Vol. 1039 No. 5
10. Deputy Bernard J. Durkan asked the Minister for Health if consideration has been given to raising the income threshold for qualification for medical cards, with particular reference to persons who may be suffering from life-changing or life-threatening conditions; and if he will make a statement on the matter. [26657/23]
This question seeks to amend the qualification levels for medical cards with particular reference to those people who may be suffering from life-changing or life-threatening conditions.
We have jumped forward significantly in the questions.
I thank the Deputy for his question and recognise his ongoing advocacy on this topic, in particular to ensure that as many people as possible have access to medical cards and, or, GP cards. Medical card provision is primarily based on financial assessment by the HSE, with each applicant assessed on qualifying financial thresholds in accordance with the Health Act 1970. The issue of granting a medical or a GP visit card based on having a particular disease or illness, which is part of the Deputy's question, was examined in 2014. The HSE's expert panel on medical need and medical card eligibility concluded that there was not an ethical basis to list medical conditions in priority; in other words, there is no hierarchy of suffering. We have had very constructive and well-intentioned debate in the House over many years; for example the call comes up as to whether patients with a cancer diagnoses should automatically get a medical card. While one would love on a human level to cover everybody's costs when they get a diagnosis of cancer or something else, the expert group came back to say that there was no ethical justification to say "Yes" if a patient is diagnosed with cancer, and "No" if he or she is diagnosed with motor neurone disease. Therefore, we have to stay away from a hierarchy of disease. Essentially, the most transparent and the most ethical and equitable way to do it is to base it on income thresholds. As colleagues will be aware, there are particular circumstances in which patients who are particularly sick can make an additional application. One of the areas where we have extended it - and I credit John Wall for his tireless advocacy on this - was if somebody had a terminal diagnoses, we extended the diagnoses period from 12 months to two years. Critically, that treats all patients, all disease and all sickness in the same way.
I ask that consideration might be given to the fact that it is quite a considerable time since the income thresholds were adjusted. They need to be adjusted now in line with the cost of living and other compelling reasons. They also need to be adjusted on the grounds that when a household receives indication that a patient, be he or she the bread earner or not, and when it is considered that the shock to the system and to the household budget is fairly considerable in any event, and that there are many calls and charges on the household which would not ordinarily apply, I ask that further consideration be given to the fact that the family finds itself in this position. The family members are worried about their health issues and the reduction in the family income as well. On that basis, I ask that the income thresholds be reconsidered.
I thank the Deputy. We have to keep these things under constant review, particularly as part of the Estimates process. I can confirm that there has been an increase in the number of medical cards since the 2019 figures. Therefore, the numbers are going up rather than being suppressed because of inflation, for example. There has been a 1.4% increase in medical cards and a 6.6% increase in GP cards compared with 2019. As the Deputy will be aware, we are hopefully in the final few weeks of negotiation with the Irish Medical Organisation, IMO, on an additional 400,000 to 500,000 GP cards and that is going to make a big difference. It will the first time in the history of the State that half the population will now have full State-funded access to general practice. It is a really important move. Obviously, we have listened very carefully to the GPs and are putting in substantial increases in financial supports for them as part of that, while being highly cognisant that GPs are already under a lot of pressure.
I also draw attention to the fact that some patients may be suffering from a hospital misadventure, which places considerable burden on the family in financial ways, as well as due to the trauma within the family of such a situation. I plead that consideration might be given to awarding a full medical card to those patients in the interim period because they should not have to wait until a court case decides, maybe four, five, or ten years later, when it is impossible to address the situation of diminishing income within the family.
The last point I make is that I agree the number of medical cards is growing, as is the population, and therefore more people are coming into the bracket. However, I go back to the last financial review of the eligibility for medical cards and ask the Minister if he might consider having that reviewed again.
Before the Minister responds, Deputy Bruton wanted to come in.
I can understand the Minister's point about GP card and the drugs refund covering a lot of cases but medical appliances are a different situation. People who do not qualify for a medical card face huge uncertainty in accessing needed medical appliances for certain conditions. If the entire system cannot be reviewed, would it be possible that medical appliances would get some form of a different structure for dealing sensitively with people who have particular needs for such supports?
