I welcome the Minister of State, Deputy Naughton, to the Chamber.
Nithe i dtosach suíonna - Commencement Matters
Primary Care Centres
The Minister of State is very welcome to the Chamber this morning. I thank her for taking this matter on behalf of the Minister for Health. I am seeking an update on primary care centres in Monaghan, Castleblayney, Clones and Ballybay. What stages are they at? As the Minister of State will know, Sláintecare reform is about transforming how we deliver healthcare in this country and building towards equal access to services for every citizen based on patient need rather than ability to pay. In putting people at the centre of the health system and developing primary and community health services, the Department of Health is working in conjunction with the HSE to provide new models of healthcare that will allow people to stay healthy in their own homes and communities for as long as they possibly can, which is vital. It is about providing the right care in the right place at the right time.
Primary care is an essential element of our healthcare system for the future, with all of the health and social care services you can find in your community outside of hospital providing a single point of contact with the health system. This is why the development of primary care centres in County Monaghan is so important. The primary care centre in Carrickmacross was opened by the Minister, Deputy Stephen Donnelly, approximately 12 months ago and is now successfully up and running. Different elements are at varying stages of development but the feedback has been very positive.
The primary care project in Monaghan town includes the refurbishment of the old Blackwater House facility on the beautiful campus of St. Davnet's Hospital in Monaghan town. The HSE has previously said that 40 to 45 staff will be located on the site once it is fully up and running. The project will include a major refurbishment of the Victorian building in Monaghan town and is expected to comprise two GP practices - I understand GPs have already signed up and committed to the project - community nursing, dentistry, adult mental health services, civil registration, adult and child disability services, psychiatry of old age and inpatient accommodation to name but a few.
I would be grateful if the Minister of State would give us the up-to-date position on the primary care centres in Monaghan town, Clones, Ballybay and Castleblayney because there is great interest in them. People can see that this is the future of healthcare in this country and they are very eager to see these facilities up and running as soon as is practicably possible.
The Minister for Health, Deputy Stephen Donnelly, asked me to thank the Senator for raising this issue and welcomes the opportunity to provide an update on the development of primary care centres in County Monaghan to the House.
A central objective of the programme for Government is to deliver increased levels of integrated healthcare with service delivery oriented towards general practice, primary care and community-based services to enable a "home first" approach. Primary care centres play an essential role in the delivery of that objective and significant progress has been made in the delivery of these centres nationally with 167 opened to date and a further 13 currently in construction. In community healthcare organisation, CHO, area 1, which covers the counties of Cavan, Donegal, Leitrim, Monaghan and Sligo, there are currently 23 primary care centres in operation. In County Monaghan specifically, there has been the addition of a new primary care centre in Carrickmacross, which became operational in April 2022. Furthermore, an additional two primary care centres are currently in construction in County Monaghan, Clones primary care centre and north Monaghan primary care centre in Monaghan town, with both due to become operational in the coming months.
With regard to Clones primary care centre, the construction process is the final stages. Commissioning and demonstrations are ongoing prior to the expected handover to HSE estates in early July. Subject to a successful handover, HSE estates expects that this primary care centre in Clones will be operational in August. When operational, the services available will include public health nursing, occupational therapy, speech and language therapy, physiotherapy, social work, psychology and dietetics services alongside GP services. The construction of north Monaghan primary care centre was recently completed with the final handover to HSE estates taking place on 30 June.
The HSE has informed the Minister that the centre is currently at the equipping stage and it is expected this building will be operational in August. The HSE has advised that a wide range of services will be available from north Monaghan primary care centre including public health nursing, occupational therapy, speech and language therapy, physiotherapy, podiatry, dentistry, ophthalmology, social work, psychology, mental health services and dietetics as well as GP services. An additional primary care centre is to be located in Castleblayney. This centre is at the early planning phase and is to be delivered via the operational lease model. An application for planning permission has been lodged, and once that planning process has concluded, the new primary care centre can progress through to the next stages of development, and it will then be possible to provide more detailed timelines for the delivery of that centre. The development of these primary care centres will be a welcome addition to the people and healthcare workers of County Monaghan, and I assure the Senator this Government remains committed to the provision of primary care centres throughout the country and, indeed, in County Monaghan.
I thank the Minister of State for her positive response to my query. That is great news regarding Clones and Monaghan town. It is to be hoped both those facilities will be up and running by the end of August or so, and that is a huge plus to the people of those areas. Also regarding Castleblayney, the planning application has been lodged there and that is a positive development. I am not sure what the updated position is regarding Ballybay and perhaps the Minister of State might have that information this morning. It is a very welcome development related to healthcare in Monaghan. In the week that is in it, the Monaghan injuries unit was one of the only ones in the country that did not open at weekends, but as and from this Saturday, 8 July, the injuries unit in Monaghan will open seven days per week. That is a very welcome development. It adds to healthcare not just for the people of Monaghan but for the whole region, and it will take pressure off the Cavan and Drogheda emergency departments.
