Vol. 1053 No. 4
1. Deputy David Cullinane asked the Minister for Health when he will end the health service recruitment embargo; when the HSE will publish its pay and numbers strategy; and if he will make a statement on the matter. [19772/24]
This question relates to the health service recruitment embargo, which, by the way, is a Government-imposed recruitment embargo given that in budget 2024, the health service simply did not get the funding it needed. Will the Minister end that embargo and publish the HSE pay and numbers strategy?
I thank the Deputy. On the pay and numbers strategy, that has been authorised, so there should be no issue with it being published. It comes to a little over 1,800 new posts and we are seeking mechanisms to fully roll out safe staffing through agency conversion as well. The net impact will be about 2,300 staff and more staff will be announced as part of the additional €92 million new development funding towards the end of the year. There will be no issue with publishing the pay and numbers strategy.
With regard to the embargo, no more than the Deputy, I have met front-line teams, be they community or hospital teams, and I am very aware the embargo is impacting on them and causing pressure in different ways in teams throughout the country. We have put in place various exceptions, including in emergency care, in intensive care and, on a case-by-case basis, in some other areas. The Deputy will be aware we are also fully honouring our commitments to hiring nursing interns. No embargo has been applied to consultant posts and we are on our way to radically increasing the number of consultants.
Specifically on the embargo, the Deputy will be aware its genesis is not a lack of funding for this year. Rather, last year, a record number of funded posts, about 6,000, were created and the HSE hired well in excess of 8,000 posts, which left more than 2,000 posts that had been either hired or committed to for which there was no funding. Unfortunately, a coarse measure was needed. A graduated approach had been used through the year but it had little effect. I will give more information in my follow-up response.
We have a growing population and demand in healthcare has increased. When we talked a number of times last year about the deficit that existed in healthcare, the Minister and officials in the Department of Health and the HSE cited two reasons for that, namely, health inflation and increases in demand for services, and the Minister rightly said we were not going to turn away patients. Healthcare demand is what it is, and we have to have the staff and the capacity to deal with that demand. That is the backdrop here. Liam Doran, the former head of the Irish Nurses and Midwives Organisation, INMO, said this week, and he is right, that health service recruitment embargoes never work and cause reputational damage to the HSE.
I have received a number of letters from people over recent weeks. One was from a young pharmacist from my constituency of Waterford, a graduate of a top university who had applied for a role in the health service about which she was extremely enthusiastic and was told she cannot be hired because of the recruitment embargo. Likewise, a student paramedic, who was originally a nurse and went on to train as a paramedic, has been also refused a post because of the recruitment embargo, and when I come back in, I will cite more examples. The embargo does not work and is having an impact on front-line healthcare services.
The context for this is important. The Deputy quite rightly referred to the increase in healthcare demand. We have had an unprecedented increase in the number of healthcare workers as well. There has been a pretty extraordinary 24% increase in our health and social care workforce in the lifetime of this Government, or nearly 29,000 more healthcare professionals working in the health services than there were at the start of this Government. It is nearly 10,000 more nurses and midwives, more than 4,000 health and social care professionals and more than 3,000 doctors and dentists. The context for this, therefore, is that there has been a massive increase in the number of staff throughout the country.
Nobody would want to put an embargo in place, but the HSE was hiring so many people and it was not responding to a more graduated approach such that, ultimately, thousands of healthcare workers for whom there was no funding from the Government were being hired by the HSE. Unfortunately, therefore, a coarser measure, the embargo, was required. We do not want it to be in place and I am working with the Government to resolve it as soon as I can.
It is not a coarse measure; it is the wrong measure. It simply is wrong and I think Deputy Donnelly knows that as Minister for Health. We cannot seek to improve services in the healthcare system if a recruitment embargo is in place. The Minister cited the exemptions, which I accept are in place for final-year graduate nurses and hospital consultants, but all the other posts are not exempt. The HSE sought €20 million for the national cancer strategy for 2024; it got zero. There are a range of posts that need to be filled in that area, such as radiologist and radiation therapy posts, none of which can be filled. There are also many vacancies in mental health care and we have heard from advocate groups in that area, but again the embargo is presenting a challenge there. Approximately 100,000 children are in need of dental screening and, again, they cannot get their appointments because of a lack of staff. The Minister will have seen the letter I received from the HSE, which clearly states the recruitment embargo means it cannot hire the dentists it needs. There are pressures throughout the healthcare service, therefore, but there is now an embargo, wrongly imposed by the Government, that needs to be lifted, and I am asking the Minister to lift it.