I thank both Deputies. We have to keep an open mind to patient cost generally. One of the priorities for the Government has been reducing healthcare costs for patients. We increased the medical card thresholds for the over-70s; we are looking at about half a million more GP cards; we have introduced free contraception and will go further in September when we will introduce State-funded IVF. We have abolished inpatient hospital charges for now for children and for adults; and we have reduced the drug payment scheme threshold from €124 to €114 and down to €80. We can certainly keep all of this under consideration. One of the pillars of our drive towards universal healthcare is that when people need access to care, it is affordable. It is one reason I am so keen we bring in these extra GP cards. Right now, the State funds about 40% of the population's access to GPs. We have people on higher incomes who can afford to see the GPs. We have a bunch of people in the middle now who really cannot afford to see the GPs. They cannot afford the €65 to visit the doctor and that is the group we are going to target now with these extra GP cards.
Are we going forward or going back? Deputy Bruton was not here but I will allow him in.
7. Deputy Richard Bruton asked the Minister for Health if he will outline his ambition for the development of services from community pharmacists, and the challenges in meeting them. [26596/23]
I wish to ask the Minister about the development of community pharmacists. During Covid-19, they played a fantastic role. As the Minister probably knows, they feel very aggrieved about financial emergency measures in the public interest, FEMPI, obligations. They also feel there is a potential to develop them. We see GPs under pressure daily. Community pharmacists do seem like a resource we ought to exploit more creatively.
I fully agree and acknowledge this is something the Deputy has been advocating for and pushing on repeatedly. We greatly value the work that pharmacists and pharmacies do in terms of their place within the health and social care service. I fully agree that the practice of pharmacy and the provision of pharmaceutical care has the potential to be substantially enhanced to deliver more care and it can really help in terms of the pressure on patients, GPs, and on primary care. My ambition, and that of the Government, is to work with pharmacists to make sure that we can have them working to the full extent of their practice and training, which they are not at the moment. There are several pieces of work ongoing in the Department with the HSE and in consultation with the Irish Pharmacy Union as well. These include a proposal for implementing a minor ailment scheme. Essentially, this would allow medical card patients to get over-the-counter medicines without having to go the GP for a prescription, which they currently have to do. We are looking at an enhanced role for pharmacists in the current contraceptive scheme, particularly around oral contraction. We are looking at more involvement of pharmacists in the delivery of the seasonal flu vaccine.
For all this to work it is essential we have the availability of the appropriate workforce, so work is also underway to assess emerging risks and opportunities with respect to the ongoing availability of pharmacists in Ireland. I will have a report on that in the coming weeks. I fully agree there is a lot more pharmacists can do and much more value they can add. We are actively pursuing various measures to that effect.
From previous replies, I think the Minister indicated a working group in place during Covid had been repurposed to look at taking advantage of low-hanging fruit in a highly-qualified segment of the population that has community confidence. The HSE is approaching this by looking at one column after another, which is going to be very slow and it will be difficult to make progress. Can the Minister not see his way to broadening the scope of the work a pharmacist can take on so it is much wider than a case-by-case basis?
I thank the Deputy. I suggest that is exactly what we are doing. We have met the IPU and spoken to pharmacists around the country. I tasked the Department with putting together a package of enhanced practice for pharmacists. That includes minor ailments, flu, access to contraception, medicine shortage protocols to enable pharmacists to substitute medications, and so forth. We have a group that is looking at medicines one by one to say which of them would be appropriate for a pharmacist to be able to provide. We are looking around the world, including at the UK. There are training modules being developed at the moment by the Royal College of Surgeons in Ireland, RCSI, for pharmacy prescribing. When they are in place we will want them for undergraduate and graduate training. We will also want them made available for continuous professional development opportunities for pharmacists. I agree with the Deputy's framing but I suggest we are doing exactly that, insofar as we are trying to go quite broad on this and do several of these things at the same time.
Can the Minister give me a timeline for when we might see a significant package rather than the drip, drip, drip of individual arenas?
No. We are progressing things this year but I cannot yet tell the Deputy when these things will happen, to the month. I am determined we move quickly on this. There is a lot of advantage to be had here, especially with GPs under so much pressure. I cannot give the Deputy an exact timeline because there are clinical governance issues that need to be worked through. There are training modules that have to be gone through as well. I am eager to have it in place as quickly as possible and some of it in place this year, but we have to get the clinical governance and the regulatory side of it right as well. Some of the changes we are proposing are things that have been talked about for many years but have not happened. One of the reasons they have not is because of the clinical governance, oversight and regulatory framework that has to be in place. There is a certain amount of complexity to it. The changes will happen as quickly as possible.