I thank the Senator and will ask the Minister, Deputy Donnelly, to come back to him regarding Ballybay as I do not have that information here. I thank him for his question and reiterate what we have both said around the importance of primary care centres and that infrastructure to support the delivery of integrated care by facilitating closer co-ordination and co-operation between health professionals across the disciplines. I will come back to the Senator on his specific question on Ballybay.
Local Drugs Task Forces
I thank the Minister of State for coming to the Chamber. I am conscious this is my first interaction with her in her role as Minister of State with responsibility for the national drugs strategy. My question relates to the north inner city drugs and alcohol task force and I hope that when the Minister of State came into this role, this was one of the first issues brought to her attention. Over the past 26 years, successive governments have supported drug and alcohol task forces since they were established throughout the country. This is a really brilliant model in terms of understanding how we help those in addiction. It is not just about addressing the symptom of why people take drugs or what drugs they take but rather what are the supports required around it. The beauty of drug and alcohol task forces is that we have the statutory agencies, the community representatives, and those providing the services - the projects - sitting around the table.
The north inner city drugs and alcohol task force, under the chairmanship of Dr. Joe Barry, worked really well for many years in the north inner city until his retirement more than 18 months ago. Since then, there has complete stalemate. In fact, there has been a stand-off because the Department of Health, in its wisdom, decided it wants to let the north inner city drugs and alcohol task force effectively die. That is my question to the Minister of State, because there has been pleading to the Minister, to the Secretary General, to Department officials to ensure we have a functioning north inner city drugs and alcohol task force. Yet, we hear there is a report, and we have heard for many months now that there is a report coming, and yet nothing has happened. I really have to question the Department's motivation and intentions with regard to the task force. We know the officials in the Department are briefing the North East Inner City, NEIC, implementation board about drugs projects in the area, and that is fine. However, Government policy has been to support the drug and alcohol task forces where they are located, throughout the country, and yet it is failing to do so in the north inner city. It is doing so at a time where we are seeing crack cocaine, in particular, take off and replace heroin as the major source of addiction, and there is also the damage it inflicts upon individuals. On the supports that are needed, with crack cocaine, in particular, there is a much quicker deterioration in individuals . They have a much greater need for outreach because there is no parallel methadone or opiate replacement programme like we see for those who are addicted to heroin.
I am very conscious that the chairs of all the drug and alcohol task forces throughout the country are meeting at this time in Buswells Hotel across the road to talk about the increase in support they need from the Minister of State's Department, so I hope she is listening to them. In the face of all the problems I have mentioned, my appeal today is about the north inner city drugs and alcohol task force because the deprivation in communities there will only be solved if we ensure there are proper housing and health services and that we treat the underlying trauma that exists within these communities. That is what the task force is there to do, to co-ordinate services and identify where services need to go, and we do not have that in Dublin's north inner city. This has been acknowledged by many Ministers with responsibility for tackling the drugs issue, that the north inner city is probably one of the most disadvantaged and deprived parts of the country, and yet this Government is effectively letting that area down.
I thank Senator Sherlock for raising this issue and I welcome the opportunity to update the Seanad on this topic. Under the national drugs strategy, drug and alcohol task forces play an important role in co-ordinating drug and alcohol services in the community, based on an interagency partnership. I reassure the Senator that I am fully committed to the task force model. I recently addressed a conference on the role of task forces in responding to the needs of disadvantaged communities and tackling health inequalities, organised by the chairpersons’ network and hosted by the Department of Health. Last week, I published the strategic action plan for 2023-2024 under the national drugs strategy. It includes actions to address the social determinants and consequences of drug and alcohol use in disadvantaged communities. The task forces have a central role in delivering these actions.
I am also a strong supporter of the Government initiative to promote the social and economic regeneration of Dublin north east inner city. In 2022, the Department of Health allocated additional funding of €1.5 million to provide new health services for the local community. The Department of Health, through the City of Dublin Youth Services Board and the HSE, provides €2.2 million annually to community-based drug and alcohol services in conjunction with the north inner city task force. It is important there is effective and transparent governance of this funding by the task force.
The Department of Health and the HSE had been working with the task force to enhance its contribution to the NEIC initiative and to address governance issues identified in an independent review of services. In January 2021, the Department of Health and the outgoing chair agreed a process for selecting a new independent chairperson, in accordance with the task force handbook and with the assistance of a professional recruitment agency. Unfortunately, this process was not adhered to, leading to an impasse in the appointment of a new chairperson. The Department of Health sought to work with the task force leadership and membership to address governance concerns. However, it was not possible to resolve these concerns without the support of all parties. The outgoing chairperson resigned in September 2021, and in November the task force informed local services that it was no longer in a position to function.
