Other Questions

Mental Health Services Funding

Robert Troy


26. Deputy Robert Troy asked the Minister for Health his budget allocations for a service (details supplied). [47977/17]

Good2Talk Counselling and Psychotherapy Support Services in Mullingar is a counselling service that offers crisis intervention and long-term crisis prevention, helping clients to develop healthier coping strategies, preventing suicide and high-risk behavioural patterns. It deals with financially disadvantaged clients aged from 16 years and many different ethnic groups. It has made an application for funding. Its funding was cut by the HSE in previous years. Can it look forward to good news in 2018?

Good2Talk Counselling and Psychotherapy Support Services is a counselling service based in Mullingar that covers County Westmeath.

Good2Talk was awarded funding through the HSE resource office for suicide prevention of €25,000 for 2014 and €39,600 for 2015. In addition, it received €18,000 under the National Lottery grant scheme for 2016, and has, I understand, made an application under the National Lottery grant scheme for 2017.

The HSE funding was accessed by the resource office for suicide prevention under the community resilience funding stream financed by the National Office for Suicide Prevention. This funding stream ended in 2015 with the advent of the national strategy, Connecting for Life, in 2015. The ending of the community resilience funding stream after 2015 was communicated to all of the recipients of the funding, including Good2Talk. All future needs for funding will be assessed under the provisions and implementation of the new county suicide prevention plans, which aim to develop and implement consistent multi-agency suicide-prevention action plans to enhance communities' capacity to respond to suicidal behaviours. Good2Talk has been informed about the development of the Connecting for Life implementation plan for Longford and Westmeath and has been invited to participate in the plan's consultation process.

It is noticeable that the Minister of State failed to outline the funding for 2016 and 2017, which was cut. It was cut because of what happened in Console. Rightly the Department had to ensure that State money that was being allocated was going to help the people who needed it.

Good2Talk is governed by a board of directors. It complies with the CRA requirements. It works within clear guidelines, policies and procedures, working towards transparency and accountability. Its accounts are audited every year and presented at its AGM. Its clinical work is guided by best-practice guidelines and ethical guidelines of the IACP. In 2013 it dealt with 167 clients; in 2014 it dealt with 397 clients; in 2015 it dealt with 480 clients; in 2016 it dealt with 444 clients; and this year it has dealt with approximately 485 clients. It is dealing with people who need help and it is filling a gap the HSE is leaving wide open. It needs to know if it will be eligible and in receipt of much-needed State funding for 2018.

This is not a reflection on Good2Talk; it is a change in the system for allocating funding that was announced to all organisations, including Good2Talk, in 2015. Many of the organisations are admittedly doing very good work but on an ad hoc basis. We need to streamline that and understand what everyone is doing. It is one of the reasons I want to see the introduction of a national phone line which co-ordinates all of these services and directs people appropriately. It is not possible to have a bottom-up service delivery system; we need a nationally co-ordinated system with localised delivery. That is what we announced in 2015 with the Connecting for Life strategies that are being rolled out in every county. Every county has its own specific means and demands on it. From here on in funding will be allocated on a countywide perspective and not on a nationwide perspective. This was communicated in 2015 to Good2Talk in 2015, as it was to all other organisations.

Good2Talk has made an application for national lottery funding.

It also takes contributions towards the delivery of the service and organises many charitable collections. That is the way matters will remain until the local Connecting for Life strategy is rolled out countrywide and then decisions on funding will be made by it. I suggest that the Deputy take this matter up with the people involved with the strategy. It is a local issue. It is not a matter for my Department and neither the Department nor I will be making a decision on the allocation of funding.

When will the local people be making the decision? This organisation has failed to secure any State funding for the past two years despite the large number of people it is supporting. The Minister of State was correct in what he said. This organisation has organised bucket collections and fundraising cycling events. The former Taoiseach, at my invitation, participated in a fundraising cycle event not alone to raise money but to create awareness of this service. It is not right or proper that people are out in wet weather shaking buckets and selling scratch cards and lotto tickets in order to provide a service that the State should be providing. I accept the service needs to be streamlined to avoid duplication but there is no duplication of this service in Mullingar. These are the people providing the service in Mullingar. They still do not know the funding for which the organisation will be eligible next year. That is not right. They must be given a clear timeframe in order that they might know the funding for which they will qualify next year. It is not fair to expect people to provide a service voluntarily and for tens of people to fundraise voluntarily for that service, which should be provided for by the State.