I am going to go back to Deputy Alan Farrell, but I ask Members for their co-operation generally. People are running in, in fairness to them, to take questions. I am just making a general point.
6. Deputy Alan Farrell asked the Minister for Health his views on the progress being made to develop a national sexual health strategy; and if he will make a statement on the matter. [26756/23]
Go raibh míle maith agat, a Leas-Cheann Comhairle. My question relates to the Minister of State's view of the progress being made on developing a national sexual health strategy.
I thank the Deputy for his question. The sexual health strategy is a core priority for Healthy Ireland and for the Government. Additional funding of approximately €4 million was allocated to sexual health between budgets 2022 and 2023.
The recent independent review by Crowe Ireland of the first National Sexual Health Strategy 2015-2020 identifies some key successes. These include: expanding free access to contraception through the free contraception scheme for women and national condom distribution service; the introduction of pre-exposure prophylaxis, PrEP, for HIV prevention and joining the HIV fast-track cities programme; introducing a nationwide free home sexually transmitted infection, STI, testing service in 2022; additional data and information through surveys and research; developing a wide range of educational resources; public engagement and communications campaigns; the sexualwellbeing.ie website; and working in partnership with NGOs to support patients and communities.
The review includes 32 recommendations to inform the next strategy. These were drawn from stakeholder consultations, international comparisons and expert recommendations. The review is published and available through the Healthy Ireland website. Work on a refreshed national sexual health strategy was delayed due to Covid, but commenced earlier this year. The first meeting of the policy development group is scheduled for July. The renewed strategy will build on the priorities of its predecessor. Given the rapid development and change, it is likely the remit of the strategy will be widened. It is envisaged the strategy will be published in quarter 4.
I thank the Minister of State for her response. Noting the delays caused to pretty much everything by Covid, I welcome the strategy being published back in March. On implementation and the availability of such services across the State, is there continuity of service delivery? I point to access to PrEP, where I understand there is a regional imbalance. Undoubtedly, the Minister of State has been made aware of that. If so, is there a plan in place to address that?
On the delivery of the strategy itself, I am aware the Government is hoping to implement it by the end of the year. Is that still on the cards?
On PrEP, I agree this is a really important area. As the Deputy knows, Ireland established a national HIV PrEP programme in November 2019. PrEP clinics are provided within 13 of the free STI clinics and 17 private GP providers are approved to prescribe free PrEP medication. In 2022, 4,314 individuals had their PrEP eligibility approved via the primary care reimbursement service, PCRS and 3,388 individuals had a PrEP prescription filled at least once, of whom 1,240 had their first ever prescriptions. There have been changes to the international guidelines. These widened the access criteria for PrEP. Consideration is now being given to incorporate the resulting unmet demand. That will be part of the new strategy as well and will also be considered in the Estimates process. It is important we expand that.
I will come back in on the roll-out of it, but there is much good work happening in that space as well.
That is appreciated. After the Minister of State has addressed that outstanding question, she might say whether she is satisfied there is sufficient training available for professionals.
I will give examples of really good models. I want to ensure we are funding evidence-based programmes across the country. These should be programmes and initiatives that work. I was recently down in Cork at UCC. There is a novel project there where the work of HSE CHO 4 drug and alcohol services, Cork Local Drug and Alcohol Task Force and the Southern Regional Drug & Alcohol Task Force. They are providing a night-time mobile unit like a drugs, alcohol and sexual health, DASH, unit that goes into parts of Cork and Kerry. It goes into rural areas to provide information for young people. It is a mobile unit and the first of its kind in Ireland. It provides rapid HIV testing, condom provision and drug and alcohol assessments. It is an informal way of providing information to young people out and about. Third-level institutions will play a fundamental role in rolling out sexual health campaigns. This is going to be a key area of focus for me. Education, training and development are part of the strategy. I am open to working with the Deputy if he has any suggestions in that area.
8. Deputy Pádraig O'Sullivan asked the Minister for Health if he will appoint a HSE patient liaison team official with a special focus on rare disease patients; and if he will make a statement on the matter. [26591/23]
Will the Minister appoint a HSE patient liaison team official with a special focus on rare disease patients?
I thank the Deputy and acknowledge his ongoing work on behalf of patients and families with a rare disease diagnosis.
