The Minister of State, Deputy Anne Rabbitte, is very welcome. As always, it is good to have her in the Seanad.
Nithe i dtosach suíonna - Commencement Matters
Covid-19 Pandemic Unemployment Payment
Good morning. I will go back to something that has been raised here on numerous occasions by numerous representatives and it relates to the pandemic unemployment payment. I am speaking on behalf of the staff at St. Christopher's Services in Longford, which is a section 39 organisation with more than 200 staff members providing daytime, residential and respite care for many adults and young children in our community. I am aware it is a place the Minister of State knows personally. I know she has visited it and that funding has been made available through her Department for numerous advances in the facility. It is one of those treasured facilities that we have in our county. There were challenging times, particularly during the pandemic, and there were challenges in keeping staff and pay parity etc. because of the fact that it is a section 39 organisation. We have to put on record our thanks to all the staff for the work they did during that time. That was recognised by the Government with the announcement of the pandemic payment, that is, the €1,000 grant for those who worked throughout that time. However, like other areas within the health service and similar to other organisations, a substantial number of staff still have not received that payment two years on from the initial announcement. Frustration is growing among the staff regarding this. I bring it to the House and to the Minister of State today, on behalf of all the staff to get clarity as to what the situation is and on when all staff will receive their payments. Yet again, we thank the staff for the work they have done down through generations in St. Christopher's Services on behalf of all the families in the county. We need clarity now on when that payment will be put in place.
I thank the Senator for raising this issue this morning. Last year, the Government announced a generous tax-free Covid-19 recognition payment for front-line healthcare workers to recognise their unique and exceptional role during the pandemic. The Senator is quite right; I know St. Christopher's Services quite well. I have visited a number of times and acknowledge the phenomenal work of the staff. Following extensive union consultation, eligible guidelines were first published online by the HSE on 19 April 2022. The Government based its decision on the substantial risks eligible healthcare workers faced. To be eligible, healthcare workers employed by the HSE section 38 organisations must have been in Covid-19 vaccination cohorts 1 and 2 and worked ordinarily in a Covid-19-exposed healthcare environment for at least a four-week period between March and June 2020. The first flaw in this script is that while it clearly acknowledges the HSE and section 38, whoever typed this for me has omitted to include section 39. It is my understanding that section 39 organisations were part and parcel of the cohort of workers who were to receive payment. Therefore, I apologise for the fact that it has been omitted from the Cathaoirleach's script also and I will seek clarity on that.
In addition to the HSE section 38 staff, six specific cohorts are eligible subject to all other criteria. These include private sector independent nursing homes and hospices; eligible staff working on site in section 39 long-term residential care facilities for people with disabilities; agency staff working in the HSE; healthcare support assistants and members of the Defence Forces redeployed to work in front-line Covid-19-exposed environments; and pandemic paramedic staff employed by the Dublin Fire Brigade to deliver services on behalf of the HSE. It is also important to understand that when long-term staff who supported people living in long-term residential services, that is, day-care centre staff, went in to support during that period of time, it also applies. That is a nuance that needs to be understood. To date, those who meet the criteria, more than 2,000 eligible healthcare workers, have received the pandemic recognition payment.
As of 2 June the HSE shows 143,556 staff paid, comprising 90,410 HSE staff and an estimated 53,146 section 38 staff. The payment to staff in the HSE and section 38 organisations is substantially complete. Appeals for these specific groups were referred to an agreed joint HSE management and union committee. Over 3,500 appeals outcomes are now complete. The Department of Health transferred funding to the Defence Forces and Dublin City Council in respect of Dublin Fire Brigade paramedics and eligible Defence Forces staff. I understand that these payments are now complete.
Regarding non-public sector employees, the HSE and the external contractor, KOSI Corporation, are continuing to make significant efforts to progress payments to those eligible. Information on the process involved has now been provided to 850 organisations and, of these, 740 have applied for funding to make the recognition payment. Some 689 organisations have already been paid or approved for payments for 66,693 eligible staff. Due to the complexities of the cohort, contractors had more supporting evidence to compile, while agencies have a large number of employees and employee locations to collate. These submissions are currently being managed through the KOSI process.
