Thomas P. Broughan
Ceist:6. Deputy Thomas P. Broughan asked the Minister for Health if he will report on the waiting lists for clinical services for children with autism spectrum disorder in north Dublin. [7943/15]
Other Questions
Autism Support Services
The Minister and Minister of State are well aware that early assessment and intervention are critical for children with ASD and other disabilities. A couple of years ago, the then Minister for Health, Deputy Reilly, told me that the Beechpark Autism Services team was getting an extra five posts to try to reduce the waiting list. Under Progressing Disability Services for Children and Young People, of which the Minister of State is also aware, 21 new posts were sanctioned for Dublin north. What is the current position on those posts? Last year, I was disappointed that the then Minister had not filled them. If they have been filled, what is the waiting list currently?
I thank the Deputy. Health-related supports and interventions for children with disabilities, including those with autism, are generally accessed, depending on the level of need, through primary care and specialist disability services. Information on waiting times for primary care and specialist disability services is not generally collected in terms of specific disabilities, such as autism.
While it is recognised that there are challenges in providing children with timely access to these services in the north Dublin area and elsewhere, the Government is committed to addressing this issue through the development of primary care and specialist disability services. An additional €20 million in funding has been allocated to strengthen primary care services and to support the recruitment of more than 264 prioritised front-line posts. Forty-nine of the posts have been allocated to the north Dublin area.
The HSE is also engaged in a major reorganisation of existing therapy resources into geographic-based teams for children with disability aged from birth to 18 years under the Progressing Disability Services for Children and Young People programme. The reconfiguration programme is due to be fully implemented by the end of 2015 or early 2016. This will result in a more equitable service provision for all children with a disability, including those with autism, in the localities in which they reside. It aims to achieve a national, unified approach to delivering disability health services so that there is a clear pathway to services for all children, regardless of where they live, what school they attend or the natures of their disabilities. An additional €4 million was specifically allocated in 2014 to drive the implementation of the programme. This equates to approximately 80 therapist posts, 21 of which have been allocated to support the reorganisation of services in the north Dublin area and to address waiting lists. Recruitment of these posts is still under way. A further investment of €4 million is being made to support the roll-out of the programme in 2015.
I welcome the allocations, but there is concern at the speed with which recruitment is taking place and the long, drawn out process. The Minister of State might report on this matter.
Apparently, the work of the independent expert review group that the then Minister, Deputy Reilly, set up a few years ago to examine the Beechpark model of services was nearing completion last year. Has the group reported? Following an earlier Government decision, is the disability manager for the north of Dublin in place? Early intervention and assessment are critical. It is disappointing that the Minister of State does not have data. There is a major dearth of data on the incidence of ASD in the population, as Professor Anthony Staines's report shows. The level seems to have increased significantly in recent decades. What of our determination to identify this condition as early as possible and to help children?
While I welcome the Minister of State's point, we need more urgent recruitment and implementation. I also need data. The Minister for Health, Deputy Varadkar, gave me a reply-----
The north Dublin area 9, Health Service Executive social care operational plan, which I think the Deputy is referring to, indicates that the local implementation plan is due to be completed by the end of 2015 with full reconfiguration into 12 teams in quarter one of 2016.
In respect of diagnosis, those representing the people aged from birth to 18 and those with progressing disabilities tell us that it is a question of early intervention. The diagnosis may come later, provided the speech therapy and occupational therapy, the type of one to one intervention that children with autism will need, is provided. We have seen long waits for diagnosis while nothing was happening. We are trying to put the teams in place. North Dublin does not get these posts more than other areas because we like the look of the place but because we recognise there is a deficit. Recruitment is an issue for us and is taking longer than expected but there are few people qualifying in these areas. It is being worked on daily.
Would the Minister of State follow up on the new model of immediate service provision and early diagnosis?
I have asked the Minister for Health to provide all the data on autism spectrum disorder, ASD, in young people, for 2013-14 and to date in 2015 and have been waiting some time for that. The Minister gave me his famous 15 working days deadline for this as he used to do when he was Minister for Transport, Tourism and Sport, but I have been waiting some time for that reply and for one or two other replies. The Minister and Minister of State might follow up on those questions.
Only at the point of diagnosis can we get the absolute data the Deputy is looking for. If we make the interventions before we make the diagnosis, the data will take a bit longer to collect. That is not to say we should not have it. I believe if we do not know where and what the need is and if we cannot absolutely put our hands on that type of data, we cannot plan properly. If we do it this way, there will be a time lag in collecting the data.