We are fully committed to doing everything possible to assist people living with a rare disease and to support their families as well. Good progress was made under the national rare disease plan, including the establishment of a national clinical programme for rare diseases and, critically, a national rare disease office. While there is currently no HSE patient liaison team official with a special focus on rare disease, the national rare disease office established the national rare disease information line which provides current and evidence-based information on rare conditions and signposts to available expertise in Ireland and across Europe.
Patients can seek information, advice and support through the patient advocacy service. It is a free and confidential service, independent of the HSE, providing information to support people who want to make a complaint about their experience or give feedback on their experience in an acute hospital. Then we have the Your Service Your Say process as well. Responding effectively to feedback and learning is essential in providing very high quality services. As such, the patient liaison officers referred to in the Deputy's question are located in each hospital group and community health organisation to support patients, service users and staff in the implementation of the complaints management process.
In February I announced a plan to develop a new national rare disease plan, in line with the commitment in the programme for Government. Work for the new plan has commenced and, critically, the voice of patients and families will be central to the development of this policy. The measure the Deputy is proposing through his question is one that we will consider through this forum. A patient liaison officer with a special focus on rare diseases can be put in place within the HSE potentially as part of the new plan.
I welcome that the Minister took the initiative to publish the Mazars report recently because it was sitting there for an awful long time. I acknowledge and welcome that. The Minister is quite aware of its contents and what it proposed. There are various steps being taken on the positive front on foot of that, including increasing transparency through an online portal that will keep people informed about the progress of the drug in question in terms of reimbursement. The problems still prevail in respect of waiting times for reimbursement, however. I also welcome the fact that the Minister has commenced a review of the rare disease plan. It is much needed. I appreciate that he has said that through that process he will consider the appointment of a specific rare disease officer. That is also something I would welcome. Initially when that Mazars report was commenced and recommended by the Oireachtas Joint Committee on Health, it was to have a specific focus on orphan medicinal products. Can we go back and revisit that?
Starting, if I may, with the patient liaison, the Deputy and I had a really positive and useful meeting with patients and families who are dealing with rare diseases. The point they were making was that there is all manner of frustrations, blockages and complications in the system and they would really benefit from having someone within the HSE who engages with them and can take on board what may be fairly minor improvements that would make a big difference to the children, adults and families involved. In the first instance, I want to continue that conversation as part of putting this new plan together. I am certainly very open as per the Deputy's question to having a specific point person. Because these are rare diseases and the numbers of people involved are so low, the patients and families do not have the same share of voice and representation, let us say, as oncology patients or others. That is something I am very open to. I will answer the Deputy's second question when I come back.
I appreciate that the Minister is considering that request in the process that is to come. If I can go off on a bit of a tangent around the greater reimbursement process, does the Minister have any proposals in terms of allowing early access to drugs? Is that being considered by his Department or by himself? Will he be doing any review or report on it? Previously I spoke to the Minister about risk-sharing initiatives that could be done with partners in industry. Is that being considered by the Department at present? I spoke to the Minister yesterday about the report in The Lancet that was published earlier in the month. It shows that time lags here in Ireland are considerable compared to our EU counterparts. Could the Minister give us an update on any other initiatives, be they legislative or non-legislative? I am more interested in any non-legislative measures that the Minister might be considering taking and ask him to give us an update specific to orphan drugs.
Before the Minister responds, Deputy Durkan wants to come in briefly.
In support of my colleague, I want to ask the Minister if any measure is taken of the number of patients reporting with heretofore unidentified conditions that might come under the guise of rare diseases, on a monthly or yearly basis, in order to reassure patients.
I will have to come back to Deputy Durkan on that. With regard to Deputy Pádraig O'Sullivan's question, the short answer is "Yes". We can do more and we can move faster. I believe we are now moving faster. The article in The Lancet referenced by the Deputy quite rightly looked at Ireland's slower response historically. A lot of money has been put in place in the last three years. As the Deputy will be aware, 127 new drugs or new uses have been approved and 50 of them are cancer drugs. There is a lot going on. Can we do more? Yes. Can we be more transparent? Yes. Ultimately patients and clinicians want to know where any drug is in the process. That is really the benefit of implementing the Mazars report. To the Deputy's question as to whether we need to legislate for that, we do not. That is just about getting on and putting a more transparent process in place where everyone can see where the drugs are in the process.
