Vol. 1042 No. 4
6. Deputy Thomas Pringle asked the Minister for Health the number of people waiting for genetic testing for each of the years 2018 to 2022 and to date in 2023, disaggregated by waiting times between zero to six months, six to 12 months, 12 to 18 months and 18-plus months, in each hospital, in tabular form; and if he will make a statement on the matter. [39630/23]
I was not expecting to be up this quickly. This question requests the number of people and waiting times for genetic testing for each of the years 2018 to 2022 and if it could be broken down by the length of time they are waiting.
The Government is fully committed to improving genetics services. A key ambition of the national strategy for accelerating genetics and genomic medicine in Ireland is to build an excellent national genetics service. In 2023, the Government allocated €2.7 million to support the first year of implementation of this strategy. This funding supported the creation of a national office and expansion of front-line staff. To improve national genetic testing, we must first build a strong evidence base. To date, genetic testing has been administered at local level. Information is maintained by individual hospital sites and is not disaggregated by age cohort. Therefore, these data are not currently available centrally to support decision-making. It is a priority for the national office to address this challenge. The HSE has begun development of a national genetic testing directory. This directory will provide an accurate picture of current testing. It will also allow for improved national testing capacity in the future. Patients will receive faster, more accurate results without duplication of testing efforts. To inform improvements, the HSE commissioned a study into current national lab capacity. A report examining infrastructure and workforce was submitted to the HSE this week. Findings will be shared with the strategy’s implementation steering group. This will support evidenced-based decisions on genetic testing expansion and service improvements.
That is interesting because I have been trying for some time to get an answer from the Department of Health to this question. I have submitted a number of questions and emails to try to get a response. The day after I submitted this question as a parliamentary question, I got a reply from the HSE, which is different from the reply the Minister for State just gave. It states that it talked to Children's Health Ireland and got figures from the organisation that 1,620 people are waiting for genetic tests. St. James's Hospital cancer genetic testing on 16 August had a waiting list of 3,167. That is different from the response the Minister of State gave today, which is disappointing but it goes back to what Deputy Shortall said; there is something wrong in the Department of Health. This is not the first time this has happened in relation to a question. In July, I put forward a question regarding Cuban doctors and the likelihood of them coming to Ireland. The Minister did not respond. I sent emails to him over a year but he still did not respond. The day before the question came up in the Dáil, a response is issued by the Department. Something is wrong and needs to be addressed. It is very important.
We are way over time.
It is important.
The Deputy will get a chance to come back in.
I also have the figures the Deputy listed in my supplementary response but the question was in relation to the disaggregated figures by age cohort. That is maintained by individual hospitals. It is not disaggregated by age cohort. The data are not currently available centrally to support decision-making. It is a new office. In 2022, funding of €1.34 million was provided for the initial establishment, for example, of the national perinatal genomic service. In December 2022, the national strategy for accelerating genetics and genomic medicine in Ireland was launched. In budget 2023, €2.7 million was allocated to support the implementation of the strategy. The initial investment focused on establishing a national office for genetics and genomics and recruiting front-line staff and roles like the national director for the national office, the national bioinformatics director, a general manager and six genetic counsellors. It is a growing office. I take on board the data the Deputy requested. I hope, in time, we will be able to get the disaggregated data he requested.
The point I was making is that it is the exact same question, word for word. This one was answered on 11 September by the HSE. There is a problem, which must be recognised. The Minister and Minister of State come to the Chamber and read off scripts that are clearly different from the information we can get from other sources. Straight away, there is a problem. The political system needs to address that problem urgently. It does not inspire any confidence in the health services.
I will ask the Minister for Health to come back to Deputy Pringle directly-----
There is no point in that either.
-----on that specific question. I have answered the parliamentary question. The main point is that this is a new office. It has to collate the data so that it is evidence-based. It is an expanding office and will be funded through budgets in order that we can have the data that will directly help patients on the ground, as per the Sláintecare model. It is a growing office that has to be developed.
7. Deputy Mark Ward asked the Minister for Health the reason no additional funding was given to the national clinical programmes in mental health for 2023; what this means for the timelines for completion of the expansion of the national clinical programmes; if increased funding will be delivered in budget 2024 for the national clinical programmes for mental health; and if he will make a statement on the matter. [40731/23]
We are coming up to the budget. I would like to know why no additional funding was provided to the national clinical programmes in mental health in 2023. This meant there was no additional funding to expand national clinical programmes for self-harm and suicide, attention deficit hyperactivity disorder, ADHD, eating disorders or early intervention in psychosis. What does this mean for the timelines for completion of the expansion of the national clinical programmes? Will increased funding be delivered in budget 2024 for the national clinical programmes for mental health?
I thank the Deputy for his question. As he will be aware, I have prioritised the clinical programmes since I came into this role. I am now heading into my fourth budget. The Government’s clear commitment to enhancing mental health services is shown by significant mental health funding increases in recent years and 2023 saw a record budget for mental health of €1.2 billion. Budget 2023 delivered almost €58 million in additional funding and a further €10 million in once-off funding for much-needed minor capital works across the mental health system. This additional funding includes support for national clinical programmes. Since I took up the post of Minister of State with responsibility for mental health and older people, I have secured just under 800 additional posts for mental health services and recruitment continues. I work closely with mental health colleagues in the HSE, including regular meetings with the national clinical adviser and group leads to oversee the development and expansion of the national clinical programmes and models of care in line with Sharing the Vision. Just after the recess, in July, I met all the leads of the clinical programmes to discuss priorities for next year. I am very pleased that in the past few weeks I have been able to work with the HSE to launch new models of care for both dual diagnosis and five new child and adolescent mental health services, CAMHS, hubs. I welcome the continued work being done throughout the mental health services to ensure that modern, patient-centred care is developed and rolled out.
