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Dáil Éireann debate -
Tuesday, 12 Jul 2022

Vol. 1025 No. 3

Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions

Health Services Staff

David Cullinane


81. Deputy David Cullinane asked the Minister for Health the status of the pandemic bonus payment and special leave with pay for frontline healthcare workers with long-Covid; and if he will make a statement on the matter. [37351/22]

The first question is to afford the Minister for Health an opportunity to outline the status of the pandemic bonus payment, how the payment of the bonus is progressing for all healthcare workers who are entitled to it and to outline the status of the special leave with pay for front-line healthcare workers with long Covid and, more importantly, what long-term payment will be put in place.

I thank the Deputy for raising this issue. As of last Friday, approximately 90,000 eligible HSE and section 38 staff have received the Covid-19 pandemic recognition payment. We estimate that is approximately nine in every ten people who are eligible for the payment, as public sector healthcare or section 38 staff. This payment recognises the extraordinary contribution and efforts made during the pandemic by our healthcare workers.

Roll-out of the payment continues to be prioritised across all services, and should be completed within the coming weeks.

Officials are working to ensure payments to eligible non-HSE, non-section 38 employees are rolled out. This will take time for several reasons, as I am sure the Deputy appreciates. One such reason is these employees are not normally paid by the public health service. Another is that we must avoid duplicate payments. For example, we may have somebody who is working as a healthcare professional in one of our hospitals and who has been paid but who also works for another organisation. We want to avoid that duplication. As I am sure the Deputy will appreciate, there are very many organisations to be covered in this wider group. I very am keen that all efforts are made to pay these eligible staff as quickly as possible. To clarify, the comment about the "coming weeks" is with regard to the HSE and the section 38 staff. There are other staff there who it will take a bit more time to pay but I have no doubt if we were making payments in ways that were not verified, the Deputy would quite rightly be raising the question of the proper allocation of public resources.

I am happy to come back on the second issue the Deputy raised in the next round.

I am fair-minded when I come at this because I understand we must ensure we get it right and the payment is made appropriately but I think the Minister would also accept this was a concept first mooted 18 months ago. The Government started the year announcing the payment yet six months later, here we are with many workers still not having received it. I am referring to section 39 workers, contract workers and workers working in private nursing homes. In fact, I do not know if some of the lowest-paid workers, including cleaners, security staff and catering staff are being paid but we are being inundated all the time on the status of that, as I am sure Government public representatives are too.

When the Minister comes back on the second round he might be able to outline to us why it is the case the special leave with pay payment, that was changed on foot of an instruction from the Department of Public Expenditure and Reform to now only cover the period of isolation when a front-line healthcare worker is out with Covid, no longer includes long Covid. When will the Minister put in place a permanent solution to that?

I thank the Deputy. The Department of Public Expenditure and Reform introduced the temporary special leave with pay scheme for Covid at the start of the pandemic. It was there to assist in preventing Covid spread in workplaces. Since 1 July this pay continues to cover Covid-related illnesses for the duration of the self-isolation period. Any period of illness extending beyond the isolation period is treated as ordinary sick leave. A special scheme specific to the health sector is merited in recognition of the requirement on staff to work on site through the most challenging phases of the pandemic and where they were clinically exposed or in a clinically-exposed Covid-19 environment. There are ongoing discussions between the representative unions and the Departments of Health and Public Expenditure and Reform. My understanding is, and I want to acknowledge, that not everything that has been asked for has been included. However, critically, what was sought first and foremost was an extension to the scheme and it has now been extended for a full year.

The Minister will be aware that when he attended a conference organised by the Irish Nurses and Midwives Organisation, INMO, he made a clear commitment there would be no cliff edge and that the payment would not simply end without an alternative in place. That is precisely what happened. I was in contact with the INMO today to find out whether there were any changes to the special leave with pay payment for front-line workers with Covid. There have not been, so at the moment there is no support. Of course the Minister can talk about the merit of a scheme but we have similar schemes in place for, for example, front-line workers who contract MRSA, or in the past contracted TB, or blood-spread illnesses and a whole range of different risks front-line workers must take when they go into work. Covid is an occupational hazard and there is obviously an additional risk for those on the front-line, so it is not good enough that cliff edge has come and workers with long Covid have gone over it and are now entitled to no payment because the Minister simply did not extend that option to them.

