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Dáil Éireann díospóireacht -
Wednesday, 26 Apr 2006

Vol. 618 No. 2

Other Questions.

Cancer Screening Programme.

Marian Harkin

Ceist:

53 Ms Harkin asked the Tánaiste and Minister for Health and Children if, in view of the fact that breast cancer is a terrible killer, health care apartheid exists here and that 260 more women will die needlessly in the west and south before BreastCheck is up and running; if she will take up the offer made by the Galway Clinic on 11 February 2003 to provide a BreastCheck service until a unit is built in Galway; if she cannot fast-track BreastCheck before 2007, will she allow the Galway Clinic to provide a breast screening service in the meantime to save these 260 women’s valuable lives; and if she will make a statement on the matter. [15108/06]

BreastCheck, the national breast screening programme, commenced in 2000 with the programme covering the former Eastern, North Eastern and Midland Health Board regions. In 2003 the extension of the programme to counties Carlow, Kilkenny and Wexford and its national expansion to the rest of the country was announced. Screening commenced in Wexford in March 2004, in Carlow in April 2005 and in Kilkenny in March this year.

I informed the Deputy last month of my meeting with representatives of BreastCheck and of my wish to have the programme rolled out to the remaining regions of the country as quickly as possible. Some €2.3 million was made available to BreastCheck this year to provide among other things for the early recruitment and training of staff. The interview process for the posts of clinical directors is now completed and BreastCheck has also commenced the recruitment process for other essential staff. The notice for the procurement of a construction company for the new clinical units in Cork and Galway has been published in the EU Journal and the design team is in the process of short listing applicants. Following the selection of the contractor, construction of the units will commence. BreastCheck is confident that the target date of next year for the commencement of the national roll out will be met. On full roll out, all women in the target age group in every county will have access to breast screening and follow up treatment where appropriate.

As I previously informed the Deputy, any proposal received by BreastCheck to support the roll out of its screening programme is carefully examined to assess the extent to which it complies with existing standards. BreastCheck has advised my Department that it has engaged in extensive discussions with the Galway Clinic. BreastCheck conducted an evaluation of this proposal and has concluded that the clinic in question would not be in a position to provide a population based screening programme in line with its requirements.

I thank the Tánaiste for that reply. As she knows this is something that I am particularly anxious about. When it was introduced in 2000 BreastCheck covered half the population. It is now 2006, however, and it will be 2009 before the full roll-out is completed, according to BreastCheck. There is no other term for this but cancer care apartheid. I have calculated that at least 200 women have died in the south and west since BreastCheck was rolled out for half the population. That is a disgrace, considering the position in other countries. This is not rocket science, as the Tánaiste has conceded. This information has been available for 20 years and it is a terrible disgrace that BreastCheck was allowed to cover half the country and not the other half. On my calculations more than 200 more women will have died by 2009, who need not have. I know the Tánaiste says the Department has talked to the Galway Clinic, which offered to intervene in 2003. If that offer had been taken up, at least 150 more women would be alive today. The excuse then was that BreastCheck was an analog service and the Galway Clinic's service was digital. BreastCheck has upgraded its service to Galway Clinic level, however, and is now digital. I am asking the Tánaiste how she can let those 200 women die who need not. It is a question of money. Money was available for all sorts of matters, the wasteful PPARS system, the horse racing industry and all types of stupid things. We are talking about real lives here.

It is not Galway Clinic that is saying this, but the Department of Health and Children. This is the same Department that said that this must be done on a phased basis, as it was so complicated. The complication is how the service is available to half the population and not the other half. I ask the Tánaiste to please save the lives of those 250 women. She has the power to intervene. Has she the will to do it? It can be done.

I have looked at population screening as regards another area in which I am interested in pursuing when we can. Any population screening is always done on a gradual basis for a host of reasons. One cannot move from a situation where there is no population screening for a particular type of cancer to one where the entire population is covered in a short period of time. That is not to say that perhaps things could not be done quicker. However, this is the reality.

BreastCheck did not get subsumed into the HSE. It is an autonomous body with a board of directors. I asked it to look at the proposal from the Galway Clinic which had been sent to me and the Department has discussed matters with BreastCheck. It is a matter for BreastCheck to assess whether the proposal meets its requirements and it has concluded that it does not. I have to accept that.