Specifically, to answer the Deputy's question, around 10,500 whole-time equivalent posts have been approved for HSE mental health services, of which 4,924 are nursing posts. In 2021, the HSE approved the release of 302 previously held programme for Government posts. This occurred alongside planned recruitment of an additional 154 posts under new development and 322 posts under new development 2022. This provided for an additional 780 staff across services. Significant progress continued in quarter 1 of this year, with the recruitment of 423 staff. I will come back with the rest of the answer later.
According to the response I got on 20 July, national clinical programmes did not receive any funding for new posts to expand clinical programme services in 2023. We are approaching budget time and the Opposition Members have to turn into forensic accountants to try to go through what is being said and what is actually being delivered on the ground. Last year, the Minister of State tweeted that there was €72.8 million in additional funding for mental health. The budget book added up to €57 million - I think the Minister of State mentioned €58 million. When I eventually made my way through all the smoke and mirror tactics, it was revealed that there was only €14 million in additional money for new developments in vital mental health services. It was only in the middle of this year that we found out there was no funding in 2023 for the national clinical programmes. I want to know whether the money committed to national clinical programmes in budget 2024 will be additional to new funding not provided this year. Will the Government eventually commit to multi-annual funding for national clinical programmes?
The Deputy hit the nail on the head about multi-annual funding. I have secured 800 posts since I took over this role. We are currently recruiting for clinical programmes this year. Whether the money was secured in budget 2021, 2022 or 2023, that does not really matter when a child is in front of one of these clinicians.
What really matters is that money was provided for ongoing services across clinical programmes.
As regards new development funding, it takes 18 months to put a full clinical multidisciplinary team in place. As of this year, we have recruited 423 staff. Of the 800 staff, 423 are in place and there are 360 posts at various stages in the recruitment process. All of the clinical programmes will see new staff this year. It is irrelevant whether the money was secured in budget 2021, 2022 or 2023; we secured 800 posts and they are currently being recruited.
I spent the recess meeting several different groups and organisations. For example, I will go through some of the national clinical programmes mentioned. I met with Lucena CAMHS, which deals with ADHD. I also met with ADHD Ireland and Families for Reform of CAMHS. They all cited issues with waiting lists for young people with ADHD accessing mental health supports. Nothing the Minister of State has said gives me confidence that will improve. There are still only three public inpatient beds for adults with eating disorders. The Minister of State said she would commit to improving that through her time in government but it has not improved. There have been improvements in other areas but there has been no improvement on those three beds.
As regards suicide, I refer to statistics relating to CAMHS. There are children waiting more than 100 days to be treated for suicidal ideation in various CHO areas. There are children waiting 190 days to be treated for deliberate self-harm and there are children waiting 60 days or more to be treated for suicidal intent. It has been proven that every €1 spent on early intervention saves the Government €17 but that area has not received the money it needs. I am seeking assurances that the Government will provide money to these national clinical programmes.
The clinical programmes have been expanded across the country for the past three years. The Deputy stated that he met Lucena. I met it last week. It has two new ADHD teams that were approved this year and are in place. I was delighted to hear that. As regards psychosis, many of the clinical programmes are originally started on a pilot basis and then rolled out. I travelled to Sligo this year, where there is a new psychosis team in place that is doing phenomenal work.
I take the point being made by the Deputy. He knows there are demands on the availability of staff. Since I have come into my role, however, 800 new posts have been funded. To date, 423 of them are in place and there is currently recruitment of 360. I want to recruit people into all the multidisciplinary teams in order that the teams are padded out. It is very important we do that. It is irrelevant whether the funding was secured in 2021 or 2022. The posts were secured and they are being recruited now. The most important thing is that we get people into these posts and deliver the services for children.
8. Deputy David Cullinane asked the Minister for Health when he will publish a multi-annual investment plan to address the capacity deficit in hospitals; and if he will make a statement on the matter. [40790/23]
We need a multi-annual plan for the health services. We know there is a crisis in emergency departments, with people waiting too long. There are almost 900,000 people or more on waiting lists when one includes diagnostic waiting times, acute hospitals and community waiting lists. There are problems in children's healthcare. A multi-annual plan is needed. I have been calling for one for some time. What plans does the Government have to put such a plan in place?
The health service is currently experiencing its largest multi-annual capacity growth since the HSE was established. This is based off a number of multi-annual strategies. Since 2020, we have opened 1,019 acute beds nationally. This is expected to reach 1,204 acute beds by the end of 2023 - an additional 185 beds over the current position and well ahead of the 2018 capacity review target. The objective of the HSE's 2023 national service plan is to bring critical care capacity to 352 beds, an additional 94 beds since 2020.
Progress is being made on new elective hospitals in Cork, Dublin and Galway. Approval in principle at gate 1 of the public spending code was given to the sites at Galway and Cork at the end of 2022. The HSE is progressing the development of elective surgical hubs as quickly as possible and considering all options to expedite the delivery of these units in south Dublin, north Dublin, Galway, Cork, Waterford and Limerick. The first of these, in south Dublin, is expected to be operational before year end and the rest following next year.
As well as this infrastructural investment, there has been a net growth in workforce of 21,910 whole-time equivalents, WTEs, an increase of 18% since 2020. In July 2023, the total workforce of the HSE stood at 141,722 WTEs.
