Health Reports

Questions (48)

Martin Heydon


48. Deputy Martin Heydon asked the Minister for Health the progress on implementation of the recommendations and findings of the report of the independent review group established to examine the role of voluntary organisations in publicly funded health and personal social services; and if he will make a statement on the matter. [27965/19]

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Oral answers (6 contributions) (Question to Health)

The voluntary sector plays a key role around the country in the delivery of health and personal social services. The origin of many voluntary organisations was to provide a service at a time when the State did not. The value of their contribution is immense but given the variety of arrangements, all formalised at different times in the State's history, it is right that we review the relationship we have with organisations in the voluntary sector and the key role they play, and that we make sure the relationships are fit for purpose in the future and provide the very best service for all service users. I ask the Minister to comment on the independent review that was carried out, its recommendations and their implementation.

I thank Deputy Heydon for this important question. The report of the independent review group established to examine the role of voluntary organisations in publicly funded health and personal social services was published by me in February this year. It makes 24 recommendations covering areas such as the governance of voluntary organisations; dialogue, engagement and contractual processes between the State and the voluntary sector; ethos, asset ownership and public capital investment; and broader issues related to health system development.

The recommendations are grounded in two key overarching findings. First, the report recognises, as does the Deputy, the important contribution voluntary organisations make and concluded that they should continue to play an integral role in the delivery of health and social care services. Second, it found a high level of mutual interdependence between the State and voluntary organisations and called for the development of a stronger relationship based on trust and partnership.

I fully agree with and endorse the findings. Voluntary organisations have an important role to play in the delivery of health services. I have already signalled my commitment to further strengthen the relationship between the State and voluntary organisations but I also think I have an important role, as does the Government and the Oireachtas, in setting out policy. It is a relationship that must mutually respect the responsibilities of each other.

As a first step, I have given approval for the establishment of a new dialogue process between the Department, the HSE and other relevant health agencies and representatives of voluntary organisations in the health and social care sector, as was recommended in the report. My Department is currently designing this process, including its terms of reference, membership and other practical considerations, and will be engaging with voluntary sector representative organisations in that regard.

I believe that this new dialogue process can provide a forum for engaging more effectively with voluntary organisations on key policies and initiatives. I also believe it can provide a forum for taking forward other recommendations in the report such as those relating to governance, but perhaps more importantly, it can provide the platform for developing greater levels of trust and partnership across the system. This must be a two-way process with recognition of the respective roles and mutual dependencies of both sides.

There is also a broad range of other recommendations in the report that are under consideration. The good news is that many of themes align with the Sláintecare programme and will be taken forward in that context. Some require collaboration with other Departments such as the Department of Public Expenditure and Reform and that work is ongoing.

I am conscious that we have remarkable voluntary organisations such as KARE in my constituency. The Minister is aware of it, as it is also involved in west Wicklow as well as Kildare. It was established in 1967 by parents and friends of children with intellectual disabilities who wanted their children to be able to live at home and to go to school locally. KARE is a fantastic organisation that has since seen the development of two great schools in St. Anne's in the Curragh and St. Mark's in Newbridge. I was a member of the board of management in St. Mark's for some time. They provide a very good service. I am aware of the challenges they face on an ongoing basis. What the Minister said is very important about the future relationship between the Department, the HSE and voluntary organisations such as KARE. The Department, the Minister and Members of the Dáil are responsible for setting policy and we cannot abdicate that responsibility.

I recently attended the KARE AGM and I was struck by what many of the service users said about their desire to live alone instead of in group houses in the community. In order for them to be able to do that it requires multi-annual funding and long-term planning. I note there is a key policy recommendation on multi-annual funding.

The Minister of State, Deputy Finian McGrath, and I support Deputy Heydon in that regard. I am aware of the very good work of KARE in the Deputy's constituency and in mine, and the very good work of so many voluntary organisations across the country which are an integral part of the health service. We could not do without them. They were providing services long before the State bothered to do so. My Department did not exist until the 1940s. We had a State without a Department of Health because we were reliant on the voluntary sector and the church. In addition, some of the largest hospitals in this country are also voluntary. I respect the role of voluntary hospitals. Many countries have them, but they must modernise, be more transparent and open and they must provide a seat at the table for public policymakers and representatives of the State.

In the excellent report we are discussing, Ms Catherine Day made some good recommendations about having a public interest director or whatever we wish to call him or her. We can and must respect the voluntary ethos, which I very much do, and the good work that is being done, but there is only one forum that sets public sector policy and health policy and no ethos should prevent people from accessing healthcare. That is the type of discussion we need to start having with the sector in terms of how we can help by providing certainty of funding and multi-annual funding and how they can help us by making sure we can implement public policy.