I was criticised earlier for encouraging the private sector. Here I am being criticised because we are not giving business to a private independent operator. I want to see it rolled out as quickly as possible. That is why we made the funding available. We also need to see cervical screening rolled out. That is in only one pilot project at present and I hope it will form part of the new contract with general practitioners since it clearly can be done at primary care level. Again, this is an area where early detection can bring about fantastic results, which Deputy Cowley knows, as a doctor. I am committed to ensuring that we put the resources in place to do that as part of the new contract of employment.

The roll-out will begin next year. Clearly it will take time before everybody in a given catchment area is called. I know the response rate to BreastCheck is about 70%, which by international standards is apparently very good. However, this means that about 30% of those called do not respond. We should all do everything we can to encourage people. I meet people from time to time who receive a letter and take the view that they prefer not to know. Yet we know there can be fantastic results if cancer is detected early. I would encourage everybody who is called to respond and to go for the mammogram. It is a wonderful service, and I hope we can have it in place everywhere before long.

The death rate in Scotland was cut by 30% in only five years.

That is right.

This has been happening all over the world, in the USA, the UK and so on. There is no reason the service could not have been extended to the whole country in 2000. We are suffering the effects of this now. I know the Tánaiste argues that she is not an advocate of anything other than keeping people alive. If the Galway Clinic route is the way to go, then it should be let do it. I spoke to the clinic and was told it could do it. We keep getting the same answer as regards the intricacies. There is no intricacy here except the conundrum as regards how people in the west and south cannot have this service which is in the other half of the country. I just cannot understand it. It does not make sense. Why did those people die?

I assure the Deputy it is my intention and that of the Government to have it rolled out as well. That is why provision has been made by way of resources for that to happen and why we have gone to tender for procurement of a contractor to build the facility. However, it is not just about a building. It is also a question of highly qualified staff such as a radiologist, specially trained nurses and others. As I told the Deputy earlier, clinical directors and other key staff have been selected. In addition to the screening process and the 2% of the population that require follow-up, there is the question of the surgical team. In the case of the west there is the University College Hospital, Galway. Staff in the whole facility must work together and it is not just an issue of screening, as the Deputy is aware.

I welcome the Tánaiste's earlier response on the number of women who do not take up the opportunity, for the following reason. Does she recall that a mammography machine was located at Cavan General Hospital for several years, that it was never used and was then transferred to Our Lady of Lourdes Hospital, Drogheda? During its time at Cavan a number of radiographers were specially trained in England to use it, but never allowed to actually put the equipment into use at Cavan General Hospital. Does the Tánaiste not agree that this is yet another indication of the folly of over-centralisation and that the powers-that-be have decreed from on high that services as regards BreastCheck in the north east will be centred at Our Lady of Lourdes Hospital, Drogheda?

On the numbers of women to whom she refers as not taking up the opportunity — and some who require after-care referral — it is not always a question of preferring not to know. While I appreciate the importance of the roll-out throughout the rest of the State and fully concur with Deputy Cowley's points, nevertheless, where the service is in place it is not being taken up by all the women who should avail of it. Part of the reason is that we have a very serious transport problem. The Tánaiste should know that there is practically no public transport system in place in the north east. It is virtually non-existent. There is no regular service to Drogheda from any of the other key locations within the neighbouring counties, certainly not Cavan and Monaghan. Accepting that deficiency, will the Tánaiste outline steps she may be considering to help ensure all women have the opportunity to avail of the service already in existence and, in preparing for its roll-out throughout the rest of the State, will she build in to the plan transport arrangements because often women are left isolated and alone? There may be a vehicle at home that is used by another person in the home for work and other reasons. It is not always simple. I would like to know if any measures are being considered to address that deficiency.

As the Deputy is aware, we have mobile units that go to more remote areas to do the screening. Not everybody has to come to the big centre. Among the people I referred to earlier, one person in particular whom I met last weekend lives within a mile and a half or two miles of St. Vincent's Hospital where BreastCheck is located in Dublin. There are different issues. I am not taking away from the transport issue but we do have mobile screening facilities and clearly they are of great use in the more peripheral areas of the country. Some 98% of people do not require any follow-up. Thankfully they get good news after being screened. Only 2% of people may come for follow-up treatment.

