Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Thursday, 28 Sep 2017

Vol. 959 No. 5

Other Questions

Respite Care Services Data

Louise O'Reilly


6. Deputy Louise O'Reilly asked the Minister for Health the number of hours of respite care offered to families of children with disabilities in the first nine months of 2017 as compared with the first nine months of 2016; and the way in which this compares with the number of applications for respite care by families for their child with a disability in the first nine months of 2017 as compared with the first nine months of 2016. [40778/17]

The question is straightforward. I doubt if there is a Deputy in the House who does not receive daily requests for help and assistance from parents and carers who are desperate for respite. We are speaking to people who have not had respite for years rather than months and some who have not had any respite.

I am taking this question on behalf of the Minister of State, Deputy Finian McGrath. We discussed this matter yesterday at a meeting of the Joint Committee on Health.

I am very much aware of the importance of respite service provision for the families of children and adults with disabilities, including the impact the absence of respite service provision can have on other parts of the health service and the well-being of families. As Deputies are aware, the provision of respite services has come under additional pressure in recent years. More children and adults are now seeking access to respite and the changing needs of people with a disability are also having an impact, as they, along with the rest of the population, thankfully live longer lives. A Programme for Partnership Government recognises the need for respite services to be developed further and the Minister of State and I are committed to ensuring this happens.

A number of factors impact on respite capacity. A significant number of respite beds are regularly utilised to allow unplanned emergency admissions, leading to a decline in the number of available respite nights against planned activity. As I indicated to members of the joint committee yesterday, one of my greatest concerns in respect of disability services is the large increase in the number of emergency admissions and the need to address this issue adequately. The regulatory and policy context has also changed the manner in which residential and respite services are provided, as agencies must, correctly, comply with regulatory standards.

As a result, capacity has generally decreased with the requirement for personal and appropriate spaces. Beds can no longer be used for respite where residents go home at weekends or for holidays. This is an example of how additional beds are not available when they would have been previously. It is not a criticism, only the reality. Implementation of the national policy on congregated settings is also reducing available capacity.

In the HSE's social care operational plan for 2017, some 6,320 people with disabilities are expected to avail of centre-based respite services, totalling 182,506 overnights. Based on existing levels of service and in addition to the centre-based respite service, it is planned that between 2,000 and 2,500 persons will avail of respite services such as holiday respite or occasional respite with a host family. It is also planned that a further 41,100 day-only respite sessions will be accessed by people with disabilities. Furthermore, the HSE has been funded to provide 185 new emergency residential placements, and new home support and in-home respite for 210 additional people who require emergency supports has been allocated. This marks a significant change in the way that respite services are delivered.

The most recent available data from the HSE indicate that 81,836 overnight respite sessions were accessed in the first six months of this year compared with 90,861 in the first six months of last year. The number of day-only respite sessions accessed for the same period in 2016 was 22,351 compared with 22,051 in 2017. The HSE is also developing an eHealth case management system, which will facilitate the tracking of all residential and home support-emergency respite services across all HSE divisions.

Additional information not given on the floor of the House

The HSE social care division has also committed to developing home sharing as a person-centred and community-inclusive type of support for people with disabilities involving the development of an implementation plan in 2017. This will address the priority recommendations of the national expert group report on home sharing published in 2016. It will be led by the national designated disability lead in this area.

The HSE continues to work with agencies to explore various ways of responding to this need in line with the budget available.

When I last raised this issue, it was on Leaders' Questions, which the Minister for Education and Skills, Deputy Bruton, was taking that day. I raised the case of Jacob Dooley, whose mother and father were in a desperate situation. As often happens in such circumstances, they had to turn to the media just to get some movement on their son's case.

I asked specifically about the number of hours provided compared with the number of hours requested. My clear understanding is that the latter far outstrips the former. The Minister, Deputy Harris, cited the figure of 182,506 overnights as representing some sort of progress, but we see the truth in our clinics and here. People have protested outside Leinster House about the unmet need on more than one occasion. Has anything been done to quantify it and, if so, will the Minister share the figures with us? I believe that there is a large amount of unmet need.

I do not think that the Deputy is in any way incorrect. In fact, she is entirely correct. There is not a Deputy on this side of the House or the other who is unaware of the fact that there is unmet need. To be honest, developing a policy to address it will be challenging. The Deputy will be fair enough to acknowledge that this is not just a resourcing issue. Also involved is the availability of beds, for example, where places that used to provide X number of beds can now only provide Y number due to regulatory standards. Previously, a respite bed could be used at the weekend for someone who was normally there during the week, but that cannot be done now.

The social care division of the HSE has committed to developing a number of proposals, including home sharing as a person-centred and community-inclusive type of support for people with disabilities, which will involve the development of an implementation plan. This will address the priority recommendations of the national expert group report on home sharing published and will be led by the national designated disability lead in this area. This could be a good thing, given that home sharing that is in compliance with new national standards will be developed.

We also need to examine the number of emergency residential placements. This year has seen an increase of 185. It is a priority for the Minister of State, Deputy Finian McGrath, and me in the context of budget 2018 because it has a knock-on effect on the availability of respite for children and young adults. This is a challenging issue and the Minister of State is prioritising it. We will continue to do what we can.

Is "home sharing" the new term for foster care? I met a group in Kerry recently. Although they could not take it in the end, some of its members had been offered the option of foster care. I do not need to tell the Minister, given that he has read about it in the newspapers,-----

-----but foster care for people with disabilities has received a negative airing recently. That is not meant disrespectfully to the hundreds of people-----

-----who do fantastic work providing foster care for people with disabilities. Foster care is in no way a solution, however. If that is the direction that we are going-----

I thank the Minister for confirming that it is not.

As to quantifying the unmet need, it strikes me that, if the number of requests is not assessed against the number of available hours, the Minister will not know how many hours will be needed or be in a position to plan for them.

