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Dáil Éireann debate -
Thursday, 8 Dec 2022

Vol. 1030 No. 7

Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions

Health Services Waiting Lists

David Cullinane

Question:

1. Deputy David Cullinane asked the Minister for Health when he will publish a multi-annual capacity plan and waiting list strategy; and if he will make a statement on the matter. [61487/22]

This question relates to healthcare waiting lists. At various points during a meeting of the health committee, I asked about the total number of people on waiting lists. I am unsure as to whether that information can be provided in the format I want. I received some information yesterday, but it did not include people awaiting diagnostic scans or planned procedures. When will we see the multi-annual waiting list plan that was promised some time ago?

I thank the Deputy for his question. The 2022 waiting list plan is part of a multi-annual approach to reduce waiting times. Most importantly, it focuses in the first instance on long waiters to meet the Sláintecare targets.

We now have three-year waiting list plans. A great deal of effort was made on waiting lists in the last quarter of 2021, which resulted in a reduction of 5% in the lists. It was a successful activity. That effort transferred into the €350 million waiting list plan for this year, which mainly focuses on hospital waiting lists. It also focuses on, and makes an investment in, community waiting lists. Under the budget, a significant allocation has been made for next year.

The most important message is that, despite the challenges of Covid, including Omicron, the plan is working. I will cite a few examples. The number of patients waiting more than a year for an outpatient appointment has fallen by nearly 25% in the year to date, which is a large decrease. The number of patients waiting more than 12 months for an outpatient appointment has fallen by nearly 40% of the Covid peak in March 2021 and the number waiting more than six months for a procedure has fallen by a third since September 2020. A great deal of progress is being made and more is being provided for in next year's budget.

Regarding a multi-annual plan, something that we are addressing is recurrent funding. Much of this year's funding was one-off funding. Through the 2023 budget, we have allocated approximately €125 million to recurrent funding. One of the permanent changes that are being made is being led by Dr. Colm Henry and involves approximately 30 initiatives to accelerate specific patient pathways.

I acknowledge that there has been a reduction in the number of long waiters, which is important, but the Minister will accept that the overall waiting lists are still too high. For some time, I have called for the National Treatment Purchase Fund, NTPF, to publish all waiting lists. Currently, it only publishes acute hospital waiting lists. For transparency purposes, it would be better if community, diagnostic, mental health, children's disability network team and other specialised waiting lists were published so that we could capture what was happening.

I welcome the new public-only hospital consultant contract, which will play an important part in making consultants more available in our hospitals, particularly at weekends and after 6 p.m. on weekdays. I hope that it will result in more consultants joining the system. Selling the contract and, in so doing, attracting more consultants into the public system must be a priority for us all.

I agree with the Deputy's first point, in that we need a single consolidated waiting list view. Among other measures, we need electronic patient records to achieve this. Many patients are on many different waiting lists and they all get counted as individual patients. We are making a significant investment in e-health and electronic patient records.

I acknowledge the Deputy's support for the consultant contract. This morning, I heard the public contributions he made yesterday. I thank him and his party. I acknowledge that other Opposition Members have also supported it. This contract is a core part of Sláintecare and is something that we are all behind. A united front in the Oireachtas is important. As the consultant bodies rightly say, we need to hire many more consultants. One of the ways to do so is for Oireachtas Members and the consultant bodies to back the contract and encourage consultants to stay in or return to Ireland so that we can hire more into our public health service.

It is important that we welcome the contract and attract more consultants. In tandem with that, though, I have been hearing from consultants for many years that they need more access to hospital equipment, including diagnostic equipment, and surgical theatre capacity. We will ratchet up the number of consultants working in our public system, but many of the current cohort are battling as we speak to get access to precious surgical theatre capacity. This is an important issue.

