Other Questions

Vaccination Programme

Clare Daly


62. Deputy Clare Daly asked the Minister for Health if he has recently met with representatives of the Reactions and Effects of Gardasil Resulting in Extreme Trauma, REGRET, group, to discuss available or potential health support services, and other supports for families represented; and if he will make a statement on the matter. [3892/16]

This question relates to the parents who organise a group called REGRET. Almost 200 teenage girls have experienced serious side-effects having taken the human papillomavirus, HPV, vaccine. Has the Minister met with that group recently to discuss what supports might be put in place? While we might debate their origin the problems these young women are experiencing are undoubtedly real and the families need urgent support.

I am aware of claims of an association between HPV vaccination and a number of conditions experienced by a group of young women. The vaccine protects against cervical, penile and anal cancer and helps to prevent genital warts. It appears that some girls first suffered symptoms around the time they received the HPV vaccine, and understandably some parents have connected the vaccine to their daughter’s condition. As the Deputy is aware, in November 2015 the European Medicines Agency, EMA, completed a detailed scientific review of the HPV vaccine which found no evidence of a link between the vaccine and the two conditions examined. On 12 January 2016, the European Commission endorsed the conclusion of the European Medicines Agency that there is no need to change the way HPV vaccines are used or to amend the product information.

However, this does not get away from the fact that these young women are unwell. I want to make it quite clear that anyone who is suffering ill health is eligible to seek medical attention, and to access appropriate health and social care services, irrespective of the cause of their symptoms. The individual nature of the needs of some children may require access to specialist services and they may be different in different cases. The HSE will be in a position to facilitate that access to these services for any children or young adults who may require them.

As Minister I consider meeting any organisation that requests to do so. However, due to busy parliamentary and other business it is not always possible to meet all representative groups. I have been informed that the HSE has met with members of REGRET concerning this issue.

It is important to say that these families are not anti-vaccine crusaders. They had their daughters vaccinated and now their daughters are severely unwell and as the Minister says, the side-effects are real. It is all very well to acknowledge the EMA review of the drug but it only examined it for two side-effects and did not take into account the full range of symptoms that some of the parents have outlined, anything from a leg tumour to chronic fatigue and so on. The problem is that while it is all very well to say they can access health care and support services if they are ill it is not as straightforward as that, particularly when means testing or reliance on private health care come into play. The parents who attended a meeting of the Oireachtas Joint Committee on Health and Children wondered how they would meet their daughters’ medical needs in the years to come. They looked for long-term treatment plans. Families cannot cope with the ongoing need to go to doctors, specialists, never mind hospital stays and medication. They need to explore alternative options for schooling and education because some of these young women cannot get out of bed. They want exemptions for the leaving certificate and all such supports which might not be available. It is much bigger than that. We are on the eve of an election and the parents may have met the HSE but they need urgent assessment and assistance to meet these needs now.

What I said is that their symptoms are real and they are unwell and nobody is suggesting for a second that anyone is making anything up, or that any of the young women is doing so. What I did not say was that they were as a result of a side-effect or that they were caused by this vaccine because there is no epidemiological evidence to support that view. That is a belief, not something that is based in evidence or fact, or at least as we understand it.

I remember not that long ago a similar vaccine scare around the measles, mumps and rubella, MMR, vaccine and some people believing that it caused autism because children developed autism at around the same time as they were getting that vaccine. Some may even still believe it. That does not stack up in evidence. The doctor who originally made those claims was struck off for falsifying some of the research. As a result of that parents were scared off giving their children the MMR vaccine, or in some cases, for whatever reasons, decided to give separate vaccines. It is very important that we as parliamentarians are careful not to give credence to something like that happening again. We can keep an open mind on new evidence but we should not give credence to anything that may discourage parents from giving this vaccine to their daughter to prevent her getting cancer.