The embargo is simply a mechanism that was required for an organisation that was hiring staff it had no money or sanction to hire. If a school principal started hiring teachers he or she had no money to hire, the school would be told immediately to stop hiring because it had no sanction to hire the teachers and no funding had been allocated for their salaries. The school would be told it simply needed-----
We are training these people.
-----to stop hiring teachers, and it is the same in this case. Unfortunately, we had a deeply frustrating situation where the HSE had hired thousands of people. The central controls within the HSE failed. The HSE, as soon as it saw it was coming anywhere near its funded target for the year, should have identified that. Had it done that, no such measure would have been required.
I fully acknowledge the frustration for our front-line workers. I meet them every week and hear their frustrations, and we are working to resolve the situation. I would have greatly preferred if the graduated approach had worked but, unfortunately, the HSE continued to hire at a level we had never seen.
2. Deputy Gino Kenny asked the Minister for Health if he is aware of the report conducted by the Health Research Board that informed his Department of the current status of the medical cannabis access programme, MCAP; when his Department will consider the findings and make a clinical decision on whether to expand the criteria of the MCAP; and if he will make a statement on the matter. [19872/24]
Earlier this year the Health Research Board, HRB, published a very extensive report on the efficacy and safety of the medical cannabis access programme. The programme has been in place since 2019. Could the Minister give me his thoughts on the report and what the Department of Health intends to do next?
I thank the Deputy for his question and acknowledge his ongoing work in this area, both in terms of the MCAP initially and the evolution of the programme. As he will be aware, we launched the medical cannabis access programme in 2021 for three conditions initially: refractory epilepsy, spasticity as a result of MS and nausea from chemotherapy. Since the inception of the programme, 55 separate patients have availed of it - 52 adults and three minors, mainly for spasticity associated with MS. There were 38 patients in that category.
As the Deputy quite rightly said, we have conducted a review now that we have the programme in place to see if there is a clinical case for it to be expanded. It certainly is something that I am very open to. At my request, the HRB was requested to carry out an exercise of initial evidence-gathering, the results of which have been published. The publication is now subject to clinical review. We want to ascertain whether there is sufficient evidence to broaden the scope of the conditions that could be treated under MCAP. I am certainly very open to it. I will be entirely led by the clinicians on the board. As the Deputy will be aware, I allocated significant funding to get the MCAP initiative moving.
On a second positive note, since we launched MCAP, which is for the unlicensed medicinal cannabis products, we now have several licensed cannabis products. What I hear back from the clinical community, is that the preference of clinicians, where possible, is to prescribe on the licensed programme because they argue that there is greater clinical evidence from trials, and we are seeing prescriptions under the licensed programme increase, which is very positive.
The concept of the medical cannabis access programme is a good idea, because the licensed system is very bureaucratic and, in some instances, archaic. Since the inception of MCAP, only 55 people have got access. That is a tiny number of people given that the legislation was introduced in 2019 and the access programme in 2021. The HRB report says there is significant evidence of good efficacy of medical cannabis for neuropathic pain. The programme must expand, otherwise, it will become redundant. If that happens, people will either go to the black market or go without. There is a huge amount of frustration with the limitations of the programme thus far.
I accept the Deputy's position. It is a smaller number of people. We know from the clinicians that in many cases they are nervous about prescribing, even though the MCAP is in place for the unlicensed products. As I said, we will do a clinical review of the HRB findings. I am very open to expanding the programme. We will be led by the clinical view on this.
What is interesting though is that while I take the Deputy's point that there are only 55 patients, which is a low number, we are seeing a much higher number now on licensed cannabis medicine products. For example, as he will be aware, Epidiolex is one of the medicines used for seizures associated with Dravet syndrome and Lennox-Gastaut syndrome, among others. More than 144 patients have been prescribed on that and, therefore, the clinical community would appear to be more engaged with the licensed products.
