I welcome the Minister of State, Deputy Calleary.
Nithe i dtosach suíonna - Commencement Matters
Hospital Services
Gabhaim buíochas leis an Aire Stáit as ucht teacht isteach chun an nithe i dtosach suíonna seo a fhreagairt. This important issue affects families throughout the country. It relates to neonatology services, particularly in children's hospitals, and the provision of neonatal intensive care units, NICUs. We have a problem. There are NICUs in maternity hospitals, but where babies requiring surgical interventions or interventions in certain specialist areas are transferred to the four Children’s Health Ireland, CHI, hospitals in Dublin, there is no NICU available to them. They are going into what is called a paediatric intensive care unit, PICU. Although the professionals there are highly qualified, they do not have the specialist skills involved in neonatology, including neonatological intensive care.
We are discussing incredibly vulnerable children - the tiniest, most premature, sickest babies who are born in Ireland – who are most in need of highly specialist intervention. These are babies who sometimes weigh less than 0.5 kg and whose lives are very much in the balance. We are lucky to have people within our medical services who are highly qualified in making surgical interventions – what is called subspecialist intervention – to save these babies’ lives.
I read in The Irish Times that Dr. Ann Hickey has resigned from her position as clinical lead of neonatology services because she has repeatedly asked the Department and the HSE to provide an adequate number of qualified people and NICUs in children’s hospitals to serve these vulnerable patients. Those have not been provided, which I understand is why she has stepped down.
What I have outlined creates a major problem. It sets us behind every other EU country. We are not making these necessary facilities available. Worse, we hear all the time about how we are spending so much money on a state-of-the-art children’s hospital. That is welcome and there is physical provision within that for NICUs and the neonatology teams that would service these very vulnerable patients, but it will not be possible to set up such a team there once the hospital opens. It is something that needs to be in place already. That team could then transfer from the existing CHI infrastructure into the new children’s hospital. There is no such team, though. The people leading other teams are telling us that it is not there and that they will not have the capacity to transfer over to the new hospital. This means that, after the physical facilities have opened, it will take years before the personnel are in position to deliver the services that we need to save the lives of very premature and very ill children.
The consequence of this is that there are children being born today who have less of a chance of survival because the State – the Government or the HSE – is not providing the infrastructure we require to give them a fighting chance. That is unforgivable, as we have the means to do it. This is about an investment in human capital. We need to put the neonatological nurses and consultants in place. I am told that approximately 15 consultants and 80 nurses would be required. It is not a massive investment, but the return on it for the families and tiny children involved is huge. This country has such a good record of low-mortality birth rates. It would be a terrible shame and a massive tragedy for the individual families concerned if we did not maintain that record and ensure that every child born with a difficulty had every chance of surviving.
I thank Senator Ward for raising this issue, which I am taking on behalf of the team in the Department of Health, who are dealing with Question Time in the Dáil at the moment.
I agree with the Senator that newborn infants are some of the most vulnerable patients within our health system. For any parent, having a child who is unwell and requires medical care is devastating, particularly at that time. Ensuring good continuity of care for newborns is vital to having the best medical outcomes. The Government has been investing significantly in care for all newborns. I am delighted that, in the past month, further funding has been announced by the Minister for Health to develop four new postnatal hubs. These hubs are delivering vital structured care in the community for women and infants in the first weeks after birth.
For some infants, more intensive medical intervention and support is required from birth. Through funding for the national maternity strategy, work is ongoing to train more clinical staff in neonatal resuscitation and a set of national neonatal resuscitation training standards will be published this year. Over 3,200 staff in our health services have undertaken neonatal resuscitation advanced provider training.
As the Senator noted, for infants requiring high levels of medical care, there are 19 neonatal intensive care units, NICUs, across the maternity services in Ireland. There are four level 3 units based at the maternity hospitals for infants with more complex needs, with regional NICUs in Limerick and Galway.
In 2022, CHI opened a new high dependency neonatal unit in Crumlin, as part of its plan to develop a new and highly specialised NICU in the new children’s hospital. Young babies with surgical or complex medical needs are transferred to CHI from neonatal units throughout the country and on admission through the emergency department. The service includes six neonatal high-dependency beds for babies with additional care needs. Together with six well-established neonatal high-dependency beds in Temple Street, this provides specialised cots for a particularly vulnerable group of patients. Funding for an additional 26.5 staff was provided for in 2023 for the neonatology service, with a full year cost of €2.6 million. This was to enhance the service in preparation for the establishment of the NICU in the new children’s hospital. These posts include consultant neonatologists, nurse practitioners, staff nurses and other clinical staff.