Health and social care workforce planning is a top priority for Government. The Department is developing a health and social care workforce strategy and action plan and a planning projection model. Initial workforce planning projections are due to be completed in quarter 3 of 2023. The Department and the HSE are planning a refresh of capacity targets in the 2018 health service capacity review. This will cover both infrastructure and workforce to ensure we are developing the right level of capacity and plans to meet the needs of the population.
I have met with dozens of hospital managers, front-line healthcare staff and advocate groups in recent months. They all talk about plans they have submitted for new beds in hospitals, surgical theatre capacity and diagnostic capacity, all of which are necessary to reduce wait times in hospitals. The same can be said in mental health, where there are many buildings that are simply not fit for purpose. We need a long-term investment plan. We need a decongregation plan for people with disabilities. All of these areas, however, do not have multi-annual plans.
I need to ask a more fundamental question relating to what is actually going on in the Department of Health. So far this morning, the Government has been unable to give us a completion date for the national children's hospital. For whatever reason, we just cannot get it. We have no idea what the cost overrun in the Department of Health will be. Despite the fact that there is an ongoing debate, discussion or row - call it what you want - between the Department of Health and the HSE, nobody in government is prepared to tell us what that cost overrun will be, and we have all these crises in healthcare. The Minister needs to get a grip with his Department and what is going on. It is not good enough that on days like today, when it is our opportunity to put fundamental questions to the Government and the Minister for Health, we are provided with no answers, almost right across the board.
To reiterate, there is a significant amount happening in this space within the Department. We have had the largest expansion of the workforce since the inception of the HSE, with more than 21,000 WTEs added since 2020, while 1,019 acute beds have been opened nationally since 2020 and a total target of 1,204 beds will be delivered by the end of the year. Delivery is an absolute priority for the Government and I know the Minister, Deputy Donnelly, and his officials are exploring all available opportunities to improve the pace of delivery of capital health projects. In March this year, there were changes to the public spending code which will help the delivery of the national development plan that was introduced to streamline that process and make it more efficient. The Deputy can rest assured that work is also under way through the Estimates process in the upcoming budget. Many discussions are happening with me, the Minister of State, Deputy Butler, and the Minister, Deputy Donnelly, in respect of securing the funding that will be necessary to meet the increased demand within the health service.
While I respect the Ministers of State who are present and we all understand why the Minister for Health travelled, I again make the point to the Leas-Cheann Comhairle that a real crisis has unfolded at Temple Street hospital but there have been no statements on the matter this week in the Dáil. I asked questions on one of the most important issues facing the Department, that is, to get the national children's hospital delivered. The Government has a completion date but it will not share it. We are being told there will be updates and there has to be validation. It seems that time stops when it comes to the children's hospital but what goes on are cost overruns, lack of accountability and the fact that this Chamber, the Oireachtas and the public still cannot be given a completion date. That is absolutely bonkers. There is potentially €1 billion or more of a cost overrun in a Department and there is a row between the HSE and the Department of Health but we cannot be given the figure and the Minister cannot tell us it. It seems the Minister is asleep at the wheel on crucial issues in his Department and that is simply not good enough.
I cannot accept the Deputy's statements regarding the work that is happening within the Department. There are, and always have been, challenges in the health system. People are living longer and there is increased demand, which is fantastic. We need to be able to meet those demands and that will require extra funding through the budgetary process.
The Minister will address the Dáil next Tuesday on the issue of scoliosis. He has given that commitment. He had to travel to the United Nations and could not be here but he has given his commitment to address the Dáil next week.
On the children's hospital, I have answered that question previously. There are ongoing negotiations and discussions between the board and BAM, and that has to be bottomed out. Huge pressure is being applied with regard to the delivery of that critical hospital for the children of Ireland for today but also to the future. Yes there are challenges but the Deputy can be assured that the Minister, Deputy Donnelly, and his team are working to expedite these projects as quickly as possible.
9. Deputy Marc Ó Cathasaigh asked the Minister for Health if, in light of the opening of the second cath lab in University Hospital Waterford, he will outline the anticipated timeline for moving to a cardiac care service operating 8 a.m. to 8 p.m., seven days a week; and if he will make a statement on the matter. [40037/23]
After many years of campaigning by local campaign groups and, to be fair, due to a consistent cross-party effort by Oireachtas Members here in the Dáil and elsewhere we finally have the bricks and mortar of the second cath lab delivered on the site of University Hospital Waterford, commissioned and up and running. The people of Waterford are now asking for an expansion of the services and particularly an expansion of the hours of service. Will the Minister of State let us know what progress has been made in that regard?
I thank the Deputy for the question. The three Waterford Deputies sitting in the House could probably have written the answer such was the cross-party collaboration since 2016 on the second cath lab.
As the Deputy will be aware, the programme for Government committed to the delivery of a second cath lab at University Hospital Waterford. Funding was allocated in the 2019 capital plan for the provision of this second cath lab. The Minister, Deputy Donnelly, is pleased to report that the second cath lab opened on 4 September and is operating five days per week, Monday to Friday, from 8 a.m. to 8 p.m.
During the lifetime of this Government, significant extra resources have been provided to increase the level of cardiology services at University Hospital Waterford. Prior to the opening of the new cath lab, a service level agreement was in place with UPMC Whitfield to provide a three day a week service to assist with cardiology diagnostic procedures at Waterford. This service has now been replaced with the opening of the new second cath lab in University Hospital Waterford.