The Department of Health has consulted members of the task force and other stakeholders on the next steps to establish effective, inclusive and transparent governance of the task force.
This involved a series of meetings with public representatives, statutory and non-statutory members of the task force, front-line community and alcohol projects funded under the ambit of the task force, community and service user representatives, staff employed by the task force company, and other stakeholders. A report on the governance of the task force has been prepared, which I am now considering. I am committed to establishing effective, inclusive and transparent governance of the task force, informed by a review of developments to date and the consultation process. It is my intention to approve steps to reconstitute the task force shortly.
I thank the Minister of State. We need the report. She has been in her role for seven months. Our understanding since late last year is that the report has been prepared. It is telling that while the Government and, with respect, the Minister of State, speak about commitment to the task force they sit on a report for a period of seven months or longer. If it is not for that period, then correct me. The Minister of State has said it is her intention to take steps to reconstitute the task force shortly. Will she give us a timeline today? Will she advance this and bring some news on this situation? When I speak to the projects in the inner city, they state they face an enormous crisis with regard to recruiting staff and trying to advocate for more money. The task force did that for them but it is no longer there. It no longer functions, as the Minister of State has said. We need to hear today when she will announce the steps and when exactly she will publish the report.
I acknowledge the important contribution of the independent chairs of the task forces. They facilitate the partnership between the statutory and the community bodies at the heart of the task force model. The success of the task force model depends on the commitment of the skills and energies they bring to the role. The independent chairs are also key to the effective governance and performance of the task forces. I want to ensure the north inner city task force has an independent chairperson who has the support and confidence of all of the members of the task force and can lead it in contributing to the social and economic regeneration of the area. The officials are working on proposals to develop a governance and performance framework for task forces. This will assist task forces in complying with best practice, including the selection and appointment of an independent chairperson. They will engage with the chairs network to progress this work.
Disability Services
I thank the Minister of State, Deputy Rabbitte, for coming to the Seanad. She is always very welcome here, as she knows.
I welcome the Minister of State to the House. Every time I table a Commencement matter I have the pleasure of her responding. It is great to have an opportunity to debate this major issue. I know the Minister of State has a great interest in it, given the correspondence she has sent to my office.
This is about trying to make sure we put in place a suitable transportation network for vulnerable adults trying to attend services in Bantry. For the past 12 months in particular, it has been a big issue for 11 vulnerable adults in the Bantry, Beara, Castletownbere and Ardgroom area. They need transportation in a very remote part of Ireland on the Beara Peninsula. They must go from places such as Ardgroom and Castletownbere to Bantry for services they truly love. They are very much part of the services being provided. The transportation network is a major issue. There has been a month-by-month saga about how the transportation network would be provided. The HSE has been involved, as has the Society of St. Vincent de Paul and private charities, trying to make sure a service is put in place so these vulnerable adults can get to their destination.
We had a scenario where Local Link, which is a wonderful service in many ways, became part of the solution. To be quite honest, it was never going to be a solution to the degree that the parents and vulnerable adults hoped it would. There are three destinations involved. These are the National Learning Network centre, CoAction and the Rehab care centre. The transport network needs to be tailored to the needs of these individuals and vulnerable adults. They need that little bit more support to make sure they can reach their full potential. The parents and the community are up in arms about where we are going. I realise the Minister of State got involved in recent months and provided funding so that it would be extended to the end of this month. The question now is what will happen next. The clock is ticking.
We have had a big debate in Irish society about how we will make sure we will put transportation links in place. There is a review of the school transportation scheme. It is not in the Minister of State's Department but it is a very important part of making sure everyone is part of the transportation network. The school transportation scheme will look at children. I believe there should be a transportation scheme put in place for vulnerable adults. I was contacted by a mother from Kilbrittain who had to give up work to take her vulnerable adult to services in Dunmanway. There were services for the person as a child but there was no transportation after the person reached the age of 18. This mother has taken a step back in her own life to support her family.
There is a policy issue with regard to how we can make sure vulnerable adults in all settings can be catered for when it comes to transportation networks. This is an important plank we need to start talking about. The issue is about a very remote part of west Cork going from Ardgroom all the way over to Beara and into Castletownbere and Bantry. This cohort of 11 adults need a little bit of extra care. Putting them on a Local Link service will not work. Their parents are absolutely distraught about what will happen. I realise this is a very tough situation but we need a roadmap and we do not have one at present. I hope the Minister of State will be able to enlighten us on what the national policy is and how we will progress this issue.