I understand the appeal of licensed products, but the MCAP was set up for those who have tried every known medication for their condition and they want to be in a position where they could try a number of these other medications. It think nine medical cannabis products are listed, which is better than it was perhaps 18 months ago, but there is enormous frustration with the restrictions and limitations of the MCAP, under which medication can only be prescribed by a consultant. The number of medical professionals in this field is very limited. Another limitation is that it is confined to the three conditions. If MCAP does not expand, I do not see where the programme will go. The Danish medical cannabis access programme has a number of conditions where the evidence for the use of medical cannabis, in particular relating to neuropathic pain, is very good.
I take the Deputy's point. I think that is all very fair. We have now a pathway to address exactly those issues. I will ask my officials to bear all of that in mind. The unit dealing with this will take note of our interaction this morning.
The first question is whether we expand from the three conditions. I am very open to that. Second, what we need to do is engage with the clinical community as well and ask even if we do expand, whether clinicians are still nervous of prescribing under MCAP versus licensed products, and if there is anything we can do there. We could expand the conditions and try to understand if there are other barriers or concerns that clinicians have. I am very open to a clinical recommendation coming back as well on whether we expand beyond consultants. I will certainly be led by the clinical advice coming back. I am very open to all the points the Deputy made.
3. Deputy David Cullinane asked the Minister for Health if he will commit funding to 288 additional acute inpatient beds at University Hospital Limerick, UHL; the timeline for the full implementation of the coroner's recommendations following an inquest (details supplied); and if he will make a statement on the matter. [19773/24]
This question relates to the mid-west region and University Hospital Limerick. I will start by recognising the loss of Aoife Johnston. I pass on my heartfelt condolences again to her family and her parents. Aoife was one of many patients whom we know were failed in that hospital. As the Minister knows, her family are grieving. We have a real challenge and a real problem in UHL. What additional beds and capacity will be put in place in the mid-west and UHL to once and for all fix the problem for the people who live in the region?
I join the Deputy in offering my condolences to Aoife's family and friends. I met her mum and dad at the start of the year and offered my apologies as well as condolences because she was failed and she should not have died. It is heartbreaking.
The answer to the challenge of overcrowding in the emergency department in UHL is capacity and reform. We have made sure that UHL is the hospital that has had the biggest increase in money and staff in the country. It has had a bigger increase in budget and staff than any other hospital. The Deputy quite rightly asked about beds. To date, it has had an increase of 108 beds, 98 ward beds and ten critical care beds.
I was in UHL about four weeks ago, and we launched an additional 86 beds for this year, in advance of the first 96-bed block coming online. I have also authorised the building of the second 96-bed block as well. Of the 86 beds for this year, 70 of them will revert to the communities in counties Tipperary and Clare when the permanent beds in Limerick are opened. Some 16 of them will remain, which increases the net amount as well. The numbers are as follows, specifically in terms of the beds. We have already added 108. We have 86 more coming this year, so coming into next winter we should be up by 194 beds. Then on top of that there is a second 96-bed block being built as well. The total increase will be approximately 290 beds. As well as that, we have been investing in the community and in Ennis, Nenagh, St. John's and Croom.
The tragedy of all of this is that most of those beds have come far too late. There is no reason those beds should not have been funded years ago. Everybody knows that when the decision was made to close Ennis and Nenagh emergency departments, additional capacity was needed in Limerick. It was promised that it would be a centre of excellence. It has not been able to perform as that centre of excellence and the main trauma and emergency department service for Limerick because it does not have the capacity.
There is a number of things needed. The Minister needs to stay ahead of the problem, which is why we are saying more beds are needed. The hospital says it needs a minimum of 230 beds right now. We have to stay well ahead of that because we will have further population growth and demand on the healthcare system.
Ennis and Nenagh hospitals need to be examined. Their emergency departments were closed but there is no model 3 hospital in the region. I live in Waterford, as does the Minister of State, Deputy Butler. Wexford has an emergency department and a model 3 hospital. St. Luke's in Kilkenny has an emergency department and a model 3 hospital. We have a model 4 hospital and an emergency department in that radius. The mid-west has only one either model 3 or model 4 hospital, and that is Limerick, and it is struggling. We must have a much more holistic review of what is needed in the region.