Unfortunately, Deputy Keaveney is ill and we cannot take question No. 7. Question No. 8 is in the name of Deputy Boyd Barrett but he is not present.
Questions Nos. 7 and 8 replied to with Written Answers.
Hospital Waiting Lists
Billy Kelleher
Ceist:9. Deputy Billy Kelleher asked the Minister for Health when he expects an improvement in both the numbers on waiting lists and the numbers on trolleys in emergency departments; and if he will make a statement on the matter. [8031/15]
When does the Minister for Health expect to see an improvement in the numbers on the waiting lists and the numbers on trolleys in emergency departments and will he make a statement on the matter?
Emergency department, ED, overcrowding and eliminating very long waits for inpatient, outpatient and day case treatment are key priority issues for me and for the Government and I acknowledge the difficulties the current surge in ED activity is causing for patients, their families and the staff who are doing their utmost to provide safe, quality care in very challenging circumstances.
All hospitals have escalation plans to manage not only patient flow, but also patient safety in a responsive, controlled and planned way. The Government has provided additional funding of €3 million in 2014, secured in the Supplementary Estimate, and €25 million in 2015, secured in the Estimates for this year, to address delayed discharges and actions being taken include the provision of additional home care packages, additional transition beds in nursing homes, of which there have been several hundred, 300 additional fair deal scheme places and an extension in community intervention teams. Building upon these initiatives, the HSE is currently finalising an action plan under the auspices of the ED task force to address ED issues with a view to a significant reduction in trolley waits over the course of 2015.
My Department is also working with the HSE to put in place a plan to eliminate very long waits by the end of the year. This will involve both operational improvements and better waiting list management.
As I have stated publicly in the context of the significant emergency pressures currently being experienced by hospitals, realistically I do not envisage significant improvement in elective waiting times in the early part of the year. However, based upon the high priority attached to this area in the HSE service plan and the first overall increase in the HSE budget in seven years, it is expected that some improvement will occur later in the year.
We have referred to the fair deal scheme problem in detail in a previous question. When one adds all the waiting lists together, there are 76,666 patients waiting for inpatient, day case or gastro-intestinal procedures, according to the most recent report from the National Treatment Purchase Fund, NTPF. The Minister is as aware of the figures as I am.
We cannot just acknowledge that it is bad and might get worse before it gets better. We need to see some clear commitment on how it will be addressed. We cannot tell people live horse and eat grass or if they hang on long enough, they will be seen to. The Minister needs to outline a roadmap and accept that additional resources are required and the Economic Management Council has to support the Minister in announcing additional funding in advance of the panic stations between next October and December with a supplementary budget landed in to the Dáil at the end of the year to keep the show on the road. The Minister needs to achieve a sustainable funding model so that he can plan for the crisis situation of waiting lists and people on trolleys.
The figure the Deputy gives may also include people waiting a few weeks-----
I accept that.
There is a big difference between somebody waiting a few weeks for an appointment or investigation and somebody who is waiting several months. It has been the case for a very long time, including when the Deputy’s party leader as Minister for Health promised to abolish waiting lists in two years and broke that promise, but we can both accept that in Ireland there have been far too many people waiting far too long for appointments, diagnostics and treatments.
There is a roadmap. I have outlined it several times. It has three elements, first, transparency, which involves online waiting lists and strict adherence to chronological order which is not happening in some hospitals where people are going up and down lists although they are not sicker than others. The second element is efficiency, more day surgery, 20,000 more cases this year, more day of surgery admissions, an improved ratio of new patients to returns, which is really important, and reduced numbers of non-attenders, which are still very high and above international averages. There are specific initiatives and there is additional funding in place for scoliosis – we are trying to get a plan in place to make that happen but the resources are there for additional cases – ophthalmology and some other areas that are being prioritised such as general practitioner, GP, access to ultrasound and a minor surgery list for GPs. There is a roadmap.
The Minister’s party outlined a roadmap in advance of the election and in the programme for Government. We can travel that road for a long time but it did make many promises and campaigned on many issues, none of which has been implemented, including free GP care for everybody, Roscommon, Mallow and Bantry hospitals etc. - name them and the Minister’s party campaigned on them. Anywhere there was a lorry they were up on it, shouting to the high heavens. With all that talk, commitments have not been made. What is definite now is that the 76,666 people waiting, admittedly some are only waiting a short time, are in the difficulty that there is an escalating number going into the system and they are not being treated or dealt with. The key pinch points are, as the Minister and Minister of State have accepted, lack of funding for the fair deal scheme, delayed discharges and recruitment of consultants. These are all well within the Minister’s gift to address but many measures were populism, such as cutting consultants’ pay when he knows in his heart and soul that to recruit people it is necessary to maintain a certain level of remuneration rather than hunt people out of the country and pretend that he wants them back again. The Minister needs to be consistent. That is not the case.