11. Deputy Duncan Smith asked the Minister for Health if he will provide an update on the progress made with regard to the pay parity claim by medical scientists, one year after they suspended their industrial action; and if he will make a statement on the matter. [26661/23]
We are just over a year on from when the Medical Laboratory Scientists Association, MLSA, suspended its industrial action to return to talks. Can the Minister provide an update on the progress made with regard to the medical laboratory scientists' long-standing pay parity claim?
Yes, I can. I acknowledge the dedication, professionalism and commitment of our medical scientists all across the country. As the Deputy says, we are a year on now since the MLSA engaged in two days of industrial action on 18 and 24 May of last year. That was for their claim for pay parity between medical scientists and clinical biochemists. I am very happy to report that important open engagement has continued between health management and the MLSA since this time without industrial action being initiated again. I commend the representative body, the medical scientists and the HSE on making sure that has happened.
Following what I am told were very productive talks at the Workplace Relations Commission, WRC, in May and June of last year, agreement was reached to conduct an independent assessment of the role, responsibilities and pay of medical laboratory scientist grades. The assessment was undertaken by an independent assessor and the final report issued in January of this year. Following the issuing of that report, the parties involved in the matter have resumed engagement to determine a way of progressing the recommendations outlined in the report. It is important to note that these recommendations may only be addressed in the context of the next public service pay agreement, which is to be negotiated later this year. Thanks to the efforts of all involved, they have a report, they have the recommendations and now they are working to see how they can be progressed through the standard pay bargaining channels.
The recommendations from that report were most welcome. They backed up what medical scientists knew for a long time, that there was no material distinction between the work they do and the work the clinical biochemists do. This dispute is not just a year and a bit long, it is 22 years long. We have the upcoming pay discussions that this will be included in. This group of workers have been waiting a long time for this. They need support. They need to see that the Minister and his Government are supporting them and putting energy into the issue. We gave them an awful lot of platitudes, particularly during the Covid crisis, for the work they did behind the scenes in the basements of hospitals and health facilities all over the country. Now they need public support and public pressure from this House, the Government and the Minister to ensure they get their pay parity and that is done as soon as possible.
I thank the Deputy.
I agree. The assessment and the report concluded that critically there were no material differences in qualifications, duties and responsibilities between medical scientist grades across laboratory specialists and biochemist grades. Small differences were highlighted particularly in regard to the educational requirements. The assessor gave recommendations for addressing these. The parties met again in February and in March to discuss the recommendations. Following the March meeting, the MLSA referred the matter back to the WRC.
In good news, one of the issues we all discussed at the time was that there was an anomaly and a pay discrepancy with regard to laboratory aids. It was really frustrating the medical scientists. I am happy to be able to say that during the WRC engagement last year the parties agreed to remove the anomaly created between the maximum value of the medical laboratory aid salary scale and the basic medical scientist grade. That overlap and anomaly has been resolved.
It is worth pointing out that this is all happening against the backdrop of 13% of medical scientists' posts being vacant. Staff are being attracted out of the public health service. Many are going into the private sector. We have a booming pharmaceutical industry. There are many jobs outside the public health system. With morale low, the increase in demand and pressures on staff in the public health system, and the stubbornly high levels of vacancy, it is understandable how demoralised these staff continue to feel. Negotiations have been ongoing and there was a degree of positivity to those negotiations. These workers are not feeling it in terms of full laboratories, full complements of staff nor in their pay packets yet. I cannot overemphasise how demoralised these staff continue to feel at what they see as the lack of progress.
Progress is being made. The representative body has been engaging through last year. As I said, they met in February and in March. They are back into the WRC. The pay anomaly has been addressed in regard to the laboratory aids. Good progress is being made to that effect. The workforce has gone up since before the pandemic. It increased by about 7% since pre-pandemic levels which is very positive. I fully agree that we need more medical scientists working in our labs and in our hospitals. My view is we need to double the number of healthcare college places including these. The Minister, Deputy Harris, and I are working to put a very ambitious plan in place to do this. As the Deputy will be aware we recently, just in the last few weeks, appointed a chief health and social care professional officer in the Department of Health. That has been warmly welcomed for example at the Forsa conference in Galway two weeks ago. She is going to be working on exactly these kinds of issues to make sure that we are listening to and respecting these workers and making sure that they can work to the greatest extent of their training and licence.