The question was very carefully worded and asked what support the Minister would give to the young women who we all agree are undoubtedly unwell at the moment. The parents of some of them have had to give up work to care for them. They are just not coping and they want to know what support will be available to them. In some cases, individuals can access support but it is not always there. It will take some time for the scientific community to come down on one side or the other, although at the moment the consensus appears to be that the benefits outweigh the risks. That would be the majority view of the scientific community but it is constantly under review. While that is going on, these parents have given up their jobs to look after their children. They are not getting support and need something different.

The adversarial approach that is so symptomatic of how the HSE deals with all such controversial matters will not be a good model for the families of the hundreds of young women whose parents are not coping. They genuinely feel abandoned and are seriously unwell at the moment.

They may need different supports in different cases. We may actually do them a disservice by treating them as a single group. People are treated based on the diagnosis of the condition they have and not based on what they believe caused it. We may do people a disservice by treating them as a single group. We should be trying to treat them based on their symptoms and diagnosis rather than what they believe the cause to be. That is why I do not want to do anything that would give credence to this. Obviously, I do not know where I will be in the next few weeks but if it would be beneficial to meet me or my officials, should I still be in office in a few weeks' time, to discuss that specifically, I am sure it can be facilitated. However, it would need to be on the basis that such a meeting could not be used in any way to give credence to the view that their symptoms are caused by this vaccine because in doing so, I would do more harm than good.

Deputy Boyd Barrett has notified the Ceann Comhairle's office that he cannot be here, so we will move on to Deputy Maureen O'Sullivan's question.

Question No. 63 replied to with Written Answers.

Disability Services Funding

Maureen O'Sullivan


64. Deputy Maureen O'Sullivan asked the Minister for Health to address serious concerns regarding intellectual disability care given successive cuts to funding, staff and available care, given that an ageing population is impacting on intellectual disability care and that carers, such as parents, are often elderly and given the need for care for such persons. [3941/16]

My question relates to cuts to both staff and services in the intellectual disability area. As we have an ageing population, it is impacting more severely on intellectual disability care. Where are we going with this?

The Government values the role which people with disabilities play in Irish society. I believe they are playing a far greater role now, which is a significant change. The Government also values those who support and care for them and is committed to facilitating the full inclusion of people with disabilities in the life of the community through access to individualised personal social supports and services. The vital role performed by carers is acknowledged in the national carers’ strategy, published in 2012, which sets the strategic direction for the policies, services and supports provided across the public sector for family carers.

This year the Government will provide €1.56 billion for health-funded services and supports to enable all individuals with a disability to achieve their full potential and maximise their independence. The quantum of services to be provided, together with key deliverables and priorities, are outlined in the HSE’s national service plan for 2016. The HSE is committed to protecting front-line services for people with disabilities and at a minimum maintaining the overall level of service provided in 2015 with targeted improvement in priority areas.

The Deputy will be happy to know that these areas include: the reconfiguration of children's therapy services, for which an additional €4 million has been provided; the provision of services for 1,500 young people on leaving school and rehabilitative training, which has been allocated an additional €7.25 million; the development of alternative respite models, with €1 million targeted in this area; the reconfiguration of residential services, supported by €20 million in capital funding; and quality improvements to increase compliance with national standards for residential centres for children and adults with disabilities. As the Deputy is well aware, this is now being inspected by HIQA, which, I know, she also welcomes.

Like everybody else, I would welcome the increase in funding the Minister of State has mentioned.

That is all very well on paper but, in the same way we are told about all this extra funding for housing, we are not seeing it in reality. The reality for people with an intellectual disability is that there are problems with their respite grants, along with a lack of respite places. Since 2008, before this Government entered office, the budget for this area has decreased by almost €160 million but demands are increasing while staff numbers have fallen by 15%. There is an issue in the context of having enough intellectual disability nurses because it is a specialised area. However, what has been happening is that agency staff who do not have extra training in dealing with people with intellectual disabilities are being employed.

Another issue I have raised here before concerns our accident and emergency departments and how we need to look at them in a different way. It cannot be the free-for-all whereby everybody presents at these facilities. Those with addiction issues who present at accident and emergency need access to specialised services, while those with intellectual disabilities who present need to be treated in special areas. We need nurses who are trained to deal with people with intellectual disabilities to work in accident and emergency departments.

