Commencement Matters

Home Care Packages Provision

Given the Senator's knowledge of the situation, I would welcome it if he did not name the individual concerned. He has supplied the details to the Minister of State anyway.

Go raibh míle maith agat a Chathaoirligh. Cuirim céad fáilte roimh an tAire. Mar a fheiceann sé táim ag ardú ceist anseo maidir l'othar a bhfuil an galar néarón luadrach air atá insan ospidéal i nGaillimh le blian anuas.

I have raised this matter on many previous occasions and I know that the Minister of State has the details of the person to whom it relates. Motor neurone disease is incredibly debilitating and is absolutely life-changing for anybody who suffers from it. I was involved in a campaign with this person - he instigated that campaign on his own behalf - in order that he might have a tracheotomy operation, which he would see as a life-prolonging in nature. That campaign was very successful. A lot of fund-raising took place in the Galway area in order to support the person in question when he was released from hospital following the tracheotomy. The operation went very well and it was expected that afterward, once an agreed home care package was put in place and suitable nurses and carers were made available, that this person would come home and be able to spend the remainder of his years there. That has not happened unfortunately, even though the efforts of his family, particularly his wife, have been ongoing. It appears that there is a kind of stand-off between two parts of the HSE, namely, that which runs the hospital section and the primary care section. What will happen is that once this patient is allowed home from the high-dependency unit, HDU, he will become a financial burden on the primary, community and continuing care, PCCC, system and the money will have to come out of it budget. The HSE has known about that for quite some time and it is time for a decision to be made.

The family has done a great deal of research. It is quite unusual for this to be done and I think it is to be welcomed that the operation took place because it certainly will help the patient in question and he is feeling better after it. Even though his physical ability is obviously deteriorating, his mind certainly is not and he is very much on top of the situation. His researched and costed potential care services that would be available to him in the Galway area. The PCCC in the HSE area initially estimated that it would cost something of the order of €750,000 to provide home care on a 24-7 basis. The family's research indicates that this could be done for a fraction of the money that was being asked, so they actually made a saving for the HSE in respect of the potential cost.

The person involved does not want to hold up a HDU bed as such beds are in short supply. There is pressure on University Hospital Galway but there is also pressure on the family to travel to from their home place to the hospital - it is quite a long round trip - each day in order to visit the patient. That is unacceptable. The person has young children of school-going age and he would like to be able to be with them on a daily basis.

I would like to find out what discussions have taken place between the Department of Health and HSE west. If discussions have not taken place, will the Minister of State intervene as quickly as possible in order to try to get the management at HSE west to sit down with the management of the hospital and of the PCCC? A decision must be made at some stage. Let it be made sooner rather than later so that the patient can go home and spend the rest of his life with his family in a proper care environment. This would also take the pressure off the family. I look forward to the Minister of State's response.

I thank Senator Ó Clochartaigh for raising this very important matter. I know that he is very passionate about health and disability services, particularly in his constituency in Galway but also nationally.

In the first instance, I wish to assure the Senator of the Government's commitment to providing services and supports to people with disabilities that will empower them to live independent lives, allow them greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in A Programme for a Partnership Government and is guided by two main principles: equality of opportunity and improving the quality of life of all people with disabilities. One way in which the HSE is working to improve the quality of life for people with disabilities is through the provision of home support hours. One of the Senator's concerns relates to that particular issue. In the context of its service plan for 2016, the HSE's priority was to provide 2.6 million home support hours for over 7,300 people with disabilities. In reality, the actual number of home support hours provided in 2016 was higher, at 2.9 million hours. This reflects the responsive nature of the service and takes account of the fluctuation of assessed need over time as the needs of individuals change.

This year, the HSE has committed to maximise the provision of health and personal-social services, including home support services, within available resources.

This year, the HSE has committed to maximising the provision of health and personal social services, including home support services, within available resources. As provided for in its national service plan for 2017, the HSE expects to deliver 2.75 million home support hours to over 7,400 people with a disability, an increase of 150,000 hours over last year's target. The goal is to help as many people as possible. This is a positive development which we can build on in years to come. I accept the Senator's point that we must build on it.