13. Deputy Thomas Pringle asked the Minister for Health when a substantive reply will issue to correspondence on 23 August 2022 and 17 May 2023 from this Deputy in relation to the provision of GP services by Cuban doctors; and if he will make a statement on the matter. [26675/23]
This question relates to correspondence I sent to the Minister on 23 August 2022 and again on 17 May 2023 to which I received no response. In order to try to get a response I put it down as a question here today.
I thank Deputy Pringle. I checked in when I saw your question. The advice I have from the Department is that there was an acknowledgement and a response to the correspondence. That is the advice I have from the Department. If that is not correct we need to chase that up because certainly the view is that correspondence has issued. We need to make sure that has been received. If it has not, I will revert to the Department on that. Apologies if it has not. The Deputy should have had a response. I am told the response has issued.
Yesterday.
Yesterday, fair enough, well then he should have had a response earlier than that. I have no issue saying that at all. I thank him for getting in touch with me on it.
Increasing the medical workforce is a top priority for me and for the Department. As Deputy Smith and I were just talking about, I want to see a doubling of healthcare college places. The 2018 capacity review in regard to GPs, referring to the question, showed that Ireland had broadly similar per capita levels to the countries benchmarked. However, rapid access to GPs in certain areas is a real challenge. There is no question. I hear this throughout the country. The number of doctors in training is increasing. This is one of the ways in which we are tackling this. There is an increase from 120 in training in 2009 up to 258. That has more than doubled to last year. Further increases are planned for this year. Critically, we are working with the Irish College of General Practitioners, ICGP, on bringing international GPs into the country. In the Deputy's own county and constituency, there are issues. The ICGP is looking to bring in GPs including from South Africa but critically, support them in setting up in more rural areas. That is something that we fully support and want to see more of.
This is what I am talking about. The action as outlined in the correspondence yesterday could be done on a national basis by the Department of Health or the HSE actually talking to the Cuban ambassador and the Cuban authorities about the provision of doctors throughout the whole health service and for the hospital service as well. They are available but it requires the Minister actually to ask, to pick up the phone and have a conversation with them in regard to the actual possibility of this happening. This could happen quickly and could go a long way towards easing the burden while we wait for all those training places, as the Minister outlined, to come on board. Fortunately, the training places seem to be happening now, which is good, but we have heard about extra increases in training places for a long time and we have not seen any delivery on it. There will be gap between the training taking place and the actual delivery of the people and the easing of the burden on the health services. It is vitally important.
The HSE is working in collaboration with the Irish Medical Council, IMC, to identify potential regions for recruitment of doctors around the world who meet the IMC registration standards. Any such recruitment needs to be in line with our ethical guidelines. We are a signatory, as the Deputy will be aware, of the WHO's global code on the recruitment of international health professionals. Through this code, developed countries are encouraged to attain self-sufficiency in the domestic health workforce. Hence, I believe we are now moving to significantly increase college places here in Ireland. We should be moving to a position where we are happy to bring in international healthcare professionals, give them extra training and experience but with a view to their going back to their own countries as more highly trained and experienced professionals, while we have self-sufficiency within our own system. Any doctor who wants to practice in Ireland has to meet the registration requirements of the IMC. It is my understanding that the IMC does not automatically recognise qualifications from Cuba as indeed it does not from many countries throughout the world. However, there is a process in place for such doctors to take examinations and have their qualifications recognised.
Doctors from Cuba have been working in Portugal, Spain and Sweden, all within the EU, all recognised and all providing cover for the health services in those countries. What is so different about Ireland that this cannot happen? In County Fermanagh, in Enniskillen’s South West Acute Hospital, the health trust recently met with the Cuban embassy based in England and is now putting in place a procedure to look at how Cuban doctors can assist it in meeting the credentials it has in regard to providing cover there. It is doable. There seems to a complete reluctance in the Department going by the fact that it does not respond to correspondence and by not actually doing something to bridge the gap that we are talking about. There is going to be a long timeframe, as seen by the number of questions this morning about the lack of trained staff, the lack of doctors and the lack of availability. There is going to be gap between what the Minister is talking about, which I hope comes to pass, and improvement in the situation on the ground. This is an opportunity that could ease and alleviate that burden. The Department does not seem to be interested in taking it up.
Before the Minister comes in, Deputy Durkan wanted to come in briefly.