I thank the Deputy. The first ask made was that the scheme be extended and it was something I committed to advocating for. It is not a Department of Health scheme but it is something I committed to and we have secured an extension for a year, and that is very welcome. Any employee who is eligible for the payment receives his or her full rate of basic pay. Such employees receive the fixed allowance and, if eligible, they receive-----

Not if they have long Covid.

-----premium payments as well. The Deputy has raised various issues on which I am in conversations with the Department of Health and on which the officials are talking to the Department of Public Expenditure and Reform. I again acknowledge that not everything the representative bodies have sought is included. There is an ongoing conversation but critically, what was important was we got the scheme extended and that has been secured.

Cannabis for Medicinal Use

Gino Kenny


82. Deputy Gino Kenny asked the Minister for Health if he acknowledges that the medical cannabis access programme, MCAP, is not fulfilling its potential given that only 12 persons have been registered on the MCAP, the limitations to date and the programme’s upcoming clinical review. [38141/22]

My question relates to a report commissioned five years ago, namely, Cannabis for Medical Use - A Scientific Review, which was commissioned from the Health Products Regulatory Authority, HPRA. One of the main recommendations was an access programme. That was five years ago. The programme has been extremely restrictive and has omitted many people who could benefit from medical cannabis. I want to get the Minister's views on the programme itself.

I thank the Deputy and acknowledge his ongoing advocacy work on this area and indeed on the MCAP. The programme was initiated following a ministerially commissioned expert report some time back on cannabis for medical use. Access to cannabis for medical purposes for the treatment of three specified conditions was the recommendation, when all other treatments had failed. The programme commenced in July 2021 and I was very happy to initiate that. It is operated by the HSE. There have been some initial issues with availability of products and I am happy to come back to that. Most issues have now been resolved and one additional product will be available in the coming weeks.

We must recognise there are of course limitations to the programme. Products are not authorised medicines and assurances regarding the safety, quality and effectiveness are not the same as they would be for an authorised medicine. The required structures have been put in place to function as expected for the programme to function as expected. However, it is a clinical decision whether to prescribe these products. Currently 20 patients out of 22 applicants have been accepted onto the programme. In parallel there are 40 patients assessing cannabis for medicinal use through the ministerial licence scheme.

I think the Minister will agree with me the policy of a ministerial licence was from the outset overly bureaucratic and very arduous for parents. Many parents had to fight tooth and nail to get access for their children. I have always found it strange that with the more than 40 people who have ministerial licence, there is no joined-up thinking. There is no research done or joined-up thinking. The access programme gives that kind of joined-up thinking. Twenty people is a very small number to be benefiting from medical cannabis. If we look at the Danish medical cannabis programme, which I will allude to in the next part, it has been broadened out with more conditions. The clinical review is very important.

I thank the Deputy. I think the question he is posing is whether we can extend the programme to different conditions. As we were discussing, the original report recommended its use for three conditions once other treatments were no longer deemed viable. The question is whether we can broaden that. The Department of Health has now commissioned an evidence review. This is examining the efficacy and the safety of the cannabis-based treatments for a wider range of conditions. When that is completed a clinical group is going to be convened to assess the evidence and provide guidance to the Government on any potential amendments to that list. That is something that would potentially widen access. As I was saying to the Deputy, two products are currently available and there is a third product, Tilray, that will be available shortly. I am aware there are some clinicians who have been waiting for that specific product for their patients.

If the programme is not broadened in its conditions, I do not see it going anywhere for medical and commercial reasons. The Danish medical cannabis access programme has been open since 2018 and 2,500 patients have got medical cannabis products via prescription. Some of the conditions it is being prescribed for are not in the medical access programme here. One particular example of that is neuropathic pain. The evidence around the effect of cannabis on neuropathic pain is very good. Access programmes throughout the world allow cannabis for the treatment of chronic pain or neuropathic pain. Chronic pain is a very broad term. The omission of chronic pain in the initial report was very controversial. A whole host of people could benefit from medical cannabis, particularly for neuropathic pain.