The Minister is dead right. At the heart of the issue is addressing service level agreements and making sure they are fit for purpose. In many ways, that will involve the agreements being reviewed and simplified so that they focus on service provision as much as possible. I come across issues in my constituency all the time, which I have raised with the Minister of State, Deputy Finian McGrath, regarding challenges for school leavers with intellectual disabilities when they reach the age of 18. I am thankful that KARE is not among them, but we have voluntary organisations around the country that are constantly in deficit. Recommendation 8.8 in the report is to assess if an organisation is adequately funded in the first place and if there are better ways to manage its budget. If an organisation is in a constant cycle of deficits year-on-year, it will never get out of the cycle. Such organisations are then hamstrung and cannot provide the service we need.

Recommendation 8.3 relates to official recognition through a charter of the legally separate status of the voluntary sector reflecting its public service role. Ultimately, it is about due recognition. The report produced by the review group chaired by Ms Catherine Day is excellent. It is a great opportunity for us now to drive on, show the voluntary sector that it is a dual relationship, that we are interdependent on each other and we must work together in order that we can better provide a service for people in the future that is fit for purpose.

I agree with Deputy Heydon that it is an excellent report. I thank Ms Catherine Day, Ms Jane Grimson and Ms Deirdre Madden for doing that body of work. In the report we heard from the voluntary sector that the organisations do not mind complying and providing information but they object to the level of bureaucracy and want us to make it simpler, in particular for smaller organisations, and not constantly ask them for the same information in multiple formats. We must reduce the bureaucracy and form filling while making sure that we have the right level of oversight as well.

I accept that we will have to address the funding issues. The Minister of State, Deputy Finian McGrath, and I will have to look at the legacy issues with Government colleagues. I am sure Deputy Heydon will agree that alongside any funding there must be reform. I refer to such things as personalised budgets. I do not believe the provision of disability and social care services is likely to be confined just to block grants, but will be more about personalised budgets and empowering the person with a disability as well. Like any conversation with any interest group we will have to speak about appropriate levels of funding and certainty of funding but also how we reform and modernise the delivery of the services.

Primary Care Centres Provision

Questions (49)

Anne Rabbitte


49. Deputy Anne Rabbitte asked the Minister for Health the timeframe for the provision of primary care centres in Portumna, Gort and Headford, County Galway; and if he will make a statement on the matter. [27815/19]

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Oral answers (6 contributions) (Question to Health)

I wish to ask the Minister for Health the timeframe for the provision of primary care centres in Portumna, Gort and Headford in County Galway and if he will make a statement on the matter.

I am pleased to be able to inform the Deputy that the development of the primary care centres in Portumna, Gort and Headford is being progressed.

Planning permission has been obtained for the Portumna development, and the HSE expects to enter into a lease agreement with the developer in quarter 3 of this year, which is quite shortly.

Previous efforts to develop primary care centres in Gort and Headford have not been successful. However, Gort was included in a recent national advertisement seeking expressions of interest from developers for the delivery of the next tranche of 47 primary care centres. We have gone back to the market through advertisement. Submissions have now been received by the HSE and they are currently being considered. The Headford site was re-advertised locally in 2018, and the project has since progressed to a stage at which short-listed candidates have been invited to submit a priced offer.

Unfortunately, it is not possible at this stage to provide an estimated operational date for any of the three centres. Nonetheless, the HSE and the primary care sector are very determined to deliver on these projects. There are now 127 primary care centres in operation across the country, and a further nine are expected to open in 2019. I am aware, however, of how important the three in question are to the people of Galway East. The Deputy has raised this with me on an ongoing basis. We now have the planning permission for Portumna, and we will have the lease agreement in quarter 3. Gort will, I hope, attract some interest through the current expression-of-interest process, and suitable candidates have now been short-listed for Headford. I will undertake to revert to the Deputy on all three as we continue to see progress on them.

I thank the Minister for his response. It is very welcome because, as he knows, throughout the whole county there are only five primary care centres. It is important, therefore, to have primary care centres spread not just across Galway East but also across the rest of the county.

My main concern about primary care centres is probably related to the fact that Galway is such a large county. The centres in Loughrea, Athenry and Tuam are very welcome. This time last year, the Minister and I were at the opening of the primary care centre in Tuam. It was very welcome but, at the time, it appeared that the X-ray department was omitted from the original plans. While it is not within the scope of my question, what is the current position on the X-ray department at the Tuam site? It is important to the people of the area.

I thank Deputy Rabbitte. She is correct that we had an excellent day at the Tuam primary care centre. It is a really state-of-the-art centre of which I am aware the community in Tuam is very proud. There are now requests from that primary care centre to put in X-ray facilities. This is the next big step. We have over 120 primary care centres open. The big prize is getting the diagnostic facilities into the centres with the appropriate populations. That obviously keeps people out of hospital. I saw centres in Athlone and Castlebar recently that resulted in incredible redirection of people from the hospital setting to primary care. The HSE is working locally to secure capital for the Tuam X-ray facility. This is not covered in the Deputy's question so I will have to revert to the Deputy directly in regard to it.