To support our medical staff to deliver better continuity of care, we are directing significant investment to eHealth. Through the national maternity strategy, a full electronic health record, EHR, is being rolled out across maternity and neonatal services. An EHR makes it easier for all clinicians to access patient information that is instant, consistent and up to date. It enables more information to be gathered more quickly on how services are operating. Phase 2 roll-out of the maternity and newborn clinical management system will extend this EHR to University Maternity Hospital Limerick and the Coombe. This work is currently under way. This expansion will mean that all stand-alone maternity hospitals have this EHR. It will therefore cover 70% of births nationally, and 60.5% of neonatal intensive care activity.
There has been significant medical progress in the care and lifesaving treatments that can be provided to newborns. I am glad that this Government is supporting clinicians and the wider health system to deliver better outcomes for infants and their families.
I accept entirely the bona fides of the Minister and the Minister of State. Having listened to what the Minister of State has said, I do not think there is an understanding within the Department of the urgency of this matter. It is not enough to make reference to an investment of a full-year cost of €2.6 million “to enhance the service in preparation for the establishment of the NICU in the new children’s hospital”. It must be in place now. The NICUs must be operational now with the staff complement of specialist nurses, specialist doctors and consultants because that is the team that has to transfer wholesale to the new hospital. It will not be enough to build it up when the new hospital opens. It must be there now. I am calling on the Minister to prioritise investment in the human resources, staffing and facilities that are needed to have those NICUs in place so they can hit the ground running. It is not enough when the hospital opens to say “Great, we will use the facilities that are there to build up a team”. That team has to be in place now.
The reason I say I do not think it is understood here is that I have read what has been said in the papers by the people who work in this area. They do not feel it is there. It is not there and it needs to be if we are to serve all the children of the nation.
I would point out that funding was put in place for 2023 to start establishing the teams. So the Minister and the Department of Health have put the funding in place. It is now a matter for the HSE and CHI. They have the funding. There should not be anything stopping them from putting those teams in place. I agree that this should be done now. The teams should be in place before the move. The funding is there. I think HSE and CHI should be driving it on.
Hospital Services
I know that the Minister of State, Deputy Calleary is taking this on behalf of the Minister for Health but I also know he will be well aware of the ongoing challenges and issues with healthcare in the mid-west. I have not tabled this Commencement Matter to look for a 24-hour consultant-led emergency department at Ennis Hospital. In the engagement the health committee had recently with all the stakeholders, including unions and medical professionals, none of them were looking for that, and neither, obviously, was the HSE. People want increased services in Ennis Hospital, which makes complete sense because if we can move non-critical healthcare services from UHL to places like Ennis, it will make a huge difference.
I have raised here on a number of occasions the need for a dialysis unit in Ennis. I tabled a Commencement matter on this as recently as three weeks ago. We were told the earliest it would happen was 2025. There are at least 70 or 80 people from County Clare who travel in a taxi, some leaving places like the Burren and spending two hours to get to Limerick, and then have to get their dialysis for another six hours. It takes another two hours to travel home. If that service was available in Ennis, it would cut a significant amount of time off their journey. That is one example. I spoke to someone recently who had to have some cardiovascular work as an outpatient. They were travelling into UHL and could not get parking so they missed their appointment as a consequence. There is no excuse for that type of thing when we have the capability to increase capacity at Ennis Hospital. It has the minor injuries clinic and a number of other services and supports but there is so much more that could be done which would free up space in the main hospital in Dooradoyle in Limerick. What are the plans? What are the short-term, medium-term and, indeed, long-term plans to scale up non-critical care services in Ennis Hospital?
I would like to thank Senator Conway for raising this matter. The Government remains fully committed to improving services in Ennis and the mid-west region. The Minister for Health has engaged extensively with the University of Limerick Hospitals Group and the HSE. He has announced a series of measures to increase capacity and improve services across the region, including over the last 48 hours and including in Ennis Hospital.
The smaller hospital framework, which was published in 2013, provided a stronger role for smaller hospitals like Ennis Hospital. They are delivering higher volumes of less complex care, in many cases closer to patients’ homes. This ensures that patients who require true emergency or complex planned care are managed safely in a larger hospital environment. Ennis Hospital provides inpatient medical beds, a medical assessment unit, MAU; a local injuries unit, LIU; and day surgery. Patients are admitted to Ennis Hospital via the MAU injury unit and transfers from UHL for step-down care.
There has been significant investment in the mid-west model 2 hospitals in recent years, with budgets increasing in all three hospitals. The total 2024 budget for all three hospitals is €350 million. Staffing levels in Ennis Hospital have increased from 235 whole-time equivalents in December to 290 in March of this year. This represents a 23% increase in staffing. There was €1.57 million allocated in 2023 to recruit an additional 19.95 whole-time equivalents to extend the opening hours of the MAU at Ennis Hospital to 12 hours a day, seven days a week. This investment has enabled attendance at the MAU to increase from 6,228 in 2020 to 7,735 in 2022.