The Minister gave me figures recently for the waiting list in Beaumont Hospital. I was really shocked to see the number of people waiting for a date for an appointment or for letters to be read. I saw on the television that the Minister was in Castlebar.
We are over time.
He was speaking in a theatre with many empty chairs and laying down the law about other parties in this House-----
Please. The Deputy should not abuse the fact that I allowed him to ask a short supplementary question-----
-----regarding what we would like to do on health.
-----but not a political statement.
It is a question of money and resources. The Minister will not spend the money because he is a neo-conservative financially.
It sometimes really amazes me that people actually elect Deputy Broughan. I can absolutely assure him that there is no money I am not spending.
But he needs more. He needs to ask for more, like Oliver Twist.
Whether I am a neo-conservative is entirely irrelevant. I absolutely assure the Deputy I will spend-----
Is the Minister confirming he is a neo-conservative?
-----any money that I-----
He was always a neo-con.
Is this Question Time or just some sort of general circus?
Deputy Broughan should not abuse the fact that I let him in. I should not have done so. This is Deputy Kelleher's question and I ask the Minister please to reply to him.
The Deputy's follow-up question was about promises. I am not making any promises and that is-----
He made enough of them previously to keep him going.
The only promise I will make is to work night and day and do everything I can to improve our public services and make insurance affordable for more people. The Deputy mentioned specifically the issue of consultants. One thing I have achieved in office is an agreement on pay scales for new consultants. Over 30 new posts have already been advertised. I am in the same boat as the Minister of State, Deputy Kathleen Lynch, the senior officials in our Department, the HSE leadership team and everyone else working in the health service. We are doing our very best to deliver as good a health service as we can with very constrained resources and very limited time. Expenditure is some €1.5 billion less than seven years ago, and there are 15,000 fewer staff. Therefore, we are really struggling but we are doing everything we can to provide as good a service as we can.
Question No. 10 replied to with Written Answers.
Drugs-related Deaths
Billy Kelleher
Ceist:11. Deputy Billy Kelleher asked the Minister for Health the number of deaths caused by drugs; and if he will provide a specific figure for those involving methadone in each of the past five years; and if he will make a statement on the matter. [8033/15]
What is the number of deaths caused by drugs? Specifically how many people have been using methadone in each of the past five years? Will the Minister make a statement on the matter? Could we have a broader discussion in the context of the methadone treatment programme itself?
Drug-related deaths are a human tragedy for the families and friends of the people involved and have a considerable impact on communities and society as a whole. While there are no easy solutions to addressing the problem, the Government is committed to stepping up the effort to reduce the number of drug-related deaths. The latest annual figures from the national drug-related deaths index indicate that 350 people died in 2012 due to the toxic effects of drugs, a decrease from 387 in 2011. There were 86 deaths involving methadone in 2012 as compared with 118 in 2011, 60 in 2010, 69 in 2009 and 80 in 2008. Methadone was involved in one out of four poisoning deaths, and in most of these deaths methadone was mixed with another drug.
Many drug-related deaths are avoidable, particularly those involving methadone or heroin overdoses. For this reason, I have authorised the HSE to undertake a demonstration project on the use of naloxone in the prevention of opioid overdose. Naloxone reverses the effects of drugs like heroin, morphine and methadone in someone who overdoses. The pilot study, which is being carried out this year, aims to increase access to naloxone for non-medical staff, such as the families or friends of a drug user and those who work with drug users. The HSE budget includes an extra €2.1 million to support this project and other measures targeting vulnerable drug users, including through the provision of additional residential detoxification beds and additional rehabilitation facilities.
My Department is commencing work on the development of a new national drugs strategy for the period after 2016. The process will involve comprehensive consultation with stakeholders and the public on the current national drugs policy and future priorities. It will also take account of evidence-based research, information and data sources on the extent and nature of problem drug use in Ireland, including drug-related deaths.
I thank the Minister for his reply and welcome the fact that there is a commitment to carry out a review of our drug treatment programmes and the national drugs strategy. Let us be very clear: this has fallen off the political agenda. That is many people's fault but the key issue is that there is a major problem of drug abuse in the State. It is escalating continually.