We need to consider consultant packages, by which I mean ancillary staff such as nurses, healthcare assistants and junior doctors, surgical theatre capacity and hospital equipment, including public diagnostic equipment, in which I would like more investment. There must be a plan to put in place all of this infrastructure so that we can get bang for our buck and have the capacity in our public hospitals that we want.

I agree with all the Deputy's comments. We want to run our existing theatres, diagnostic suites and outpatient clinics for longer so that consultants and their patients can get more access to our current resources. As he correctly stated, this will require more theatre nurses, administrative support and technicians. We can get much more for patients out of our current capacity, which is why the new contract will gradually double the time available to them.

That said, we also need a great deal more new capacity. Yesterday was a good day in that regard. There was Government agreement on two new elective hospitals and five new surgical hubs, including one in the Deputy's constituency of Waterford, which will make a significant difference. This is in line with a fundamental increase in the permanent capacity of our public health service.

Citizens' Assembly

Duncan Smith

Question:

2. Deputy Duncan Smith asked the Minister for Health the timeframe for a citizens' assembly on drugs policy (details supplied); and if he will make a statement on the matter. [61090/22]

Following our Private Members' motion last week on the decriminalisation of drug users, I wish to ask about the timeframe for the citizens' assembly that has been agreed by the Government. Are we any closer to understanding when we will have that assembly?

I thank the Deputy for raising this issue. The Government is committed to establishing a citizens' assembly on drug use at the earliest opportunity in 2023 along with a citizens' assembly on the future of education. The terms of reference and the timelines for the citizens' assembly on drug use will be presented to the Oireachtas for approval.

I am very positive about the potential contribution of the assembly to the Government's health-led response to drug use and the strategic priorities for the remaining period of the national drugs strategy to 2025. Drug use affects all members of society, whether directly or indirectly so involving citizens in decision-making on drugs policy is, therefore, appropriate. I acknowledge the interest in the assembly among politicians of all parties and civil society organisations.

The Department of Health has commenced preparations for the citizens' assembly on drug use, in conjunction with the Department of the Taoiseach, so that there will be no delay in establishing the assembly in early 2023. I am keen that the voices of young people are included in the citizens assembly on drug use. The Departments of Health, and Children, Equality, Disability, Integration and Youth have held a consultation with young people on how drug use impacts on them. The findings will be shared with the citizens' assembly when established. I would also like to see an international component to the assembly to facilitate learning from the British-Irish Council work sector on drugs, which I chair, the EU drugs strategy and action plan and the Council of Europe Pompidou group on drugs and addictions. The good news is that the citizens' assembly work has started and, hopefully, it will take place early in 2023.

That is encouraging. I am conscious that following last night's debate on the Patient Safety (Notifiable Patient Safety Incidents) Bill, the Department of Health is having to do more work on that going into January. That is understandable and a good thing. I am conscious of the pressure the Department is under but this is something we feel must be brought forward as early as possible.

The work of the national drugs strategy that would complement the health-led approach to drug use and, ultimately, decriminalisation of the drug user is important. Initiatives such as the national injecting centre in Dublin city centre need to be delivered. That has to be moved forward. I acknowledge that we are waiting for the decision from An Bord Pleanála on that. These are the services that we need. We need a citizens' assembly, legislation and policies but we need the resources and services like this to be in place. I welcome the commitment that it will be as early as possible in the new year.

There is an An Bord Pleanála appeal on the supervised injection facility in Merchants Quay. We hope it will be taken as quickly as possible. It is part of the overall national drug strategy. I am very fortunate as Minister of State to have the national drugs strategy to which there has been more than 20,000 submissions. It has had its mid-term review. That is about reducing harm and supporting recovery and is a health-led approach. The Department has commenced preparation for a citizens' assembly on drug use and discussions regarding the national oversight committee for the national drugs strategy.

Officials from the Department of Health have engaged with counterparts in the Department of Children, Equality, Diversity, Integration and Youth and are gathering the perspectives of young people on how drug use affects them, their families and communities. That will be provided to the citizens’ assembly on drug use. The programme for Government includes a commitment to convene a citizens’ assembly relating to drug use. A lot of work has gone on and I look forward to that citizens' assembly taking place early in the new year.