I appreciate the Deputy's passion with respect to this service. He has a serious conviction and commitment to the cause, and I salute that. I will ask the HSE to outline the answers to the questions he has posed. I cannot answer as to what it will do locally. Therefore, I will ask the HSE to communicate directly with the Deputy to provide clarity on that. I appreciate that every organisation wants to know where it stands into the future in the context of its requirements and the funding resources on which it can depend. I will ask the HSE to clarify the position. I am aware that the former Taoiseach, Deputy Enda Kenny, visited the organisation in June 2014. This is not a reflection on Good2Talk or the work it is doing; this is a changing of the systems. I will ask the HSE to clarify the position for the Deputy.

Orthodontic Services Waiting Lists

Michael Moynihan


27. Deputy Michael Moynihan asked the Minister for Health the action being taken to address the long waiting times for orthodontic services in counties Cork and Kerry. [48208/17]

Will the Minister address the issue of the waiting times for orthodontic services in counties Cork and Kerry?

I thank the Deputy for his question. The HSE provides orthodontic treatment to those who have the greatest level of need and have been assessed and referred for treatment before their 16th birthday. An orthodontic assessment determines if the referral meets the criteria for the service and, if so, what priority the patient is given. Those with greatest clinical need are prioritised, which is appropriate, and are seen within one year. Some patients will particularly benefit from treatment coinciding with their growth. These patients are generally seen within 18 to 24 months. While too many are waiting, it is important that we factor in the clinical view regarding treatment coinciding with a patient's growth and appropriate age.

A Programme for a Partnership Government contains a commitment to providing timely access to orthodontic care. In order to address long waiting times, the HSE has procured orthodontic services in primary care from a number of private service providers and a budget of €1 million per annum is being dedicated to this initiative, which commenced in 2016. To date, 142 patients from Cork and Kerry have been treated under this initiative. The Cork and Kerry community health care organisation, CHO, has also commenced a capacity planning review of orthodontic services. This will identify whether changes may be required to the current allocation of resources, including staff, in order to be more responsive to patients' needs.

Nationally, the HSE is also working on a programme to upskill dental hygienists and dental nurses to become orthodontic therapists. This will facilitate a greater throughput of patients, which has been very much welcomed by those working in dentistry.

The national approach to future oral health service provision will be informed by the national oral health policy, which is currently being finalised. I expect to publish that in early 2018. Resources are being finalised as part of the service plan. I expect more funding to be available to help utilise private providers while building up capacity in the public service, including in Cork and Kerry, in 2018.

The report may determine that more funding is needed. A total of 1,200 children in Cork and Kerry are in need of orthodontic treatment, with the vast majority in the grade 4 and grade 5 categories of higher-level need. There is an outcry about this characterised by the large number of parents who are calling into our clinics trying to get orthodontic treatment for their children. It is an emotive issue and there are other issues associated with it. There is a crisis in terms of those waiting for treatment, particularly in Cork and Kerry. For us to have to wait for a report or a paper to state that more resources may be needed is fantasy stuff. More resources are needed. Something needs to be seriously done to tackle this issue and to discover how treatment can be secured for these children in a faster and more efficient way to ensure they get the treatment they require. Rather than waiting for a report, we need to act now.

I assure the Deputy that we are certainly not waiting for any report and that, as I already outlined, under the procurement procedures being put in place, a number of children in Cork and Kerry and a significant number of children throughout the country have had offers of treatment and received orthodontic treatment in a primary care setting through private providers. In addition, as we speak, we are upskilling dental hygienists and others to perform the function of orthodontic therapists, which will help to increase the capacity within our existing primary care structures.

