing an analysis of what they have and do not have, versus what they must have. It is using an approach, called the five fundamentals, which is drawn from experience in Scotland and across the UK. Essentially it comes down to looking at pre-admission and reducing the numbers coming in, ensuring hospitals have the facilities and management they need, and ensuring patients can be discharged. We are carrying out an analysis for every emergency department. I am determined that the identified gaps will be addressed.
We obviously need more inpatient beds in some hospitals, but it is not all about beds. In some hospitals which got additional beds in recent years, we are not seeing the improvements we need. Of course, we need more inpatient bed capacity because if we have more beds, we can admit patients more quickly. We also need a discharge plan for each patient as soon as they go into the hospital. That needs to be multidisciplinary with all staff working together as a team. They also need to know that step-down beds are available in the community which very often is not the case. Many patients cannot get home care support packages. There is a clear linkage between what is happening in our acute hospitals and a lack of capacity in GP care and out-of-hours care, a matter I have raised with the Minister before. Unless we get the enhanced community care piece right, 40% of patients, who should be treated within the home or in the community, will continue to go to emergency departments. That is where the Minister's focus needs to be.
I agree with all of that. In Bray on Friday, I met the new chronic disease management team, the new older persons team and the new community healthcare network, including a pilot on mental health led by an advanced nurse practitioner in mental health. The level of prevention that is going on, including emergency presentation, is very impressive and fully in line with the Sláintecare vision, involving a massive investment in community-based care. We are beginning to see a reduction in referrals in the areas where that has been deployed.
There is no monopoly in wisdom for fixing this issue. If the Deputy, other colleagues or members of the health committee want to meet or make a submission, that would be very welcome. We are in the middle of a very intensive planning phase at the moment with the HSE. I have asked the HSE to work with the Department on a hospital-by-hospital basis because the solutions are different by hospital. Any insight or ideas the committee or colleagues may have would be a very welcome part of that planning work.
3. Deputy David Cullinane asked the Minister for Health the status of the sodium valproate inquiry and the provision of community-based care to patients and families affected by foetal valproate syndrome; and if he will make a statement on the matter. [26376/22]
The Minister will know that 1,500 children have experienced a major congenital malformation or some form of neurodevelopmental delay because of exposure to sodium valproate. He committed to an inquiry into this but that has not happened. I believe terms of reference have still not been agreed. Support packages were supposed to be put in place for victims and survivors but that has not happened. I want to get a sense of the status and how this can be advanced as quickly as possible.
I thank the Deputy for raising the matter. I am very sympathetic to the patients and their families over what has happened. I met the patient groups involved in late 2020 and supported their call for a review into sodium valproate. I committed to making it happen. Since then, senior officials in my Department have been engaging closely with the patient groups and other stakeholders over the past year to finalise the terms of reference to get this review under way.
Critically, the review will be designed around giving a voice to patients and their families and looking at the use of sodium valproate in Ireland since it was first licensed. It was important that enough time and resources were invested in scoping out the work to be done and engaging with patient groups as opposed to simply designing something and telling them what it would be. Many factors needed to be considered and I wanted to ensure the terms of reference incorporated what people wanted to see.
Many different groups are involved here, including the manufacturer, prescribers of the drug, our medicines and pharmacy regulators, and most important the patients and their families.
As a result, there has been a lot of preparatory work to get this together and to make sure all of the groups involved would come together for the review.
With regard to community-based care, as part of the valproate response project, the HSE has developed a diagnostic and community pathway to ensure patients are properly assessed and are referred to community services if they receive a diagnosis of foetal valproate syndrome, FVS. The first step in developing the pathway was establishing a dedicated diagnostic clinic in 2019. That was established in Children's Health Ireland in Crumlin and is headed by a specialist consultant geneticist. As of today, 36 patients have received a diagnosis. There is, critically, no waiting list at the moment for that diagnosis. I will, in my next response, continue on the rest of the community pathways.
People want to hear when the terms of reference will be complete and when the inquiry will be established. Does the Minister have any timeframe at all? That commitment was given a long time ago. There was also a commitment given in 2019, when the HSE recommended medical cards for all individuals who have FVS. That has not happened.
I understand it was also recommended that community healthcare organisations, CHOs, submit business cases for additional supports to provide these services. According to a report in The Medical Independent, none have been submitted. A national FVS co-ordinator was to be appointed. Has such a person been appointed? My understanding is that to date, only 35 people have been diagnosed with FVS and we know the number is going to be much higher than that.