Breast surgery takes place in a large number of centres. All the evidence would suggest that a unit should carry out at least 100 operations a year and that it is not safe for the procedure to be carried out in a facility that is smaller. That is why I asked Professor Niall O'Higgins, the president of the Royal College of Surgeons, and a group of experts to make recommendations in regard to this area in particular. The Minister for Health and Children of the day and the Department should at least make sure that surgery takes place under safe conditions. We cannot stand over a situation where a patient's outcome is disimproved because an operation is not taking place in an appropriate setting.

What is the Minister doing about the transport needs?

We must proceed with Question No. 54.

I am not the Minister for Transport. My job is to try and provide health services and that, as the Deputy knows, is a challenge even with a budget of €13 billion.

We must proceed with Question No. 54.

Transport is a matter for others.

It is not a matter for others, it is a matter for the Tánaiste. She cannot wash her hands of this.

Proposed Legislation.

Liam Twomey

Ceist:

54 Dr. Twomey asked the Tánaiste and Minister for Health and Children when she intends to amend the Medical Practitioners Act 1978; and if she will make a statement on the matter. [15503/06]

Work on the new medical practitioners Bill is well advanced and it is envisaged the heads of the Bill will be circulated for comment to interested parties, including the Deputy, before the summer. This will assist in drafting the Bill. I intend to publish the Bill later this year.

That is good to hear because there is a fear that somehow this legislation will not be implemented before the next general election and considering the recommendations that were made in the Lourdes hospital report, this is very serious legislation. However, I also wish to ask the Tánaiste what is being done in regard to clinical governance, clinical audit and competence assurance because these are not just catch phrases we can throw out all the time. In some respects the Tánaiste is trying to slip away from the importance of these issues by saying she will ensure a lay majority on the Medical Council.

As a State organisation, whether the Medical Council has a lay majority or is self-regulated with a majority of doctors is of no benefit to patients unless the issues around clinical governance, clinical audit and competence assurance are dealt with. As we saw from the Lourdes hospital report the Medical Council acted appropriately once it was informed. In fact, the Medical Council had to report Dr. Neary to itself in order to investigate the matter. Many facts have been lost in the very emotive issues that surrounded this crisis in the north east. What does the Tánaiste intend to do before the summer in regard to issues such as clinical audit and competence assurance?

The Tánaiste has quoted Professor John Higgins in CUH about clinical directorates and doctors having to do more themselves. It is our responsibility to protect patients. It is not up to the goodwill of a few consultants, doctors or voluntary organisations, it is our responsibility. I would like to hear more, not just about the legislation, because even if we do bring the Bill to the House in September it will not be enacted before the next general election, and we need to know what will happen in regard to those other big issues.

I certainly hope it will be enacted because otherwise it will fall. A huge effort is being made in the Department of Health and Children to try to make sure we have modern and robust legislation enacted with great speed.

Clearly, there are deficiencies in the 1978 legislation. We need more modern and robust legislation but, notwithstanding the deficiencies, that is no excuse for what happened in the maternity unit of Our Lady of Lourdes Hospital for 25 years. To be quite frank, if it were not for that brave midwife and the response of both Ambrose McLoughlin at the time and Mr. Lennon we might never have got to the stage of finding out what happened there. Notwithstanding the legislation or the deficiencies in it, many things could have been reported that were not reported and we need to learn from that. Everybody has responsibilities in regard to this issue.

Specifically on competence assurance, in medicine in particular, but more and more in other professions, continuing professional development is an important prerequisite for maintaining one's skill base. That will become mandatory in the new legislation. We need to ensure that those who are on the register, the specialists in our health care system, are involved in a process where the patients can be reassured that they are competent to do the job they originally qualified to do. I know most progressive doctors feel very strongly about this as well.

The Lourdes hospital report also raised issues for the college of obstetrics, the Royal College of Surgeons and others, as well as for hospital management. That is why we want to have clinical directors in the context of a new consultants' contract. Currently in the health care system consultants are independent contractors. They are not required to work as part of a team. Each person is his or her own boss, as it were. I know some doctors are critical of this but the best health care systems in the world are ones where people work as a team and there is a clinical director with specific responsibilities. Generally, the chairperson of the medical board of a hospital does this on a pro bono basis and maybe in some places they might get a session or something in lieu of the work they put in. We have to take this issue more seriously and see this role as a job in itself where people are hopefully appointed to the position based on their expertise and competence. They would then be responsible for the team with which they work. That is when we would get the best results.