In addition, the opening hours of the existing cath lab at University Hospital Waterford were extended in September 2022 and that cath lab is now open from 8 a.m. to 8 p.m. Monday to Friday. We can all definitely say that significant progress has been made. We now have two cath labs in University Hospital Waterford. The original cath lab was always the single point of failure and there were always issues around it breaking down. That has all been completely refurbished and we do not have those issues any more. The second cath lab opened on 4 September and it is very positive. It is state of the art. This is the most important thing to say.
Further cardiac service developments at the hospital will be informed by the recommendations of the national review of specialist cardiac services. The national review aims to set out the programme of reform to improve cardiac care across Ireland. This includes an assessment of trends in prevention, diagnosis, management and treatment, and data on current healthcare provision.
I thank the Minister of State. As she said, any of the Members here from Waterford could have written that response. The Minister, Deputy Donnelly, was down with us relatively recently when he opened the state-of-the-art palliative care facility on the University Hospital Waterford site. The Minister gave a commitment then that in a short frame of time we were going to move to a seven day a week service from 8 a.m. to 8 p.m. Everybody in Waterford and everybody in the south east has a heart story and has the friend who just about made it within the operating hours or the person who did not. It became a mantra in Waterford among the campaigners that time is muscle, and especially when referring to the stenting service and that intervention capacity, which we thankfully now have available in both of the cath labs. It is really not acceptable in this day and age that a cardiac care patient at a weekend will have to take that journey to Cork when we know they would lose all of that functional capacity. Will the Minister of State outline what steps we need to take in order to get to that seven day service from 8 a.m. to 8 p.m., which is at least a stepping stone to the 24-7 service that we all want.
I will give the Deputy some more information. The HSE has confirmed there are 24 whole-time equivalents approved to support operation of the second cath lab, with 21 whole-time equivalents currently in post. The HSE has confirmed that interviews for two healthcare assistants are scheduled for 21 September, which is today, and the recruitment campaign for a senior cardiac psychologist - one of three for the second cath lab - is under way. The hospital will use a combination of day beds and recovery spaces to support the second cath lab. The medium to long-term options for recovery beds being discussed with HSE estates involve the relocation of the on-call residents at the hospital and refurbishment of this area.
The Deputy is quite right in what he said and we have all heard the Minister say it. At a recent visit to the hospital in July 2023, the Minister asked the hospital to work towards an 8 a.m. to 8 p.m. service for the second cath lab at the hospital by year end 2023 and that is where the situation currently is. The onus is on all of us, me as Minister of State in the Department of Health and working with all my colleagues, that this is the next step for us to deliver it incrementally.
While none of us would think it is the cardiologists alone who are required for the staffing, they are absolutely pivotal and we know they are like hens' teeth. We need to get those posts approved and we also need to run the recruitment campaigns for those cardiologists because without that we cannot provide the service and we cannot roster for that expanded service, which is exactly what we need. The issue of dedicated recovery beds is also pivotal. We want to be able to provide that service. We know that space across the University Hospital Waterford campus is tight. They have done an absolutely fantastic job in managing that space. We have heard all of those good news stories about management in University Hospital Waterford and particularly around the emergency department, which is worth mentioning.
We have achieved a key stepping stone in delivering this second cath lab. Let us sweat the assets, let us get it staffed and get it working. People in Waterford and across the south east deserve that seven-day service at the very least and we have to always keep driving towards that ultimate goal of providing a 24-7 service for people of the southeast.
Before the Minister of State responds I will bring in Deputy Cullinane.
I welcome the second cath lab. It is a fantastic development and real progress for cardiac services in Waterford and the south east. It was one of those issues on which all Oireachtas Members in Waterford campaigned very hard over a long number of years, and indeed colleagues who are no longer in the House. I commend everyone involved in that. It is also real progress that we will get to a point where we have a seven day a week service from 8 a.m to 8 p.m. for emergency cardiac care. That is real progress and should be acknowledged, celebrated and warmly welcomed.
I am aware of the level of additional staffing capacity that was required to make that happen but obviously the next question is whether we can transition to a full 24-7 service. I believe that the answer to this question will lie in the national review. This review has been sitting somewhere for a long time. I do not know how many times I have asked the question on it. We really need to get an update on when that review will be published. I imagine that will answer the question as to what is next for University Hospital Waterford.
I agree with what both Deputies have said. I take a lot of positivity from the current situation. In order for the new cath lab to open we needed 24 whole-time equivalents and 21 are currently in place. At a time when recruitment is quite challenging across health services that is very positive. Two more healthcare assistants are being interviewed today and the recruitment campaign for the senior cardiac physiologist, one of three for the second cath lab, is under way. At a time when recruitment is challenging across all sectors that is really positive.
I do take on board the Deputies' points but it is important to point out that University Hospital Waterford - as we all know - is a busy level 4 hospital with 2,660 staff. This is an increase of 36% since 2019. The hospital's budget is €261 million for 2023, an increase of 30% on 2019. We have made significant progress but there is more to be done. I know we will all work together to get to the next step, which is 8 a.m. to 8 p.m. seven days a week.
10. Deputy Brendan Griffin asked the Minister for Health if more beds will be opened at West Kerry Community Hospital; the current bed and staffing breakdown; how this compares with each of the past five years; and if he will make a statement on the matter. [40649/23]
My question concerns West Kerry Community Hospital and efforts to get more beds for the hospital. It has been a long-running saga to try to get more beds opened in the hospital. Given the current number of bed versus what was originally envisaged, there is quite a difference between the numbers. We need assistance in getting more beds open.