Let us see what the research comes back with. I acknowledge the Deputy's position and I know there are others here and around the world who share his view. I want to see what the evidence comes back with and we can then look at clinical recommendations about expanding the conditions.

Part of why it might be more limited than would have been expected is good news. Approximately 85% of the expected cost for the programme was specifically being attributed to refractory epilepsy patients. In December last year, the HSE agreed to reimburse a product called Epidiolex. It is a licensed cannabis-based medicine that the clinicians have been going for, I imagine in part because it is licensed rather than unlicensed.

Emergency Departments

David Cullinane


83. Deputy David Cullinane asked the Minister for Health his plans to tackle the crisis in emergency departments; and if he will make a statement on the matter. [37352/22]

This question relates to the Minister's plans to tackle the crisis in emergency departments. As he knows, waiting times in emergency departments are unacceptably high. I accept that Covid-19 is in part responsible for that but there are also issues in respect of the lack of capacity in some hospitals. Part of the problem is patients are not getting sufficiently good care in the community or through a GP. I also wish to ask the Minister specifically about the mid-west region and the particular problems we have at University Hospital Limerick.

I thank the Deputy. I agree that the time patients are having to wait in emergency departments is not acceptable. Much of that is due to Covid and it is frustrating for everyone, including the patients, our healthcare professionals and all of us, because there is a level of capacity in the system now that has never been there before. There are more hospital beds, doctors, nurses and healthcare assistants than ever before. There is more community-based care than there has ever been. There are more home care hours and there is more preventative community care. One would expect the emergency departments not to be under the pressure they are.

A big part of the problem is the unprecedented level of presentations. May of this year saw the highest monthly national emergency department attendance on record. That was May, not December or January. Not only was that number the highest on record, the people coming in are older and more frail as a result of many of them having been at home for two years during the pandemic. I know the Deputy has acknowledged that.

What are we doing about it? I am working with the Department and the HSE to put together a short-term plan for all 29 emergency departments. There is now a draft plan in place and being worked out. More and more detail is being added to it. That plan is for all 29 emergency departments. It is considering how we keep people out of the emergency departments unless they really need to be there. Injury units, access to GPs on call, community-based care, older person intervention teams, home supports and other measures are the alternatives. When people need to come to emergency departments, we must consider whether the hospitals have the resources they need in the emergency departments and elsewhere in the hospital. Something that is critical, and the closer we look at this issue the more we realise this problem must be resolved, is the discharge option. For example, one of the big issues in Limerick is that patients are not being discharged as quickly as they should be. It would help with patient flow in the emergency department if they were.

We need a comprehensive review of healthcare services in the mid-west. I would, in fact, argue that one of the first regional health areas should be established in that area. We need to properly align community care, primary care and acute care. We must also consider capacity in Nenagh Hospital, Ennis Hospital and St. John's Hospital. I know the hospital group has advocated for an elective hospital in the mid-west. There is possibly merit in that. I know that representatives of the group have met the Minister on that issue. That might be one of the solutions. I certainly believe we need to consider increasing capacity in Nenagh and Ennis. The question of whether that is emergency department capacity is something that would have to be clinically assessed but elective capacity can certainly be considered to take the pressure off.

It is not difficult to understand what is happening in our emergency departments. It is partly a result of Covid but if people cannot get access to out-of-hours GP care, they will go to their local emergency department. If they cannot get access to an injury unit quickly enough, they will go to an emergency department. Far too many people are attending emergency departments. Admission avoidance is necessary and we need a plan to make it happen.