I hope the funding to which the Minister of State referred, particularly that relating to respite services and places for ageing parents, will become a reality.

There is very seldom an issue on which Deputy Maureen O'Sullivan and I disagree. However, we cannot have separate accident and emergency departments for people with disabilities, for those who are older or for all the different conditions because that would be unrealistic. The Deputy and I know that it would be unaffordable and foolish to promise it. I completely accept, however, that within an accident and emergency department or emergency department there must be somebody with specific knowledge of particular areas, such as, for example, what we are doing in respect of suicide awareness. We should have that for older people and those with disabilities, be they physical or intellectual.

The problem with disabilities is that one is either going to do it or one is not. If one does not take action, the matter is quickly brought to one's attention. In the context of residential services, we are dealing with 9,000 people. Some 22,000 people have access to day services, 35,000 day-only respite sessions have been provided and 180,000 overnights have been granted with regard to respite residential support. In addition, some 1.3 million personal assistance hours have been provided, 2.6 million hours have been provided in the area of home supports and, as pointed out in reply to a question on this matter on a previous occasion, 160 people were moved out of institutions in the past year. It is a slow process about which we need to be careful.

I want to highlight the example of a grandmother I met recently. There are many issues with addiction in the Dublin Central constituency. This grandmother, like so many others, took on the care of five grandchildren because their mother was an addict. They are all adults now but the youngest is 18, has Down’s syndrome and is autistic. The grandmother is waiting to go into hospital for various operations but she has the worry of what will happen to her 18 year old grandchild. While St. Michael's House provides a fantastic service, it cannot give her any guarantees. This young lad, let us call him John, loves St. Michael's House. He is challenged and stimulated there, his friends are there and he is really well looked after. He is 18 but will be out next summer, like so many others who are 18 years of age. Will the Minister of State guarantee that out of this funding a follow-up service will be provided? Young people with Down’s syndrome, autism and so forth need access to some form of service when they reach 18 years of age. I have met others in similar circumstances involved in activities which are not stimulating them and from which they are not getting any benefit. We owe them so much. They can also give so much as well. We know people with intellectual disabilities who are great members of society and who give so much. I am seeking a guarantee for those with the conditions to which I refer who are over 18 years of age in order that they and their families will not be subjected to the type of stress they have experienced up to now.

For many years when I was on the Opposition benches, every June and July there were protests outside the gate in respect of people with intellectual disabilities who were about to leave second level or rehabilitative training and who had nowhere to go. Deputies Kelleher and Ó Caoláin will remember this too. There was always a crisis. What we have done since I took up my position is ensure that such crises do not arise. We have put aside almost €8 million this year for the 1,700 people who will be coming out of that section. We have done that every year since I came into this post.

On the young man in question, John, if I could guarantee things, I would guarantee everything. However, that is not realistic. There are other methods and we are doing things differently.

St. Michael's House has been very adventurous in the type of things it has allowed the people in its care to do, and it is the one group with which I am always impressed when I present certificates in terms of new action to be taken by the people themselves. There are other ways of doing things but I fully accept that this grandmother must have additional concerns over and above what one would have regarding an 18 year old in those circumstances.

Accident and Emergency Departments

Billy Kelleher


65. Deputy Billy Kelleher asked the Minister for Health why the overcrowding in hospital emergency departments has not seen a significant improvement despite the initiatives taken during 2015; if the €100 million shortfall in the funding for hospitals will have a detrimental impact on access to emergency department and scheduled waiting list targets in 2016; and if he will make a statement on the matter. [3924/16]

Why has the overcrowding in hospital emergency departments not seen any significant improvement despite the plethora of announcements made last year, the establishment of the emergency department task force, the move to address the issue of the shortage of nursing homes and the increase and enhancement in the fair deal scheme to move people from an acute hospital setting into community nursing care? Why do we still have a trolley crisis day in, day out, in our emergency departments across the country?