Last week's two-hour debate included many examples, stories and emotive words on this. This question is not replaying that but is a demonstration that we are continuing to push this until it is delivered beyond the citizens’ assembly. The work of Deputy Ó Ríordáin on this especially is to be commended. Public opinion is with this. When speaking to families, communities and people impacted by this, they know the direction of travel and they want to see politicians on all sides of this House support it. There is a Minister of State with responsibility for drugs but they would also greatly appreciate it if the Minister would speak on it and lead at senior ministerial level. We look forward to progress on this early in 2023.

I thank the Deputy for his informed and measured remarks. The Government is committed to a health-led approach for those in possession of drugs for personal use through the health diversion programme that will divert them away from the criminal justice system and connect them with health services.

The terms of reference for the citizens’ assembly will be a matter for the Oireachtas to agree. We need to meet the diverse health needs of people who use drugs and how to prevent harmful impact of drugs on families and communities. It is important to have an international component to the citizens’ assembly so that there is an exchange of good practice from the British Ireland Council work sector on drugs and the EU drugs strategy and action plan. We are examining alternative approaches to coercive sanctions. We have come a long way. Again, I thank everyone who has worked so hard on the national drugs strategy. It is my roadmap until we discuss these issues at the citizens’ assembly.

Health Services Staff

David Cullinane

Question:

3. Deputy David Cullinane asked the Minister for Health the reason for delays in implementing agreed pay rises for healthcare workers; and if he will make a statement on the matter. [61488/22]

When I submitted this question, many health workers had not received their cost-of-living pay increase under Building Momentum. I very much hope that since submitting the question that there have been positive developments. I look forward to the Minister’s response. It is important that we value public healthcare workers. When pay increases are put in place, they should be delivered quickly. The same is true of the pandemic bonus payment. People should not be waiting. I hope that since I submitted this question that there has been progress.

I thank the Deputy for raising this. We agree. I am keen that all pay adjustments due under Building Momentum are paid to HSE and section 38 staff as soon as possible, with retrospective application to the appropriate date.

As he will be aware, all public servants, including HSE staff and section 38 staff, are entitled to pay adjustments due under Building Momentum, along with relevant claims that were resolved under the sectoral bargaining process. I can confirm that my Department has issued pay circulars and consolidated salary scales for all agreed pay adjustments due under Building Momentum in 2022. The circulars instruct the HSE, and other State bodies that fall under the aegis of this Department, to implement these adjustments.

The HSE has advised departmental officials that due to the complex nature of the adjustments being made, and added complexities with payroll systems, half the adjustments due will be made before Christmas with the rest made early in the new year. The cost-of-living increase of 3% and February adjustment of 1% will be prioritised. The HSE has issued correspondence to all staff advising on expected timelines for the payment of all pay adjustments. The HSE has advised staff that HR personnel will communicate locally, ensuring that all staff are aware of how the pay adjustments will be made between now and the end of March 2023. All adjustments due will receive retrospective application to the appropriate date.

The Minister will accept that it is unacceptable that many of those healthcare workers will have to wait until after Christmas to receive a payment that was due in October. Many workers in nursing homes and elsewhere have also not received their pandemic bonus payment, albeit they are not public sector workers.

This speaks to the issue of the need for an integrated financial management system and an integrated IT system so that we do not have these complicated systems that do not allow us to move quickly. Most workers would have had an expectation when they heard there is a new pay agreement due in October and other Departments have been able to pay this. It is once again in the health sector where staff are waiting and some will have to wait until after Christmas. It is unacceptable. The Irish Nurses and Midwives Organisation has been lobbying all of us on this because it represents its members and it wants them to get the payments due to them.