I thank Deputy Griffin for the question and for his constant advocacy for West Kerry Community Hospital. It is not the first time the Deputy has raised it here on the floor of the Dáil.
West Kerry Community Hospital provides important and valued services for people in the west Kerry area. The hospital has 46 beds registered, of which 35 are long-stay beds and 11 are short-stay beds, including two respite and one palliative care bed. The maximum number of people who can be safely accommodated in the hospital are currently being accommodated.
The intention of the HSE is to continue to sustain the current workforce to maintain the 46 beds in the centre into the future. Considerable efforts are also being made to increase staff numbers and bed capacity in west Kerry, as well as to facilitate clear pathways for the transition of patients from the acute sector to the community.
However, similar to other hospitals in remote locations, staff recruitment challenges have unfortunately had an impact. Cork Kerry Community Healthcare continues to endeavour to recruit staff to increase the number of community beds for the region and maximise the services available. The HSE will continue to seek qualified and interested candidates through recruitment campaigns undertaken at national, regional and local levels.
I advise the Deputy that the HSE is collating the information requested concerning current staffing levels and the breakdown of staffing and beds over the past five years. I will arrange to have this information forwarded to him in the coming days.
I agree with the Deputy, especially in respect of rural areas. The whole premise of Sláintecare entails the right care at the right time, as close to home as possible. When people need long-term care or short-stay, respite or palliative care, it is important to provide that service in their own community.
I appreciate the Minister of State's response and the efforts being made. In recent years, we had the appalling images of a very elderly lady being moved out of a hospital far away from home, a place with which she had become familiar and was comfortable, because of a shortage of beds. This is the type of thing we do not want to see repeated. I raised it here at the time. I have been in constant contact with the HSE locally regarding efforts to recruit staff. I seem to be getting the same answers over and over, namely that efforts are being made to recruit staff, that we cannot recruit staff and that, if we do recruit staff, it is only when others have retired. It is very frustrating for people. Given the growing population in the locality, it does not auger well. It points to an inevitable shortage of beds again in the future.
If the current efforts to get more beds and staff are not working, maybe we need to alter the approach. It is the same story over and over, and it is not working. Maybe we need to consider different recruitment ideas because the current approach is just not working.
I have made it crystal clear in the Department, working with the Minister, Deputy Stephen Donnelly, and to the new chief executive of the HSE, Mr. Bernard Gloster, that I am not prepared to see any more public beds close. It is as simple as that. The statistics for the past 12 months show it is not the case that we have closed public beds.
Let me refer to the current situation on care for older people provided in private and voluntary nursing homes and community nursing units such as West Kerry Community Hospital. These are mainly hospitals for older people. Providing these supports is important. Currently, 81% of supports are provided by private nursing homes, 3% are provided by voluntary nursing homes, and only 16% are provided by the rest. Therefore, I have made it very clear that I will not stand over the closure of any of these beds. We have to become inventive in recruiting people into these areas, and I will work with the HSE to determine what we can do. The maximum number of people who can be safely accommodated in the hospital, which is 46, is currently being accommodated.
Gabhaim buíochas leis an Aire Stáit. Tá níos mó leapacha ag teastáil anonn. Caithfimid rudaí nua a dhéanamh chun banaltraí a fháil sa Daingean agus beidh na leapacha ag teastáil sa todhchaí. We will need those beds in the future. It is as simple as that. If the current recruitment processes are not working, we need to consider doing things differently. I am not being cynical but I must say that I keep getting the same answers back from the HSE, namely answers referring to recruitment drives and efforts. At what point do you have to say that this is ridiculous and that we are getting the same answers over and over again and no nurses in? We know there are various reasons for this but we need to consider different models. It is inevitable that if this continues, not only will we not get more beds but we could also see closures of beds. The latter is what nobody wants to see but I believe it will be coming down the line unless there is a change of tack by the HSE.
I agree with what the Deputy says. Pending the recruitment of additional staff, Cork Kerry Community Healthcare plans to increase bed capacity at West Kerry Community Hospital. That is what I am trying to achieve. It is important to have community nursing units giving people options regarding where they would like to spend the latter days of their lives. The Sláintecare model is to give the right care at the right time, as close to home as possible. We are aware that there are challenges in recruitment. I do not always buy the view on the geographical locations. Many people choose to live in rural Ireland, in the most beautiful parts of the country, but I will certainly keep this as a focus because I want to see all beds open in our community nursing units across the country.
11. Deputy Neasa Hourigan asked the Minister for Health the revised care plan for those seeking gender identity services, taking into account World Professional Association for Transgender Health, WPATH, standards of care; and if he will make a statement on the matter. [40454/23]
How is the Department seeking to review services for gender-affirming care according to WPATH best practice?
The HSE National Quality and Patient Safety Directorate has reviewed the interim Cass report and how it applies to clinical pathways in Ireland. Based on the recommendations of the report, the HSE has identified the need to develop an updated and integrated model of care for transgender services, informed by the best evidence-based clinical care for individuals who express gender incongruence or dysphoria.
The HSE is establishing a team to lead the development of an updated model of care for the treatment of gender dysphoria. As an initial step, the HSE has advertised for the post of a clinical lead for transgender services, who will develop the model of care and implementation plan for transgender care. The HSE will consult a wide range of stakeholders in the development of the new model of care, including those who use the services and advocacy groups.