In the short term, one of the issues we are looking at is exactly the point the Deputy has raised. The injury units are superb. Many people who are walking into emergency departments could be seen quicker in an injury unit. We are considering whether the injury units can be opened for longer. Can they see more people? There are age limits on many of the injury units. Is everybody in the community aware of exactly the kind of injuries for which one would attend an injury unit? For example, there is a brilliant injury unit in Smithfield in Dublin but not that many people know about it. We need to have much more comprehensive engagement and communication. We are also looking, in the medium and long term, to build out the permanent capacity in the step-down facilities in the community.

All of that is necessary. However, I would like to see what is in the short-term plan about which the Minister is talking. I have visited a number of hospitals, as the Minister knows. I have attended 15 in total in the past year. I know the Minister has attended some as well. Some hospitals have taken a zero-tolerance approach to patients on hospital trolleys. In fact, in my own constituency of Waterford, there have been no patients on trolleys for the whole year. It does not mean that people are not waiting too long in emergency departments but very clear action was taken. I know that a hospital in Drogheda, for example, has got to grips with what was happening in its emergency department and the trolley situation involved. The last thing it wants is more pressure and that is why there is controversy around closing the emergency department in Navan. We need short-term plans but without medium- to long-term structural changes that will bed in community care, provide alternative care pathways and increase admission avoidance, we are going to see more pressure on our emergency departments.

The Deputy raised the example of Waterford, which is a great example of what can be done. A specialist team was sent into Waterford a few years ago. I stand to be corrected but from memory, I was told that it went from being one of the worst performing in respect of patient waiting times to the best. They have done things differently in Waterford.

They have good Deputies there, for a start.

There are, for example, overflow beds. The hospital is doing incredibly well. We have taken the same approach, for example, in Kerry and Limerick, where we have sent in specialist teams. There is a plan. It is a living document and as we learn more, the plan changes. I would be very happy to share the draft we have now with the Deputy. There are at least ten specific items that are being actioned for Limerick. The team is down there right now working with management to try to achieve in Limerick exactly what was achieved in Waterford.

Dental Services

Verona Murphy


84. Deputy Verona Murphy asked the Minister for Health the provisions that his Department is making to provide emergency dental cover for adult medical card holders who are unable to access a dental service due to the current oral healthcare crisis; and if he will make a statement on the matter. [38125/22]

Last week, a man from Wexford in his 80th year, Seán Hayes, pulled his own teeth having contacted seven dentists in Wexford as well as the primary care centre at Grogan's Road, all of whom told him they could do nothing for him. He said on local radio that he blames the Government and not the dentists. I am asking the Minister for Health what provisions his Department is making to provide emergency dental cover for adult medical card holders unable to access dental services due to the current oral healthcare crisis and request that he makes a statement on the matter.

The situation the Deputy has described is unacceptable. Everybody who has a medical card needs to be able to access a dentist under the dental treatment service scheme. As the Deputy has quite rightly identified, the number of dentists participating in the scheme has fallen substantially, particularly over the past two years. There was a precipitous drop in participants in 2019, 2020, 2021 and this year.

I looked at the figures for the Deputy’s county and that is seen in Wexford as well. Unfortunately, the majority of dentists who were on the scheme just three years ago – just before Covid – are no longer on the scheme. That is causing huge pressure in terms of people in Wexford who have medical cards and who are trying to find a dentist who is on the scheme.

What are we doing? There is a longer-term solution to this, which is root and branch reform of the dental treatment scheme. That is something on which the Department of Health is engaging with the representative body, namely, the Irish Dental Association. However, that is not enough because it will take time for that kind of scheme to be negotiated and implemented.

In the meantime, for this year, I have allocated a very significant amount of extra money. The forecast spend for this year would have been about €40 million for this scheme. We have increased that from €40 million to €66 million. We have increased the amount of funding into it by more than a half. That has meant two things. First, there are services available, such as scale and polish, which had been removed from the scheme, which we added back into it. More importantly for the dentists, the fees that we are paying have dramatically increased. What we would like to see and what I would ask the dentists to do is to re-engage with the scheme. We have many dentists around the country and, indeed, in Wexford who had been involved in this scheme for many years. The fees are now substantially higher and I would ask those dentists to re-engage and stay with us while we negotiate our new scheme.