Let me clarify.

That is not what home sharing relates to. Home sharing relates to a situation whereby - this goes along with the decongregation agenda - one can safely and appropriately enable a number of people with disabilities to share a space within the community. If I did not explain that clearly, I am happy to do so now.

The Deputy is correct, and there is no point in beating around the bush. There is no centrally maintained list of people awaiting these services. It is not that I have an answer that I am simply not providing the Deputy. This is done on a community health organisation, CHO, level. As with our waiting list conversations, we must find a way of seeing the full range of needs. The HSE is working on better co-ordination of the existing residential base through the establishment of a residential executive management committee in each CHO and the development of an eHealth case management system that will facilitate better and more effective management and tracking of all residential and home support-emergency respite services across all CHOs and for each funded service provider. We do not want each CHO to be a silo. This system will provide a detailed inventory and a bed registry map of current service capacity, which will help us to match capacity to demand. I will be happy to share further information on this with Deputy O'Reilly.

Home Care Packages

Bríd Smith


7. Deputy Bríd Smith asked the Minister for Health his plans to expand the provision of home care services that are provided directly by State bodies; if future funding will continue to be disproportionately directed to private home care providers; and if he will make a statement on the matter. [40921/17]

I thank the Deputy for her question. Home care services are provided on the basis of assessed health care need and there is currently no means testing. The HSE-funded home help service is delivered predominantly by HSE staff or, in a minority of cases, private and not-for-profit providers. Home care provided as part of the home care package scheme is delivered by HSE home help staff or by arrangements with not-for-profit and private providers who have been selected through a tender process as approved providers.

I assure the Deputy that the Government is committed to promoting care in the community for older people so that they can continue to live in their own homes for as long as possible. We propose to establish a statutory home care scheme along with a system of regulation for home care services. On 6 July, the Minister and I announced the opening of a public consultation in this regard. I urge all of those with an interest in home care services to make a submission to the consultation.

The consultation is an important step in informing the development of a statutory scheme for home care, which will introduce clear rules on what services individuals are eligible for and how decisions are made on allocating services. The new scheme will ensure that home care services operate in a consistent and fair manner for those who need them and help to improve access in an affordable and sustainable way. It is also envisaged that a common system of regulation will be introduced for all providers, be they public, not-for-profit or private.

I thank the Minister of State for outlining the situation and informing us of the consultation process, but his response did not answer my question on the Government's plans to expand the scheme via public operators as opposed to the private sector. Everyone has had experience at some level, be it through family or friends, of someone who has had a stroke or suffered from dementia going into hospital only to return home with all of the problems that go with that. It is difficult to obtain the support and home help hours that are required.

Back when people in my community were much younger, many of my neighbours got extra hours of work providing home help. They got a few bob from the health board to help someone have a shower, clean up, get the pension, buy food, etc. This and the previous Government have cut 1.5 million hours from that system and driven everything towards the private operators. That is why, when I turn on the radio, I hear ads about how wonderful Home Instead Senior Care is; it is all being privatised.

The proliferation of advertisements relating to the treatment of our old people and those suffering from strokes and dementia is shocking. It is something we pay for through the public purse. We would not do it to cancer patients. There are advertisements for VHI and BUPA but we do not have advertisements on television telling people to come to us if they suffer from cancer and that we care about the victims of that disease. The State is giving up on the people who need to be kept at home. Their distress is palpable because they are either being left waiting in hospital for home care or are at home not getting adequate care.

I will be very brief. The Deputy has raised a number of issues. We all acknowledge that there is unmet demand in the home care system. There are 10.5 million home help hours in the system this year. We are spending €373 million on it. We would love to double it in the morning if that was possible. However, it cannot be done overnight. There is a commitment in the programme for Government to try to increase that budget. I cannot announce the budget here; I am not in a position to do so.

The argument about private versus public is a slightly different issue introduced by the Deputy. Health care has been provided on a public and private basis in all areas, whether it is in acute care or nursing home care where about 80% of our people are being cared for in private nursing homes. There is no intent on the part of the Department or the Government to privatise home care and the provision of home help hours. In the vast majority of cases, such care is provided by HSE staff. Where possible, it is always done by the HSE. Where we have a shortfall and have to rely on private interests rather than let people go without, we will use the private services. We do not look down our nose at any particular service or consider one to be better than the other. We want to have a statutory regulatory scheme. The consultation is out at the moment to ensure that both public and private services are regulated in full.

I will submit a series of questions to the Minister of State to check his facts to the effect that, in the majority of cases, the service is provided publicly by HSE staff. I dispute that contention and would like to see the figures that support it. Our experience is that more and more people are being treated as though there was an inheritance tax on their health when they get old because they have to seek private care providers to look after them and to come in and fill in the hours that are not available from the home help service. Some of my neighbours who deliver home help are told to go in and - in 15 minutes - clean up, get the messages, wash a person, get him or her out of bed, provide breakfast and then get out again. We cannot treat human beings in that way. Pressure is increasing for those who need care to go to the private operators. They are advertising enthusiastically and non-stop in respect of their services because the public service is letting people down. I am not eulogising the previous home help service but, by and large, it was far superior to what is available to people now. At least it was available to them and they did not have to root into their pensions, etc., and suffer a selective inheritance tax on their health.

In accordance with Standing Orders, I call Deputy Louise O'Reilly.

The average cost per hour of a home help is €23.20 according to the Department of Public Expenditure and Reform. In the not-for-profit and directly-employed home care arena, we would get that hour for approximately €17 so what is pushing up the price is the private home care providers. Deputy Bríd Smith is right: people in global multinational corporations can afford to pay for prime-time advertising space on radio and television because they are getting money from the State and making a massive profit. Prior to being elected, I represented home helps. We concluded a deal on their hours in order to put a bit of a floor on it and ensure that they had some continuity. This is not being utilised to the greatest possible extent. There are home helps directly employed and working for the not-for-profit organisations who cannot access additional hours. We could remove the barrier on those organisations providing extra hours where clients might have a few bob to supplement it themselves. The Government put a stop to that and I would like to see it come back and for more emphasis to be put on directly employed and not-for-profit home care. I will put it to the Minister of State in terms he might understand - it is the best value for money for the public purse.