We are coming up to Christmas. That half of them have not received their payments and will have to wait until the new year, even if the payment is retrospective, is not the way to treat those who work in our healthcare system.

Yes, it is frustrating. It is frustrating for the staff, first, and for the Government and all of us as public representatives. It is not for any lack of will on the part of the HSE or the Department. As the Deputy correctly pointed out, unfortunately, we have outdated legacy systems, including for payroll. A new process is being put in place. One of the first places we are applying it is to the non-consultant hospital doctors to get rid of the situation where they were paying emergency tax every time they rotated. They will be a priority.

It is good to point out that while about half will be paid before Christmas, the other half will be paid after Christmas, into the new year. The amounts involved are significant. In my response, I asked for two worked examples, namely for a staff nurse and a clinical nurse manager, just to give a sense of the amounts due, including the arrears. I will mention those in a supplementary response.

The Minister will accept that a 3% increase is modest. It is welcome and deserved by workers but we are in the throes of a cost-of-living crisis in which inflation is running high. For many workers, any pay increases is just allowing them to stand still to meet all the rising costs and so on. A priority for all of us with an interest in healthcare, in addition to all the other things we are trying to get done, is to ensure we have proper IT systems and that, once and for all, we deal with all the legacy issues.

On children's disability network teams, we cannot get real-time data in respect of much of what is happening because of the outdated system. It is working off a database that cannot be updated because the company behind it has, I believe, gone out of business. A new one is being built. Voluntary and HSE hospitals have different systems. Even within public hospitals, there are different systems.

We had the same argument concerning the Estimates and an integrated financial management system. This will require significant public investment and take time, but we have to collectively agree we are going to do what is required and do it as quickly as we can.

It is expensive but the funding has been allocated. As we were discussing, the systems will become operational in the new year, which is important.

Let me refer to the changes. For a staff nurse on point 4, the gross salary last year, excluding the premium and overtime, was €35,130. With the cost-of-living increase and the Building Momentum increase, that is now €36,684. Regarding the cost-of-living increase, the 3% that will be paid before Christmas, the arrears due to the nurse is €966, with a further €167 to be paid in February. That will be the 1%. For a clinical nurse manager on point 6, the salary went from €56,745 to €60,968. The sectoral bargaining arrears is €1,820, paid in December. The 3% cost-of-living element is €1,611, paid in December. The Building Momentum payment in February will be a further €201.

Emergency Departments

Cian O'Callaghan

Question:

4. Deputy Cian O'Callaghan asked the Minister for Health when the new and expanded emergency department at Beaumont Hospital is expected to be delivered; and if he will make a statement on the matter. [61446/22]

As the Minister will be aware, the population of Beaumont's catchment area has expanded massively since the hospital first opened, in 1987. While the healthcare staff in the emergency department do tremendous work in stressful and challenging conditions, the promise of a much-needed new and expanded emergency department has not been honoured to date. When can we expect work on the new, expanded emergency department to start?

I, too, commend the staff of Beaumont on their work. It is an impressive hospital with an impressive team. In spite of the challenges of Covid, respiratory syncytial virus, winter and the flu, the team is doing fantastic work. I fully acknowledge that the new emergency department is important. The proposal includes a reconfiguration of the existing emergency department. Associated works, including road realignment, will also be necessary.

The HSE has appointed a design team. While it is in the early stages of development, I am happy that the design report has been completed. It is only one step but an important one. The design team will continue through this design process, including planning. In parallel, rather than sequentially, we are trying to get these things moving quicker. The HSE is drafting the strategic assessment report that is required. I expect this to be submitted early next year to my Department. If it satisfies the requirements of the public spending code, a preliminary business case can be developed.

Given the impact of construction inflation, supply chain issues and the war in Ukraine, the capital bill for the project could be in excess of €100 million. It is a substantial build. If the requirements are satisfied, it will be a question of the public spending code and a matter for the Department of Public Expenditure and Reform. When we have the strategic assessment review, we will be able to give a more detailed timeline as to when the new facilities will ultimately be in place for patients.