I am a little bit baffled with that reply. It refers to eligible staff working on site in section 39 organisations, which covers St. Christopher's, yet there is reference made constantly to section 38. I just want to get clarity on that. I do not think the Minister of State's response answers what I asked. I does not give me the answer I looked for. I wonder if the Minister of State might be able to clarify it further with specific reference to St. Christopher's.
As I am taking this on behalf of the senior Minister in the Department of Health, I will give the Senator my understanding from reading the script here. My understanding is that the €1,000 bonus payment was paid firstly to the HSE staff. It was then paid secondly to the section 38 staff. They are currently working their way through the section 39 organisations. There are 850 of those section 39 organisations, of which 689 have compiled a report back in. There are 66,000 staff right across it and they are currently working their way through it. That is how it reads to me. The process is going far too slowly for the staff who are section 39 workers. It is my understanding, based on the first page, that anyone who worked in a Covid centre qualifies for the payment if they were there for longer than a month. If they had to flick in and out, or if they were day service staff who had to step up to provide relief cover, they qualify as long as they did that over a period of a month across the entire pandemic. I think it is unfortunate that the likes of St. Christopher's and other organisations actually have to demonstrate how the person calculated their days if they were not solely assigned to that residential facility.
I thank the Minister of State. Let us hope it is resolved. I know the wonderful work the staff in St. Christopher's in County Longford do every day.
Mental Health Services
I thank the Minister of State, Deputy Rabbitte, for coming in. She will know that the report of the task force on youth mental health was published in 2017. Subsequently there was a commitment by the Government to set up a pathfinder unit for youth mental health. One of the asks of the youth mental health pathfinder project was to effectively embed a new model of cross-government working using section 12 of the Public Service Management Act 1997. This pathfinder project is crucial to opening up a more collective approach to youth mental health, facilitating the working together of several key Departments, namely the Department of Health, the Department of Children, Equality, Disability, Integration and Youth, the Department of Education and the Department of An Taoiseach. Organisations such as the Irish Society for the Prevention of Cruelty to Children, Mental Health Reform, BeLonG To Youth Services and Spunout.ie, as well as Professor Mary Cannon of the Royal College of Surgeons in Ireland, Dr. Tony Bates and other individuals and politicians, have continuously highlighted how children and young people have been seriously impacted by delays in access and lack of resources in mental health services in Ireland. Six years later, there has been no action by the Minister of State's Department to deliver on this commitment.
Responses to several parliamentary questions from various Deputies including my good comrade, Deputy Mark Ward, have received almost identical responses each time. This response states that the proposal is to formalise a new model for collaborative working within government and place a pathfinder unit on a statutory footing through section 12 of the Public Service Management Act 1997. The response goes on to state that as this section has not been used before, various administrative, budgetary, governance and legal arrangements need to be developed and agreed with the Department of Public Expenditure, National Development Plan Delivery and Reform to ensure a robust and workable model for the unit. It goes on further to state that the demands on both Departments during the pandemic have presented challenges in progressing the proposals and that, nonetheless, the Department of Health has engaged with the Department of Public Expenditure, National Development Plan Delivery and Reform to develop an implementation option that fully addresses these issues. That is a very long way of saying that this is complicated and the Department is too busy. Is that really what the Minister of State's Department and the Government are telling our children and young people at home who are waiting years for appointments for their mental health?
The mental health services are beyond a crisis. We have seen a damning report in January and the spotlight report released at the beginning of May. We know the situation is dire. We have reached record numbers waiting for first-time appointments with child and adolescent mental health services, CAMHS, with 4,434 waiting overall, of whom 682 are waiting over a year. This is a rise of 110% and 215%, respectively, since the Government first took office. There are more than 11,000 children waiting for an appointment with primary care psychology. Some 22% of children in community healthcare area CHO 3, which covers Limerick, are waiting longer than a year for their first appointment. Jigsaw in Limerick has waiting times of around 18 weeks, nearly five months for a young person in crisis to be able to get some support. CAMHS must be extended to help young people up to the age of 25, by which age 75% of chronic mental ill-health has been established. Provision should also be made for child counselling in primary care. I want to stress the importance of setting up the pathfinder unit as a matter of urgency at a time when youth mental health services in this country are wholly inadequate and in a state beyond crisis point. That the Government has not progressed the long-awaited pathfinder unit after six years is another piece of damning evidence that it does not treat mental health and the well-being of our children and young people with the urgency it deserves.