There are two separate issues. If I am correct, what Deputy Bríd Smith is referring to is the need for people to engage with private providers as opposed to the HSE using private companies.

No, I asked the Minister of State his plans to expand the provision of home care services directly from the State, not from the private operators.

To answer the Deputy's question, 63% of the hours are provided directly by the HSE and the remainder are provided between not-for-profit organisations and private providers.

Yesterday, the Minister discussed the issue Deputy O'Reilly raised. It was raised at the Joint Committee on Health and the Minister has undertaken to go back to his officials and examine the position regarding the provision of private home care hours and the value for money attached to it.

Hospital Waiting Lists

Marc MacSharry


8. Deputy Marc MacSharry asked the Minister for Health the reason the 18-month target for outpatient appointments set by his predecessor has yet to be met at Sligo University Hospital. [40988/17]

Jim O'Callaghan


14. Deputy Jim O'Callaghan asked the Minister for Health the assistance that will be given to reduce the waiting times for outpatient consultations at the Royal Victoria Eye and Ear Hospital. [40991/17]

Why is the 18-month target for outpatient appointments set by the Minister's predecessor, now Taoiseach, Deputy Varadkar, yet to be met at Sligo University Hospital?

Are we taking Deputy O'Callaghan's question too?

Yes, but only one Deputy can use the 30 seconds to introduce his or her question. Deputy O'Callaghan will have an opportunity to ask supplementary questions. We will have the Minister first.

I was just checking.

I propose to take Questions Nos. 8 and 14 together.

I thank Deputy MacSharry and Deputy O'Callaghan for their questions on waiting times at Sligo University Hospital and the Royal Victoria Eye and Ear Hospital.

I acknowledge that waiting times are often unacceptably long and I am conscious of the burden this can place on patients and their families. Reducing waiting times for those on the list longest is one of our key priorities. Consequently, €20 million - rising to €55 million in 2018 - was allocated to the National Treatment Purchase Fund, NTPF, in budget 2017. In order to reduce the number of those waiting longest, I asked the HSE to develop waiting list action plans for 2017 in the areas of inpatient-day cases, scoliosis and outpatient services. The inpatient-day case action plan is being delivered through a combination of normal hospital activity and insourcing and outsourcing initiatives utilising NTPF funding. Since early February, almost 24,000 patients have come off the inpatient-day case waiting list, 84,000 have come off the outpatient waiting list and 249 children have received necessary scoliosis procedures.

In the context of Sligo University Hospital, I acknowledge the point Deputy MacSharry makes about too many patients waiting too long for outpatient appointments. I will highlight some progress being made as a result of the investment that has been made. Out of a total of 11,833 people on the outpatient waiting list at Sligo University Hospital, 567 - 4.7% of the overall number - have been waiting over 18 months. On inpatient cases, 3,412 people are waiting and 228 patients have been waiting over 18 months, which is 6% of the total list. Not everybody is waiting a long period of time and I want to highlight that many people are being seen much more quickly.

There are still too many people waiting too long. We saw in last month's NTPF figures that there is beginning to be a reduction in the length of time relating to and the total number of people on our inpatient-day case waiting list. We hope and expect to see progress on our outpatient waiting list. We have now developed a new strategy for the design of integrated outpatient services. This strategy seeks to improve waiting times for outpatient services by restructuring referral pathways and utilising technology to improve service delivery. I have also asked the HSE to put in place capacity to ensure the validation accuracy of our outpatient waiting list which is something many of us come across in our constituency clinics.

On the Royal Victoria Eye and Ear Hospital, which is the subject of Deputy O'Callaghan's question, I opened a new theatre there in July which will enable over 1,000 additional cataract procedures to be carried out this year and to have no waiting lists for cataract procedures at the hospital by the end of 2018, and no waiting lists for cataract procedures within the hospital group by the end of 2019. On outpatient appointments, when I visited the Royal Victoria Eye and Ear Hospital, those with whom I spoke highlighted their view, which I share, that the primary care eye service review, which was published in the past number of months, provides a way forward whereby a number of these procedures and a number of outpatient appointments will actually take place in primary care. This is something I hope to be able to act on in the context of the HSE service plan for 2018 and the Estimates discussions in which I am currently engaged.

This target has not been met once in the past two years. While the Minister has correctly said that the number is 567, the response he gave, which was prepared by someone in the HSE, is a celebration of all that is not happening. The number increased from 73 in February to 123 in March to 182 in April to 297 in May to 353 in June to 437 in July and to 567, as the Minister rightly said, at the end of August. That is an almost eightfold increase in six months. Despite the great many people who are being seen and the great work those in the hospital are doing, the 18-month target has been an abject failure. Instead of a reduction, there has been an eightfold increase. There are specialties in particular that stick out. In neurology, there were 28 people waiting 18 months ago and in February and now there are 192. In the context of ear, nose and throat procedures, there was one person waiting six months ago and there are now 224.

The trend is not just upwards, it is out of control and accelerating, and we are doing nothing about it. What is the Minister going to do? He mentioned the NTPF. Are we going to expand the restoration of the latter to address outpatient procedures?

Yes, I am considering that. We need to be very careful in doing that because with certain specialties, outsourcing one outpatient procedure may adequately address the patient's needs but others might require the patient to go back into the public system for an inpatient or day-case procedure.