I agree. The reconfiguration was not done right at all and the measures that the Government is putting in place should have been put in place before the reconfiguration happened. That is my view. What I can stand over is what the Government is doing. The Government has added a level of capacity into Limerick that has never been done before and there is no hospital in the country that has had more money or staff. The increase in staffing in UHL in the lifetime of this Government is nearly 1,200. It is vast. The beds are being added in Limerick more than in any other hospital with the two 96-bed blocks being built.
It is essential that we do not lose sight of the reform piece of this because the beds will only make a difference if they are being used properly. There are better reforms happening. There was an unannounced HIQA ED inspection. I believe that they will note that things are getting better but they hospital still has a ways to go. Weekend discharge is still too low. Limerick has the lowest uptake of any of the large hospitals of the new consultant contract.
Some important reforms have been happening. The new regional executive officer has been pushing on them and she has my full support. There are further reforms that we need to help the local clinical communities engage in.
The Minister will get a chance to come back in.
Sorry, a Leas-Cheann Comhairle.
I am all for reform in that hospital and every other hospital, but I was one of those members, including Deputy Crowe, who attended the briefing for the Oireachtas health committee. We met with the head of the HSE and clinicians, hospital management and healthcare trade unions. All of them, to a man and a woman, told us that the big problem in Limerick is capacity. We need reforms but every single day there are patients who are deemed sick enough to be admitted to a bed but the beds are not there. Approximately 200 staff are needed, including more nurses in the emergency department, according to the INMO.
We also need to look at the other areas. When the Minister says that the hospital has received more staff than any other hospital, that is because there is no other model 3 hospital. It is the only major hospital in the entire region. Of course, it will get, and needs, more staff. The problem is it is struggling. I hope that the additional beds and the staff will be the only solution that is necessary but I genuinely believe that we have to look at other hospitals in the region, and from a health, medical and clinical perspective, whether it is safe to do so, to serious look at a model 3 hospital for another part of that region as a prospect.
Let us bear in mind that when I say we have added more staff, we have increased the staff by more than 40%. This is not a few more staff. An additional 433 nurses, for example, are working in the hospital. It has been a vast increase.
In terms of a model 3 hospital, we should never rule anything out. The chief executive and I have asked all six of the regional executive officers, now that we are moving to regional health areas, to conduct a strategic review of their regions in terms of community care and hospital care in the round. We should never rule anything like that out.
It is, however, important that we in the Oireachtas keep the focus on reform. We are doing our bit in adding capacity. It is being added at a level it has never been added before but weekend discharge is not where it needs to be, the uptake of the public-only contract is not where it needs to be and basic patient flow approaches which are standard in other hospitals are not currently being used in UHL. What we are seeing around the country is a very encouraging reduction in the number of patients on trolleys, except in UHL where we are seeing a nearly 50% increase in the year to date. That difference is not about capacity. That difference is about running the hospital as well, as the Deputy referenced, his own hospital in Waterford.
4. Deputy David Cullinane asked the Minister for Health his plans to achieve a maximum of four months waiting time for paediatric spinal surgeries; and if he will make a statement on the matter. [19774/24]
This question relates to spinal surgeries for children with scoliosis and spina bifida. The Minister will be aware that over the past number of months there has been a number of high-profile reports of children and their families having to take the media. Some of those children have been waiting since as far back as 2020 for their spinal surgeries to be done. The families are pleading for help and looking for Children's Health Ireland, CHI, to deliver the care their child needs. What more can be done to ensure that the promise that was made that no child would have to wait longer than four months is delivered?
I thank the Deputy for the question. I acknowledge that the waiting lists for these children are simply too long and that while more capacity is being is being added and more surgeries are being done, there are a number of children for whom the wait is simply unacceptable.
In 2022, I asked Children's Health Ireland to come up with a comprehensive plan that would mean that of the children who are scheduled and actively waiting for surgery, no child would be waiting more than four months. CHI devised a plan and I funded it to the tune of €19 million. The assurance I was given was that by the end of 2022, no child would be waiting more than four months. Unfortunately, that plan clearly did not work.
I intervened again in 2023. I went and I met privately with the surgeons and asked them what they believed needed to be done. What they said ultimately was required was to establish a dedicated spinal service. They referenced places such as Stockholm where the services are ring-fenced, including the theatres, specialist nurses and anaesthetists, specialist wards, intensive care units, high-dependency units, health and social care professionals and specialist ward nurses. That is exactly what we are transitioning to.