There is a diagnostic pathway but it is clearly not working fast enough. When will the inquiry be established? When will the supports that were promised be put in place?
The inquiry will be established as soon as we get the terms of reference finalised. It is important that the terms of reference, first and foremost, make sense for the patients, families and groups. We must also ensure all the stakeholders can work with those terms of reference. We are reviewing the terms of reference at the moment. I cannot give an exact date but I will revert to the Deputy with an update when I have it.
After a diagnosis, the geneticist makes a recommendation on the health services that are needed for the patient. This is important. The geneticist is designing or recommending a package of care. The relevant CHO is then informed and a liaison officer is appointed. We will all agree that is important. The liaison officer establishes the link to the services and, critically, is an advocate for the patient. At that point, the appropriate healthcare services and the appropriate equipment are provided through the care pathway and with the CHO.
I have met with the campaign group and many of the affected families. They are very sore about this. They said that nurses were sent to families to assess their support needs but no supports ever came. That is the problem. There has been a commitment to an inquiry which has still not been established. I heard the Minister say he wants to get it right. Those affected also want to get it right but they need some sort of timeframe for when it will happen. Solid commitments were given in respect of community care, as the Minister has outlined. Nurses sat down with patients and assessed their needs but those patients simply have not received supports. Commitments and promises were made in respect of medical cards and a whole range of medical supports. It is a sore point for them that while they are still waiting for word on when the inquiry will be established, their healthcare needs have not yet been met. It is great that nurses are engaging with these individuals but it does not suit anybody if there is nothing coming out the other end, the HSE is stating it does not have the resources and there is a blame game going on. The situation needs to be resolved.
I thank the Deputy. It is very serious if that is the case. It is not the advice I have from the Department or the HSE. The advice I have is that the services and equipment are being provided. There is a mechanism whereby if a CHO does not have a budget specifically for this group of patients, it can put a business case together centrally. The HSE has not received any business cases and the advice I have is that the CHOs are providing support. What the Deputy is saying is serious. I will look into it today.
Somebody is at fault and it is not the patients.
Let us take a look. I will revert to the Deputy with a note.
4. Deputy Róisín Shortall asked the Minister for Health the status of the Sláintecare consultant contract negotiations; the rationale for not appointing a new independent chair; the timeline that he is now working towards for the introduction of a new contract; and if he will make a statement on the matter. [27163/22]
I am yet again raising the issue of the consultant contract. If the Minister is serious about tackling the inordinate waiting lists in hospitals and getting our health service to function properly, we must recruit consultants. It is now five months since the independent chair had to withdraw from her role in the talks. What are the plans? Why has she not been replaced? What is the timescale to which the Minister is now working?
The Government, as provided for in the programme for Government, is committed to introducing the new public-only consultant contract. I want to do so in a timely manner. A new consultant contract, as I know the Deputy will agree, is one of the important steps towards universal, single-tier healthcare, with public hospitals exclusively used for the treatment of public patients. That is the cornerstone of the contract from the State's perspective.
Last July, terms of reference were agreed with the representative bodies. There were several months of talks with an independent chair. My Department, in conjunction with the HSE, engaged with the representative bodies, the Irish Medical Organisation, IMO, and the Irish Hospital Consultants Association, IHCA, on the new contract last autumn. As the Deputy will be aware, those talks continued until Christmas. The chair was appointed to the High Court and had to go.
My preference is that the new contract will be introduced following negotiation and agreement. My strong preference is that this is an agreed contract. I am committed to recommencing the talks very soon under a new independent chair. I recently met with the IHCA and the IMO about the talks and their parameters, and some of the key issues around the talks, with a view to getting all the groups back into a room. We do not have a set date for the talks to reconvene but my hope is that it will happen very soon. It is my intention and that of the Government to have this contract in place this year.
I must remind the Minister that he said at the IHCA conference several months ago that he wanted the contract finalised within weeks. He said in reply to a number of parliamentary questions over the past six months that his timeframe was a number of weeks. There has been considerable slippage and one must question if the Minister is serious about this.