I thank the Senator for raising this important issue. I am taking it on behalf of my colleague, the Minister of State, Deputy Mary Butler. The Government remains committed to the development of all aspects of mental health services nationally, including those for children and young people. This is reflected by the record allocation of over €1.2 billion for mental health in 2023, which includes a wide spectrum of services for young people ranging from prevention and early intervention to clinical programmes or acute inpatient care. The Sharing the Vision policy has various recommendations relating to children and adolescents, including promoting a more holistic and whole-of-government approach.
In terms of child and adolescent service development and improvement, a significant recent announcement under the HSE service plan 2023 is the creation of a new post of youth mental health lead at assistant national director level, and a new clinical lead for youth mental health. These posts will allow the HSE to focus on the provision of more integrated services for young people, as envisaged under Sharing the Vision and Sláintecare.
With regard to the proposal to establish a cross-governmental youth mental health pathfinder unit, ministerial approval was received during the previous Government to convene an interdepartmental group with participation from the Department of Health, the Department of Education and the Department of Children, Equality, Disability, Integration and Youth. In addition, its establishment is contained within the current programme for Government. It has always been envisioned that such a collaborative approach would provide a beneficial way to address service improvement, and would help to ensure that barriers to accessing mental health services by young people are broken down, with the benefit of services being integrated, signposted and accessible. This integration of accessible, signposted services remains to the forefront of all youth mental health service improvements.
However, as the Senator will be aware, the demands on these Departments during the pandemic have presented challenges to progressing the pathfinder unit.
The realignment of departmental functions in the education sector, specifically the establishment of the Department of Further and Higher Education, Research, Innovation and Science, has also necessitated some further consideration of the initial proposal and make-up of the pathfinder unit. This is not to say that work in this area has not continued or that important interdepartmental collaboration has not continued. As my colleague, the Minister of State at the Department of Health, Deputy Butler, will confirm, improving mental health services for young people is a key focus for her and her Department. Opportunities for service improvement and policy implementation are constantly being actively engaged in by both the HSE and officials in the Department of Health.
To this end, I can confirm to the Senator that the Department of Children, Equality, Disability, Integration and Youth is currently developing the next national policy framework for children and young people as a successor strategy to Better Outcomes, Brighter Futures. As part of this work, that Department is liaising with the Department of Health to launch a youth mental health spotlight programme aligning Departments with responsibility for health, well-being and education and tasked with making the navigation of treatment and support mechanisms easier for parents and young people alike using resources in this area to best effect. Both I and the Minister of State, Deputy Butler, look forward to how the work of the pathfinder project to date can be used to inform the youth mental health spotlight programme. I assure the Senator that I will continue to keep this matter under review in the context of progress to date or planned-for mental health legislation, policies and services relating to young people.
It is an extraordinarily long reply that tells me very little. The simple question at the heart of this Commencement matter is when will the pathfinder unit be set up? We are six years on from the recommendation and excuses are fairly thin. The Minister of State talks how about the establishment of the Department of Further and Higher Education, Research, Innovation and Science has necessitated some further consideration of the initial proposal. That was three years ago. What the Minister of State seems to be saying is that six years on from the recommendation to set up the pathfinder unit, she is not even in the position to tell me when it will be set up.
If that is the case, and it looks to be the case from the answer the Minister of State gave me unless she is able to give me a date in her response, that is an abject failure on the part of the Government. It is an abject failure on the part of the Government that is failing our young - our most vulnerable children and adolescents - and is entirely unacceptable.
As I am deputising for the Minister of State, Deputy Butler, I cannot give the Senator a date and time. There is no doubt that the issues around youth mental health span many Departments and improved co-ordination in this area is needed. Improving access to youth mental health services for children and their families remains a priority for the Minister of State, Deputy Butler, the Minister, Deputy Stephen Donnelly, and the Department of Health. The fact that the pathfinder project is a programme for Government commitment also highlights how this Government is committed to ensuring that interdepartmental collaborative work is best used to ensure that mental health services are integrated, accessible and signposted.
While the Covid pandemic may have delayed the formal progression of pathfinder, I can confirm to the Senator that the important work on the delivery of its priorities has continued at pace. This can be seen in the establishment of the new assistant national director post of youth mental health and the inclusion of youth mental health as a spotlight project for the forthcoming national policy framework for children and young people. There will be further updates on this work as the year progresses.