Over the last number of months the HSE has implemented initiatives to reduce emergency department overcrowding and wait times. From mid-January to the end of January there was a very significant increase in daily trolley numbers. This was due to higher numbers of patients presenting with flu-like and respiratory illnesses and a 10% increase in the number of older people presenting. In total, there was a 9% increase in emergency department attendances throughout January, which is an enormous increase. This has eased in recent days and, fingers crossed, that will continue. Today's trolley count is 15% lower than it was on the same day in 2015; it was 388 this morning, of which 190 people were on trolleys for more than nine hours.

In 2015, significant additional resources of €117 million, additional hospital beds and increased staffing have all been put in place in a four-pronged approach to tackling the problem. In order to reduce the number of patients having to attend emergency departments, community intervention teams and services have been expanded. The HSE has also driven a number of initiatives to expand hospital capacity. Some 338 hospital beds are being opened or re-opened, and more than 750 new nurses and 80 new consultants have been employed in the health service during 2015. Also, there have been additional measures in 2015 to support timely patient discharge from hospital, including reducing waiting times for nursing home places to four weeks, an additional 4,002 transitional care places, 224 public community beds and 2,250 home care packages. Mount Carmel also opened last year as a new community hospital. A new escalation protocol has been implemented, which sets out action that hospitals must take when overcrowding occurs, to provide better and safer patient care.

In 2016, health will have funding of almost €14 billion from the Exchequer, which is an increase of 7% on the original allocation for 2015. Of the 2016 health budget, €4 billion has been designated in the HSE national service plan for acute hospital services. This accounts for about one third of the health budget. With the full operation of the expanded services introduced during 2015 and continued productivity and efficiency improvements, emergency care will be delivered at or above the 2015 level.

Many of this Government's policies on health are based on crossed fingers and a wing and a prayer because as we start into February 2016 we know full well that the acute hospital system is already underfunded. It will not have the capacity to deal with what presents, either through the emergency department or in the area of elective surgery, and that is already happening. There were cancellations of scheduled care on a continual basis during January to deal with hospital overcrowding. The Minister said, and this was an extraordinary statement, that the cancellation of elective surgeries showed that the protocols were working to deal with overcrowding in our emergency departments. Clearly, the difficulty is that we cannot consistently cancel elective surgeries to deal with the issue. We simply do not have the required capacity in the acute hospital setting, primarily in our emergency departments. Today there were 51 people on trolleys in St. Vincent's Hospital and 37 in Cork University Hospital, CUH, and throughout the country, 456 people were on trolleys either in the emergency department or on wards. Clearly, something must be done and the shortfall in hospital funding is not a good start for 2016.

I do not want not quibble with the Deputy about figures but those figures he used also include people on beds, people in day wards and overflow wards, as opposed to regular wards. The number who are actually on trolleys is somewhat lower than that, but I appreciate it is not about the numbers.

The Minister will always pick the lowest number.

If I took the lowest number, I would take the number at 8 p.m. in the evening, which is generally lower than 200, even on a bad day, so that is not the case at all. The number at 8 a.m. is always the worst because of the number of people who come in overnight. A huge amount has been done in this space, probably more than in any recent year, but it needs to be sustained. The demands are very significant.

With regard to elective surgery, which is non-urgent and is being postponed, it is not being cancelled entirely. The fact that we are using the private hospitals has allowed us to keep some level of control over the waiting times for inpatient procedures and day cases. In recent months those waiting for long periods - more than 12, 15 or 18 months - for inpatient and day case procedures has gone down.

When one analyses the full import of the Government's policies in the past five years, one sees it has adopted been a very scatter-gun approach. There has been no cohesive strategy whatsoever. We spoke earlier about universal health insurance, free GP access for everybody and the abandonment of the National Treatment Purchase Fund, NTPF, in favour of the special delivery unit. We now find that we are using private capacity to deal with elective and scheduled surgery. What was the logic in getting rid of the National Treatment Purchase Fund in the first place and for us then to be back out in the market trying to secure operations privately? The bottom line is that the Minister must accept he cannot consistently use the cancellation of elective surgery to deal with overcrowding in emergency departments. That is consistently storing up difficulties for the system and, equally it is simply not good enough for all those individuals who are waiting an inordinate period for their elective surgery only to find they are cancelled at short notice.