The Cork and Kerry CHO has decided that it wants to examine what it considers it needs in terms of current resources, including its staffing and service level agreements. I assure the Deputy that as soon as it comes back with that information, we will look at acting upon that in the context of the HSE's service plan for 2018. I would like to see much more done on this area. We are providing additional funding for this year and substantial additional funding for next year in terms of addressing waiting lists and longest waiters. I do not see why we cannot direct more of that to the Cork and Kerry area. After these questions, I will link with the CHO, through the HSE, to see when I can expect that ask from the Cork and Kerry CHO.

When will the Minister get that document or information in order that we can have a resolution to this issue? As Minister for Health, does Deputy Harris agree that it is completely unacceptable that people have had to wait so long for fundamental orthodontic treatment? I ask that he give a "Yes" or "No" answer to that question. Will he consider availing of the National Treatment Purchase Fund? That is the only way we can reasonably address the numbers on the waiting list, not only in this sector but across the health sector. Is he prepared to consider using the National Treatment Purchase Fund to source funding and resources and to avail of services outside the State to alleviate this problem?

Regarding when the report is due back from the CHO, I will find that out directly from the HSE and revert to the Deputy. I absolutely find this unacceptable. Who could find it acceptable? What I am going to do to solve the problem is probably what citizens and the Deputy's constituents want to know. I am very much open to using the National Treatment Purchase Fund as a vehicle. In many ways, we are doing the equivalent by already procuring through private service providers. There is a more effective way of doing that in a co-ordinated way with the National Treatment Purchase Fund that might even drive better value for money and a greater volume of patients. I am due to meet representatives from the National Treatment Purchase Fund this afternoon and I will discuss that matter with them in this context. I have no difficulty whatsoever in considering orthodontics in the context of the putting together of our waiting list plans for 2018.

Maternity Services Provision

Robert Troy


28. Deputy Robert Troy asked the Minister for Health when anomaly scans will be available in the Midland Regional Hospital Mullingar. [47978/17]

Mick Barry


39. Deputy Mick Barry asked the Minister for Health if the provision of anomaly scanning for all pregnancies will be expedited; and if he will make a statement on the matter. [48181/17]

When does the Minister envisage anomaly scans will be available in the Midland Regional Hospital Mullingar?

Is this question being grouped with Question No. 39?

Yes, Nos. 28 and 39 are being taken together.

I propose to take Questions Nos. 28 and 39 together.

I thank Deputies Tory and Barry for their questions. I accept that the provision of anomaly scanning is not uniform throughout the country. However, we are working to address this. I want to assure Deputy Troy of that. The national maternity strategy is very clear that all women must have equal access to standardised ultrasound services. The strategy will be implemented on a phased basis over the coming years - I have just published the first implementation plan - and this work will be led by the HSE national women and infants health programme. This is a specific programme office within the HSE very similar to the way we delivered improvements in cancer services in the past. Last month, I was pleased to launch the programme’s detailed implementation plan.

I am advised that anomaly scans are available in each hospital group, as distinct from each hospital. I am also advised that those maternity hospitals and units which currently provide anomaly scans accept referrals from other maternity units. This occurs where the medical team in the referring maternity unit considers that such a scan is clinically indicated. I am informed that the Midland Regional Hospital Mullingar provides anomaly scans to women when clinically indicated to do so.

One of the current challenges to increasing access to anomaly scans is the recruitment of ultrasonographers. In this context, it is expected that the establishment of maternity networks across hospital groups will assist in the development of a sustainable model that ensures all women can have access to anomaly scans routinely. They are already happening where clinically indicated. I think what the Deputy is asking me is when they will be available routinely for all women. I am assured that the programme will continue to work with the maternity networks to assist in increasing access to anomaly scans for those maternity units that currently have limited availability. The additional funding that will be provided for anomaly scanning in 2018 will be set out in detail in the national service plan, which I hope to publish in the coming weeks. I assure the Deputy in the interests of clarity that specific funding will be provided for the recruitment of additional ultrasonographers in 2018. The exact details will be outlined. I expect, and the national women and infants health programme expects, that we will have more sonographers working in our health service next year. That should enable us to further increase provision beyond just where clinically indicated and to offer anomaly scans on a routine basis. I will keep in touch with the Deputy as the service plan details become apparent.