In recent weeks I met representatives of the NTPF and asked them to look at what role, if any, they can play in respect of outpatient procedures. I hope to be able to progress some of that in the context of the funding that will become available to the HSE in 2018. The number of people in Sligo waiting more than 18 months is a small percentage of the overall list. However, that is no consolation for the people on the list. Some 4.7% of people waiting for outpatient procedures have been waiting for more than 18 months. I accept that is too long. Demand continues to grow. More outpatient procedures are being done in the health service, but we also have a growing and ageing population requiring more medical care.

The referral pathway is the approach for this. As the Deputy knows, as part of our negotiations on the GP contract, we are investigating if things we do in acute hospital settings could be done in primary care which will free up more capacity. That will not work for everything but will provide more capacity. I will take on board the points the Deputy has made about Sligo University Hospital as we develop and frame our NTPF and waiting list plans for 2018.

I welcome that the Minister is considering expanding the NTPF to include outpatients. He should do that as a matter of urgency. The trend is accelerating. We must have an answer to the question. Is it a question of resources or of management? What is the problem in Sligo? A sixfold increase, regardless of the percentage of the overall total, is completely unacceptable in a six-month period. I appeal to the Minister to address the House on this as a matter of urgency.

I would certainly be happy to talk to representatives of the Saolta hospital group and seek a greater understanding of the issues the Deputy wishes to have addressed regarding Sligo University Hospital. As the Deputy did, I wish to thank the people working in the hospital for the number of people they are treating and for the fact that it compares very favourably with other hospitals. I will revert to the Deputy directly.

The situation in Sligo may be significant, but there is also a very serious issue in respect of the outpatient waiting list at the Royal Victoria Eye and Ear Hospital in my constituency. At the end of August, a total of 2,486 patients were waiting for outpatient appointments at the hospital. As Deputy MacSharry noted, the Taoiseach - who formerly served as Minister for Health - gave an assurance that there would be a time when no one would be waiting 18 months for an outpatient consultation. That objective was achieved in respect of the Royal Victoria Eye and Ear Hospital in December 2015, but matters seem to have gone completely out of control since then. One would have expected that having solved the problem on one occasion, we could have kept that solution in place.

At present, many people are waiting for these operations to be performed. As the Minister knows, it is crucial that sight operations are performed early. The conditions are avoidable and reversible if treated early. However, these 2,486 people are dependent on the Minister to provide a solution.

The Deputy makes a fair point. We have the makings of a solution in respect of the Royal Victoria Eye and Ear Hospital that is twofold in nature. The first part relates to providing additional capacity in the hospital, which we did. I was in there in July to open its new cataract theatre. That will result in 1,000 additional cataract procedures being carried out this year, meaning there will be no waiting list for such procedures at the hospital by the end of next year. That is not a target set by me, as Minister. Rather it is the target the hospital is publicly professing and confident of reaching. That will provide additional capacity for the people working in the hospital to address the outpatient list, which is to be welcomed.

Clinicians remind me that considerably more eye and ear work could be carried out in the community. A number of clinicians at the Royal Victoria Eye and Ear Hospital were involved in the primary care eye review, which has given rise to a number of proposals to move services out of acute hospitals and into primary care. I hope and expect it can act on that in 2018.

Yesterday, Deputy Micheál Martin and I met representatives of the National Council for the Blind of Ireland to discuss its pre-budget submission. We also had a broader chat with them about the number of people, not just at the Royal Victoria Eye and Ear Hospital but throughout the hospital system, who are on ophthalmology waiting lists. They brought to my attention that up to 75% of sight loss is avoidable if treated early. We need to consider other proposals. It is not fair for us simply to state that the people who are on the waiting list now will have to wait until the end of 2018 or 2019. There is no assurance that will happen. The Minister needs to consider innovative proposals, perhaps using the NTPF, as mentioned by Deputy MacSharry. Something needs to be done.

I recognise that eye procedures can be done very quickly and often outside hospitals. It is not satisfactory for people who are waiting on a list to be told we will have a solution in a year or so; they need a solution now.

I am sure the Deputy would not wish to misrepresent me because that is certainly not what I said. I said that as a result of investing in and opening the new theatre at the Royal Victoria Eye and Ear Hospital, an additional 1,150 cataract procedures will be performed there by the end of the year. This means that 1,150 people will have the gift of their sight restored, which is obviously a great relief to them.

The Deputy is correct on the broader point. When it comes to eyes and ophthalmology, many of the procedures are simple procedures that can be done quite quickly. That is why we are targeting the resources of the NTPF at cataract procedures. In addition to the NTPF continuing to do that, I also want to see a much quicker migration of some of these services to primary care, which makes sense from a cost point of view and much more importantly from the patient's point of view. I will come back to the Oireachtas shortly with proposals in that regard.

Mental Health Services Provision

Catherine Connolly


9. Deputy Catherine Connolly asked the Minister for Health further to Question No. 468 of 20 September 2017, if he will clarify the proposal to locate the community mental health team base at a site at Dangan, Galway; the status of the proposal; the timeframe for the opening and operation of the facility; and if he will make a statement on the matter. [40768/17]

What is the status of the proposal to locate the community mental health team base at a site at Dangan, Galway? I understand from a local radio interview that it will now not proceed. I hope the Minister of State can tell me that is not correct. What is the status of that given the commitment under A Vision for Change?

As stated in the reply to the previous question from the Deputy, community mental health teams will, over the medium to long term, be co-located with other services in primary care centres in their catchment areas. In the interim, while such facilities are being developed, several other options are being considered by the HSE locally.

In accordance with national policy set out in A Vision for Change, community-based teams have been established to provide outreach and outpatient services across the local community health-care organisation area. Two teams, covering Galway city and the Connemara region, are currently located within the adult acute mental health unit in University Hospital Galway, and they provide outpatient services. Outreach clinics are also provided in rural locations within their sectors.