There is a point I wish to make. The Minister is negotiating with people who are already in posts and are operating under different arrangements entirely. When I raised this issue with the Minister a number of months ago, I asked him to meet with the hospital doctor retention and motivation project, led by Dr. Niamh Humphries. Representatives of the group were before the Joint Committee on Health. They have done incredibly important and interesting research on why it is that so many of our doctors leave these shores and go to work elsewhere. As far as I know, the Minister has not met the representatives of that group. Perhaps I am wrong on that and I hope I am. Has he considered the points that group is raising about the reasons people are leaving and the kind of new contract we need?
As it happens, I met Dr. Humphries and her associate on Monday or Tuesday. As the Deputy is aware, they have done five years' work on this. They have focused their work specifically on Australia but I fully agree that the matters are intrinsically linked. A root-and-branch reform of the non-consultant hospital doctor, NCHD, pathway is needed. The current pathway for NCHDs is not acceptable and we should not be surprised that too many of them elect to go to Australia, New Zealand or Canada. There is a whole piece of work we are doing with the Department and the HSE. I have met several groups of NCHDs. When I speak to them about the job, one of the first things they reference is the new contract. They want to know that when they finish what is a very tough training scheme, a new contract will be there. They are intrinsically linked. The Deputy can be assured that I and the Government are fully committed to getting this contract in place. A lot of informal work has been going on about the talks. The Deputy will appreciate the details of that are confidential.
Unfortunately, I do not get a great sense of urgency from the Minister. What we know about the new consultant contract sounds attractive and would be attractive to all of those many doctors who have left these shores. What they are looking for, first and foremost, is a proper work-life balance. They are looking for respect in their job, which, unfortunately, they have not had during their training period. They are looking for part-time work, especially for women. They are looking for that kind of flexibility. Most of all, they are looking for a system that works and serves patients and for which they do not have to apologise.
They want to be confident that the Government is serious about reform. The Minister needs to progress this very quickly. He needs to tackle the attitude within the HSE at the start of these talks, where there was talk of preventing doctors and consultants from advocating for their patients. There is a need for respect and a catch-up in respect for newly trained doctors because they have been treated so badly in the system that is there at the moment. There is a real urgency about this and the Minister needs to move on it because the health service cannot wait any longer.
I agree with everything the Deputy said other than her point about a sense of urgency. If I am not conveying a sense of urgency here, I can assure her that the groups involved, including the Department, are very aware that there is a sense of urgency. We are moving on this as a priority and we are doing two things at the same time. We are looking at the NCHD contract, at the six to ten years that they are with us but separately to that, we are moving on the contract. Obviously they are linked but they are separate pieces of work.
It is my absolute and very clear intention, and all of the stakeholders involved know this, that we will have a new consultant contract in place this year. That contract will be public-only in public hospitals. That is a cornerstone of everything we are doing. I fully agree with Deputy Shortall that it must be attractive to our existing consultant cohort, to those abroad who we want to come home and to the NCHDs coming through so that Ireland is seen as one of the best places in the English-speaking world for doctors to work.
We will go back to Question No. 2 and Deputy Duncan Smith.
2. Deputy Duncan Smith asked the Minister for Health if he will meet with representatives of an organisation (details supplied) with regard to its claim for pay parity; and if he will make a statement on the matter. [26880/22]
I apologise for being late and thank the Leas-Cheann Comhairle for facilitating me.
This question relates to the Medical Laboratory Scientists Association, MLSA, industrial action. While I welcome the return to talks, I am interested to know what the Minister is going to do now in terms of engaging with the workers and their representatives. As the Minister knows, this is not over and we do not want it just to disappear back into the Workplace Relations Commission, WRC, and for the Minister to hope that it just goes away because it will not.
A number of Deputies have tabled questions on-----
This is a priority question.
Is it dealt with separately?
Yes, unless there is another priority question on the same issue.
Thank you.
I thank Deputy Duncan Smith for raising this issue. We had a good debate on this yesterday. I want to acknowledge the incredibly valuable role that medical scientists play in our healthcare system but on top of that, the fact that they, along with their healthcare colleagues across the system, have put in even longer hours and tougher shifts during the pandemic. I have met a lot of them and am fully aware of the personal and professional cost of this. It has meant very long hours working in even more stressful conditions. It has also meant time away from family and friends and I want to acknowledge that they stepped up, along with the rest of the healthcare community, during Covid.