The logic of getting rid of the NTPF was twofold. First, it was self-selecting in that people went to it themselves if they were waiting for a period and, second, it never managed to get rid of long waiting lists or waiting times. Instead, the resource was given to the special delivery unit, SDU, which then selected the patients who were waiting the longest and focused on them.

For the past 17 to 18 months the Deputy has taken pleasure in describing me as an analyst or commentator rather than an actor, which of course I dispute given the amount of things that have been done in the past 18 months in the health area.

No, the Minister is an actor as well.

The time has come for Deputy Kelleher to stop being a commentator and to set out what Fianna Fáil will do differently.

We have, within the fiscal space.

Is Fianna Fáil reiterating its prior commitment to abolish waiting lists and is Deputy Kelleher promising to get rid of trolleys from emergency departments?

Within the fiscal space.

I take that as a "No".

Vaccination Programme

Maureen O'Sullivan


66. Deputy Maureen O'Sullivan asked the Minister for Health if he is aware of revelations made by a doctor (details supplied) to the World Health Organization, of the manipulation of data and the suppression of science, in order to maintain the illusion of the safety of the human papilloma virus vaccine, in the face of valid contradictory evidence and that the length of time for which Gardasil is effective is suspect; and if he will address the serious health issues experienced by more than 200 girls, where the common denominator is the vaccine. [3940/16]

We are back to the issue of vaccines, in particular in regard to a recent report to the World Health Organization, which does raise concerns about it, and the reality of the more than 200 girls in this country who are presenting with very serious issues.

The HPV vaccine, Gardasil, which was introduced in 2010, protects girls from developing cervical cancer when they are adults. It also protects against head and neck cancer, anal cancer and genital warts. It is available free of charge from the HSE for all girls in the first year of secondary school.

I am aware of claims of an association between the HPV vaccination and a number of conditions experienced by a group of young women. It appears that some of the girls first suffered symptoms around the time they received the HPV vaccine and, understandably, some parents have connected the vaccine to their daughters' illness. I want to make it clear that anyone who is suffering ill health is eligible to seek medical attention and to access appropriate health and social care services, irrespective of the cause of their symptoms or what they believe to be the cause of their symptoms.

In 2013, the World Health Organization's global advisory committee on vaccine safety reviewed data from post-licensure monitoring of the HPV vaccine. The review found no new adverse outcomes relating to the HPV vaccine. I am aware from the media of allegations of manipulation and suppression of scientific data relating to the HPV vaccine made by an individual doctor. The doctor wrote an open letter of complaint to the director general of the World Health Organization on 14 January 2016. I am advised that the World Health Organization has not yet responded to this letter.

In recent days my Department made contact with the World Health Organization and expressed its interest in being advised of the World Health Organization's response as soon as it is made public. I wish to know what the World Health Organization's response to the allegations is before commenting further or taking a view on them.

In November 2015, the European Medicines Agency completed a detailed scientific review of the HPV vaccine which found no evidence of a causal link between the vaccine and two conditions that it has been suggested may be linked to the vaccine. On 12 January 2016, the Commission endorsed the conclusion of the European Medicines Agency that there is no need to change the way HPV vaccines are used or to amend the product information.

I listened to the Minister's exchange earlier with Deputy Daly during which he said that the symptoms are real. That is different from a previous exchange the Minister and I had on this issue. The reality is that there are over 220 girls whose parents are distraught by the change they see in their daughters. Young women, who were bright, articulate, intelligent, going to school and looking forward to their lives are now unable to get out of bed and have to drop out of school, in addition to presenting with a number of other symptoms. This has been dragging on for some time. The parents made a very worthwhile presentation at the health committee and were definite that they are not against vaccines. The reality is that these girls are all presenting with symptoms and we are not getting to the bottom of them. There does not appear to be an urgency to do so. If it is not the vaccine then what is the cause?