Also, in accordance with the national policy, community mental health teams can be co-located with other services in primary care centres in their catchment areas. In Galway city, there is a primary care facility planned for Shantalla in the medium to long term. It is expected the community mental health team for mental health services in the city will be based there. While primary care centres continue to be rolled out across the community health care organisation, CHO, area, an appropriate site to house community mental health teams in the west of the county has not yet been identified. While the development of these primary care centres is being progressed, several other options for the location of outpatient services and community mental health teams continue to be explored by the executive.

Decisions on such matters by the HSE may involve negotiations and commercial sensitivity and are a matter for the executive to conclude so as to achieve the best outcome possible. I will ask that the HSE locally update the Deputy when it is in a position to do so.

I thank the Minister of State for the attempted answer. I am disappointed. I asked a very specific question on a specific site in Dangan in Galway. If the local official is able to say on radio yesterday that it is gone, surely the Minister of State knows. I ask him to give me an update on whether that site is gone and is no longer viable.

The bigger point is that an integral part of A Vision for Change, originally for 2006 to 2016 and now reviewed, is the community mental health team. In Galway city, Connemara and the islands - with approximately 100,000 people - we do not have a single community mental health team base out in the community. That is extraordinary. Galway will become the European Capital of Culture in 2020. It has two third level institutions and three hospitals, two private, but no community mental health team base. How can the Minister of State stand over that? I know he will say it comes back to the HSE.

What role does the Government have in ensuring that HSE west carries out its duty and will the Government provide sufficient funding for it to do that?

As Deputy Connolly said, this is a matter for the HSE. As she will appreciate, I will not get involved in site-specific negotiations and issues such as that because it is not my role or function as a Minister of State. That is the role of the executive. I will travel to Galway on Monday and I will visit a number of sites. It is something I can raise with the HSE. From the reply, it seems to be a question of the medium to long term. It does not seem to be something that will be addressed in the short term. I can pursue further information from the HSE if Deputy Connolly wishes but that is the information I have been given and that is all I am in a position to confirm here today.

I understand that to a certain extent in the context of the specific aspect of the question but under A Vision for Change, going back to 2006 - and prior to that back to 1984 when there was another plan and patients were moved out of psychiatric buildings - can the Government stand over the fact that not a single community mental health team has been rolled out in Galway city, Connemara or the islands for a population of approximately 100,000? I know the Minister of State might not be able to answer a question on a specific site but I am disappointed that the HSE has not clarified that in view of the fact that I took the trouble of tabling a question prior to this and have raised the matter again today. Can the Government stand over the fact that there is not one community mental health team in Galway city or the west of the county? That is my third time to repeat it because it is so shocking.

I cannot comment on the specifics of Galway but, as I said, I will visit the county on Monday. I will visit some of the facilities there and I will have a chance to get a first-hand view of what happening. I cannot comment on the availability of a community mental health team or otherwise because I do not have that information available to me. However, I am quite happy to discuss the matter with the Deputy afterwards and to pursue her concerns with the HSE further. As I said, I will be in Galway on Monday and I will find out what I can for the Deputy.

Psychological Assessments Waiting Times

James Browne


10. Deputy James Browne asked the Minister for Health the number of persons waiting for psychology appointments in primary care; and the number waiting more than a year. [40960/17]

I ask the Minister for Health to indicate the number of persons waiting for psychology appointments in primary care and the number waiting for more than one year.

Some 8,415 people are awaiting psychology appointments nationally, of which 2,584 are waiting for over a year. Approximately 80% of those waiting are in the five to 17 year age group.

The HSE has a service improvement initiative under way for psychology services. This includes the recruitment of people to fill an additional 22 psychologist posts and 114 assistant psychology posts. The posts were advertised recently. A cross-divisional working group, including the mental health division, is working to ensure standardised delivery of service, setting out and communicating the arrangements for care pathways and reporting of metrics. Each community health care organisation, CHO, has been requested to submit a short-term action plan to address waiting lists in priority areas as part of the service improvement initiative.

Other developments in this area include: the counselling in primary care service for adults over 18 years of age who are medical cardholders; a greater awareness of fostering mental health promotion in society through campaigns like the Let's Talk and The Little Things Campaign; implementing the suicide prevention strategy, Connecting for Life; the ongoing reduction of child and adolescent mental health services waiting lists for those waiting over 12 months; the development of counselling services across both primary and secondary care, including early intervention at primary care level; and the opening of new Jigsaw youth mental health services, bringing the total number of services to date in the country to 13.

It is 25 years since Ireland signed up to the UN Convention on the Rights of the Child. The statistics show that of the 8,000 on the waiting list, almost 6,000 are children, with in the region of 2,000 waiting for more than a year for primary care psychological services. That was at the end of June 2017. It is fair to say that figures like those are clear evidence that there is a crisis in the provision of mental health services for children in the community. The fact is that almost one in three children is waiting for an appointment for more than one year. It is simply unacceptable that children have to wait for that length of time to get their first appointment just to assess where they are at or what supports they need.

Vulnerable children and teenagers need the service and there is an obligation to provide it. We know there are significant regional variations across the country depending on where one is. There is effectively an Eircode lottery. In County Wexford, 230 young people have been waiting for more than a year. Cork has 456 young people in the same category and Galway has 208. There are similar lists across the country. Could the Minister of State address some of those key points?

I can indeed. The waiting lists and the numbers behind them are an issue of intrigue for me. I am not quite like the Taoiseach who has a complete fascination with statistics but, at the same time, there is more to the figures when one looks at them. The more I have looked at them since I have come into this role the more I am aware of the myriad factors that underlie the numbers and why people are waiting so long. For example, a detailed examination has shown that the most prevalent reason for the number of people waiting over 12 months is the lack of client availability. In other words, people are not turning up for their appointments. That is not me disavowing my responsibility, as I accept there are issues with recruitment and there are teams that do not have a full complement, but we also have a major issue with referrals. People present to their GPs or at other locations and are inappropriately referred to the child and adolescent mental health services, CAMHS, in many cases. When that happens, they are left on a list because they are not seen as a priority and CAMHS will continue to deal with priority cases.