I thank Senator Lombard for raising this important matter today. The HSE provides specialist disability services, including day services and rehabilitative training, to people with disabilities who require such services. While day service funding does not include transport, some transport supports are provided by the HSE or funded agencies on a discretionary basis, and a variety of transport solutions are pursued in different CHO areas. To be quite honest, this discretionary basis is the nub of the issue. We are speaking about a remote part of Ireland, no different than if I were speaking about a remote part of east Galway, where we do not have a DART, Luas, metro or other such service. This is what we are speaking about. It is about trying to stop the sticking plaster approach. This is what Senator Lombard is asking me about today. To be fair, on the previous occasion this arose, I intervened. I do not think it is the role of the Society of St. Vincent de Paul to solve this problem. It is incumbent on the Government and agencies out to come up with a solution.
There was hope there might be a way to work with Local Link, as it has services, but to be realistic this will not work for the 11 vulnerable young adults. There are various destinations involved. We are looking for pick-up points whereas under the public service obligation there are destination points. These are two very different conversations. We have to bottom out completely whether there is extra scope in the Local Link service whereby it can run an additional service. I would look to see whether Local Link has the flexibility to provide an additional run in the morning and in the evening to cater solely for these young adults, with no other passengers on board. To be very fair to the chief officer of the South/South West Hospital Group, Tess O'Donovan, she has given me and all of the families an extension of three months to try to come up with a permanent solution.
The most important thing the Senator can bring back to families when he leaves today is that we have funding in place for three months in order that we might bottom out a solution. However, we need a unique solution that will not be discussed every three to six months on the floor of the Dáil or the Seanad. We need to find a permanent solution to address the needs of young people going to rehabilitation training, young people attending CoAction and young people going to the National Learning Network. Young people at different levels of development need to be supported and at some stages there might be a transition period. For example, they might need a personal assistant, PA, at the start to help them to learn how to use public transport and then they might become accustomed to doing so independently. Some young people will always need PA support no matter what. We need to look at it in the round.
It is about what needs to be put in place. It is not about funding. A permanent solution to providing access to travel must be put in place. I would like to think that if we have an operator running a route, we could work with it for a morning and evening expansion of the service or that a bespoke service like the HSE initiatives in counties Kerry and Leitrim could be put in place. They are run under the open routes model. The HSE designed it. Perhaps the Senator's remote area is an example of where it needs to be piloted, operationalised and looked at as a permanent solution funded by the National Transport Authority, NTA, in conjunction with the Department of Health. The same bus route could double up to bring adults to day services, such as dementia clinics, later in the day or to bring them to hospital appointments. We need to look at not only disability but the wider community context.
I thank the Minister of State for the detailed response.
As the Minister of State correctly said, it is about trying to get a realistic approach on time so that we do not have to come back in three months. The discretionary funding from the HSE seems to be the avenue we need to start talking about. The HSE has a pot of money available. As the Minister of State indicated, it worked in a remote area in Kerry. That seems to be the scenario we need to start pressing. The Minister of State correctly said that the Society of St. Vincent de Paul and the local community are not the financial providers. It must come from the national Government. Will she give some clarity about the conversations that need to happen to get discretionary funding from the HSE in place so that this permanent service can be put in place? Will she outline where we need to go for that conversation so the HSE can come on line? I acknowledge the Minister of State's commitment that this has been sorted out for the next three months. That is important. We need a timeline for how the HSE could step in when that ends.
When I say it has been extended for three months, that means that all service users will have a service in September. That is the most important thing.
In the national context, the HSE has been working with the NTA on the issue of transport to day services through the open routes project. Open routes is based on the idea that transport to HSE services, such as day services, would be best served by accessible local public transport, Local Link, transporting people to day services and servicing the wider local community. It is a HSE open routes model as opposed to an open routes Local Link model. It is bespoke. At a cross-Government level, in the context of projects such as open routes and the transport working group which I convened and which reported earlier this year, the Government is working to find a more sustainable solution to the broader issue of transport for people with disabilities. Deputy Christopher O'Sullivan and I are trying to work out what a good model would look like, what would work for all and what would meet future needs with the NTA, Local Link, the HSE and providers. I am trying to convene a meeting in that regard, and Senator Lombard is invited to attend.
I thank the Minister of State. I know she could have done with more than one minute but, unfortunately, that is the process. I thank her for her time, for coming to the House and for being available to Members. It is greatly appreciated. I also thank Senator Lombard for raising his matter.
Cuireadh an Seanad ar fionraí ar 11.05 a.m. agus cuireadh tús leis arís ar 11.30 a.m.
Sitting suspended at 11.05 a.m. and resumed at 11.30 a.m