With regard to the matter raised, I am sure the Senator will understand my reluctance to comment here in any great detail about the specifics of any one case given the personal nature and circumstances of the matter. However, that does not mean we are not going to do anything. As the issue raised by the Senator is a service matter, I have asked the Health Service Executive for a report on the case. The HSE has informed that the person concerned is in a high-dependency unit in University Hospital Galway and is in need of 24-hour care. I understand from the HSE that it is in discussion with the family on the appropriate options for the person's discharge from the University Hospital Galway. The HSE community health care organisation for area 2, which covers Galway, Mayo and Roscommon, has assured me that it is actively engaging on an ongoing basis with the family with regard to the most suitable and appropriate care for the person.

I thank the Minister of State for his response and I note his interest in the disability services in Galway to which, hopefully, we will be welcoming him soon. The HSE response on this matter is a nonsense. Discussions have been ongoing for well over a year. It was known in advance of the operation that this would be needed. It is time for decisions to be taken and for heads to be banged together. It is probably costing as much per annum to keep this patient in the high-dependency unit as it would cost to provide services for him at home with his family. I ask the Minister of State to re-engage with the HSE on this matter with a view to a meeting being held with the relevant stakeholders and a decision being reached on when this patient can be moved home. As I said, this matter has been going on for far too long. The Minister of State, when in Galway, might take that opportunity to meet with the relevant stakeholders and raise this issue with them.

I thank Senator Ó Clochartaigh for the invitation to visit the services in Galway during my next round of visits to services throughout the country. I disagree with the Senator that the HSE reply is a nonsense. I accept that there is a problem. During the discussions on the HSE social care plan additional home support hours were agreed. This particular case is a classic example of a person who should be benefitting in that regard. I will engage with various departments in the HSE and will put pressure on them to resolve this issue. What is going on is not acceptable, particularly for a person with motor neurone disease. I agree with the Senator that the situation is extremely difficult for the person concerned and for his family, particularly his young children. It is our duty to facilitate them. It has been stated that the cost of doing so would be approximately €775,000 per annum. With a little creativity and planning we can, hopefully, come up with a resolution.

I will make known to the HSE the Senator's views regarding the urgent need for resolution of this matter.

Mental Health Services

Is the Minister of State taking the second matter?

Yes, I am taking the matter on behalf of the Minister of State, Deputy McEntee.

This is happening quite frequently. This matter relates to the closure over the last couple of weeks of 50% of the beds at the Linn Dara unit in Cherry Orchard. The engagement, thus far, by the Minister of State, Deputy McEntee, in this regard has been poor. Owing to the closure of these beds children who would have been inpatients at Linn Dara were left queuing last weekend at accident and emergency departments, some of them for 24 hours and at great risk. While some of these children are being released to the loving embrace of their families, other children are not. There are 20 children on the waiting list, which has also been culled.

We also have been left with half of the staff. It has been alleged that staffing issues caused the closure and there have been warnings about staffing shortages for a long time, particularly the shortage of psychiatric nurses.

I am outraged by the closure of the facility. The parents and children are desperate for help. We know the reality due to the publication yesterday of a report on the services available to children, the publication this morning of a report on children's mental health services by the Seanad Public Consultation Committee and from the public writing to us beseeching us to do something about access for children. We have failed them miserably and we continue to fail them every day. Numerous reports have been published and some action has been taken but what we need has been ignored. We need a robust 24-7 service for children in need.

I want the Minister of State, Deputy McEntee, to up the ante and engage with the Psychiatric Nurses Association, PNA. The association, of which I am a member, has solutions that it gave to the Minister of State but they have been completely ignored and not acted upon. Action is much more than kicking something into touch, undertaking reviews and waiting for recommendations to be implemented, which has gone on forever. We just need some action. I urge the Minister of State present to convey my comments to the Minister of State, Deputy McEntee, and ask her to re-engage with the PNA.

I thank Senator Máire Devine for raising this important issue, along with the staffing issue and her call for the Minister of State, Deputy McEntee, to engage with the PNA. I shall respond to the latter issues at the end of my response.

The Linn Dara facility is a state-of-the-art child and adolescent mental health services, CAMHS, inpatient unit. It provides support and services to young people who struggle with their mental health and find it hard to cope with everyday life. Linn Dara consists of two 11-bed units called Hazel and Rowan and a two-bed high observation unit called Oak.