In support of my colleague, given that there is an emergency and an actual shortage of doctors at various levels throughout the health services in the country, and in anticipation of maybe an even greater and more acute shortage in the years to come by virtue of population changes, could I ask the Minister whether it might be possible to ensure that whatever procedures prevail throughout the EU in respect of incoming doctors, might be applied here?
We are looking to bring in GPs from around the world. We are not excluding Cuba from that. The HSE and the ICGP would welcome the inclusion of doctors from many additional countries, and Cuba is no different. The two bodies have been doing a lot of work with South Africa and various South American countries with a view to bringing over GPs from those locations. There is no issue in doing the same with Cuba. The HSE and the ICGP can link in with the Deputies on this matter.
It would be better if they would link in with the Cuban Embassy.
16. Deputy Ruairí Ó Murchú asked the Minister for Health the options, if any, for multi-annual core funding for a network (details supplied) based in Dundalk; and if he will make a statement on the matter. [25206/23]
What options are there for multi-annual core funding for the Family Addiction Support Network, which is based in Dundalk and operates throughout counties Louth, Meath, Cavan and Monaghan? The organisation provides an important service to families of people suffering addiction. It also provides a service to the Garda and helps to deal with the absolute disaster of drug debt intimidation.
Goal No. 4 of the national drugs strategy recognises the key role families play in contributing to the planning, design and delivery of effective addiction services. Families have unique insights that are a valuable resource to those involved in developing addiction services and interventions. Facilitating their involvement in the development and design of services is a core objective of our drugs policy.
In 2022, the Department of Health allocated €280,000 in additional recurring funding to the HSE to support family services. This funding was to develop and broaden the range of peer-led, mutual aid and family support programmes, in accordance with best practice. It included an allocation of €70,000 in recurring funding to Louth and Meath, as part of community healthcare organisation, CHO, 8. In the same year, the Department established the community services enhancement fund, with annual funding of €2 million on a recurring basis for community-based drug services. Of this allocation, a further €80,000 in recurring funding was prioritised for Louth and Meath as part of our commitment to support the implementation of the recommendations on drugs services from the scoping report on community safety and well-being in Drogheda.
I understand an independent evaluation of community and voluntary drug services was commissioned by the north-eastern regional drugs and alcohol task force. The conclusions and recommendations arising from that report and the HSE review of addiction services in counties Louth and Meath will inform the development of a roadmap for drug services in the Louth-Meath area. I encourage relevant organisations, including the one referenced by the Deputy, to engage with the regional task force and the HSE on the options and opportunities for multi-annual core funding for the provision of family support and community-based drug services in the area.
The Family Addiction Support Network was probably late to the game in seeking funding. Back in 2008, the north-eastern regional drugs and alcohol task force, like every other body, had its money slashed. It then had to try to keep a skeleton of its service in play. That is what happened across the board. We all know the issues that exist at this time in regard to drug addiction and drug crime. We have not seen the sort of funding that is required. A lot of positive stuff has happened under the Drogheda implementation plan and the new board, but we are starting from way behind.
The Garda recognises that the Family Addiction Support Network is doing significant work. The organisation offers a service the Garda cannot offer in dealing with families who are going through an absolute disaster. It also offers a route map for people who would not necessarily go directly to the Garda because of the stigma, fear and severe pressure they are under as a result of drug debt intimidation. We have been talking about the issues for a long time. The Garda has been involved in direct fundraising for this organisation. It is a crazy situation and we need to do far better.
I acknowledge the importance of groups like this one. It is important that the organisation in question engages with the regional task force, which can provide technical assistance to prepare its business case for funding.
It is important to note the other sources of support. Merchants Quay Ireland, MQI, is in receipt of funding of €109,000 in 2023 to provide family support services. MQI family support services in Louth and Meath have met with many community, voluntary and statutory services, including the Family Addiction Support Network, Tusla, the probation and welfare service and the Garda. MQI advised the Family Addiction Support Network that it is happy to take any referrals for family support from across the Louth and Meath area. Currently, there are no waiting lists for families who wish to engage with MQI family support services. That provision is there. As I said, however, my fundamental response to the Deputy is that the organisation in question should engage with the regional task force in regard to the provision of multi-annual core funding.