What I would like to see is, first, a more appropriate referral system. There must be a clear care pathway outlined in each and every CHO. I would like to see one person made responsible in every CHO for that pathway so that when somebody rings up with a mental health query, he or she will be referred appropriately and seen at a more appropriate level than everybody being just sent up the list and left on the CAMHS waiting list. When one asks the CAMHS teams about the people who are waiting for over a year one finds they are a low priority but the names are left on the list and add to the statistics. We have a number of challenges to deal with in this area, including the gathering of metrics.

I welcome the Minister of State's response. There needs to be a type of one-stop shop for a first appointment so that a person can be put onto the correct list. Children are waiting ages for the National Educational Psychological Service, NEPS, only to be told they should have been on the CAMHS list. Likewise, children are waiting for ages on the CAMHS list only to be told they need to be somewhere else. I am aware of a parent who is terrified that their child will be diagnosed with autism because they are getting the supports they need within CAMHS but if the child is diagnosed with autism, they will be ripped off the list and put onto another list in respect of which the supports are not available. We need a child-centred approach whereby children are given first assessments and are at least put onto the right list and then given the appropriate supports. Currently, we have different lists and nobody is talking to anyone else and children wait sometimes for up to three years for a first appointment, which is simply unacceptable.

Deputy Browne clearly has a very good grasp of the underlying issues. I accept there are issues and challenges but there are also many management issues to be addressed. One of the initiatives I wish to drive through, which I have discussed with the Department, is what I call the front-door system whereby there is one point of contact for everybody who has a mental health issue who is seeking help. When a person dials the number, he or she is appropriately referred. At the moment, if a person wakes up and is feeling a bit low, it is not clear who to ring - ALONE, Aware, Jigsaw, primary care, the emergency department or the GP.

Deputy Browne referred to the number of children on various lists. A GP could refer a child to CAMHS, Jigsaw or NEPS. Children can be on several waiting lists. We need a point of responsibility within each CHO to take responsibility for the care pathway. I want to meet with such a person when he or she is appointed in order to ensure we have a national streamlined, coherent plan. Some of the people included on the waiting lists are waiting for one day. They could have rung yesterday seeking an appointment. I am reasonably assured, for the most part, that everybody who needs an urgent appointment gets one. That is what most practitioners on the ground tell me.

Hospital Waiting Lists

Bobby Aylward


11. Deputy Bobby Aylward asked the Minister for Health if he will report on the progress regarding the commitments he made in respect of reducing surgery waiting times for children with scoliosis; and if he will make a statement on the matter. [40786/17]

I wish to ask the Minister for Health if he will report on progress regarding the commitments he made in respect of reducing surgery waiting times for children with scoliosis.

I thank Deputy Aylward for raising this important matter. It is one the Deputy has consistently raised with me in this House and I know he has taken an active interest in it. The HSE is actively implementing the action plan it developed to ensure that no child will be waiting over four months by the end of the year for such surgery and is focussed on maximising all available capacity both internally within the health service and externally to achieve this target.

Additional nurses are now in post in Crumlin and Temple Street. An additional consultant orthopaedic surgeon commenced in Crumlin earlier this month. In 2017, up to the end of August, 202 scoliosis procedures were carried out in the two children's hospitals. That compares with 142 in those hospitals in the same period last year, representing a 42% increase in surgeries between the two hospitals in one year. Since February 2017, patients are also being transferred for treatment to the Mater, Cappagh and Stanmore in the UK. To date, 23 surgeries have been completed in those hospitals.

The HSE has completed an international tender for paediatric spinal fusion procedures and three hospitals were successful in their applications.

These hospitals will initiate patient reviews immediately with a view to commencing treatment in October for patients whose families take up the offer of having procedures carried out in overseas hospitals. I know that will not work for everybody but it is another option to try to provide as many avenues as possible for treatment for children who urgently need their surgery.

The HSE is also developing a forecasting model to predict, on a weekly and monthly basis, the number of patients expected to receive surgery by the end of the year. This will assist it further in monitoring the progress made in achieving the target. The overall number of patients waiting for scoliosis procedures has been reducing this year and progress continues in delivering on the HSE's four-month target to the end of 2017 in a planned, safe and sustainable manner. I really hope that once we get through this very difficult backlog, next year we will be able to ensure a sustainable situation whereby we can meet the four-month target in this country without having to outsource any procedures.

I have raised this matter consistently since 2015. I raised it with the Minister's predecessor, the current Taoiseach, Deputy Varadkar. I have raised it with Deputy Harris on a number of occasions since he took responsibility for the Department of Health. Few cases that come across my desk are more heart wrenching than those relating to the shocking waiting times for children and young people for surgery for scoliosis. We hear the horror stories of children's lungs and hearts being slowly crushed while they wait. We hear about children who can no longer retain their food because their stomachs have been squeezed so badly as a result of their condition. These stories were read into the record of the Dáil in late 2016 by my colleague, Deputy Kelleher, following a meeting I facilitated with the Scoliosis Advocacy Network, which campaigns on behalf of the children involved.

Following the very damning television programme on RTE, which highlighted the long waiting time for young people with scoliosis, the Minister promised earlier this year that a target of a four-month waiting period for treatment of scoliosis would be met by the end of 2017. The former Taoiseach, Deputy Enda Kenny, described the target as an absolute priority. Finally, we began to see meaningful action, although in 2014, 2015 and 2016 the resources were not provided and the scoliosis waiting lists were allowed to grow far too long. However, the problem remains. The number of children at Our Lady's Hospital for Sick Children in Crumlin and Children's University Hospital Temple Street waiting longer than four months for surgery has grown by 17%. In March, there were 134 children waiting for longer than four months for spinal fusion or surgery at the two hospitals. By last month, that number had increased to 145. The figures from the HSE show this.