With regard to opiate substitutes, has the Minister considered buprenorphine as an option? Treatment centres seem to depend continuously on methadone. We must consider other options. It seems that, as a people, we are just satisfied to give addicts methadone and hope they will not annoy us on the street. We must look beyond that. The drug users need support and assistance. Collectively, we should try to reach some consensus on how to address this issue.
Professor Farrell's report of 2010 did come up with various views on opiate substitutes. Are we very blinkered or channelled in our approach and completely dependent on methadone as a treatment for heroin and opiate addicts?
The objective is to reduce the number of drug deaths. At least for the years for which we have the most recent figures, the number of drug deaths has decreased slightly. There will be two developments this year that I hope will improve circumstances. First is the naloxone project, which is to make naloxone available to users, their families, friends and those who work with them to reverse overdoses. This will be the single most effective measure we can take to save lives. The second development, which is very important, is to increase the budget for drug treatment by over €2 million this year. This will include traditional needle exchanges and additional detoxification beds to facilitate people who want to come off opioids altogether and go clean. That is why the additional beds have been provided. Some additional ones have been provided in my constituency in Ashleigh House, Coolmine, which particularly target drug users who are pregnant or who have young children. I visited the centre and have seen its work. I am very happy I have been able to provide additional resources for Merchants Quay Ireland, Ashleigh House and other facilities this year. I hope to be able to continue to do so in the coming years.
I do not expect the Minister to answer my next question if he does not know the details. In the context of rolling out the naloxone programme, will Garda stations and other places in areas of high drug use have naloxone available? It seems that while we make some efforts in the treatment of heroin and opiate addicts, in particular, we seem to be happy enough just to give them methadone and hope they go on their merry way and not annoy society any more. Collectively, that is not good enough. Some are on methadone for up to 20 years. We must examine other options to try to ensure we give addicts every assistance in trying to address their drug addiction. Handing out methadone alone without other supports, including detoxification programmes, and without considering other substitutes is insufficient. We have not given heroin users options to try to treat or deal with their addictions in recent times. I welcome the broader issue, which concerns a full review of our drug treatment systems.
Long-term methadone maintenance may be the best option for some people. It is certainly not the best option for everyone, and that is why we are increasing the number of detoxification beds this year. We will certainly consider all these issues in the context of the next national drugs strategy. I very much welcome the Deputy's input into that.
On the specific question on the naloxone demonstration study, initially the programme is aimed at non-medical staff, care workers, families and peers of opioid users. It is already the case that paramedics can use naloxone. Its administration by gardaí and prison officers would require willingness on their part to be part of this project. It is important that there be consent. It is intended at some point to have a discussion with those concerned and to include them, if appropriate.
Questions Nos. 12 and 13 replied to with Written Answers.
HSE Funding
Charlie McConalogue
Ceist:14. Deputy Charlie McConalogue asked the Minister for Health further to Question No. 105 of 11 November 2014, when follow-up funding will be provided for the 550 adults who require general surgery, the 953 patients who require diagnostic testing, the 110 patients who require an outpatient review, and the persons outsourced, under the 2013 outpatients initiative, to have their treatment; if this treatment will be provided by the hospital to which they were referred; and if he will make a statement on the matter. [7898/15]
This is to ask the Minister, further to a previous parliamentary question, when follow-up funding will be provided for the 550 adults who require general surgery, the 953 patients who require diagnostic testing and the 110 patients who require an outpatient review. These patients are part of the 2013 outpatient waiting list initiative. The patients' cases were outsourced from Letterkenny General Hospital for private appointments, and the patients had their appointments with a consultant.
Funding has not been provided for follow-up treatment and their files have been recalled to Letterkenny General Hospital to be added to its waiting list. Will funding be provided for them to continue their treatment with the consultant to whom they were initially referred?
I understand that the Deputy's previous parliamentary question relates to the number of patients outsourced by Letterkenny General Hospital under the 2013 outpatients initiative. The HSE has advised me that all patients from the 2013 waiting list initiative who have not been seen, diagnosed, treated and discharged back to their GP have all been accepted back to Letterkenny General Hospital on their appropriate waiting list. This includes the surgical pre-assessment, day surgery and inpatient surgical waiting lists. These patients will be treated within the hospital's service and budget for 2015. For some outsourced patients, the treating consultant required further review to either verify their clinical requirements or perform further diagnostic tests. Patients requiring review were reinstated on the public waiting list to have them scheduled for treatment in chronological order. All paediatric patients concerned have already received treatment.