With regard to Galway, there are now primary care centres operational in Tuam, Mountbellew, Loughrea, Athenry, Galway city east, the Aran Islands, Ballinasloe and Moycullen. The centre in Inishbofin is now under way. The one for Portumna is in early planning, as are those for Oranmore and Moycullen. Another, for Galway city west, is in early planning. Headford is at stage 3 of the operational lease process, and the price offer has been submitted. For Gort, we sought interest through national advertisement on 3 May. Therefore, we have a quite ambitious programme for primary care centres for Galway. I understand, however, particularly from a geographical point of view, the importance of the three in question. I will keep in touch with the Deputy.

I am glad the Minister addressed in his response the matter of diagnostics. Just before I came here, I got figures on orthodontic and dental care. We want more primary care centres and further expansion because it is hard to believe that in County Galway, over 14,000 children have been waiting for dental screening for more than 12 months. Considering that anaesthetics are involved, we must remember those who are waiting are in pain. There are 58 young people waiting more than 52 weeks to have a filling or a tooth removed. That is hard to believe. If in pain, we would like to have the tooth removed. It would be beneficial to have diagnostic facilities attached to primary care centres. Maybe we have such long waiting lists because people are working and cannot get time off to bring their kids to the city centre, to Newcastle. Therefore, the opening of more primary care centres with attached diagnostic facilities would be very welcome.

On the broader issue of dental services in the country, as the Deputy probably knows, I launched our new dental strategy, Smile agus Sláinte, a couple of weeks ago. The previous dental strategy was published in 1994 and was working from dental data from the 1980s. Another reason we end up with such dental difficulties is cost. Regarding the plan to roll out free dental care to children, children are currently seen only on a couple of occasions in primary school. Therefore, trying to expand free dental care to children, starting with the under-sixes, will also be a budget priority for me.

The Deputy is correct that collectively, her party and mine have invested an awful lot in trying to roll out primary care centres. Fine Gael is doing so with its Independent colleagues in government on this occasion. We also need to make sure we put the diagnostic facilities in place so we can take people out of the hospital setting.

Cancer Screening Programmes

Questions (50, 69)

Alan Kelly


50. Deputy Alan Kelly asked the Minister for Health if he or his officials understood that the second Scally report was to be delivered in February 2019; and if he will make a statement on the matter. [27723/19]

View answer

Alan Kelly


69. Deputy Alan Kelly asked the Minister for Health if he or his advisers received communications in January or February 2019 confirming the Scally report was imminent; and if so, if he will publish same. [27452/19]

View answer

Oral answers (8 contributions) (Question to Health)

I return to this topic. Was the Minister or his officials of the understanding that the second Scally report, published a couple of weeks ago, was actually due in February 2019? As the Minister knows, I have taken a deep interest in this because it was my understanding that it was due in February of this year and to be presented.

I propose to take Questions Nos. 50 and 69 together.

Deputy Kelly has taken a deep interest in this. As he will be aware from responses to previous parliamentary questions, I met Dr. Gabriel Scally to discuss the progress of his supplementary report on 31 January, following an excellent meeting I had in my Department with members of the 221+ patient support group, which Dr. Scally kindly attended. Following this meeting, I understood from Dr. Scally that the supplementary report would be finalised shortly thereafter. This continued to be my understanding and that of my officials up until 14 February, when Dr. Scally met officials in my Department to discuss the progress of the supplementary report. He indicated at that meeting that the work would take longer than expected. He wrote to me on the following day, 15 February, advising that the breadth and complexity of the issues involved in the supplementary report required further time for analysis. Neither I nor my advisers received any further communication, written or oral, from Dr. Scally on this issue. The supplementary report of the scoping inquiry was received in my Department on Tuesday, 4 June, and Dr. Scally briefed me on its content on 7 June. I then brought the report to the Government, and I published it on the website of my Department following the Government decision on 11 June. Dr. Scally is attending the health committee meeting on Thursday and will have an opportunity to expand further on these points.

I thank the Minister. On 12 February, the Minister answered a question by me saying he was awaiting Dr. Scally's report, which he was expecting shortly thereafter. The following day, at a meeting of the health committee, the Minister's Secretary General said the report was imminent. Obviously, the Secretary General of the Department would have been in touch. Dr. Scally was in Ireland the following day. If the Secretary General was saying the report was imminent at the meeting of the health committee, his understanding was that the report was going to be given to the Minister and published. I understand from patient advocates, to whom the Minister referred and to whom we both speak, that the report was due in February. They understood it was coming out in February. I really want to know what happened such that it took four more months to be issued. It was to be nine months in total. I took four months longer than expected, however. What changed on 12, 13 and 14 February?