I accept the Deputy's very sincere interest. He is right that this is a very important issue. When I became Minister for Health, there was a brand new theatre at Crumlin hospital in which procedures could be performed but that was closed. It is open now. Nurses have been hired and a new consultant orthopaedic surgeon is working there. There were 312 children waiting for such scoliosis procedures on 9 February and 247 on 22 September. We have got to continue to drive that down. We are putting additional resources in place. We have hired the extra surgeon and will hire more surgeons in 2018 in order that we might get that theatre open for at least five days a week. I want to see that happen.

We are going to use every tool available. That is why some children who can have their procedures carried out in the Mater or Cappagh - older children often are being transferred there. Some children have very successfully had their surgery carried out in Stanmore in the UK and have reported positive results. In my time as Minister for Health, I have not seen the HSE make such a proactive and determined effort - as well they should because it is far too high a waiting list - to get this down. They are working extraordinarily hard and we will resource them every step of the way to get there.

I understand that outsourcing is helping to alleviate the list. Why can we not cater for more of these children by expanding capacity in the Crumlin theatre and opening it for at least five days? My understanding is that it is only open on three days each week at present. Why can we not extend that to five days? We have the surgeons - I think five have been appointed - and we have the nursing staff. Due to their condition, not all of the children can travel abroad although I am glad that some can go abroad to get treatment. Also, referral between the Mater and Crumlin can sometimes break down. I ask the Minister to consider extending the Crumlin theatre's capacity from three days to five. I accept that progress has been made, and the advocacy group accepts that. More must be done.

I agree. The advocacy group has done Trojan work in highlighting this area of shame in the context of how the situation was allowed to develop. I would like to see the theatre open five days a week. I am assured by the Children's hospital group that this would require more consultants being recruited so, realistically, it will be 2018. Let us work to get there and, in the meantime, let us do everything we can.

The Deputy is right that some children cannot go abroad. I understand there are 68 children and young people whose cases are classified as medically complex. I am informed that, as of 25 September, 61 of these patients require treatment prior to the end of the year. There is capacity for 32 of those procedures to be carried out in Crumlin and there will be a treatment plan put in place for the remaining patients, I am told, within the next two weeks. We will continue to do everything we possibly can in the Department and in the HSE, not just to drive down the list once and for all but to ensure that once we get to an appropriate target, we keep it there. Four months is the clinically appropriate target. We must make sure that we can provide the capacity in this country without ever needing to send children abroad. This year, we have got to do everything we possibly can to get the list down.

Can the Minister extend the number of days on which the theatre is open each week from three to five?

If we can get more consultant surgeons. That is a priority but it is likely to be 2018.

Hospital Waiting Lists Data

Jack Chambers


12. Deputy Jack Chambers asked the Minister for Health the number of persons on waiting lists who were due to receive scheduled treatment during October, November and December 2017 and who have been notified that their procedures have been postponed; and if he will make a statement on the matter. [40956/17]

I want to ask the Minister for Health the number of persons on waiting lists who were due to receive their scheduled treatment during October, November and December 2017 and who have been notified that their procedures have been postponed or cancelled.

I thank Deputy Jack Chambers for his question. I fully acknowledge, as all Deputies would, the distress and inconvenience for patients and their families when elective procedures are cancelled. Maintaining scheduled care access is a key priority for hospitals, and balancing this with emergency demand is challenging. However, all efforts are made to limit cancellations, particularly for clinically urgent procedures.

Cancellation of elective procedures can occur for a variety of reasons. The classifications for cancellation of elective surgery include the following: patient had procedure externally; already had procedure in-house; cancelled by a consultant; cancelled by a patient or guardian; cancelled because of no bed; correction of clerical error; no theatre time available; patient did not attend; patient has undergone emergency admission; and patient unfit for procedure. Based on data provided by the NTPF, approximately 3,400 elective procedures are cancelled per month on average. However, this must be seen in context of the reasons I have just listed, which can be complex, and an average of 53,000 admissions to acute hospitals on a day-case and inpatient basis per month.

The NTPF national inpatient-day case planned procedure waiting list management protocol, published in early 2017, sets out the national protocols for the management of waiting lists including the scheduling of patient treatment. Under this protocol, and in line with best practice, patients should not be scheduled for treatment more than six weeks in advance. On this basis, the HSE has advised that patients will not have been scheduled, as yet, for treatment in November and December. I am happy to come back to the Deputy when we have the relevant data. Also, data on cancellations are reported to the NTPF after cancellation and therefore are not available in advance.

The HSE continues to work with hospitals to improve the management of emergency care demand and planning of elective procedures to minimise the impact on patients, as well as the number of sessions lost through cancellations or non-attendance. As the Deputy is aware, the Department of Health has commenced a health service capacity review, the findings of which are due to be published before the end of the year and which will inform future capacity developments. We need to arrive at a place where there is a decoupling between the beds needed for elective care and those needed for emergency care.

I thank the Minister for his response. My question concerns a number of examples of which I am aware, whereby someone was given an appointment for six weeks' time and then the appointment was cancelled the following week. This is not an emergency process. It is not about capacity or urgent demand in a hospital in a particular week. It is scheduled postponement which I see as taking place on a systemic basis. As we enter the winter period, my fear is that the HSE is trying to scale down its operations in our tertiary hospitals to the detriment of people who are trying to get treatment for which they have been waiting many months and, often, many years. As the Minister and the Taoiseach have repeated this week, we have the biggest budget for health care ever in the history of the State. If appointments are being postponed a week after they have been scheduled, it shows complete management dysfunction and a total disintegration of our hospital system. I fear the winter ahead because we are going to see massive systemic cancellations across our hospital system to the detriment of many patients who had hoped to have treatment.