Over the past few weeks, as is normal practice, a number of patients were discharged from Linn Dara's CAMHS unit for clinical reasons. The decision was taken not to refill those beds due to staff shortages. Unfortunately, the decision has left Linn Dara with just half of its 22 beds occupied, and that is the core of the issue. I can assure the Senator that the Government is taking the issue very seriously. The Minister of State with responsibility for mental health, Deputy McEntee, met the HSE last week specifically about this matter and she also visited Linn Dara so the process has started.

I want to assure the Senator that the HSE has confirmed that no young person is discharged from Linn Dara unless deemed clinically appropriate by his or her mental health team. It should be clearly understood that nobody is discharged to allow for a bed to be closed. For those discharged for clinical reasons, dedicated follow-on supports from the community-based CAMH service will be provided, if deemed necessary. The HSE will also make available the CAMH day service, as appropriate in individual cases, to enhance supports for young people and their families.

The core issue that faces Linn Dara, which we must face, relates specifically to staff recruitment and retention difficulties for mental health professionals. Unfortunately, this matter reflects wider health system issues. The problem in this case does not relate to funding availability. Staffing cover has been augmented in recent times through methods such as staff working additional hours, overtime and engaging the services of agency staff.

I assure the Senator that the HSE is exploring every option to maximise the operation of this service, keeping quality and safety to the fore. The HSE has intensified its recruitment efforts. A number of staff have been identified to join the Linn Dara service in the near future but realistically, such recruitment will take some time.

The Minister of State, Deputy McEntee, has told me that she will remain in close contact with the HSE and the management at Linn Dara on this issue. The Senator may rest assured that all efforts will continue to be made to address ongoing service difficulties at Linn Dara. In this context, I urge all relevant health professionals, including those represented by the Psychiatric Nurses Association, to consider working in a modern high-quality CAMHS unit, such as Linn Dara, or other CAMHS units nationally.

I will briefly address the wider issues around mental health services for children and adolescents. It is the policy of the HSE, as reflected in its annual service plans, to provide an age-appropriate mental health service for people under 18 years.

Mental health remains a key priority for the Government, underscored by the fact the HSE mental health budget increased from €826 million in 2016 to €853 million this year. That is a substantial increase. The HSE service plan for 2017 commits to further development of child and adolescent mental health services, CAMHS, including more acute bed provision, better out-of-hours liaison and seven-day-a-week response services. This is the strategic priority action in the plan against a background where the population of children is expected to increased by around 8,500 over 2016 and 2017, inevitably creating additional demands in CAMHS. Around 18,500 young people under 18 years are expected to attend a CAMHS service this year. That is a great many children. Additional resources and facilities means there are 67 CAMHS teams and three paediatric liaison teams, until recently supported by 66 operational CAMHS beds nationally. Further beds were planned to come on stream as approved staffing posts materialised at local level. However, I acknowledge that difficulties have clearly arisen in recent times in the HSE securing adequate staffing to maintain approved CAMHS capacity, including the Linn Dara unit in Cherry Orchard. I assure Senator Devine that all efforts will be made to continue to address the ongoing service difficulties at Linn Dara.

Linn Dara is a modern unit and it is a shame to see it half empty. The 20 or more children on the waiting lists to all intents and purposes have been culled.

Ireland's overall suicide rate has stabilised in the past two years, but among young boys and young men, it is increasing alarmingly. Our country shouts out in despair to remind us to look after, embrace and make sure our children are safe. This is what every parent wants to do and what every State should be doing for our children. The Minister of State, Deputy Helen McEntee, needs to be really proactive now. She has been told to re-employ the bank of retired nurses. I have spoken to retired nurses who have just left the health services and they are willing to come back and keep this unit open. Where is the bespoke recruitment campaign that was to happen for Linn Dara in particular? There are many things that can be done.

The Minister of State needs to understand how heavy a burden is placed on the medical teams when staff are told to find a bed by discharging a person right now. The burden is placed on a medic to tell a person that he or she is being prepared for discharge. The risk the medic is taking is enormous. That risk has to be taken by the Government and it should act now.

I totally accept there is a major issue with mental health issues, particularly among our adolescent and younger population. I mentioned that 18,500 persons used the services last year. These are people under 18 years, which is a very high number for those using CAMHS.