The timeline works logically. On 12 February, I answered a parliamentary question stating I expected to receive Dr. Scally's report shortly thereafter, because I did. On 13 February, my Secretary General was at a committee meeting and reiterated that, because he too expected it. On 14 February, Dr. Scally visited my Department and said he would require a longer period. On 15 February, he put that in writing to me. I am aware he has been communicating with the Deputy also. On the last occasion we had statements on CervicalCheck here, the Deputy raised questions in regard to this. Dr. Scally stated that, as the Deputy knows, he had hoped to complete the supplementary report on laboratories fairly soon after the publication of the final report and that the discovery of additional laboratories, particularly the four revealed in January, added considerable complication. He stated he had hoped to be able to deliver a report to the Minister by the end of February or the beginning of March. This very much ties in with my timeline. He said the late availability of data on laboratories, combined with the necessity of engaging in due process around the issues dealt within the report and his analysis of these matters, rendered that an undeliverable timescale. He said he was sure the Deputy would appreciate the importance he attaches to accuracy and also to his being able to comment in an honest and forthright fashion on what has been uncovered. He stated the Deputy will also appreciate that he attaches equal importance to his independence.

Dr. Scally took longer because, according to him, the laboratories were not forthcoming regarding the data. As the Deputy knows, Dr. Scally discovered four more laboratories, most disappointingly, in January. He is extraordinarily independent in his business and takes that independence very seriously.

I do not doubt that. What the Minister quoted is a letter from Dr. Scally to me that I was not aware he had.

Dr. Scally sent me a copy of it. We all have the same information.

Interesting. The real issue for me is that I asked Dr. Scally when he found out about the laboratory in Manchester and its lack of accreditation.

One of the main issues from the first report was the fact that Dr. Scally felt that the accreditation issue was appropriate. He found that the issue regarding Manchester was surprising and disturbing. I want to find out when Dr. Scally found out about the non-accreditation of the lab in Manchester. Was it sometime in January? If it was in January, then what the Minister understood on 31 January, and the complexities, would have been known already. All the issues that have been outlined as an explanation for the delay would have been known at that time. Patient advocates still understood, however, that this report was coming out in February. This is a very important question. I have asked Dr. Scally but I have not got a satisfactory answer.

It is an important question. I accept Deputy Kelly's bona fides regarding this matter. All I can tell him about is the chain of correspondence, meetings and parliamentary questions regarding my situation. Dr. Scally made it clear that he expected to give me a report at the end of February. That was the information I relayed to these Houses. It then took Dr. Scally longer to complete the report. He wanted to get it right. He wanted to get all the data and analyse those so that he could deliver the report with the assertiveness that we all expect from him and that the patient representatives respect. It took him some time longer to do that. The timeline concerning when the report arrived in my Department, when I went to Government and when I published it is all a matter of public record as well. Dr. Scally will be before the health committee. He is best placed to answer these questions and Deputy Kelly is best placed to ask them. Dr. Scally is before the committee on Thursday and I am sure he will be delighted to expand further on this issue.

Autism Support Services

Questions (51)

Oral answers (12 contributions) (Question to Health)

Question No. 51 is in my name and I seek the permission of the House to ask Deputy O'Rourke to take the Chair for a few minutes. Is that agreed?

I thank the Chair.

I am sure that Deputy Eugene Murphy will comply with the timing.

Eugene Murphy


51. Deputy Eugene Murphy asked the Minister for Health if a full review will be undertaken of services provided for children with Down's syndrome in County Roscommon in order to determine the number of therapists required to provide a service fit for purpose in relation to the improvement of fine motor skills, gross motor skills and speech therapy; if the recommendations of such a review will be implemented with immediate effect; and if he will make a statement on the matter. [27451/19]

View answer

I certainly will. The Acting Chairman will be surprised and I hope he gives me credit at the end. This question is to ask the Minister for Health if a full review will be undertaken of the services provided for children with Down's syndrome in County Roscommon to determine the number therapists required to provide a service fit for purpose regarding improvement of fine motor skills, gross motor skills and speech therapy; if the recommendation of such a review will be implemented with immediate effect and if he will make a statement on the matter.

I thank Deputy Eugene Murphy for raising this important issue. I also thank him for the warm welcome I was given last week in Creggs in County Roscommon. I visited the Creggs national school where I met all the neighbours and families. They have a lovely service and it is a brilliant community. It is a very inclusive school where there are children with special needs. I thank Deputy Eugene Murphy again for that warm welcome and for his particular interest in all children with disabilities.

In Ireland and in our policy view, disability service provision promotes a non-condition-specific approach with services based on need rather than diagnosis. In Roscommon multidisciplinary services for children with Down's syndrome are provided by the Roscommon early intervention service for children up to six years and the school age disability team for children aged six to 18 years. Multidisciplinary services including occupational therapy, physiotherapy and speech and language therapy, continue to be provided to all children with disabilities regardless of condition, based on their specific needs. The requirement for additional resources to provide appropriate and timely services for children and young people with complex needs has been identified by the Health Service Executive, HSE, and formal approval to proceed with the recruitment of 100 new therapy posts was issued last month.