There is also a serious issue around the lack of substantial information provided to parents beforehand. They were given a leaflet providing limited information in the schools and were directed to a website if they wanted to check further. These are very ill young women. Will we have a proper investigation into the cause of their illness so those issues can be addressed?

I would like to correct the record, if I have ever suggested otherwise. If a patient has symptoms, the symptoms are real. If a patient has pain, it is real and if a patient has a headache, it is real. The patient's symptoms are always real. In this and other circumstances, a person may have a range of different illnesses. Perhaps part of the reason there has been delay in diagnoses or they have not received the treatment and support they need is because the symptoms have been connected - erroneously, in my view - to this vaccine. It may be the case that there is a whole range of people with a whole different range of symptoms that could be attributable to any number of physical or mental illnesses. The fact it is being tied up with a belief about this vaccine is impeding them from getting the care they need. Perhaps the Deputy will give that some consideration.

I know from some of the parents that the doctors they brought their children to were at a loss as to what could be the reason for the symptoms they were presenting with. It appeared that, from what I have been told, they had nowhere to go with their inquiries into why these girls were presenting with these symptoms. There was a real problem there. The World Health Organization report that the Minister mentioned will be interesting. These are very ill girls and it seems we are saying that we do not know what caused it and we will not investigate. That does them a disservice because their lives have changed. Some of the parents have been circulating video clips of their daughters to make people aware of it. It is gruesome to see the physical change between what they were like and what they are like now. Something is causing this change and the HSE should be coming forward to investigate it. We owe it to them.

Does the Minister have anything further to say?

No, not unless the Deputy has a further question.

Question No. 67 replied to with Written Answers.

Mental Health Services Provision

Mick Wallace


68. Deputy Mick Wallace asked the Minister for Health if he has plans to put a 24-hour acute mental health unit in County Wexford; and if he will make a statement on the matter. [3923/16]

I have raised this issue with the Minister of State before. One of the key messages of A Vision for Change was the need to reduce reliance on acute in-patient beds in cases of mental illness by strengthening early interventions by community mental health teams. Last autumn, in reply to my question, the Minister of State said the delivery of mental health services had been transformed. However, the people on the ground in Wexford strongly disagree with that. The community health teams do very good work but are only open until 5 p.m. To access these services, people need a referral from a GP, otherwise they go to Wexford A&E, from where they can be sent to Waterford A&E, all the while in mental crisis. According to the people on the ground, until things are better in the community services area we need a 24-hour acute service in Wexford.

We will struggle for time now and as we have had this debate before I think it is important that rather than reading the set reply, which I am sure the Deputy will be supplied with, we should look at the services that are available in Wexford. The majority of the €18 million investment programme was spent in County Wexford on Tara House community mental health centre in Gorey, which is a day hospital; Tus Nua rehabilitation unit in Enniscorthy, which has 12 beds; Heavenview, which is a 14-bed unit; Millview, which is a 12-bed intellectual disability and rehabilitation unit in Enniscorthy; Farnogue psychiatry of later life unit and team headquarters, Wexford, which has 20 designated psychiatry of old age beds and 30 beds designated as part of the community nursing unit for the care of the older person; and the upgrade of Summerhill community unit, Wexford.

A Vision for Change recommends that as part of community secondary care provision, there should be a crisis house available in each catchment area. In July 2014, a new purpose built ten-bed crisis respite unit, seven day service, An Tearmann, opened in Enniscorthy for service users who are referred there through their mental health community team for respite care. I have already outlined the mental health services in operation in Wexford.

In addition, Wexford has recently received substantial funding which will enable it to continue into the future, a service of which I am sure the Deputy is very well aware. The mental health services in Wexford and the surrounding areas are now developing an infant mental health service for the area which is in compliance with A Vision for Change. One of the models we should look at in future should include respite and crisis houses and the type of innovative development that we see in Wexford. It is the Deputy’s job not to be satisfied but there has been substantial investment in Wexford and a completely new type of service.