I thank the Minister. He is right that the national maternity strategy states there must be equal access to standardised ultrasound services for every pregnant woman, not just where there is a potential risk to the child or the mother. That followed the identification of a geographic inequity in the availability of 20-week foetal anomaly scans. The Midland Regional Hospital, Mullingar does not just serve Mullingar. It serves all of Westmeath and Longford, and parts of Offaly, Meath, Louth and Roscommon. It actually services quite a large geographical area. I know this matter is a priority as part of the hospital business case for 2018. I stand to be corrected but I am led to believe that the hospital has the highest rate of births outside Dublin. That is an indication of the large number of people it serves and shows how urgent it is for it to be in a position to offer anomaly scans to all pregnant women from 2018 onwards.

I thank the Deputy. He is entirely correct. The national maternity strategy is clear that it wants to make detailed routine scans available for 100% of women within the public health system. It wants to make them available on the basis of a woman's choice rather than on the basis of specific clinical indications. That is where we need to get to. I think it is right and proper that we start with clinical indications, in the interest of women's health and wellbeing, and that we make sure the scans are available in every hospital group, which is the current situation. The regional hospital in Mullingar is doing an excellent job in that regard and I thank its staff for that.

We will be looking at how we can deploy the extra ultrasonographers we will be hiring in 2018 to best ensure geographic equity. Mullingar will be considered in that context as well. It is estimated that for everybody to have absolutely routine access to such an anomaly scan, we would need an additional 52 ultrasonographers - 35 for anomaly scans and a further 17 for dating scans. It is important to note that the benefit of this planned recruitment will be released incrementally because, let us be very honest, the likelihood of finding all of that cohort in one go is slim. We will be increasing the number of ultrasonographers in 2018. I will talk to the HSE about the point the Deputy makes about Mullingar and the fact that it is very much a regional hospital.

I appreciate that the Minister has undertaken to look at Mullingar hospital given its location, the number of counties it serves and the high level of births that take place there, as I said at the outset. On the recruitment of the additional 52 sonographers, obviously that will not happen in one year. Has the process of recruiting the additional staff commenced? Quite often what happens with the HSE is that it makes an allocation for a particular calendar year, for example, 2018, but does not commence the recruitment process until well into that year. The full benefit of the services is therefore not realised in the calendar year. How long is the recruitment process going to take? Has the Minister identified exactly how many additional staff are going to be hired in 2018?

No, we have not because that will be a matter for the HSE service plan, which is the subject of ongoing discussions within the HSE. It is due to be presented to me and published by the HSE in the coming weeks, and one would hope this will be the case. That will provide the more granular detail of how many and in what year. It is the very clear aim of the programme and the national maternity strategy to ensure that all women have access to routine anomaly scans by 2019. That is where we want to get to. We want to make progress in 2018.

The Deputy's point is well made in respect of the recruitment process. There is no point in the HSE saying it is going to do something in 2018 and starting in the middle of that year. I will give the Deputy my assurance that once the service plan is finalised, I will ask the HSE to prioritise the recruitment process. It should start immediately once the service plan is signed off on so that we can have actual ultrasonographers in place in our hospitals in 2018. I expect that will happen.

Health Services Expenditure

Richard Boyd Barrett


29. Deputy Richard Boyd Barrett asked the Minister for Health the portion of the additional €658 million allocated to the health service in budget 2018 that will deal with changing demographics; the amount allocated to new or additional services; and if he will make a statement on the matter. [48131/17]

Every year, the Government propaganda machine states that it is spending more this year than has ever been spent before on health. Every year, the number of those on waiting lists increases and the number of those on trolleys increases or stays the same. Given that the Government is doing it again this year and spending €600 million more than we have ever spent before, I want to know whether that sum is actually going to cover the increased demographic demand for those services, produce anything like new services, or deal with the massive crisis we face in respect of waiting lists.

I thank Deputy Boyd Barrett for the question, although I can assure him that it could not have been said every year by every Government. Before my party came into Government, the health budget was cut in the previous three budgets. It has not risen every year. The Deputy is right, however, that it has risen significantly again this year.