WPATH publishes the standards of care and ethical guidelines, which articulate a professional consensus about the psychiatric, psychological, medical and surgical management of gender dysphoria. The guidelines are designed to help professionals to understand the parameters within which they may offer assistance to those with gender dysphoria conditions.
The HSE is also working to identify an alternative pathway for children and young people experiencing protracted waiting times. Discussions are under way with the paediatric endocrinology service at Children's Health Ireland and also with a psychology service to work on an interim solution until a full, dedicated multidisciplinary service is established.
I welcome the development of a model of care that will deliver a high-quality, seamless and integrated service for people with gender identity issues, in line with the programme for Government.
I am wondering, given that the question was put to the Department in July, whether it is possible to get some sort of timeline for those with the issues in question. As the Minister of State knows, WPATH set out that part of best practice would be to respect patients, part of which would involve a workable service. It sets out the need for local, accessible services that are affordable and not overly centralised in a way that creates barriers for people. By that, I mean we should not make it that people have to travel very far to receive services and not have them on waiting lists so long that the service becomes ineffective. If the waiting lists are long, it is not an effective service. Timely service provision is required. These are all things set out by WPATH. It is not simply about medical practice but also about wider support for the service.
Could I get some kind of timeline as to when the changes will be made and when the response to the Cass report will be implemented?
I completely agree on the urgency. It is a priority of the Department of Health and HSE to provide a transgender healthcare service that is aligned with best practice internationally and meets the needs of children and adults.
Dr. Cass from the National Health Service came to Ireland at the start of this year and presented the findings of her interim report to a wide range of stakeholders from the HSE, the Department, Children's Health Ireland, Ireland East Hospital Group and others involved in providing services. This facilitated a really constructive and informative discussion about the challenges in developing gender services in Ireland, given the limited availability of data and evidence on which to base the clinical approach and also the recruitment challenges.
That meeting helped to inform the HSE on its next steps. I think that is what the Deputy is alluding to when she asks about timelines for developing the programme of work, including the development of a new model of care. It is important that supports are in place in psychology, psychiatry and endocrinology, especially for those with gender dysphoria. I will come back to the Deputy about timelines as I know the HSE is engaging in the next steps of this process.
I thank the Minister of State. She is right insofar as there is sometimes a dearth of clinical data. Most services are now linking up with that issue. We have good principles from WPATH, including dignity, equality, equity, justice and fairness. At the moment we have entered into a public debate around people's very right to exist, but in real life those services do not exist in Ireland. They are not accessible. The community and people like me are looking for some kind of timeline as these things can be dragged out. It is now urgent. It is time sensitive for people who require the service.
I thank the Deputy. On timelines and delivery, funding will be important. The delivery of this service is part of the Estimates discussions that are happening at the moment for the upcoming budget. We will keep the Deputy updated about this important issue.
15. Deputy Brendan Griffin asked the Minister for Health if a public health awareness campaign around cocaine use and its adverse effects will be considered; and if he will make a statement on the matter. [40650/23]
My question is about the availability of cocaine, the habit of the consumption of cocaine that has almost been normalised in recent years and creating awareness of its health implications. Quite frankly, I do not think the current policy is working because of the popularity of cocaine and how common cocaine use is. We need to do things differently.
I thank the Deputy for raising this important issue. As the Deputy will be aware, cocaine is an addictive stimulant drug which can make people feel more alert, energetic and confident. Cocaine can cause a range of acute health-related problems and even sudden death. It is highly risky for anybody with high blood pressure or a heart condition. Even perfectly healthy young people can have a fit or heart attack after consuming too much cocaine. Repeated sniffing of cocaine powder irritates the nose and can cause a breakdown of nasal cartilage.
Less than 7% of the population has ever used cocaine in their lifetime. Some 2% of the population has used cocaine in the past year. In 2022, 4,084 cases were treated for cocaine use. That is an increase of 800 or 26% on 2021. Cocaine accounts for 34% of all drug treatment cases.
In partnership with the Ana Liffey Drug Project, the HSE has developed a harm reduction campaign focusing on the dangers of cocaine at www.drugs.ie. The campaign - Cocaine: Drug and Alcohol Information and Support in Ireland - seeks to raise awareness of the dangers of using both powder cocaine and crack cocaine and to reduce the harms associated with the use of the drug. In 2023, the HSE has partnered with a number of festivals to put in place the Safer Nightlife harm reduction programme. This multi-component campaign involves outreach at festivals, back-of-house drug checking, media awareness and a social media campaign.
Drug prevention and education is a cornerstone of the national drugs strategy. I recently launched a €1.5 million drug education funding scheme, which supports evidence-based initiatives that engage with people who may be at risk of using drugs in a variety of contexts. I also recently announced funding of €500,000 to expand cocaine services. Enhancing access to drug services in the community and increasing awareness of the harms associated with drug use are a priority under the national drugs strategy. This demonstrates my commitment to a health-led response to drug use. We need to increase that funding and keep developing the education programme.
The question is perhaps timely as we are running into the budgetary cycle. I do not see in mainstream media and across the board the type of awareness campaigns this problem needs. I acknowledge the figures the Minister of State has quoted. Certainly among some demographics, I think the figures are far worse than those she has quoted. Among our younger population, this is something that needs to be addressed. The short-term, medium-term and long-term consequences of cocaine use and abuse in some circumstances - to be honest, I think any use is abuse - need to be a serious issue on the agenda. In my day, back in the 1990s and 2000s, when people were out after a few drinks, they might go to the top shelf if they were taking things a bit further. It seems that cocaine has now gazumped all other types of behaviour and is now the accepted normal drug of choice. That is extremely worrying. I see much more in the media about vaping, for example, than about cocaine and that needs to be addressed.