Clearly, there has to be a national audit. As Members are aware, we have given resources to Cork University Hospital to establish an audit in regard to maternity issues. Professor John Higgins from Cork is the person who put the idea to me. It is borne out of something he had seen elsewhere. I am happy to say we have provided the funding to get that up and running so that details in regard to all births nationwide will be fed into a central unit at Cork University Hospital. I hope it will be possible to detect something like what was happening in the maternity unit in Our Lady of Lourdes Hospital much earlier because it should be evident if the pattern in one hospital is very different from the pattern in some of the other hospitals in the country.

While I acknowledge that the Tánaiste clearly envisages that the legislation will address the important issue of ensuring that all medical practitioners are properly qualified and trained, would she not also accept that we can have no dependence on whistleblowing alone in terms of drawing public and wider attention to malpractice or irregularities in terms of service delivery in any of the disciplines? The legislation must contain a guarantee of regular monitoring and ongoing assessment.

Will the Tánaiste give an indication of what is intended in the medical practitioners Bill in that regard because, ultimately, it is the only real safety net and the one that can instil the greatest confidence in the widest number of people. The confidence of many people has been greatly diminished and in some cases shattered by the experiences of the Neary case and others in recent years. What can the Tánaiste tell us about that and can she give us an indication of when exactly the medical practitioners Bill will come before us? If she is in a position to do so, will the Tánaiste release the heads of the Bill which would be of assistance to Opposition Members in assessing exactly what she intends?

I intend to release the heads of the Bill. This will be helpful given that it will be major legislation that will be of great interest not only in this House. A better debate on the Bill will ensue if there is feedback and input at an earlier stage. There will be an ongoing process of competence assurance because we have noted this happens elsewhere. Most of our best doctors constantly attend seminars or international events and keep their skills up to speed by writing in journals and undertaking research. We must ensure this becomes the norm for all specialists in the health care system. The president of the medical council, Dr. Hillery, has done some very innovative work in this area and we are working closely with him on those aspects of the legislation, whatever about the issue of lay participation.

The medical council currently has 25 members. Any member involved in a fitness to practise inquiry could be involved for up to three days a week and this would also entail considerable advance preparation, yet the lay members do not receive any remuneration nor is the fact that they have other lives and other careers taken into account. These are some of the issues that need to be examined. If we want to have lay participation — which most people would welcome — we must facilitate this happening. We must consider the significant time involvement by the current members, particularly those on the fitness to practise committee which is an onerous committee for many of them. It is certain that we would not be able to continue with the current regime on an ongoing basis if there were to be many fitness to practise inquiries in any one year. These inquiries can go on for a considerable length of time.

The medical practitioners Bill will not cover alternative practitioners. The Tánaiste was given a report in December and I believe she will launch it on 12 May. Is it true that this will not include any regulation to cover alternative practitioners and will be just a voluntary code? Having seen two people in my area die at the hands of Mineke Kamper, a common killer, who operates in my area without any regulation whatsoever, has the Tánaiste any news on this?

This is not in order.

This is a medical practitioners Bill, so clearly it does not deal with anyone other than medical practitioners. The Deputy is well informed about the date of 12 May because I did not know the specific date. It is a good report which makes some very practical suggestions.

General Medical Services Scheme.

Joe Sherlock

Ceist:

55 Mr. Sherlock asked the Tánaiste and Minister for Health and Children her views on the State’s €65 million bill for drugs and medicines in hospitals and in the community which is significantly ahead of expectations; if her attention has been drawn to the fact that in six of the country’s major acute hospitals, drug costs increased by an average of 19%; her plans to address these rising costs; if she has plans to encourage use of generic drugs; if so the way in which she intends to do so and the timescale of this plan; and if she will make a statement on the matter. [15472/06]

The financial report to the board of the Health Service Executive in respect of the cumulative expenditure to end December 2005 highlighted the growth in expenditure on drugs and medicines of €65 million over the 2004 expenditure level. This represents an increase of 13% on a total expenditure figure for 2004 of €500 million on both major hospitals and the community drug schemes. This expenditure excludes the cost of drugs and medicines provided to medical card holders under the GMS scheme. The growth in expenditure is attributable to increased patient numbers and the introduction of new drug treatments.

I have previously expressed concern about the increasing cost to the Exchequer of drugs and medicines and the sustainability of trends in this regard. It is essential to secure maximum value for money for this expenditure. All aspects of the drug delivery system, from the manufacturer to the patient, are being reviewed by my Department and the Health Service Executive. A number of possible measures to address the rapidly rising medicine costs being incurred by the State are being considered. These include greater access to generic drugs and supply chain costs such as pharmacy mark-ups.