I thank the Minister for the reply. The people I talk to in my constituency every week, many of whom are elderly, tell me that despite the excellent work done by the staff in the emergency department, they are left waiting for hours in overcrowded conditions. They can be left on chairs and may not even be able to get a trolley. Elderly people who go into the emergency department in the morning may not get out until 6 a.m. the next day. These are intolerable conditions.

Promises have been made over the years. The design team appointed in 2018 concluded its work in February 2019, and its costings are very much out of date. While I appreciate the Minister's response, people want to know when the much-needed new emergency department will be provided.

The figures very much back up what the Deputy and people in the hospital know, which is that emergency department attendance today, by comparison with 2019, is up by approximately 8.5%. On top of that, admissions from the emergency department are up 20% on 2019. There has, therefore, been a huge increase in the number of patients coming in and the complexity of their care needs. A 20% increase since 2019 is huge. It underscores the Deputy's point, which is that new capacity is required.

While the main project is going through the process associated with the public spending code, enabling works are taking place, including the relocation of the existing administration accommodation. Refurbishment is proposed for Rockfield House, St. Anne's and Beaumont house. The design stage for the enabling project is progressing along with the planning application, and various control works are being undertaken on the site.

I thank the Minister for the reply. When the hospital and its emergency department opened, the population in the area was much smaller. There has been significant growth in the population of the catchment area of Beaumont over the years, and that is one reason the works are very much overdue. They need to be progressed as quickly as possible as one element of the infrastructure needed at the hospital. It is important.

The conditions, mainly affecting older people, can be intolerable. Patients tell me the hospital is the last place they want to be when sick; that it involves a trial of endurance; and that even young, fit, able people put into those conditions would find it difficult. I urge the Minister to make progress on this as quickly as possible.

It will be progressed as quickly as possible. I intend to make funding available to continue with the work in the capital plan for next year. As projects progress and we move through the various stages, the costs involved increase, as the Deputy will be aware. In the short term, before the new development is in place, we are making available many more resources for the emergency team. There are more emergency medicine consultants, healthcare assistants and nurses, and also more emergency medicine. Additional beds have been made available. We are finding that the most important thing we put into the emergency department is not capacity but discharge options for patients. Despite the many millions of additional euro being invested in home care, the approval of many more home care packages and the investment in nursing homes and step-down facilities, the delayed discharge level is still higher than we want it to be. The most important thing we are doing probably is working with the community to discharge patients, freeing up the beds for patients admitted to the emergency department.

Mental Health Services

Mark Ward

Question:

5. Deputy Mark Ward asked the Minister for Health the terms of reference and timeframe for the Mental Health Commission review into child and adolescent mental health services, CAMHS; if he will outline the concerns raised by the Mental Health Commission with the HSE and the nature of those concerns; if he will outline the HSE's response to those concerns; and if he will make a statement on the matter. [61489/22]

The Mental Health Commission is carrying out a review of CAMHS after major concerns were raised in the Maskey report on children who were subjected to significant harm in south Kerry. Could the Minister outline what concerns have been raised by the commission in the review?

When were they raised with the HSE? What was the nature of these concerns and what was the Government's response to them?

I thank Deputy Ward for his question. The Deputy will be aware that the Mental Health Commission is an independent statutory body established under the Mental Health Act 2001. The commission’s principal functions are to promote, encourage and foster the establishment and maintenance of high standards and good practices in the delivery of mental health services and to take all reasonable steps to protect the interests of persons detained in approved centres under the Act.

As the Mental Health Commission is an independent body, and in light of the fact that the commission has not completed its final review, the specific issues raised by the Deputy are, in the first instance, a matter for detailed consideration by the Mental Health Commission and the Health Service Executive. Any actions arising by the commission will, in the first instance, be raised by the Mental Health Commission with the HSE.