Let me be clear. The Family Addiction Support Network has had a huge amount of engagement with the drugs and alcohol task force. In fairness, the latter has put in business plans and requests for funding that have not necessarily been met at this point. However, the requests that have been put in probably would not cut the mustard in regard to the particular issue we are dealing with, namely, the drug addiction crisis and the pressures families are under as a result. As I outlined, State agencies use this organisation. It is not some organisation that exists in a silo and only imagines it is doing really good work. Christy Mangan, the former Garda chief superintendent for Louth, is still personally involved with it on the basis of the work it has done in the past. As I said, the Garda is involved in fundraising every year to keep the organisation afloat. We really need to look at how we deal with organisations like this one. When I speak to people in Turas Counselling, the Red Door Project and the Dundalk Counselling Centre, they all talk about the issue of corporatism and the difficulties of dealing with State agencies in regard to funding.
The Deputy's time is up. The Minister of State may give a final response.
We are talking about existing services that are not being sufficiently resourced.
Fundamentally, the Department allocates the funding and it is to up the HSE to look at the applications that come into it. I do not know the exact detail of the situation the Deputy has raised but if there are difficulties, it is up to the organisation in question to work directly with the HSE and the task force to tease through a business plan. We all want to ensure funding is allocated to initiatives that work and are evidence-based. From what the Deputy is saying, this particular organisation works well and is well respected within the community. As I outlined, MQI family support services are available and there are no waiting lists. Where there are pressures on the system, referrals can be made to MQI. I take the Deputy's fundamental point about resourcing. The organisation needs to engage with the regional task force, which will provide assistance to work through any technical issues relating to its business plan for further funding.
24. Deputy Duncan Smith asked the Minister for Health if he will provide an update on the pay claims by section 39 organisation workers following the meeting of officials from his Department, the HSE, the Department of Children, Equality, Disability, Integration and Youth and Tusla with union representatives; and if he will make a statement on the matter. [26663/23]
I am seeking an update on outstanding pay claims for workers in section 39 organisations. This is an issue on which we have been supporting the trade union movement. It goes back to the problem with recruitment and retention right across our healthcare provision, including the voluntary sector.
I acknowledge the hugely important role section 39 organisations and their workers play in our health and social care services. They are absolutely essential in providing services, including to people with disabilities and older people in the community.
A process of engagement to examine the pay of workers in community and voluntary organisations was committed to by the Government in October last year, as the Deputy referenced. While the Government is committed to the process, it should be noted that the section 39 organisations, which are largely non-profit, are privately owned and run. The terms and conditions of employment of staff in these organisations are ultimately between the employer and the employee. However, we all know that is highly contingent on State funding.
On 17 April, officials from my Department, the HSE, Tusla and the Department of Children, Equality, Disability, Integration and Youth met with union representatives under the auspices of the WRC. This engagement sought to understand and explore the scope of the unions' claim for pay rises for community and voluntary sector workers. A follow-up engagement took place at the WRC on 15 May, with a further up follow-up engagement due to take place less than two weeks from now, on 12 June. As this is an ongoing industrial relations process, I am sure the Deputy will appreciate that I am limited in what I can say.
It is important to note that none of the organisations attending the exploratory talks are the employers of the staff in question. The Department notes that it is a cross-sectoral issue and that we need to engage across government and in the round on it.
It is not an easy issue and we are aware of the complexity of it. It is, however, important for us to keep the pressure up. These workers took pay cuts back during the economic crash, in line with public sector workers. They have not had their pay restored. We are looking at the structure of the CDNTs, which we all want to see be successful. CDNTs are provided across HSE services and across, section 38 and section 39 organisations. The vacancy rates are at 34%, the equivalent of 707 whole-time equivalent posts, given some of the more recent figures. They fluctuate and we hope they will be going in a better direction. Section 39 voluntary workers are working in CDNTs and looking into their next region where workers are doing the same job but working for the HSE and on better rates. We all accept there is a lack of fairness there. It is not easily resolved. I am glad there is a process but I would ask, and I will continue to raise this, that the Minister and the other Departments will stick with this process to try to get a resolution for pay justice here.
There is a process and there has been agreement, as the Deputy will be aware on the biggest 300, which was very welcome. Initially, it was the first 50, then it was another 250. We need to find a way to deal with this while balancing two things. On the one hand they are private organisations but, on the other, we largely fund them. We cannot divorce ourselves from their ability to pay their staff. When we looked across the organisations, the relative rates of pay and cuts that came in during the FEMPI period were different. There is quite a broad range there that does need to be looked at but, yes, we are fully committed to the process.