I would genuinely ask the Deputy to provide me with information on this if he can because I would be more than happy to look at it. As already stated, I am informed that the NTPF can only report cancellations after the fact. Nor should patients be scheduled for treatment more than six weeks in advance. If there is an issue in that regard, I would be more than happy to look into it if the Deputy can provide me with the information.

In the context of the coming of winter and ensuring that we continue to drive down the number of people on waiting lists, 2,100 fewer people were waiting for hospital procedures or operations last month than was the case the month before. We need to build on that month on month. We continue to utilise the NTPF so that procedures will continue to be performed at a time when our emergency departments are extraordinarily busy.

We will also continue to utilise public hospitals with non-emergency departments and smaller public hospitals, including Cappagh Hospital and some of the level 2 hospitals, in order that it is not all about insourcing. I will be more than happy to correspond with the Deputy on the issues he has raised.

My example goes outside the criteria listed by the Minister. I have seen a number of cases in which people who were given appointments for planned procedures have had those procedures systemically cancelled by the hospital system in a manner which is devastating for them. The hospitals in question have stated in their correspondence that they will be in touch in due course, but they have not given the patients another date. I will explain what I think is happening. I suggest the hospitals are removing particular patients from the planned electives list when they give them appointments, only to cancel the procedures the following week. Are we seeing a vacuum in the statistics caused by the systematic cancellation of apparently scheduled appointments? If so, it is a cause of serious concern for me and everybody else. This does not relate to the criteria listed by the Minister. I think it goes to the heart of the problems we are seeing with the HSE. I do not blame the Minister personally for this; the health care system is broken and disintegrating. It seems we are going to see implementation of the Sláintecare report, but I do not know whether the HSE is fit for purpose in the context of its delivery. The HSE has the biggest budget we have seen, but we are not seeing the output. We need to have a broader debate about the how the HSE, as an entity, can implement a better public health strategy.

Obviously, the NTPF is responsible for the auditing of waiting lists. I will be more than happy to pass on to it any information the Deputy might have. Very strict rules apply to the waiting list protocols. They govern how patients are added to lists and how they can be removed from them after they have undergone procedures, clinical decisions have been made or validations carried out. These strict rules should be applied consistently across the system. I will be very happy to pass on to the NTPF any information the Deputy might have on its audit function. I agree with what he has said about Sláintecare and the HSE. I do not believe the HSE, as constructed, is fit for purpose. The Sláintecare group shares that view. When I went before the committee, I said we needed a much slimmed-down HSE. I accept that there are things that need to be done at national level such as having cancer standards, maternity standards, procurement and central budgeting systems. There are also things that need to be devolved to the hospital group structure, as constituted, which we hope will become regional structures that will include community care, primary care and acute hospital services. That is the Sláintecare way. I hope we can make quick progress on some of this in the coming weeks and months.

Medicinal Products Availability

Alan Kelly


13. Deputy Alan Kelly asked the Minister for Health when life-saving drugs (details supplied) will be made available to people here. [40782/17]

Alan Kelly


61. Deputy Alan Kelly asked the Minister for Health if the overspend in the HSE budget will affect the provision of the nine life-saving drugs (details supplied) the HSE stated it would fund in July 2017. [40783/17]

I propose to take Questions Nos. 13 and 61 together.

The HSE has notified my Department it has decided, following an assessment under the process set out in the Health (Pricing and Supply of Medical Goods) Act 2013, to fund the nine treatments referred to by the Deputy in the public health system. Its decision to fund each treatment followed an examination of all relevant information submitted by the applicant companies and took into account expert opinions and recommendations under the evaluation and advisory structures it has put in place. It is in the process of concluding the commercial arrangements and prescribing process for each treatment. I have informed it of the importance I place on the speedy resolution of this process in order that the treatments may be available at the earliest possible dates. As I told the Deputy yesterday, my understanding is that they will be available from 1 November. A number of them could be available before that date. I have stressed this to the HSE. We often criticise companies with good reason in this House, but in this case I thank the Irish Pharmaceutical Healthcare Association and its member companies for working with us to try to make sure some of the drugs can be available in advance of that date.

This question has been overtaken by the remarks made by the Minister at a committee meeting yesterday. I would like to mention two issues. The announcement made in July was a stunt, given that, for budgetary reasons, the changes cannot be made until November. When the announcement was made, it should have been made clear that it would take a number of months for the arrangements to be put in place. It is not right to behave in that way and it should not have happened. I am happy that the Minister has said he hopes to pressurise the companies into bringing forward some of the drugs.

In some cases the process is not that complicated, but in others it can be more complicated. I would appreciate it if the Minister identified the drugs in question. We are overpaying for drugs, as the Department of Public Expenditure and Reform accepts. It is quite obvious that we are overpaying for them and we cannot go through this again. The process used to make drugs available which involves reimbursements and making decisions led to an embarrassing situation between the Department of Health and the HSE. What happened in the case of the national clinical care programme cannot be allowed to happen again. What process will the Minister put in place to ensure the reimbursement process for drugs will work properly in the future? I will work with him on any such process.

I would welcome the opportunity to work with the Deputy and others on this matter. The Health (Pricing and Supply of Medical Goods) Act 2013 which was passed by the House for good reasons has resulted in these matters being passed back and forth between the HSE which has all of the statutory power and the Department of Health, to which the HSE must revert if it requires funding. They often have to be considered by the Government. The process is rather unedifying and occasionally creates delays. I do not think it is the best one. As an Oireachtas, we need to look at it. I do not want to name the drugs in this House because they are subject to contractual discussions, but I am conscious that some patients are urgently awaiting some of them.

I do not want such patients to be deprived of the drugs they need for bureaucratic reasons. I have conveyed this message to the HSE in the strongest possible terms. I am aware that contacts with the pharmaceutical companies are ongoing and hope resolutions can be reached speedily in those cases.

Will everything be done by November?

I am informed that it will be done from 1 November.

Written Answers are published on the Oireachtas website.