Improving waiting lists for inpatient and day case treatment is a key priority for me and for the Government. The HSE has already put in place specific measures to address waiting lists more efficiently in collaboration with the acute hospitals. These include observation of the national waiting list protocol as approved in 2014, adherence to the relevant HSE national clinical programme guidelines and prioritising day of surgery admission where clinically appropriate. My Department is working with the HSE to put in place a plan to eliminate very long waits by the end of the year. This will involve both operational improvements and better waiting list management.
I am very disappointed with the Minister's response because he has not indicated that follow-up funding will be provided for these patients to continue their treatment with the consultant who has already seen them in a private capacity.
Under the 2013 outpatient waiting list initiative, which was a previous initiative by the Government to try to address the long waiting lists, more than 3,000 patients were referred out of Letterkenny General Hospital for private consultant appointments. Of those 3,000, approximately half were discharged back to their general practitioner. There are 1,500 others, and I listed them in the question, who need surgery, diagnostics or follow-up patient reviews and for whom Letterkenny General Hospital and the HSE were expecting to be able to provide follow-on funding to allow them continue their care with the consultant who had already seen them. That follow-on funding has not been provided and those 1,500 patients are now being put back on waiting lists in Letterkenny General Hospital, but those waiting lists have got longer in recent months because of the accident and emergency department situation.
One measure the Minister could propose to help address the waiting list problem in this hospital immediately would be to provide the follow-up funding for these patients to continue their care with the consultant who has already seen them, is aware of their case and has diagnosed the follow-on treatment or diagnostics required. Unfortunately, the Minister seems not to be doing that. I would point out to the Minister that of any hospital in the country, Letterkenny General Hospital has the largest number of patients waiting more than two years to see an outpatient consultant, yet the Minister is putting these patients back on these hospital waiting lists by not providing the funding for them to continue their care. I urge the Minister to take action today to provide that funding.
Sorry, Deputy, I will let you back in. You are over time.
I may have misspoken in my previous reply. Patients requiring review were reinstated on the public waiting list to have them scheduled in chronological order. All paediatric patients concerned have received their treatment.
What happened is that about 2,700 patients were outsourced, in effect. They were sent for private treatment. Many were discharged back to their GP. Others required further follow-up and were put back on the public waiting list into the position they would have been in. They were not disadvantaged in any way by having their case outsourced. It is not a satisfactory situation that if somebody is outsourced and sent for private treatment, they should stay in that until their treatment is completed. That did not happen in this case. They were sent out privately for their outpatient and then put back on the public waiting list, although they were not disadvantaged in any way. They did not lose their position on the waiting list.
Regarding the Deputy's question on follow-up funding, I do not have it. If I did have it, I would provide it but at this stage I do not have it. I can say, however, that nobody has been disadvantaged by the fact that their cases were outsourced or sent privately for treatment. Anybody who has gone back on the public waiting list has gone back on in the position, in chronological order, they would have been in had they not been sent privately.
I agree with the Minister that it is entirely unsatisfactory. However, unlike him, I am not the Minister for Health and if the Minister believes it is unsatisfactory, it behoves him to do something to address it. He indicated to me that these patients are not disadvantaged in any way. That is not the reality. The reason these patients were referred out in the first place was because they were waiting more than one year. They were referred out at the end of 2013. Before that they were waiting at least a year, and in most cases more than a year, to see a consultant. They were referred out at the end of 2013. They then saw a consultant at the start of last year, which is more than a year ago at this stage. They are being brought back to Letterkenny General Hospital but before their treatment can be brought forward or diagnostics done, they now have to see a consultant in Letterkenny for the first time because a consultant will not decide to treat a patient without first seeing him or her. That is the position in which they find themselves. They are back to square one, as such. The difference is they know they need some follow-on treatment. That is beneficial in itself but they are back to square one in that they are waiting to see a consultant in Letterkenny General Hospital for the first time. What is required, and this can be addressed immediately, is for money to be provided and for Letterkenny General Hospital to be asked to stop requesting the files from the consultants who are treating these patients and instead provide the funding to complete their treatment. What is happening to these patients is cruel.
I am happy to be corrected if I am incorrect but I am informed they were put back onto the point in the public waiting list they would have been on anyway, so in that sense they have not been disadvantaged. That is not to say they have been well treated, which is a different matter entirely.
If I were to provide the funding it would have to come from somewhere else, and that would mean people who are already waiting longer than these patients waiting even longer again, and that would not be fair. Funding is limited and when funding is limited, urgent cases must be treated first and then everyone else in chronological order.
Written Answers follow Adjournment.