Health Services
I thank the Minister of State for coming to the House to discuss the very important issue of palliative care services in the north east of Ireland, which is where I come from. I am raising this issue today because of a real discrepancy in the services that are being provided in the CHO region - not compared to the rest of Ireland but in the region itself. It concerns the difference between the services provided in Louth and Meath and those provided in Laois and Offaly, which are in CHO 8.
Many specialist palliative care, SPC, teams are similar in structure. They have a team of clinical nurse specialists and three consultants in palliative care medicine. In the summer of 2022, one consultant said on local north-east radio that there would be a waiting list for palliative care services in the north east as a result of increased challenges after the pandemic - a waiting list for terminally ill patients. Patients requiring palliative care have already gone through so many treatments and hospital appointments. They have done literally everything to have an extra day on this earth. Regarding the cancer strategy that was announced in 2017, we guarantee as a right that people will have the ability to die in their own home, own bedroom and own bed. There are people in my county of Louth and my neighbouring county of Meath who are not being given that choice and, as a result, are dying in hospital and acute settings, rather than where they want to be.
The reason for that is quite simple. Again, I will focus on CHO 8 in my neighbouring area. In Cavan and Monaghan, with the exception of Louth and Meath, public health nurse services are operational in the management of symptom and pain management and have the skills to administer the syringe treatments and ensure that all patients are being seen in their place of residence as opposed to a hospital. To be clear, in the CHO 8 area, in Laois and Offaly, nurses are able to go into homes and administer pain relief medicine. However, this is not the case in Louth and Meath. Nurses there are not allowed to do that. Instead they are getting the nurses above them - the specialist clinics - to do that but there is a shortage of those specialist clinics. This is not a case of a supply issue or a staff shortage. To be honest, the end-of-life treatment you get is almost a lottery based on your geographical location. If you are in Louth and Meath, we will not send in public health nurses to give pain relief medicine such as injections, syringe-based treatments and palliative care. We are, however, doing it in Laois, Offaly, Cavan and Monaghan, as well as other parts of the country. There is a discrepancy and I do not understand why this is happening. I have example after example of people in my county of Louth dying in hospitals because they were unable to die at home, which was their last wish, because staffing arrangements in the HSE are different in Louth and Meath compared with Laois, Offaly, Cavan or Monaghan. It is upsetting to say the least that this is happening. For as long as I am a Member of this House, I will continue to fight for people in my county of Louth and my town of Dundalk to ensure they have the same right of access to palliative care as that of people in other parts of the country. It is down to a staffing decision in the HSE. Why on earth is a nurse able to give palliative care treatment in Laois or Offaly but nurses are not allowed to do so in Louth or Meath? It does not make sense.
I appreciate the Minister of State coming in here and that I am throwing a lot at her that she might not have known about before coming in here. Perhaps after this debate, either through the offices of the Minister of State or the Department of Health, we could set up a meeting between myself and CHO 8 in the Louth-Meath area to see how we could fix this.
I thank the Senator for bringing such a valuable contribution to the floor of the Seanad. I compliment the Leader of the Seanad on accepting it because I was totally unaware of the discrepancy. I will read the script prepared by the Minister, Deputy Donnelly, and then I will give an answer. The Minister for Health has been advised that SPC services in Louth and Meath provide care to patients of all ages irrespective of diagnosis, cancer or non-cancer, on the basis of need alone. These services are provided by a multidisciplinary team, including consultants, clinical nurse specialists and a range of health and social care professionals. Patients may be referred at any stage of illness, in some cases from the time of diagnosis.
The HSE has informed the Minister that all patients are triaged in line with national policy. Consideration is given to the reason for referral, the patient's underlying diagnosis, his or her symptom burden, and how acutely unwell he or she may be. Triage usually occurs on the same working day as referral, or in some cases the following day. The HSE has stated that it is unusual that triage wait times would be longer than two days. The HSE has informed the Minister that the percentage of patients triaged within one working day in Louth has increased from 51% in 2020 to an estimated 81% in 2023. The triaging of patients categorises their needs, in a formalised way, on the basis of this information. The patients may be categorised as U1, to be seen within 48 hours; U2, within seven days; or U3, within 14 days. These categories have been determined nationally - this is the national policy on triaging. The triage process can be short-circuited by a simple phone call from the GP for any patient who is deemed to be at the end of life or imminently dying.