I will bring Senator Devine's suggestion of using the bank of retired nurses to the attention of the Minister of State, Deputy McEntee. However, the Minister of State assures me that she is working very closely with the hospital and the HSE to try to resolve this issue. We have a major problem with retaining nurses, which sadly is a reality. We have many vacant posts across services which we are unable to fill. I will bring Senator Devine's strong message that we have to ensure we do not lose people or put human life at risk. We have to ensure an adequate mental health service for young people. That is the message I will bring back to the Minister of State, Deputy McEntee.

Primary Care Services Provision

I thank the Minister of State, Deputy McGrath, for his presence in the House today. I wish to discuss the lack of physiotherapy services in County Mayo, which have reached a crisis point.

Patients throughout County Mayo are not getting the physiotherapy they need. This includes children, post-operative patients, people with disabilities and arthritis and elderly people. If a person can afford to access private physiotherapy and he or she is able to travel, that person can get as much treatment as he or she needs. If that person is a medical card patient living on a low income, it is becoming increasingly impossible to get physiotherapy in County Mayo.

The long-term damage of not being able to access physiotherapy is well documented. The physical pain experienced by many patients who are denied treatment is truly awful and the mental trauma of knowing permanent damage is likely to arise from delayed treatment is not acceptable. The solution to this crisis is very simple. An adequate number of physiotherapists must be appointed to meet the needs of those waiting for physiotherapy in Mayo.

Why are physiotherapists from the panels not being appointed? Why are applicants to physiotherapy panels not given the choice of which areas they would like to work in on their applications, rather than just being asked to define one area? People applying in the west should at least be given the opportunity to list the counties in which they would like to work in order of preference. If people are forced to say that they will work in Mayo, they can only choose Mayo. Somebody on the Mayo-Galway border cannot have his or her application considered for both counties. This is absolute nonsense.

I am particularly concerned that when physiotherapists go on maternity leave or long-term illness leave or move to another location, the replacement process seems to meet an absolute dead end. It is not as if the HSE does not know when someone is going on maternity leave or when someone is going to retire. It has several months' notice, yet it does not respond by employing a replacement. Why is this? I know that three members of staff have left in the last three weeks alone, in addition to others who left in recent months.

It is not a surprise that physiotherapists are leaving. The pressure they are under to provide a service without having sufficient hours is unsustainable. When they are only able to see a child who needs weekly physiotherapy for one session every four to six weeks, it reflects on the integrity of the whole discipline and causes huge distress to the children, parents and the physiotherapists themselves.

It is also having a knock-on effect in other medical disciplines. People who should be fully recovered and active are having to be admitted to acute hospitals and having to go back to their GPs. This is all taking up valuable scarce resources. Patients from community and district hospitals are unable to be discharged because they cannot get the physiotherapy that would allow them to go home. These beds cannot then be used as step-down beds for acute hospitals, which backs up the accident and emergency departments and adds to the trolley crisis. In the meantime dozens of fully-qualified physiotherapists are forced to emigrate because they cannot find work in their own areas. I know one physiotherapist who has waited on a panel for months and who has now been offered €5,000 to relocate to Canada to work in the Canadian health service. Who is accountable for this debacle? What immediate actions will the Minister of State and the Government put in place to sort this out?

I will give the Minister of State an example of what is happening. Up to last September, physiotherapy for the Belmullet District Hospital and its community nursing unit was provided through primary care. A change was then made whereby this could no longer happen. Why did this happen? This is a crazy situation. There was already a backlog, which was being dealt with by a physiotherapist who was there. Will the Minister of State explain to me who, in their wisdom, decided that physiotherapy could no longer be provided to both of these facilities through primary care, but rather that it had to be provided through social care? There is absolute mayhem in the area of physiotherapy, in Mayo at least. I ask the Minister of State those questions specifically. What can be done to sort it out?