All community healthcare organisations, CHOs, are now in the process of recruiting these posts. CHO 2, which includes Roscommon, has been allocated 3.5 whole-time equivalent posts. Nationally, including Roscommon, multidisciplinary services with children with Down's syndrome are provided through the disability services. I refer to early intervention services for children up to six years and the school age disability team for children aged six to 18 years. The multidisciplinary services include occupational therapy, physiotherapy and speech and language therapy. A review of services provided to children with Down's syndrome has not been undertaken as the current policy is to assess and provide services to children based on need. A review based on diagnosis would not be appropriate. We need to see what the needs are and then put in the teams.

I welcome that there is some good news in that statement from the Minister of State. I acknowledge that he takes a personal interest in this situation as well. I want to be fair about that. We have had meetings about such issues and we will have more. The difficulty I have is that the parents of children with Down's syndrome in my county, and I can say the same for the parts of Galway that I represent, is that they are having much difficulty accessing occupational therapists, speech therapists and physiotherapists. Many parents are finding that they have to finance that provision themselves. It is causing much financial distress for those parents. It is an area that we have to examine in general. I say that because the Minister of State is well aware of the July provision situation and what happened in the courts not too long ago. I am sure that Minister of State will agree that the goal posts have changed and that we are going to have to take an overall look at this situation. I welcome the fact that we have some good news but we have a long way to go.

I accept fully the sincerity of Deputy Eugene Murphy's points regarding the therapy services. That is why in last year's Estimates the Minister for Health sought these new therapy posts. I accept that is a start and that we have to move on that. I welcome the fact that the Roscommon area will get 3.5 whole-time equivalent posts. It is also, however, important to realise that there are 56 children's disability network teams already established with a further 82 such children's disability network teams to be reconfigured from the existing services. It is important too that we note that all HSE areas that are planning reconfigurations continue to have significant early intervention and school aid services in place. Those are provided either directly by the HSE or by the voluntary service providers which are funded by the services such as Rehab, Enable Ireland, the Muiríosa Foundation, St. John of God community services, the Brothers of Charity services, St. Michael's House, the Cope Foundation, the Central Remedial Clinic, CRC, and the Daughters of Charity services. We are also funding those early intervention services.

I thank the Minister of State. He will have a further chance to respond.

I will make the final point that a key enabler of the establishment of the children's disability network is the recruitment of children's disability network managers. There are some human resource issues but hopefully they will be resolved very soon.

I welcome the work done by the HSE staff in this area but they will say themselves that because they have so many children to treat and are so understaffed that the visits are infrequent. It is viewed as piecemeal-type therapy. Those staff are not happy. I will give some figures to let the Minister of State realise what we are dealing with in the county. These figures come from a parliamentary question I tabled recently. The number of people waiting to access occupational therapy in adult services in County Roscommon is 196. The number of priority one cases waiting is 20, priority two is 176 and there is no priority three. The number of children waiting to access occupational therapy in County Roscommon at the moment is 226. The waiting periods range from 12 weeks minimum to 36 months. That is three years. It is a shameful situation and it is something we all have to rectify. I am sure that the Minister of State acknowledges that.

I acknowledge that. Efforts are being made to resolve that particular issue regarding the waiting lists. The children's disability network teams are being put in place and that is another issue slowing down the process. We, of course, have to ensure that every child gets access to one of those therapies, whether speech and language or occupational therapy. That is a solution. At the same time, however, we can fix the figures mentioned by the Deputy with some of the constructive solutions coming on stream in the next couple of months. I am optimistic that we will see major progress by August. We will continue to drive that and we will need to continue to examine this issue.

Disability Support Services Provision

Questions (52)

Seán Haughey


52. Deputy Seán Haughey asked the Minister for Health the way in which he plans to address the increase in CHO 9 of the number of overdue first assessments under the Disability Act 2005; and if he will make a statement on the matter. [27768/19]

View answer

Oral answers (6 contributions) (Question to Health)

This question is to ask the Minister for Health the way in which he plans to address the increase in community healthcare organisation, CHO 9, of the number of overdue first assessments under the Disability Act 2005; and if he will make a statement on the matter.

The Minister of State will know that under the Disability Act 2005 an assessment of needs must begin no later than three months after receipt of the completed application and the assessment of need should be completed within a further three months from the date upon which the assessment commenced.

I thank the Deputy for raising what is an important issue for our area. I have been advised by HSE officials that there is a delay in completing assessments of need in the Dublin north city and county community healthcare organisation, CHO, due to the increasing number of referrals. A number of factors are driving this demand, those being, the growth in the child population and an increase in children presenting with complex needs. All applications and assessments of need are dealt with strictly in order of date of application. Under the Disability Act 2005, an assessment of need should begin not later than three months after receipt of a completed application and should be completed within a further three months.

Plans are in place to increase staffing levels in therapy disciplines to support the assessment of need process for children in the Dublin north city and county CHO. We are pushing this strongly. Funding for an additional 100 therapy posts was secured as part of budget 2019 - I thank the Minister, Deputy Harris, for his strong support in that regard - to improve waiting times for assessments of need nationally. The HSE is committed to the recruitment of these 100 therapy posts in its 2019 national service plan, with the Dublin north city and county CHO allocated 16 of these posts. The CHO is actively drawing from existing panels with a view to having these posts filled by the end of 2019.