"Substantially higher" would be somewhat of an exaggeration. The question I asked the Minister was what he is doing about access to emergency services. This is an 80-year-old man whose wife died a couple of years ago and who also lost his son. It is in no way reflective of the €21 billion we put into health in order to have a First World health service. As Mr. Hayes said, it is a Third World health service. Somebody of 80 years of age who worked and paid tax all his life having to pull four of his own teeth certainly does not instil confidence. I am not sure if he was here today he would have been voting for the Government in the confidence motion. Those were his words on a local radio in Wexford. An 80-year-old man pulled four of his own teeth. There was no emergency service.

In an emergency situation, people should get in touch with the HSE, which will do several things. The first thing it will do is contact dentists who are on the scheme in the area and try to arrange emergency care or an emergency visit. In an extreme situation, the care can be provided directly by a HSE dentist. However, there is a very limited number of HSE dentists and they are spending most of their time treating children, for example. That is the direct answer in terms of emergency care.

The Deputy comes from a commercial background. If she saw an organisation that had an increase in its revenue of more than 50% in one year or saw revenue going into an organisation increasing from €40 million to €66 million, I think, in fairness, the Deputy would call that a substantial increase. So let us not dismiss an increase in funding in one year from €40 million to €66 million.

Before the Minister is finished waffling, let me tell him the response from the HSE to a recent parliamentary question in relation to emergency services. It stated that the HSE is not resourced to provide treatment to adults and does not have the capacity to do so. That was in response to Parliamentary Question No. 767 received on 31 May, a month ago. Clearly, what the Minister has just told me about the HSE is a load of rubbish and he does not have a clue. A man who paid tax his whole life pulling four of his own teeth is absolutely criminal. The Minister cannot defend it, nor can he give me the answer as to where the next 80-year-old is supposed to go rather than pulling their own teeth. Unfortunately, it is not the €66 million we are discussing. It is the fact that we do not have emergency services for adults in Wexford and the Minister is not aware of it.

The only person waffling here is the Deputy. She dismissed a massive increase. She said that an increase from €40 million to €66 million is not substantial. That is nonsense. The only person talking rubbish here right now is the Deputy.

Let me tell the Minister what the Irish Dental Association said-----


The Deputy does not even have the courtesy to let other people in this Chamber speak. We all have to listen to her nonsense, waffle and insults.

Seán Hayes believes that too.

I have just answered the questions. By the way, the Deputy just described the Irish healthcare system as a Third World healthcare system.

No, I did not. Seán Hayes did that on the radio.

And the Deputy repeated it here. I wonder how many Third World healthcare systems she has been in. What an insult from the Deputy, as an elected Member, to come here and say that. What an insult to an insult to all of the dentists, doctors-----

-----and nurses. What we will do while she waffles is fix the problem.

Take your time.

Health Services Staff

Carol Nolan


85. Deputy Carol Nolan asked the Minister for Health if he will address concerns that an estimated 21% of persons with Parkinson’s disease reported having had access to a Parkinson’s disease nurse specialist since diagnosis; and if he will make a statement on the matter. [38142/22]

Deputy Michael Collins will take this on behalf of Deputy Nolan.

The Parkinson’s Association of Ireland is looking for proper care for people with Parkinson’s disease nationally in Ireland. With only a small number of specialised Parkinson’s nurses in Ireland, we are nationally falling way behind. There is a need for at least 20 specialised Parkinson’s nurses in Ireland. The very least that should happen in this budget is the Government should set aside funding for six this year. The Minister might be able to tell us his plans in relation to Parkinson’s sufferers in this budget.

I thank the Deputy for raising this important issue. I met some of the representatives outside the Kildare Street gates just last week and we discussed these issues.

The HSE’s national clinical programme for neurology has engaged with the patient organisations to identify service requirements for neurology nurse specialists. The clinical programme recognises the value of highly trained nursing staff and endorses the expansion of the neurology nursing workforce, including for Parkinson’s disease. I support it as well. Many years ago, I met patients with Parkinson’s. We went through the ratio of specialist nurses in the Republic versus Northern Ireland and the reality is that the ratios are much higher in Northern Ireland. We need to increase it, which is exactly the point of the Deputy’s question.