I stress that no single measure will contain the rate of increase in expenditure on medicines and drugs. International experience has shown that this is a very difficult task, as the sophistication and range of treatments continue to increase along with increased expectations on the part of patients.

On the specific issue of generic drugs, it is my intention to give patients and ultimately the taxpayer, as the biggest buyer of medicines, better access to generic drugs where this is possible and appropriate. Negotiations are currently under way with the Irish Pharmaceutical Healthcare Association and the Association of Pharmaceutical Manufacturers of Ireland, on a new national pricing and supply agreement for the supply of medicines to the health service. The agreement covers all reimbursable prescription medicines in the GMS and community drug schemes and all medicines supplied to hospitals and the HSE. It is intended to address the issue of access to generic drugs within this new agreement.

I thank the Minister for her reply. I assure her the Labour Party will be keen to support her in any move towards the use of generic drugs, so long as it is reasonable.

Is it not possible for the Minister to ensure that generic drugs are prescribed more often by GPs to those patients who are not GMS patients? The GMS scheme currently encourages the use of generic drugs. What is stopping the Minister from ensuring that the same principle is applied to private patients of GPs? The Minister has stated she is considering a number of options. Does this include a cap on very expensive drugs? Will she comment on the fact that some new drugs are extremely expensive and that a cap on their use is applied in other countries? Is she considering its application here?

No. These are very controversial areas and they are probably more appropriate for those with medical expertise. I am aware that many countries have protocols regulating when particular drugs may be used, for example, drugs that can cure as opposed to drugs used for an incurable illness. We have not considered going down that road as it is a very sensitive issue. In the first instance it is the intention to get better value in the whole supply chain, whether it is from the manufacturers' piece or the wholesalers' piece or the pharmacy piece. There cannot be a situation whereby we are paying the same price for a drug when it is off patent as when it was on patent. The patent should cover the innovation and I am a strong fan of supporting innovation in the pharmaceutical sector. Innovation is extraordinarily expensive. Many of the innovations never turn into products that can be sold and huge sums of money can be spent in the process. It is clearly a very expensive investment for pharmaceutical companies. I believe the patent period covers the innovation costs and the profits companies are entitled to expect. Therefore when a drug is no longer a branded product I do not believe we should pay anything like that price. This is the approach being taken by the HSE with the Department in these negotiations. Some considerable work has been done by the pharmo-economics division of Trinity College, Dublin, and others in assisting the HSE in this regard.

The Deputy makes an interesting point about private patients. We used financial incentives to encourage GPs to prescribe on the medical card. It is a good idea which we should examine.

When will we get a chief pharmacist?

Issues have arisen from time to time regarding scarcity of drugs and the unavailability of certain drugs through pharmacies. This matter has been raised with the Tánaiste. In recent months, drugs which I suspect are more expensive but are not licensed in the same way as the original drug, have been substituted because drugs are not available on the market. I know the Minister is a great supporter of the market but the market does not always deliver and from time to time, quite important drugs have not been available. How is the Tánaiste dealing with this matter?

In answer to the question about the chief pharmacist — until we can pay a public sector salary commensurate with what the market regards as reasonable we will find it considerably difficult. This has been the experience when the Department recruited some professionals in recent times. It is a real issue because of the salaries being earned in the private sector. In some of these areas we rely on retired persons coming back on a part-time consultative basis. I am currently in discussion on the matter and I hope to be able to say something about it later.

The drug industry is not quite like the market elsewhere in that prices are negotiated with governments which can vary from one country to another. This is unsatisfactory mainly because there are unique suppliers of particular products. I am not aware of the specific shortage to which the Deputy refers. It may have been brought to the attention of the Department but it has not been brought to my attention with regard to any specific drug. For a country like ours, for example, in the case of the influenza pandemic, it was much more attractive for us financially to join the UK in dealings on the H5N1 vaccine than to seek to negotiate ourselves, as a small country with a small population, with the supplier of the vaccine. That is often the story where small populations are dealing with large companies and real issues are involved.