I understand the commission has completed a review of the child and adolescent mental health services, CAMHS, in five community health organisations, CHOs, with four to be completed, and one of those four has already commenced. As is normally the case with relevant Mental Health Commission inspections and reports, any commission concerns brought to the attention of the HSE are addressed directly by the executive.

I met with the Mental Health Commission in the past month and it told me it had raised concerns with the HSE in relation to matters that had been raised during the audit of the five CHOs. I look forward to receiving the reports from the Mental Health Commission when they are completed and formally submitted to me. To date, I have not received anything in writing.

The Deputy will be aware that the independent report of the review of care provided by south Kerry CAMHS, the Maskey report, made findings regarding significant failures across multiple levels of the system. This has led to an independent audit by the HSE and a subsequent review by the Mental Health Commission.

I am extremely troubled to find out that the concerns escalated by the Mental Health Commission to the HSE have not been conveyed to the Minister of State. This is extremely worrying. We are having these reviews because 240 children were placed at risk of significant harm and 46 children and young people experienced significant harm, including weight gain, sedation, elevated blood pressure and the production of breast milk. It is worrying and troublesome that the Minister of State with responsibility for mental health has not been given the information the Mental Health Commission provided to the HSE. The word "escalated" sounds worrying. The Mental Health Commission escalated this to the HSE but the HSE has not escalated this to the Minister of State. Will the Minister of State look into this to find out why she has not been given this information?

To be fair, when the initial report from Dr. Seán Maskey was presented to me I acted quickly and promptly. I initiated an independent audit by the HSE of three particular areas, namely, prescribing, standard operation procedures and the interaction of parents and families with CAMHS. The Mental Health Commission also agreed to conduct a full review of all nine CHOs. The standard operating procedure is that the Mental Health Commission must, in the first instance, raise any issues with the HSE, which is providing the services. I look forward to receiving these reports because I believe we will get data we have never had previously. We will able to look at all 73 CAMHS teams to see what has to be changed to ensure children are safe in these services.

I acknowledge the Minister of State's response to the Maskey report and how quickly she acted. I also acknowledge that three reviews are being done by the HSE and one by the Mental Health Commission. It is very welcome to have these reviews done. We must remember, however, that before these additional concerns were escalated, there were red flags all over CAMHS. The Linn Dara CAMHS service was supposed to reopen in September and that still has not happened. Inpatient capacity is lower now than it was when the Government took office. Some 4,000 children are waiting on appointments with CAMHS, a 32% increase on the figure for 2021. There are also thousands of children who, despite being referred into CAMHS by a medical practitioner, are deemed ineligible for referral. I hope those children are part of these reviews. A consultant psychiatrist has still to be hired in south Kerry where children are receiving consultations from a doctor in the United Arab Emirates. Children are still facing a cliff edge when they reach the age of 18 and are moved into adult mental health services, despite the recommendation in Sláintecare and A Vision for Change that the age be extended to 25.

I am extremely worried that the Minister of State has not received the reports from the HSE on the concerns that have been escalated by the Mental Health Commission. Is there anything the Minister of State can do to get those reports out? Other people have contacted about this matter. Parents are extremely worried about what is going on in CAMHS.

The HSE acts when it is contacted by the Mental Health Commission. Any safeguarding issues or concerns raised are dealt with promptly and appropriately by the HSE and the relevant CAMHS teams. At the same time, we must remember that thousands of children are receiving the support of CAMHS multidisciplinary teams on a daily basis. They receive good supports. I must try to build confidence in the service.

On the Maskey report, the Deputy is right. Unfortunately, the post in Kerry south has been funded since 2014 but the service has not been able to secure a consultant psychiatrist. One of the key recommendations of the Maskey report is that services look to outside sources to try to provide supports. This is the reason services are being delivered online to children and young people in Kerry south. The initial consultation is done by a consultant psychiatrist, not online. Following the initial consultation and assessment, supports are then provided online as part of the person's care.

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