The filling of these critical posts is designed to have a positive impact on waiting times for assessments of need around the country. The 16 posts will make an impression and will be filled over the next couple of months.

I hope the Minister of State is right. The issue of children who are overdue assessments under the Disability Act has been a running sore for some time. Colleagues in the Dáil, including my party's spokesperson on disability, Deputy Murphy O'Mahony, have put sustained pressure on the Government in this regard, which has resulted in some improvements, especially in Cork and Kerry where the number waiting at the start of 2018 was scandalous. In CHO 9, which covers the north side of Dublin, we have seen the number going the opposite way. There were 442 overdue assessments in the second quarter of 2018. That increased to 707 by the second quarter of this year, representing a significant increase of almost 60%. The Minister of State will agree that to have so many children unable to receive their legal entitlement within the statutory timeframe is wrong. Why has this happened and what has been done to address it? It is all very well intending to fill the posts in question, but will the Minister of State assure the House that they will be filled in order to improve this drastic situation?

The number of new applications under the Act has increased steadily since its enactment. For example, 1,138 applications were received in 2007 whereas 5,839 were received in 2017. During that time, a total of 43,521 completed applications were received by the HSE. The number of children aged five and over and otherwise of schoolgoing age has risen steadily as a percentage of all applications received. At the end of 2011, the figure stood at 26%, while at end of 2017, it was 51%.

The level of recruitment is an issue, but funding for the therapy posts has been allocated. The HSE has told me that it is committed to recruiting for these posts and rolling them out. All CHO areas have been advised to proceed with the recruitment for all such posts immediately. All CHOs are activating their panels via the HSE's health business services, HBS, and section 38 providers. Some posts have been allocated to section 38 and section 39 organisations. It is anticipated that recruitment for these posts will proceed quickly. For example, CHO 4 has three posts filled. There is a target for all posts to be filled by the end of 2019. This is something that we must drive strongly. I will continue to do so.

In our constituency, there is a 27-month waiting time for the early intervention team. There is also a waiting time of between 36 and 40 months for the school age disability team. Parents have gone to the Minister of State's advice clinic and they have come to mine. They are distraught trying to get the services their children require.

Does the Minister of State accept that disability services for children are in crisis on the north side of Dublin? Consider occupational therapy. In CHO 9, the most recent figures we received show that 1,967 under 18s are waiting, with 881 waiting for longer than a year. When a child must wait a year or two, can it really be called early intervention? The Minister of State is aware of the situation. I appreciate that he has set out the reasons for so many people presenting for services, but there is a crisis and parents are distraught. The Minister of State has responsibility for disability services and this is his constituency. We must address the issue.

I agree that there is an issue. It is essential that we deal with the early intervention situation. There is no debate about that. It is why our constituency of Dublin Bay North has been allocated 16 posts. Will they make a dent in the assessments of need? Will the service be accessible to the families that are waiting? I know many of them. As the Deputy mentioned, they come to our clinics regularly. The bottom line is that 16 posts have been allocated, which will make a dent in the waiting list.

As we approach the Estimates in the coming months, I will be seeking more money for therapy posts. In that regard, I would appreciate the same support I received from colleagues in Fianna Fáil last year, including Deputy Haughey. It is essential that we accept the reality that children with disabilities and their families need support.

Industrial Disputes

Questions (53, 111)

Gino Kenny


53. Deputy Gino Kenny asked the Minister for Health his views on the perceived negative impact that low pay and poor conditions have on the recruitment and retention of staff in the healthcare system; the steps he will take to resolve the pay claims of the 10,000 healthcare workers who have shown good faith by deferring two days of strike action; and if he will make a statement on the matter. [27802/19]

View answer

Lisa Chambers


111. Deputy Lisa Chambers asked the Minister for Health if his attention has been drawn to the strike action due to take place by 10,000 hospital support staff; and his plans to resolve the matter in order to avoid further strike action. [25570/19]

View answer

Oral answers (6 contributions) (Question to Health)

I wish to ask about the recruitment and retention of staff in the healthcare system, particularly in light of last week's strike by 10,000 healthcare staff. Will the Minister comment on this issue?

I propose to take Questions Nos. 53 and 111 together.

I thank the Deputies for raising this important matter. I will answer the questions in the context of the Labour Court tomorrow starting three days of intensive hearings and engagements on this dispute regarding some of the staff in our healthcare service represented by SIPTU.

It is important to say that staff in the public service are already in receipt of a series of pay increases and pay restoration measures under the public service stability agreement, which will see public servants receiving an average 7% increase in their salaries over the lifetime of the agreement. By the end of 2020, there is a commitment to restore 90% of the pay reductions experienced under the FEMPI legislation introduced after the economy was crashed by previous Governments. Staff also benefit from a public sector pension, something that is highly valuable to the employees, as well as other benefits, such as flexible working, sick leave and maternity leave, that workers may not have in other areas of the economy.