The gross current budget for the health sector for 2018 will be €14.798 billion. This is equivalent to a €646 million or 4.6% increase compared to the 2017 allocation of €14.152 billion. The increased level of funding available to the health sector in 2018 seeks to address the challenges facing the health services into the future posed by demographic pressures, including a rise in chronic diseases and an ageing population, technological developments and health inflation. These challenges are being addressed through the implementation of strategic initiatives such as ongoing initiatives to improve access and the continued focus on the shift to primary care, while continuing to address effective management of resources to ensure that services are delivered in line with the national service plan and within budget.

Let us break down that figure of €658 million, which I think is what the Deputy wants me to do. Of the increase in funding, over €200 million was provided for new developments, which will include expansion of existing services - things we are not doing this year and wish to do next year, and things we wish to do more. It includes funding for the National Treatment Purchase Fund, NTPF, to reduce waiting lists, and a primary care fund. It includes expansion of services in the areas of mental health, disability and home care. The balance is available to maintain the existing level of services taking into account demographics, central pay decisions and other increases in cost. The costs of central pay decisions including national pay increases and the nursing agreement is €278 million in 2018.

To summarise, that is €278 million for central pay decisions and just over €200 million for new developments, out of an increase of €646 million. The exact quantum of services to be delivered in 2018 will be set out in detail in the 2018 national service plan currently being prepared by the Health Service Executive, which will be published before the end of the year. It is, however, not just about funding, but also about reform. I will come back to that in a moment.

I was going to say, "Blah, blah, blah" but actually the Minister did give a bit more detail, in fairness, to back up his assertions.

The Minister is on a roll.

There is a credibility problem, however, with what he is saying. In 2015, we had 386,000 people on waiting lists and there was a budget increase in 2016 of about €1 billion. In that year, the highest number of people on trolleys on a single day was 330. The following year, despite the increase, we had 490,000 people on waiting lists and a high point of 470 people waiting on trolleys on a single day. We had another approximately €1 billion spent, yet in 2017, despite supposedly covering demographics, we are up to 685,000 on waiting lists, which is a spectacular increase. Today, as we speak, the figure for people waiting on trolleys happens to be 470, exactly the same as it was in November 2016.

Can we believe what the Minister just said when all the indications are that the allocations he is making for health, although being flagged as big increases, are not even keeping pace with demographics, never mind actually delivering new services?

I was encouraged by the start of the Deputy's supplementary question but it went downhill after that.

Without wishing to damage the Deputy's credibility, I agree with him that if we continue to just pour resources into the health service without looking at the outcomes rather than the outputs, we will find ourselves in a cycle where we continue to increase investment but do not necessarily tackle the core issues. That is why I am disappointed that the Deputy's political grouping is the only one which did not sign up to the Sláintecare report. The report is a genuine effort by Deputies on all sides of the House to agree there is a need for increased resources, but it is how one spends them. If one continues to do everything in the acute hospital setting, it will continue to cost more money. As demographics continue to rise, with more older people and a rise in chronic diseases, the health system will then find it difficult to be sustainable.

I do not agree with the Deputy's waiting list figures because the figures for this year include data never published before. I have published more data as Minister for Health than any of my predecessors. The pre-planned list and the suspended list are both published, as a result of the RTÉ documentary on waiting lists. The Deputy is not comparing like with like in that regard. The waiting list trends for the past three months show some improvements.

Last week, I was contacted by a man who has been two years on a waiting list for spinal surgery and is in intense pain. He recently received a letter from St. Vincent's hospital, stating it was no longer in a position to offer appointments in the orthopaedic department for spinal review and, therefore, his referral would be returned to his referring doctor with a view to that doctor securing a spinal appointment for the man in another hospital. This is the reality of the so-called increased allocations, as against the actuality of waiting lists getting longer and being told to go back to the start while suffering chronic pain. The evidence on the ground, despite the game of statistics and so on, is that the situation gets worse because the allocations are not sufficient to meet increased demands. We get overruns, which next year's new allocation will just about cover, never mind dealing with backlogs or the need for increased services in several areas.