Recently announced measures will see the opening hours extending to 24-7 on a phased basis. In terms of capital infrastructure investment, Ennis Hospital received €2 million for a new purpose-built LIU, which opened in 2022. This unit has managed a 32% increase in LIU attendances from 11,517 in 2019 to 15,245 in 2023. Also in 2022, the new outpatient department was equipped including an X-ray room and other diagnostics at a cost of €1.29 million.
To come to the Senator’s point, work is under way to establish a haemodialysis service in Ennis. The HSE has advised that this service is proposed to be operational towards the end of 2025.
The HSE has also advised that a preferred supplier has been identified for this externally contracted service. The Minister continues to work closely with the HSE to ensure that Ennis Hospital and the University of Limerick Hospitals Group are fully supported in respect of the delivery of healthcare services for the region.
I thank the Minister of State for his fairly detailed reply. The small hospitals framework is something that I very much support and welcome. I would like to see services scaled up much quicker than is currently the case. In the of previous Commencement matters I tabled, I was told that the dialysis unit would be operational by the end of 2023, and certainly by quarter 1 or 2 of 2024. I welcome the confirmation that it will be operational by the end of 2024. If we meet that timeframe, it would be a reasonable outcome. I always add six to 12 months to any date I am given. I have already added it with this one, so I sincerely hope it happens by the end of 2024.
The staff and management at Ennis Hospital do a terrific job. The feedback from people who go there, either to the minor injuries clinic, the MAU or any of the other units, is that they are well looked after and have a very positive experience of engaging with the health service on the campus of Ennis Hospital. The management at Ennis Hospital are willing and able to scale up and provide non-critical medical supports to the people of County Clare.
I echo the Senator's comments and tributes to the staff and management at Ennis Hospital. As Senators can see from my opening remarks, we have made significant capital and personnel investment in Ennis Hospital over the past number of years. I have no doubt that the Minister, Deputy Donnelly, will continue with his commitment to the hospital.
Child Protection
I ask the Minister of State to outline the rationale for the Department's funding of the role of safeguarding officer in St. John's Ambulance Ireland and to explain if such a funding mechanism will be available for similar organisations. In the reply to a parliamentary question tabled by my party colleague Deputy Ivana Bacik, the Minister stated that the appointment of the national safeguarding officer to St. John's Ambulance Ireland was recommended by Dr. Geoffrey Shannon in his report. The Minister indicated that it is not the role of the Department to enforce Dr. Shannon's report but that, nonetheless and in light of the need to protect the positive work of St. John's Ambulance Ireland and the child volunteers, he is open to providing initial assistance to ensure recommendations can be complied with in a timely manner.
I note the reference to protecting the important work of St. John's Ambulance Ireland. I am curious in that regard. What about protecting survivors? St. John's Ambulance Ireland seems more than capable of protecting itself. It is, as we speak, taking lengthy and expensive legal actions against the survivors of abuse carried out by its members. It seems that the Minister is providing funding because St. John's Ambulance Ireland perhaps does not have its own funds. How, then, is it able to take the legal cases to which I refer? Is the Minister aware of these legal cases and the cost involved? If he is, why is he providing additional funding to a disgraced organisation that clearly has the money? Can the Minister not see how deeply disrespectful this is to survivors? In a further question, is the funding being provided with the caveat that the rest of Dr. Shannon's report must be implemented within X amount of time, or is this money being provided to protect the work? That sounds like a bit of hokum to me.
The implementation of the safeguarding measures is a matter for the organisations involved. I say that in the context of the question I asked about whether similar funding will be provided to other organisations operating in this area. One would think that the Minister might be a little more proactive in enforcing safeguarding measures relating to children, particularly as all of the organisations to which I refer have children involved. I would think that the safeguarding of children should be of utmost importance. It is one of the most important things we should be doing, so I do not know why the funding is not being provided for safeguarding measures across the board. Why is it only being provided for St. John's Ambulance Ireland? The implication seems to be that St. John's Ambulance Ireland is not in a position to do so, but, as I said - and it has been referenced both in this House and the Lower House a number of times - St. John's Ambulance Ireland is taking very lengthy and expensive cases against survivors of abuse carried out by people within its own ranks. I am sure we can all agree that leaves a very ill taste in our mouths.
It is deeply insulting to survivors that the Department is taking a hands-off approach with regard to the rest of the recommendations in Dr. Shannon's report - in other words, it is up to St. John's Ambulance Ireland to implement them - but it is willing to step in on this matter, which involves a financial connection. I want to understand - and to know whether this has been reported to the Minister - why St. John's Ambulance Ireland is not in a position to fund the safeguarding officer when, as I said and as has been referenced in this House a number of times, it has the money for these very expensive legal cases against survivors of abuse carried out by individuals within its own ranks. Has the provision of said funding come with a time-bound guarantee to enforce the remaining recommendations in Dr. Shannon's report. If it has not come with that quid pro quo agreement between the Minister and St. John's Ambulance Ireland, why is that the case? Is the Minister willing to go back and perhaps negotiate that it should be part of it?