There are currently five Parkinson’s disease nurse specialists in acute neurology centres. The HSE plans to increase specialist nursing capacity in areas, including Parkinson’s. Building a specialist capacity of this nature takes several years. There is training, recruitment and deployment involved. The HSE will be guided by the work of the national clinical programme to ensure that priority is given to the areas of greatest geographical inequity to begin with and the neurology sub-specialties most in need. Parkinson’s must be one of the priorities. I do not believe we are providing the level of service that is required. I certainly will be looking to the next budget to begin to address that.

As well as this, the HSE implementation framework for the neurorehabilitation strategy also provides guidance for the development of specialist neurorehabilitation services across the continuum of care for people with conditions, including Parkinson’s and including in the community.

I thank the Minister for his reply. I would like to also acknowledge Deputy Nolan who put this question together for me.

We hosted the Parkinson’s Association of Ireland and the Minister met representatives from it outside the gates before they came into the audiovisual room. They were from Cork, Dublin and elsewhere in the country. We were told that there has been no Parkinson’s consultant in Cork University Hospital, CUH, since 2016. There has been a promise of replacement time after time for years, but still nothing. We were also told there have been no specialist Parkinson’s nurses in Cork since 2021. That is an astonishing situation that Parkinson’s sufferers are finding themselves in. Imagine that there has been no consultant there since 2016. This an unfair situation that the people of Cork and Munster find themselves in. I know it is a national issue that there is a lack of specialised nurses, and the Minister said there are only five in total. It is a national issue, yes, but it certainly is a crisis issue in Cork. I would appreciate if the Minister might address that in his answer.

I recognise there is a shortage in the Cork and Munster area. In fact, it was one of the things that was raised in the conversation I had with the representative from the patient group just last week. The Deputy's question was whether we can we look at Cork and the Munster area as one of the areas that clearly does not have the level of resource that it needs and, therefore, is one of the areas that can be prioritised. The answer is “Yes”. We can of course look at that.

There is annual funding of nearly €3 million provided to the first managed clinical rehab network. The pilot project accepts patients on referral from hospitals.

It uses multidisciplinary teams to serve patients with complex needs who do not need inpatient facilities. The lessons from the demonstrator pilot will help to inform this national roll-out. It will consider experiences and outcomes for all neurological conditions.

I thank the Minister for his reply. Three weeks ago, I was invited to a house in my constituency to meet a person suffering from Parkinson's disease. When I got there, I found out that three people in that family have Parkinson's disease. The sad thing is that I could not advise them where to go. The only help I could offer them was Tony Wilkinson. I hope he is tuning in to these proceedings because he has done Trojan work on behalf of Parkinson's sufferers throughout the country. I think the Minister met him outside the gates of Leinster House last week. The only person I could send them to was a person who himself suffers from Parkinson's. He is an expert and a genuine person who gives hours every day trying to help people but he is not a specialised nurse and should not be treated as such. People with Parkinson's are suffering from falls, costing the State millions of euro, but they could get a little help if specialised nurses are put in place, whether in Cork or throughout the country. I would appreciate it if that were addressed straight away.

I thank the Deputy. I did meet Tony Wilkinson outside the gates of Leinster House. At the moment, there are five Parkinson's disease nurse specialists in the acute section, that is, in acute neurology. They are in Limerick, St. Vincent's, Tallaght, the Mater and Galway hospitals. The Deputy made the point that we do not have one of the nurse specialists in Cork at the moment. That is something we need to address. We also need to do so in the context of other parts of the country. The aim of the national clinical programme for neurology is equitable access to a high-quality service. That has to guide where we invest and where we deploy specialist nurses, both in terms of the clinical area, namely, Parkinson's disease, and, as the Deputy stated, the geographical area, recognising that there is no such nurse specialist in that area at the moment.