In terms of recruitment and retention of health service grades, the Public Service Pay Commission is continuing its work on assessing roles in the public service that have been identified as experiencing recruitment and retention issues. The commission has already made recommendations in respect of nurses, consultants and non-consultant hospital doctors, NCHDs, and the Government has accepted these findings.

Regarding the industrial action that took place on 26 June by SIPTU support staff grades, I was pleased that talks between the parties resumed at the Workplace Relations Commission, WRC, last Thursday. It is fair to say that some progress was made, but it was not possible to reach agreement on all issues. As a result, the matter has been referred to the Labour Court for an early hearing, which will commence tomorrow.

While I acknowledge that SIPTU acted in good faith by deferring two days of its planned industrial action, for which I thank it, we cannot forget that one day of action went ahead involving 10,000 staff across 38 healthcare facilities. In advance of the action, contingency plans were put in place to provide emergency cover. I thank those involved in that. Given the broad range of roles involved in the dispute and the fact that work practices can vary between sites, the majority of contingency planning had to be negotiated locally, which made the situation even more complex. Maintaining essential daily care for our patients in areas such as nutrition, hydration, patient transfers, cleaning and infection control posed an immense challenge. Despite the best efforts made around the contingency plans and trying to provide as complete a service as possible, however, it was the patients and their families who were disrupted most as a result of the industrial action.

I remind the Deputies that, prior to the dispute, constructive and positive engagement by the parties involved took place at the WRC. I am disappointed that the issue did not go to the Labour Court before the industrial action went ahead, but it will be before the court tomorrow and I hope for a resolution. I call on both parties to redouble their efforts.

I am a former hospital worker, and the Minister will appreciate it when I say that hospital workers are the glue that holds hospitals together.

Clerical staff, porters, care assistants, chefs and other hospital workers of that magnitude keep hospitals afloat. The crux of the dispute relates to moneys owed to these 10,000 workers. The matter goes back to 2015 and the job evaluation scheme introduced under the Lansdowne Road agreement. The HSE and the Department of Health agreed that the pay increases recommended under the job evaluation scheme should be paid to the workers. The workers are asking for moneys owed to them in respect of changed job responsibilities and descriptions over that period. They are asking for the money to be paid to them now, rather than at a later date.

I agree with the Deputy on the integral part support staff grades play in our health service. He knows of it from his personal experience and we all know of it from our use of the health service. Whether it is moving patients from an emergency department to a ward, helping to discharge a patient, keeping our hospital clean or providing a good hot meal, these staff are integral members of our health service. There is much discussion of doctors and nurses, but I agree with the Deputy that the staff to whom he refers are the gel that keeps our health services together.

There has been significant movement by the management. I do not wish to say anything provocative or that will in any way impede the work of the Labour Court tomorrow - the Oireachtas has a protocol in this respect - but there has been movement by management. In fact, much of the claim has been accepted. The debate now relates to implementation and the timeline for implementation such that it is affordable and makes progress. As the Deputy will appreciate, it is fair to say that there are differing views in that regard. He is correct that there was a job evaluation scheme. It was advised that the question of implementing the outcome of the exercise would be considered by the parties at its conclusion. The dispute centres on the timeline for implementation of the outcome of the first two phases. Phase 3 involved home help and homecare workers and phase 4 is made up of other support staff grades. Phase 3 is complete, but has not yet been officially reported on. Phase 4 is under way. I hope and believe that if all sides to the dispute redouble their efforts and use the mechanism of the Labour Court, we can try to find a resolution over the next three days.

There is significant frustration among healthcare staff, many of whom I know. They are very frustrated with the process. They held off and took the pain over the years of austerity. They want what is owed to them. The HSE and the Department of Health stated that they agree with the outcome of the job evaluation scheme. The money is owed to the workers. One way or another, the matter will be resolved. It must be resolved by giving the workers the money owed to them because if it is not, strike action will continue. If the Department of Health and the HSE stated that under the job evaluation scheme the workers are entitled to the money, why is the money not being given to them?

I agree that significant pain and hardship was inflicted on many people in this country as a result of the economic crash. We have been working to try to rebuild the country from that point. We increased the minimum wage several times, particularly after it was cut by €1. We prioritised low-paid workers in the public service stability agreements and nearly all the reductions under FEMPI will have been returned to workers by the end of next year. Wages are rising and, from a metric point of view, inequality is beginning to reduce. Those are not my figures; rather, they were published independently.

The Deputy is correct that a job evaluation scheme was carried out and that the workers are doing complex and changed jobs. They are reforming their practices and working differently. I recently launched a new nutrition and hydration policy which involves our chefs going above and beyond their duty in terms of the types of meals they provide to meet the individual needs of patients. That is not the issue in the dispute. Rather, it is around the timeline, implementation and the phasing of payments. It is not beyond us to resolve this matter. We were making significant progress before the strike went ahead. The Labour Court is the appropriate forum to resolve the dispute.