I thank the Senator for raising this very important issue. I am very interested in some of the points she has raised in this regard, particularly the last point because, in theory, we have a strong emphasis on services being provided within primary care settings. The Programme for a Partnership Government commits to a decisive shift within the health service towards primary care in order to deliver better care close to home in communities right across the country. That is the first thing. The aim of primary care policy is to provide services in local communities so that people can be maintained in their own homes and communities for as long as possible. Effective delivery of primary care services will enable people to have direct access to integrated, multi-disciplinary teams of GPs, nurses, physiotherapists, occupational therapists and others. It has been estimated that up to 95% of people's health and social service needs can be met within a primary care setting and primary care teams contribute greatly to enhancing community-based services in these areas.

In regard to the issues raised by Senator Conway-Walsh, physiotherapy services form part of the services provided by many primary care teams. In particular, physiotherapists play a key role in chronic disease management, especially in instructing and guiding patients through safe and appropriate exercise regimes. Physiotherapy services for adults and children are also delivered through specialist disability providers or early intervention and children's teams from birth to 18 years of age.

In regard to the specific issue raised by the Senator, I am advised by the HSE that physiotherapists in County Mayo have in the region of 37,000 face-to-face contacts in a year, which is a significant figure. The HSE has informed me that there are staffing related matters affecting the delivery of physiotherapy services in County Mayo. These staff issues relate to a number of factors in paediatric services across the county, including maternity leave, sick leave and a recent resignation, as mentioned by Senator Conway-Walsh. I am further advised that, in regard to adult services, a physiotherapy post in the Erris primary care area is now vacant as a result of maternity leave. The HSE is exploring the use of agencies to deal with priority one trauma clients in the area. These are the most urgent cases and require physiotherapy services after orthopaedic surgery and hospital discharge.

Delays in access to physiotherapy services can be very difficult for those affected. The need for additional therapy posts is highlighted in A Programme for a Partnership Government. At the end of February 2017, there were 529.38 whole-time equivalent physiotherapists employed by the HSE in primary care, of which 59.48 whole-time equivalents were employed in the community health organisation area two, which includes County Mayo.

To follow up the concerns of Senator Conway-Walsh, the HSE has established a service improvement group to develop a new model to improve waiting times for physiotherapy services. The terms of reference of the group include devising and implementing short-term measures to address current waiting lists and agreeing a revised national model of physiotherapy provision that will be standardised across all community health organisations. This group will examine standardisation of recruitment, which is very important, to include an agreed process and approach to vacancy management. That issue must be addressed. The work of the group is ongoing and a report on the issue is expected later in the year.

I thank the Minister of State for his reply. However, there is an absolute disconnect between what he has said and the reality on the ground. It bears no resemblance to what is being experienced by those waiting for and working in physiotherapy. It is very simple. The panels contain fully qualified, ready, willing and able physiotherapists. What is stopping them from being appointed?

The agency solution cited by the Minister of State worries me. Until he confirmed it, I could not believe it that private agencies are being engaged from Galway and brought into Mayo. Does the Minister of State know how long it takes to get from Galway to Belmullet in Mayo? It is a six-hour round trip. If that is the most economic way to deliver physiotherapy in Erris, God help us. It is not a solution.

Who is on the group and what advice is it being given? It is obviously disconnected from what is happening on the ground. The Minister of State's answer has given me no more confidence in the approach being taken. I appreciate that he has been given the answer by the HSE, but the situation needs far more urgent attention to solve the problems in the area. People are coming out of hospital after hip and other very serious operations without any physiotherapy follow-up. There is no realisation of the damage that is being done right across the board.

I thank Senator Conway-Walsh for her contribution.

I will definitely follow up the point the Senator raised regarding the service improvement group whose purpose is to improve waiting times for physiotherapy services. I will also follow up the Senator's point on the need to address issues such as the management of maternity leave and sick leave.

Another important issue and one which I regularly raise with the Health Service Executive is the outsourcing of services. When I hear about outsourcing, it sets off a red light in my head.

Senator Conway-Walsh also referred to the logistics involved in travelling from Galway to Belmullet. I have seen a similar example in the disability sector where we had a service which cost €80,000 per person. When a crisis arose in the health service, bills suddenly issued for twice this price. We will have to address that issue.

The Senator also raised the important issue of physiotherapist recruitment panels in the various counties. Those who have been placed on panels are ready to roll, as it were. I will raise this matter with the Minister. The message I will take to the Minister and the Health Service Executive is that we must ensure services are in place.

Sitting suspended at 3.06 p.m. and resumed at 3.30 p.m.