Additional information not given on the floor of the House

The Waterford-Wexford Mental Health Services serves a population of approximately 278,000. The extended catchment geographic area stretches from Gorey in north Wexford to Youghal in County Cork. Mental Health Services in Wexford are arranged in accordance with national policy as reflected in A Vision for Change. The HSE, in addition to emergency and hospital care and community based services, has a comprehensive range of services available to people in Wexford in the areas of mental health, suicide prevention and substance misuse.

Following a closure order in 2010 from the Mental Health Commission, the acute mental health unit in St. Senan’s Hospital, Enniscorthy, was amalgamated with Waterford mental health services and is now provided for in a 44-bed acute in-patient unit in University Hospital Waterford. In addition, arrangements are in place whereby service users in north Wexford who attend Tara House mental health services in Gorey and require acute in-patient admission have access to five beds in Newcastle Hospital, Greystones, County Wicklow. To support the amalgamation of acute mental health services, a comprehensive €18 million capital investment programme was implemented, with the main developments taking place in County Wexford. These, for example, relate to additional bed provision or enhancement of facilities such as Tara House in Gorey, Tus Nua, Heavenview and Millview in Enniscorthy; and the Farnogue psychiatry of old age care unit and Summerhill community mental health unit in Wexford.

The suicide crisis assessment nurse, or SCAN, service in Wexford is a skilled mental health nursing service for primary care. This provides an accessible and quick response to GP requests for a timely assessment of those in suicide or self harm distress. The emergency department in Wexford General Hospital has a seven-day liaison nurse led service. In addition, and in line with catchment area criteria recommended in A Vision for Change, a new purpose-built ten-bed crisis respite unit has been opened in Enniscorthy. Many of the services I have outlined, and others in the area, operate a seven-day service, with significant opening hours.

I am satisfied that the significant and comprehensive service developments that have taken place or are currently planned for the Waterford-Wexford mental health service area as a whole will ensure the provision of quality and patient focused mental health care across the region. In light of this, there are no plans at present to provide the type of service suggested by the Deputy.

It is not my job to be dissatisfied. The services the Minister of State is talking about may reap rewards in the future. I hope they will. I was contacted recently by a woman who lives five minutes away from me. She told me that her 24 year old son tried to take his own life in late October 2015, which was his second attempt in four years. He slit his wrists and came very close to bleeding out. He was brought to Wexford General Hospital by ambulance. A few hours later, the hospital telephoned Christine and told her she would have to take Shane to St. Vincent's for surgery because he had severed two nerves in his wrist. At St. Vincent's they had to wait five hours on a trolley in A&E before he was seen. They carried out the surgery there but would not admit him to the psychiatric unit because he is from Wexford and outside the catchment area. As Shane has been diagnosed with a personality disorder, he is not deemed to be a threat to himself and is excluded from involuntary admission to treatment under the Mental Health Act. The psychiatrist at University Hospital Waterford said he does not need antidepressants.

Things are a little bit more difficult in Wexford than the Minister of State realises. I am not saying that she should realise it as it is difficult for her to know everything that goes on in the country. Wexford is the third most disadvantaged county in the country at the moment. We have 22% unemployment and the second highest suicide rate. In the short term, a 24-hour acute unit would meet many of the concerns of the people I have been talking to until the services the Minister of State has put in place are working better.

On suicide prevention, aftercare and the process when people are in crisis, Wexford is now providing 12,000 counselling hours and has received additional funding. In addition, the suicide crisis assessment nurse service, SCAN, in Wexford is a skilled mental health nursing service for primary care. As the Deputy knows, primary care is provided on a 24-hour basis. It provides an accessible and quick response to GP requests for a timely assessment of those in suicide or self harm distress.

One of the areas I have concerns about is why people with a mental health difficulty have to come through A&E. Clearly, if they have a physical injury, it has to be assessed and put right. One of the things we will look at is the number of beds - whether it is the right number, whether we should have more or fewer beds and how people get admissions to an acute unit.

All these issues will be dealt with by the new group.