I have allocated more funding this year. Very significant capacity is in place now. We funded a fifth operating theatre and a second MRI facility. More than 200 healthcare professionals had been hired by CHI under the €19 million.
I had a meeting only yesterday with Dr. David Moore, who is heading up the service and is one of the spinal surgeons, with my Secretary General, the regional executive officer, the chief executive of CHI and the chief executive of the HSE to make it clear that everything that can conceivably be done to accelerate this dedicated spinal unit must be done. I made it clear that the view, not only of the Government but all of us in the Oireachtas, is that we must get to a point where no child waits more than four months.
Despite all of the talk that comes from Government and the Minister regarding record investment, record staff, record capacity and all of that, we have children who are waiting. Last week, I raised with the Taoiseach the case of Liam Dennehy, who has been left waiting more than five months for his surgery. Unfortunately, his spinal curvature is going in the wrong direction. I also raised, on Tuesday, the case of Paddy Murphy, a 14-year-old who has been waiting for his surgery since 2020. There are many cases like that. Unfortunately, we are failing those children.
The Government made the promise, starting with the Taoiseach, then as Minister for Health, and continuing with the current Minister that no child would have to wait longer than four months.
Deputy McDonald asked the Taoiseach a number of weeks ago when the treatment abroad option would be resumed and what that would look like. We still have not received any clarity. The Deputy also asked about the Government funding a second opinion for families who are concerned about the clinical recommendations they are being given. Given that it is their child and given the length of time they are waiting, all of these options should be looked at. Can the Minister answer those specific questions An Teachta McDonald asked and that we still have not had a response to?
I can. We had a useful session yesterday. I might organise a briefing for members of the health committee who are interested as well. There is a lot of important work under way.
As to the treatment abroad scheme or whatever it might be, we have been very clear with CHI in saying if it can find what our surgeons say is clinically appropriate care for the children, be that in Boston's hospital or the UK, Germany where it was done before, Stockholm or indeed anywhere, this Government will fund it. CHI has been given a very clear direction on that. It does not have to comply with the treatment abroad scheme, which is an EU scheme. If we can find this treatment in the United States, Canada or wherever it may be, CHI has been told that as long as it is clinically appropriate for these children the State will fund it, we will fund their families going over and we will support the whole thing.
I will respond to the Deputy's second point when I come back in.
The problem is that for many parents and many children that is not happening. A number of weeks ago I raised the case of Aiveen , a young child with early-onset scoliosis. Her family crowdfunded for her to go to America to get specialist treatment. She got that and is now doing very well. She certainly did not get the support from the HSE. Her family had to depend on the public coming in behind that campaign and her getting the support. I have mentioned two cases but there are hundreds of children waiting for scoliosis treatment, with many of them waiting longer than the four-month time period. There needs to be more urgency. The families who may be listening will be thinking it is all very well for the Minister to say he will do everything possible, because if it is not happening for those families then that is their lived reality. We have to make it happen for them. We also have to look at what additional capacity is needed domestically as well.
I asked about the second opinion. There is a lack of trust in Children's Health Ireland. It gives me no pleasure to say that, but it is a reality. The Minister had to send in an audit team to look at money that was spent to ensure it went to the right places. We have a number of reviews that are ongoing at the moment. For all those reasons the call by the parents for a second opinion to be funded by the State is a reasonable one and I am asking whether it is something he will support.
I do not disagree with any of that. The families are angry and they have every right to be angry. There is no defending what has happened. We have to fix it and fix it permanently. That is what this dedicated spinal unit is going to do. The team in CHI are meeting other international providers this week. I have told them that as far as I am concerned they have full authority to go and secure this on behalf of the children.
On the second opinion, I will get a more detailed note but I understand the families who were within the scope of the Mr. Nayagam review, whether they got actively involved or not, have been offered a second review and a small number have taken it. I point out the feedback from the CHI surgeons is that while we can secure a second opinion from Great Ormond Street or wherever we want, they ask what happens then. It is still the same surgeons here trying to do the work. We are, therefore, expanding the number of surgeons and the capacity they have. I have also instructed CHI and the HSE to completely ring-fence all theatres, MRI, ICU and ward beds required in that our own surgical teams can be fully utilised to treat as many children as possible.