The purpose of the contract is to guarantee supply of medicines. Clearly, unless we can move to prescribing more generic drugs, we will not be able to afford many of the new treatments. The new breast cancer drug, Herceptin, which cuts of the supply of blood to the tumour, costs about €20,000 per patient per year over a five-year period and is being prescribed in Ireland. We want ensure that patients have access to such drugs and any other drugs that can greatly assist, but the quid pro quo would have to be to try to get savings when drugs go off patent and more prescribing of generic drugs where possible.

Mental Health Services.

David Stanton

Ceist:

56 Mr. Stanton asked the Tánaiste and Minister for Health and Children her Department’s policy on psychiatric services and supports for 16 and 17 year olds; and if she will make a statement on the matter. [15489/06]

David Stanton

Ceist:

83 Mr. Stanton asked the Tánaiste and Minister for Health and Children if her attention has been drawn to the fact that it is estimated that more than 3,100 children and adolescents await psychological assessment; her Department’s policy on the matter; the funding she is making available; the other measures she is taking or intends to take to address this situation and improve mental health services for young people; and if she will make a statement on the matter. [15488/06]

I propose to take Questions Nos. 56 and 83 together.

The future direction and delivery of all aspects of our mental health services, including child and adolescent psychiatry, were considered by the expert group on mental health policy. The Government has accepted and published the group's report entitled A Vision for Change, and €25 million has been provided this year for the further enhancement of mental health services.

A Vision for Change acknowledges gaps in the current provision of child and adolescent services and makes several recommendations for the further improvement of these services. Recommendations include early intervention and health promotion programmes, primary and community care services, specialist mental health services for the treatment of complex disorders and the provision of additional child community mental health teams. In particular, the group recommended that child and adolescent mental health services should provide mental health services to all those aged up to 18 years who need such services. It also recommended that transitional arrangements to facilitate the expansion of current service provision should be planned by the proposed national mental health service directorate and the local child community mental health teams.

I am informed that the Health Service Executive has established a high level working group to advise on the transition arrangements and to make recommendations on the most appropriate provision for young people aged 16 and 17 years with mental health needs, both within the community and on an inpatient basis.

With regard to the issue of waiting times for psychological assessment, I am informed that the HSE is conducting a review of services nationally to identify and address gaps in service where they exist, and to identify opportunities for additional capacity in line with recommendations in the report A Vision for Change.

The development of child and adolescent psychiatric services has been a priority for the Department in recent years. Since 1997 additional funding of almost €20 million has been provided to allow for the appointment of additional consultants in child and adolescent psychiatry, for the enhancement of existing consultant-led multidisciplinary teams and towards the establishment of further teams. This has resulted in the funding of an extra 23 child and adolescent consultant psychiatrists. Nationally 56 such child and adolescent psychiatrists are now employed by the HSE.

Am I correct in saying that there are only 16 acute beds for children and adolescents in the country, none of which is in the south and all of which are in Galway or Dublin? What plans has the Minister of State to increase the number of such beds and what timescale has he set?

How come more than 3,000 children and adolescents now await psychiatric assessment? If it was a priority of the Government that it should not arise, how did that arise? What timescale has the Minister of State set to reduce this number to acceptable levels, in other words, to zero? What has he to say to parents who have children with psychiatric difficulties when no service is available at present? It is a failure. It is a disgrace. Will the Minister of State provide the House with some timescales and stop the blather? This is a life and death issue for many parents, families and young people.

As regards inpatient or residential services for child and adolescent psychiatry, there are four adolescent units in preparation and they are at an advanced stage.

When will we see them?

They must be built.

Has the Minister of State any timescale?

Within the next two or three years.

Live horse and you will get grass.

Can I also say that——

There are only 16 places in the country at present and they are in power nine years.

I did not interrupt Deputy Stanton.

Someone should interrupt the Minister of State because he is not doing his job.

He has failed hopelessly on this one. It is not a laughing matter either. It is quite serious dealing with children with psychiatric difficulties.

I am more aware than Deputy Stanton of the seriousness of it.

The Minister of State is not doing anything about it.

There was considerable debate about many of the recommendations and some of the suggestions about a new division of psychiatry for the 16 and 17 year old group and it was rejected by the expert group.

There is no service for them at present.

There are many services——

It is past the time for questions.

——and there is a significant increase in the number of psychologists being trained as well.

How come there are 3,000 waiting for assessment?

Many of those people will be picked up soon and we are employing more psychologists and therapists for those patients.

It is past the time for questions. We must conclude questions.

Written Answers follow Adjournment Debate.

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