I thank Senator Hoey for raising this matter, which I am taking on behalf of the Minister for Children, Equality, Disability, Integration and Youth, Deputy Roderic O'Gorman. This House has previously been informed that St. John's Ambulance Ireland is an independent organisation. It does not receive funding from Tusla or the Government. As a result, there was no external process by which a review into the organisation could be instigated. St. John's Ambulance Ireland did, however, receive funding relief under Revenue's Covid-19-related scheme that provided support to employees and employers. The funding scheme was put in place during the Covid-19 pandemic. In the employment wage subsidy scheme, St. John's Ambulance Ireland received a funding relief of €240,773 in 2020, and €286,800 in 2021.
A key recommendation of Dr. Geoffrey Shannon's independent review report on the handling of past complaints of abuse in St. John's Ambulance Ireland, which was published on 16 March 2023, was the appointment of a national safeguarding officer by the St. John's Ambulance Ireland organisation. On 4 January 2024, officials from the Department of children met with the commissioner and interim chair of the board of St. John's Ambulance Ireland to discuss the November update regarding the implementation of the recommendations made by Dr. Shannon in his independent review. During the meeting with Department officials, St. John's Ambulance Ireland made the Department aware of the need for financial support in order to fund the post of safeguarding lead, which is one of the recommendations made by Dr. Shannon in his report.
Due to concerns over the delay in making an appointment, the Minister, Deputy Roderic O'Gorman, made a commitment to assist with the funding of this critical role. The Department has now finalised a funding mechanism to enable this to happen. This month, the Department of children is making funding available for a safeguarding post in St. John's Ambulance Ireland. This is once-off and non-recurring funding for a total of 12 months. It sets a precedent neither for continued support of St. John's Ambulance Ireland beyond 12 months nor for any other organisation. In these unique circumstances, the Minister, Deputy O'Gorman would like to ensure that the Shannon report is implemented in full and without delay.
The Department will monitor and review progress over the 12-month period, with periodic reviews to be agreed between Department officials and St. John's Ambulance Ireland. St. John's Ambulance Ireland will be required to submit a final report on progress on the conclusion of the 12-month period. On 29 April, officials in the Department engaged further with the commissioner of St. John's Ambulance Ireland, and a meeting will be set up in the near future to finalise arrangements for the allocation of funding and the process around the safeguarding post. The terms and conditions of the safeguarding officer will be discussed between the Department and St. John's Ambulance Ireland once the post has been accepted. Ongoing consultation will continue between the Department and the organisation in this regard.
The national safeguarding lead will work with the organisation for an agreed and specified timeframe to ensure that St. John's Ambulance Ireland is fully compliant with the safeguarding regime in operation now following the recommendations set out in the report. The safeguarding officer role will include a full review; an audit of the current safeguarding practices, policies and procedures; and assistance with the ongoing implementation of those policies and procedures. The safeguarding officer role will be essential in ensuring a robust review and oversight in governance of child protection and safeguarding measures now in place in the organisation, which in turn will strengthen the efficacy of the governance regime in St. John's Ambulance Ireland.
Department officials have continued to engage with St. John's Ambulance Ireland on a number of occasions since the publication of Dr. Shannon's report. The engagement with regard to the issues raised in that report will continue, and in particular, in respect of support to survivors of abuse.
Perhaps the Minister of State knows the answer to this question. On 4 January, during that meeting with Department officials, St. John Ambulance made the Department aware of the need for financial support in order to fund the post of safeguarding lead. Is the Minister of State aware that all of these legal cases are being taken? How does the organisation not have the finances for this post if it has the finances for legal cases? Is the Minister of State aware of this? I want to make sure I am reading this right. Is part of the condition of the funding for this officer that the periodic reviews are to be agreed between Department officials and St. John Ambulance and it will be required to submit a final report on progress at the conclusion of the 12-month period? Is it part of the agreement that if it gets the funding, it must provide this report? Will the safeguarding officer have any role in the enforcement of the rest of Dr. Shannon's report? Is that part of the condition of this funding?
I do not have that information to hand. Rather than giving the Senator misinformation or wrong information, I will ask the Minister to revert to her directly with a response to those questions.
Cuireadh an Seanad ar fionraí ar 10.01 a.m. agus cuireadh tús leis arís ar 10.32 a.m.
Sitting suspended at 10.01 a.m. and resumed at 10.32 a.m.