I also want to acknowledge the long-standing claim for pay parity between medical scientists and clinical biochemists. The current public service pay agreement, Building Momentum, includes sectoral bargaining to address outstanding claims such as this one. This is the method through which claims can be addressed within the lifetime of the agreement. Health management have been engaging with the MLSA for many months to find a way to advance their claim through sectoral bargaining but no resolution to the matter has been reached so far. However, I was very happy to see that the industrial action has been suspended and did not take place yesterday. There was a very constructive engagement at the Labour Court yesterday, with all sides in attendance. It has been agreed that all sides will now convene at the WRC for a three-week period. Hopefully all issues can be dealt with in the WRC but if not, the sides have agreed that any outstanding issues at the end of the three-week period will be reverted back to the Labour Court.
When I submitted this question the industrial action was still live and I am happy that it has been suspended and the parties are back at the WRC. However, we need to use this time wisely. A consistency with this Government when it comes to industrial relations issues, not just in the Department of Health but across all Departments, is a hands-off approach and no sense that the Government wants to get things resolved. This dispute is not just about pay; it is also about retention. We have a massive shortage of medical scientists and we have seen a haemorrhaging of them from the profession over the last number of years. One thing that has come up in parliamentary replies is that the HSE does not conduct exit interviews which means we do not have accurate information as to how many people have left the profession and why. This is something that must be standardised across the HSE and across all parts of our publicly-funded health service if we are serious about tackling the retention crisis.
That makes an awful lot of sense, not just for medical scientists but right across the board. Probably the single biggest challenge we have in terms of the ongoing modernisation of the public health service is recruitment. If we are going to have a challenge, it is the right one to have. The funding has been allocated and the posts have been sanctioned but we are trying to recruit a huge number of people in a very short period of time. In community care, for example, we have sanctioned 3,500 health and social care professional posts. We have around 1,800 in post or about to be deployed now. There has been a huge increase but it does lead to pressures right across the system when we are trying to hire so many people. There has been a net increase since 2019 in medical scientists of around 6% but that said, we do need to understand why people leave, either for other jobs here in the private sector or for jobs abroad. We also need a process through which that can be addressed.
We absolutely do because it is very easy to say that people are leaving various jobs because of the housing crisis or low pay. While they are definitely factors for medical scientists, there are also really important career progression issues and other technical issues which are distinct to this industrial relations dispute. We cannot lose sight of that, which is why we need a keen eye to remain on this. The workers are not out on the picket line and the journalists and politicians are not out with them, getting their news lines and social media posts, but real work and meaningful engagement must begin. Those of us on this side of the House can lose a bit of connection because the issue is with the Government now. It is with the Minister's side. We really need to get this resolved. This is an anomaly and a mistake that dates back 20 years. As I said in the House yesterday, it is a campaign for parity that goes back almost 50 years. I hope that what has happened over the last week will finally lead to a just resolution.
Yes, hopefully through the WRC and then, if necessary, through the Labour Court, we can find a resolution to this that works for everybody. Deputy Naughten made a very salient point in yesterday's debate when he said that we need to respect, grow and develop this workforce because as science and technology become more advanced and linked into care through genetics and so forth, and as we move towards personalised medicine which is opening up incredible opportunities in terms of healthcare in the future, medical scientists are going to play an even more central role.
Dr. Colm Henry, the chief clinical officer of the HSE, is kicking off a review which will look at medical scientists more broadly across the public health system. One thing we are looking at is bringing in an advanced practice role, the equivalent of an advanced nurse practitioner, ANP, or advanced medical practitioner, AMP, in this area which is very exciting.
5. Deputy Mark Ward asked the Minister for Health the status of the national review of the Child and Adolescent Mental Health Service, CAMHS, following the mistreatment of children in south Kerry CAMHS; and if he will make a statement on the matter. [26377/22]
The Maskey report into south Kerry CAMHS found that over 200 children were put at serious risk and that 46 children suffered significant harm. I seek an update on the status of the national review of CAMHS, including the timescale for completion and publication. I also seek an update on any improvements that have been made for children in south Kerry.
I thank Deputy Ward for his question. The Maskey report contains 35 recommendations, the implementation of which will involve a range of actions by the Cork, Kerry Community Health Organisation, CHO, for Kerry south, as well as national actions.