These patients will be seen ordinarily on the same working day, Monday to Friday. New referrals over the weekend are dealt with on the next working day. The Minister has been advised that referral rates have increased for both Louth and Meath since 2020. The first assessment of all patients is ordinarily taken by a clinical nurse specialist or, in some cases, depending on the complexities, may be undertaken by the consultant. In line with the HSE policy on digital health, some first assessments are undertaken virtually. The decision regarding a virtual or face-to-face assessment is made on the basis of information in the referral and informed by discussions with the primary referring GP or hospital consultant. Should it become apparent an assessment is required face to face, it is usually done on the same or next working day.
I do not think the Minister, to be fair to him and his team, had a clear understanding of the issue the Senator laid out. The prepared reply with which I was provided relates to the national policy, the timelines and how assessments are administered, but the Senator is asking about what happens when persons are discharged to their home and pointing out that the approach to the right to end-of-life care provided to them in their home is very different from how it is done in Laois and Offaly or Cavan and Monaghan. It is not in keeping with the practice in the rest of the CHO. There seems to be a higher level of administrative inconvenience in Louth and Meath than in the other regions, where a public health nurse is able to address the issue. In Galway, the public health nurse is part and parcel of the process, as happened in the case of my own mum. I will hold a meeting, subject to securing the support of the Minister, with representatives of the Senator's CHO to have a clear understanding as to why there is not equity of access to public health nurses for all patients at a palliative care level throughout the Senator's CHO.
That is very promising. As always when the Minister of State comes to this House, she has come with a fair and balanced view. I greatly appreciate the outcome she outlined. What is needed is a fundamental review of the services in Louth and Meath with a view to finding out why they are different from elsewhere.
To be clear for the record, in Laois, Cavan and Monaghan, public health nurses provide that pain management, whereas in Louth and Meath, it is still managed by clinical nurse specialists, who are a tier above that. Why is that happening? Why do people have to return to a hospital to die, rather than have a public health nurse administer palliative and end-of-life treatment? It is deeply upsetting for the many people who have to go through this. People want to die at home, surrounded by their friends, family and loved ones. They want to die in an area where they are comfortable. As part of the cancer strategy, we have to provide that for everyone, but there is a clear discrepancy whereby people in my county, Louth, and my town, Dundalk, are being severely discriminated against compared with people living across the county border in Cavan, Monaghan and elsewhere in CHO 8. I would appreciate if that discrepancy were rectified.
I again thank the Senator for raising this issue. Due to its urgency, I will ask my office to liaise with that of the Minister to get it set up straight away. I would hate to think we did not have public health nurses throughout Louth and Meath, so we must address how the practice is delivered there. We will address that over the coming days.
I thank the Senator for raising that important issue.
State Examinations
I thank the Minister of State for coming to the House on behalf of the Minister for Education. My question relates to the inconsistencies that have arisen in respect of leaving certificate 2023. I am sure the Minister of State has heard the reports on the radio and perhaps she herself has been contacted about this. Students in the area I represent who are sitting the leaving certificate or junior certificate were very upset and a great deal of stress and pain was caused to students by the lack of consistency. Eight or ten years ago, there was always a similar thread running through the questions, but this time, the way the questions were phrased gave people an awful shock and it took them a while to understand what was being asked of them.
I was contacted by one strong student who sent me a text message to ask whether there was any hope of bringing the State Examinations Commission before a committee, for example, to hold it to task. That was how upset the student was about it. I am not asking that the questions be made easier or anything like that, but it was unfair, not least for students who had never previously sat a State exam. For the junior certificate students who are sitting exams this year, these are their first State exams and they will take the leaving certificate in two or three years' time.
What is going to happen? Will the bell curve be reconsidered in the correcting of the papers? I would like to get a commitment from the Department that there will be consistency and that common sense will prevail. This has put so much strain on students. Many of them were upset for the entire weekend. It is not right, in the middle of State exams, that students should be so upset, and it is not just them but also their families.
I thank the Senator for raising this important matter and welcome the opportunity to update the House. As she said, I am taking the matter on behalf of the Minister for Education.