Hospital Services

Written Answers are published on the Oireachtas website

Questions (54)

Barry Cowen


54. Deputy Barry Cowen asked the Minister for Health the status of the implementation of the trauma strategy; if the Midland Regional Hospital, Tullamore will provide the trauma unit for the midlands; and if he will make a statement on the matter. [27771/19]

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Oral answers (6 contributions) (Question to Health)

As the Minister is aware, the report of the trauma steering group published in February 2018 highlighted that 16 acute hospitals, including the Midland Regional Hospital in Tullamore, which could potentially meet the designation criteria for trauma units. There is an overwhelming case for a trauma unit to be located at Tullamore hospital, given that it is the only one of the 16 hospitals to be located in the midlands. It was stated by Fianna Fáil on the publication of the report that the onus was on the HSE and the Minister to implement its findings quickly and sanction the resources for units to fulfil their role. Some 17 months on, we would like to know what progress has been made. Not much, it appears. Why is that so and when can we expect decisions to be taken in that regard?

The report of the trauma steering group was approved by Government in 2018 and a HSE interim implementation group is currently progressing its four immediate actions, the first of which was the recruitment of a national clinical lead. Mr. Keith Sinnott has been appointed to that position. The second action relates to orthopaedic trauma and major trauma bypass protocols, the third relates to the selection of a major trauma centre for Dublin and the fourth relates to detailed implementation planning. I am pleased to state that significant progress is being made on the four immediate actions.

On 21 June, the formal process for the designation of the major trauma centre for the central network commenced, with each of the Dublin hospital groups invited to make a submission which will be reviewed and scored by an independent assessment panel comprising local and international experts. On 1 July, the national clinical lead for trauma services assumed his position. In order that decisions are made that ensure the best configuration of trauma services from a population health perspective for the Dublin region and the wider central trauma network, of which Tullamore is part, the submissions will also be considered for designation as Dublin trauma units. It is expected that a final recommendation to my Department will be made in autumn. There are 16 acute hospitals which could meet the criteria for trauma units, including the Midland Regional Hospital, Tullamore.

It is expected that further detailed implementation planning, including the designation of trauma units nationally, will be required to fully implement the trauma strategy, and this will be led by the newly appointed national clinical lead and the office for trauma services. On foot of the Deputy's question, I will ask that the new clinical lead, Mr. Sinnott, meet management of Tullamore hospital as it is one of the 16 potential centres.

I thank the Minister for his reply, particularly his final point that, further to that process having commenced, he will ask the clinical lead to meet representatives of the relevant hospitals, particularly Tullamore. The steering group in its report and recommendations pointed out that many of the 16 hospitals currently provide acute trauma care and that there are some resource deficiencies which need to be further enhanced in order to ensure the level of provision required to meet their current roles in addition to fulfilling the designation criteria. Can the Minister confirm that there is provision within the capital programme to ensure that whatever improvements are necessary to meet current delivery are made, let alone what might ensue on foot of the designation in the autumn?

The Deputy is correct that this will involve revenue and capital costings. The overall estimated maximum staffing requirement suggests that an indicative estimate of revenue costs of €53.6 million on the cost of developing orthogeriatric fracture liaison services is included. This can be considered as a gross cost which carries a need for careful examination because there are existing staffing levels and opportunities to optimise efficiencies. The national service plan 2018 provides for seed funding, mainly for the establishment of a national office for trauma services and the national clinical lead for trauma services. That office will prepare its estimate bid in regard to our existing trauma services. There will also be capital requirements and I am considering them in the context of a capital plan I am finalising with the HSE. I am happy to share with the House an indicative estimate of a capital cost of approximately €28 million over a seven-year period.

I wish to reaffirm that there is provision within the HSE and hospital services estimate to provide for improvements over a seven-year period notwithstanding another commitment which will ensue once the nomination in respect of the allocations has been made by the clinical lead for trauma services. I am conscious of the fact that the major trauma centre may be placed in Dublin along with a satellite to serve the wider region. I hope that due consideration will be given to all relevant hospitals in the process of selecting the site of the satellite unit and that a Dublin hospital is not selected by way of compensating it for not being selected as the location for the major centre.

The Deputy will agree that it is important that this decision will be made by clinicians and an independent assessment panel and independent of me and the House. Deputies regularly raise with me the cases of constituents who are in hospital as a result of a very bad trauma and need to be transferred to another hospital which can better deal with their complex needs.

This is about ensuring that we can get the patient to the most appropriate hospital. For a limited number of trauma procedures, this is not about altering the significant footfall that goes into hospitals; it is about the small number of patients who have undergone severe trauma. It is about getting them quickly to the appropriate hospital. That is the right thing to do. This will not be a Dublin-centric model though. While there will be a major trauma centre in Dublin - that will not come as a surprise to anyone - there will also be trauma units at other locations throughout the country. These will be able to deal with all but the most complex cases. I am happy to keep the Deputy updated as the plan advances.

Written Answers are published on the Oireachtas website.