As the Deputy knows, the audit of CAMHS is divided into three separate parts. The procurement process for the national audit of compliance with CAMHS operational guidelines is under way. This had to go out to tender. Proposals were received on 2 May 2022 and following assessment and in line with procurement procedures, a provider will be identified as soon as possible thereafter.
The successful provider will be requested to complete the audit within six months of appointment, but I want to see it completed before the end of the year. I am pushing really hard on that. There is a huge opportunity for us in relation to the 73 CAMHS teams, and to look at the complete area of oversight in relation to compliance.
An expert audit group on prescribing practice has been established. It is independently chaired by Dr. Colette Halpin, who was nominated by the College of Psychiatrists of Ireland. The audit group includes Dr. Imelda Whyte, who is a child psychiatry faculty chair, and Dr. Suzanne McCarthy, who is a senior lecturer in clinical pharmacy practice at University College Cork. We felt it was very important to include pharmacy because pharmacists have raised issues with regard to the prescriptions they receive coming across their counters.
The engagement of an academic partner to conduct qualitative research into CAMHS experiences is at an advanced stage. The research methodology for this audit strand will require ethical approval, and the process for securing same is under way. It is expected that the research into the experiences of children and young people attending CAMHS, their families, referrers and other key stakeholders can be completed within six months of the confirmation of the ethical approval.
I thank the Minister of State. On the procurement processing, I always get worried that this will slow things down and that there is a lack of urgency here. Does it go to tender after this? What happens after the procurement process and will that slow things down any further?
I am aware the Minister of State will come back on this, but it is my understanding that since the Maskey report there is still no full-time consultant in south Kerry and a locum is still filling in. We even heard the bizarre news that the whistleblower, Dr. Sharma, asked to come back - he said he would come back and work for the HSE - but his pleas were ignored. At this stage, that man should be commended and not ignored. Is everything possible being done for those children in south Kerry CAMHS at the moment? Will this review be slowed down by any procurement and tender processes?
As the Deputy is aware, we must do due diligence. These audits will cost quite a lot of money. Obviously that is not the issue but they must be done right. We will get real-time data that we have never had before. We have been talking about the waiting lists in CAMHS for so many years and we have been talking about the challenges. I welcome that we will have these data but I want it completed before the end of the year. The six-month timeline was always there. I meet regularly with the HSE to move this along.
The Mental Health Commission is also doing its own review, as opposed to an audit. I met with Dr. Susan Finnerty again last week. The commission has commenced that review and it is up and running. I welcome that the Mental Health Commission is doing a review at the same time the HSE is doing an audit. There will be great comparisons to be made at that time.
On the Deputy's specific question on the south Kerry CAMHS, that post is still vacant but not for the want of trying and not for the want of funding. Huge improvements have been made and I will come back to the Deputy on those.
I want it on the record that while I may be critical of CAMHS, I am not being critical of the CAMHS staff.
I know that.
I appreciate the pressure they are under at the moment with staffing, as the Minister of State has mentioned. At the moment, CHO 4, which includes south Kerry, is at 64% of what is recommended in A Vision for Change. I can understand the pressure they are working under.
Will the scope of the review include Tusla? The Oireachtas Joint Committee on Children, Equality, Disability, Integration and Youth found out some weeks ago that 20 children who were in the Maskey report were also under the care of Tusla. Will Tusla be included in that report to look at what its role was?
With the closure of the beds in Linn Dara, are acute mental health inpatient facilities to be included in any national review of CAMHS? I received information during the week that 27 children spent 87 days in adult mental health facilities in 2021. I am aware that this number has decreased but there was CAMHS inpatient bed availability at the time. One child spent 13 days in such a unit. Will there be any movement to stop this draconian practice?
On the Deputy's first question, the four acute units are included in the audit. I believed that this was very important.
The Deputy asked about Linn Dara. The Deputy will be aware that everything that we can do is being done. There was a report in the newspapers yesterday when I said there was capacity of 16 beds available in Cork. This is actually correct. There are 13 inpatients there at the moment.
To the end of March this year, thankfully, no child had been placed in a psychiatric ward so far this year. If there is capacity, sometimes the units in Dublin and in Merlin Park in Galway do gastro-tube feeding for young people with eating disorders if it is recommended by a consultant psychiatrist. The procedure is not available in Cork and this might be the reason the person was not sent to Cork even though there is capacity there with beds.
Most of it was in the CHO 9 area.