The work of the citizens' assembly is timely. It will report at the end of the year. It is important that we have an open and honest conversation about drug use.
I have allocated €1.5 million for an education programme. It is the first time funding has ever been allocated to that and I want to expand on it. We have allocated €130 million to the HSE for addiction services. Again, I want to increase that. Education and an open, honest conversation are needed. It is not only those who are in addiction and going into the vicious circle of the criminal justice system who use cocaine. Some people take drugs on a Friday or Saturday night because they enjoy them. We need to raise awareness around the health and safety impacts of that.
I recently attended the Electric Picnic with Professor Eamon Keenan and his team to raise awareness at the festival and help young people. It is key to know what are the emerging drugs coming into the country as they change all the time. It is important to raise awareness and inform people who may have a medical incident or who are worried about a friend so that they have somewhere to go. I absolutely agree with the Deputy's point about raising awareness of this issue.
All forms of substance abuse, whether it is the top shelf I referred to earlier or drugs, must be called out. What worries me most is the normalisation of cocaine use we have seen in recent years. Speaking to young people in my constituency, it is accepted among some people that this is what is done at the weekend on a Friday or Saturday night. That is bonkers to me as someone who is only 20 years ahead of them in the life cycle. How have things changed so rapidly and drastically in that time? Certainly, when I was that age, the idea that using cocaine recreationally might be normal was completely off the charts but it is now accepted as normal and it is a ticking time bomb. There are huge implications in the long and short term. We need to do more. A massive awareness campaign is needed nationally about this.
I agree with what has already been said. The fact is that when we talk about cocaine, we are dealing with a cocaine pandemic. The place is absolutely littered with it. Deputy Griffin is correct when he uses the term "normalised". Some young people who are involved in sport prefer to take cocaine than alcohol. Others think cocaine is the means by which they can continue to drink for three days in a slightly more presentable way. We all know the outworkings and what happens. We know that some people will run into serious issues long before health issues arise. There will be a knock on the door and the rest of it. We need to ensure there is information. We also need to look at addiction services and harm reduction. I was at a joint policing committee meeting recently. Drug dealing is happening on every street. We know that this cannot be policed out. We all welcome that the citizens' assembly is finally up and running and want to see what will come from it.
I also welcome the citizens' assembly and think the conversation will really start when it reports. In the meantime, I have allocated €850,000 for cocaine-related treatment. I also allocated €500,000 in June 2023 and €1.5 million for an education programme around drug use, for the first time. I have met drug and alcohol task forces and gone into detox units and services up and down the country. Funding is the issue. There are some fantastic programmes that need to be rolled out. However, we also need to make sure that whatever programmes are in place follow the right model and address the issues on the ground.
That is why looking at emerging drug trends is really important. That is what the HSE is doing but I absolutely realise the importance of increasing funding and making sure it goes into services not just in urban areas, but also in rural Ireland. We need to look at emerging drugs and have an honest conversation about drug use in this country.
16. Deputy Duncan Smith asked the Minister for Health if he supports the provision of the chickenpox varicella vaccine free to all children through the primary or schoolchild immunisation programme; and if he will make a statement on the matter. [40550/23]
Does the Minister for Health support the provision of the chickenpox varicella vaccine for free to all children through the primary or schoolchild immunisation programme?
The immunisation programme in Ireland is based on the advice of the national immunisation advisory committee, NIAC, which continues to revise its recommendations having regard to the prevalence of the relevant disease in Ireland and international best practice in immunisation. The varicella vaccine is not currently included as part of the primary childhood immunisation programme but NIAC has recommended that the vaccine be included in the programme. Vaccines administered through the primary childhood immunisation programme are provided free of charge. The Department of Health asked HIQA to carry out a health technology assessment, HTA, on the varicella zoster vaccine, which was published in July 2023. HIQA found that there is clear and consistent evidence that the chickenpox vaccine is both safe and effective in preventing chickenpox and its complications. It also found that adding the chickenpox vaccine to the programme is likely to be cost effective. The office of the chief medical officer is considering the HTA findings and will make a recommendation to the Minister for Health which will inform the decision on the inclusion of the chickenpox vaccine in the primary childhood immunisation programme.
At the moment, should a parent choose to get the chickenpox vaccine for their child, it will cost approximately €90. It is a prohibitive cost for many. Many make the leap to get it done not only to protect their child's health, but also because of considerations such as parents losing work time and so on. The HIQA recommendation is a game changer here. Just after the summer break, I got a reply to a parliamentary question in which I had asked whether the Department had calculated what it would cost to include the vaccine in the immunisation programme. The Department had not done such a calculation, but HIQA estimates this cost at between €13 million and €28 million. As the Minister of State said in her initial response, HIQA also said that this would be cost effective. It would be good to see some progress on this. I acknowledge that the Minister's stance on vaccines and their promotion is very strong and very good. I hope that we will see progress in this area. It would be beneficial for the children and for their parents in terms of ensuring they can stay in work.
Although varicella is typically a mild disease, there can be long-term skin scarring and serious complications requiring hospitalisation. Of the 58,000 cases of chickenpox that occur in Ireland every year, approximately one in every 250 will result in hospitalisation with the associated complications. The estimated effectiveness of one-dose and two-dose vaccination strategies was obtained from an overview of the reviews of the clinical effectiveness of the varicella vaccination. The HTA found that the introduction of one dose of the vaccine to the schedule would reduce severe disease, including hospitalisations, and overall occurrences. In addition, it was found that the introduction of two doses of the vaccine has the potential to further reduce the number of cases and eliminate chickenpox. I will certainly relay the Deputy's comments to the Minister, Deputy Donnelly. A decision will be made on this matter shortly.