Throughout the education system, including in respect of State examinations, progress is continuing to return the education system to normality following the disruption to teaching and learning resulting from the Covid-19 pandemic. The Minister and her Government colleagues recognise the impact the pandemic has had on students and their well-being and the disruption to teaching and learning it has caused. As I am sure the Senator is aware, the State Examinations Commission has responsibility for the development, operation and delivery of State examinations. I acknowledge the work and commitment of the commission and, indeed, all education stakeholders in the ongoing progress being made to return to normality.
The Senator will be aware summer 2022 marked the return to externally delivered examinations for all candidates in both the leaving certificate and the junior cycle. This was a welcome step towards normality after the calculated and accredited grades process, which was implemented in 2020 and 2021. More than 135,000 students combined are sitting this year's leaving certificate, leaving certificate applied and junior cycle examinations at more than 800 post-primary schools and other venues throughout Ireland. I welcome the recent confirmation by the State Examinations Commission that it intends to issue the leaving certificate 2023 results on 25 August. This is a full week earlier than was the case for the 2022 results, which issued on 2 September last, and it provides clarity for students, parents, teachers and other stakeholders. This is a significant and welcome step towards pre-pandemic norms in the timing of the issuing of results.
In recent years, adjusted assessment arrangements have been made for both the leaving certificate and the junior cycle to take account of the disruption caused by the pandemic. Last September, the Minister announced that adjustments would be made to assessment arrangements for the 2023 cohorts in line with the impact of the pandemic, and in May, she indicated those adjustments will also be made to the assessment arrangements for students due to sit State examinations in 2024. With regard to grade inflation in leaving certificate results, the Minister has been clear there should be no cliff edge return to pre-pandemic grade levels in the leaving certificate and, as a consequence, post-marking adjustments will be made in 2023.
The Senator is quite right in saying I too was inundated with a lot of upset callers last week, particularly on Saturday. Parents were very concerned for the welfare of their young people. To be fair, there has been a great deal of positive support in the media regarding how to move on and focus on the remaining exams, but I take on board what the Senator is saying. The Minister is acutely aware of the issues the Senator wished to raise, which is why she was adamant this Commencement matter be taken with a view to airing those concerns. There is a great deal of upset not just for the students sitting exams this year but also for those who will come forward next year and might never have sat a State exam previously. I will convey the Senator's concerns to the Minister.
I appreciate that. I hope I am not insulting the Minister of State in pointing out she is not the Minister for Education.
I appreciate her acknowledgement that students have been through a lot, as the Minister, Deputy Foley, has acknowledged as well. I hope some leniency is given to students. They are in the middle of the second week of examinations. It has been a really awful time for students and they are still very upset and downbeat about it. I hope leniency will prevail because the situation is not fair on the students, especially those who are looking to go to college or do an apprenticeship. They need their marks and many of them are concerned that if their mathematics result is down, they will not get into their course. There is a great emphasis by the Government on science, technology, engineering and mathematics, STEM, subjects. I thank the Minister of State for taking this matter and for undertaking to engage with the Minister on it.
I thank the Senator for raising this important issue. I hope the information that has been provided to the House is helpful. The Minister recognises the pressures on students sitting State examinations and the pressures on schools preparing them for these important milestones. The State Examinations Commission and the Department of Education are committed to continuing to work together to return the greatest possible level of normality for young people.
Regarding last week's higher level mathematics paper one, the Minister understands the SEC has advised that it prepares examination papers and drafts marking schemes through a rigorous development process. Those involved are experts in their subjects and experienced teachers. The commission has also advised that commentary and correspondence on the examinations from students, parents, teachers, professional bodies and other interested parties is a normal part of the examination process. Such correspondence is brought to the attention of the chief examiner and is considered in the refinement of the draft marking scheme. This approach to the development of the final marking scheme aims to ensure consistency in the marking of papers and fairness for candidates. To assist and support leaving certificate students, the National Educational Psychological Service, NEPS, has developed a range of online well-being resources. It is important to put that information on the record of the House.
I thank the Minister of State for coming to the House and taking all four Commencement matters. We know she is very busy.
Cuireadh an Seanad ar fionraí ar 10.13 a.m. agus cuireadh tús leis arís ar 10.30 a.m.
Sitting suspended at 10.13 a.m. and resumed at 10.30 a.m.