That is great. As the Minister of State outlined, for many people, and children in particular, the disease is a mild one but it can have severe complications for some. I have heard of the phenomenon of chickenpox parties for kids over recent years. The disease was almost considered a rite of passage that should be got out of the way. This was never something I thought appropriate. If you read about the complications that can arise and how severe the disease can be, you will see that we need a vaccination programme. Children are getting vaccinated now but the cost is high. I hope that the Minister of State will take this back to the Minister who might, in the context of this budget, look at putting some funding towards exploring this matter or introducing this vaccine into the programme.
I thank the Deputy. I will certainly relay that back to the Minister.
Is í an cheist dheireanach an chéad cheist eile, atá in ainm an Teachta Ó Cathasaigh.
17. Deputy Marc Ó Cathasaigh asked the Minister for Health the position regarding dedicated services to address long Covid in each of the regions; the steps his Department is taking to provide services and supports for those affected by long Covid; and if he will make a statement on the matter. [40036/23]
Covid is still with us and we are still learning about the virus all the time. We are learning about how it is turning up in people's heart muscle and how it is crossing the body-brain barrier. If you have met somebody with long Covid, as I am sure the Ministers of State have, you will know they look absolutely the same. They look in the full of their health. Despite this, they are managing their energy from day to day. I wanted to ask the Minister specifically about dedicated services to address long Covid in each of the regions and about the steps the Department is taking to improve these services and supports for people who are suffering in the long term from this new virus.
I thank the Deputy for raising this really important question. As he will be aware, the HSE interim model of care for long Covid is being implemented, building on existing service provision, in addition to the establishment of new services across GP and community services and acute hospitals to ensure a national service is in place for all who need it. In 2023, €6.6 million was allocated for the continued development of these services.
Long Covid clinics are currently operational in Cork University Hospital, University Hospital Galway, St. Vincent’s University Hospital, Beaumont Hospital, the Mater University Hospital, Connolly Hospital Blanchardstown, Tallaght University Hospital, St. James’s Hospital and Limerick University Hospital. We have a concentration of four in the Dublin area, along with Cork, Limerick and Galway. Clinics operating under the model of care are supported by interdisciplinary teams with a range of expertise. The teams include clinicians in the areas of infectious disease, respiratory medicine, psychiatry, cardiology and neurology. Allied health professionals, including occupational therapists, physiotherapists and clinical psychologists, also form part of these interdisciplinary teams. The HSE continues to develop the service and is actively recruiting clinicians into these teams.
In addition, there has been work to further inform the continued development of post-acute and long Covid services. I have raised this situation. I know the next question the Deputy is going to ask me. It will relate to specific areas of the country, for example, the south east and the north west. The HSE has launched a follow-up after disease acquisition, FADA, survey to help to increase its understanding of how people are recovering from prolonged symptoms of Covid-19. Preliminary results of the survey are expected to be available late in the fourth quarter of 2023.
As the Minister of State read through that list of hospitals, she knew that as a Waterford Deputy, I was going to get up and point out that 600,000 people live within one hour of University Hospital Waterford, and yet no long Covid services are provided there. I have been dealing with a number of people through my constituency office and, to be quite honest about it, with a number of people in my family and the main message I am getting is that they do not feel they are being believed because they outwardly look perfect and in the full of their health. Even if people go to their GP, the process of identifying long Covid really just involves trying to rule out everything else so that all that is left is long Covid. These are people who are managing their energy from day to day. One constituent of mine came into my office and said that he had not bathed his new child because he knew that doing so would take too much energy out of him and that he would not be able to get up for work the next morning. He has exhausted his paid leave and all of those things. Quite simply, these people feel like they are not believed and not supported. That is something we have to turn around.
I thank the Deputy for his question. He has really hit on something interesting. The long Covid service remains relatively new and work is ongoing to further establish, resource and embed these clinics. However, he is quite right in what he has said. This is new. Covid was new to us in 2020, 2021 and 2022. We now all know people who have long Covid symptoms. It is important that there are supports for them. Service development and planning is ongoing and recruitment into established clinics continues. As I said, the HSE has undertaken that survey. It has also launched a FADA survey to help to increase its understanding of how people are recovering from prolonged symptoms of Covid-19. The purpose of the survey is to estimate the prevalence of self-reported long Covid, to estimate the severity and nature of the symptoms among those identified as having long Covid and their impact and to inform the planning of the HSE long Covid model of care, which is an important piece.
While you should never base policy on anecdote, I was speaking to my local GP, who said that one in six of the people turning up to his GP service are there because they are suffering from long Covid.
People do not have a fixed diagnosis or sheet of paper saying they are suffering from long Covid. There is a need for that piece around self-reporting, and maybe even a public awareness campaign on that to build a better picture of what is happening there, and then pathways to reach those services that are needed for people to feel believed. I reiterate the point that in the south east, I do not want somebody who is managing their energy getting in a car travelling to either Dublin, Cork or Limerick to access services.
I fully agree with the Deputy. The survey under way will also access the severity and range of symptoms associated with long Covid and give an indication of the level and range of services required to adequately respond to long Covid in Ireland. As I said, the analysis of the survey is under way.