I will reiterate the point I already made. That is why it must be about reforming the system. It has to be about looking at what we are doing in the acute hospital setting that we could do in the primary care setting. For example, recently, we had the primary care eye review. Ophthalmologists working in the community pointed out they can do much of what their counterparts do in hospitals. This would free up hospitals to do more complex and expensive procedures. High-volume and often relatively low-level complexity cases can be dealt with in primary care. That is why we need to do more of that. We need to shift more and I will show that when we publish the 2018 service plan.

We are making progress with waiting lists. If the Deputy wants to believe my statistics or not, it is up to him, but they are the National Treatment Purchase Fund, NTPF, statistics. The number of persons on the active waiting list for a hospital operation or procedure has fallen for the past three months and is now at its lowest in 12 months. The number of people waiting for an outpatient appointment has fallen for the past two months. The overall number on those lists has fallen over the past two months.

We have a hell of a lot more to do, however. It must be remembered we are coming from a lost decade of investment in public services. I am not going to make the mistakes made in the Celtic tiger by reducing the debate to purely one about funding. Even if one gave an extra €1 billion on top of the budget without reforming the system, it will not be sustainable in the future.

Medicinal Products Regulation

Louise O'Reilly


30. Deputy Louise O'Reilly asked the Minister for Health his plans to undertake an investigation into the current and historical use of the drug, sodium valproate; if a State-wide register of those women who were on the medicine during pregnancy, and of the children affected by foetal anti-convulsant syndrome caused by exposure to sodium valproate during pregnancy, will be established; if appropriate pathways for the diagnosis and treatment of foetal anti-convulsant syndrome, in addition to providing additional services for children affected by this syndrome, will be put in place; and if he will make a statement on the matter. [48112/17]

I hope the two issues I am raising today will not be matters we will be discussing for a long time but will be addressed. The first issue relates to sodium valproate, more commonly known as Epilim, taken by women with epilepsy during pregnancy. The HSE is aware it has been shown to have serious health implications for pregnant women in particular.

I thank the Deputy for her question which she highlighted last Thursday on Leaders' Questions.

Sodium valproate is a medicine licensed for use in Ireland to treat epilepsy and bipolar disorder. It is now well established that children exposed to valproate in the womb have an increased risk of congenital malformations and developmental disorders. In 2014, the European Medicines Agency, EMA, conducted a review of valproate and issued advice placing additional restrictions on the use of valproate in women and girls.

In March 2017, the EMA's pharmacovigilance risk assessment committee initiated a new review of the use of valproate in the treatment of women and girls who are pregnant or of child-bearing age. It is expected this review will be concluded before the end of the year. When it is, the Health Products Regulatory Authority, HPRA, will communicate its outcome and recommendations to Irish patients, health care professionals and relevant stakeholders, including the HSE.

The HSE national clinical programme for epilepsy is developing a draft protocol for the effective management of women with epilepsy. It includes prescribing guidance and detailed advice on the management of clinical issues relating to epilepsy in pregnancy. This guide will be for consideration and approval by the HSE before the end of 2017. The national clinical programme for epilepsy will consider the outcome of the EMA review when finalising this protocol.

Patients taking valproate-containing medicines are advised not to stop taking these medicines. If they have any concerns about their specific drug treatment and management of their condition, they should discuss these with a health care professional.

Health-related therapy supports and interventions for children can be accessed through both the HSE's primary care services and its disability services. We have a duty to meet the health care needs of our people, regardless of the situation. At my request, officials from my Department are scheduled to meet representatives from the foetal anti-convulsant syndrome, FACS, forum, on 23 November. I hope they find the meeting useful in exchanging information, ideas and their concerns. It will be an opportunity to be updated on the Department's perspective.

We have several important developments in the next few weeks with the EMA and the national clinical guidelines.

Those developments are welcome. Information is available that sodium valproate should not be prescribed to girls or women of child-bearing age or pregnant women unless alternative treatments are ineffective or not tolerated.

Yesterday evening, I received an email from a woman of child-bearing age, which I am happy to share with the Minister outside of the Chamber, in which she described how she picked up Epilim from a pharmacist in a plastic bag with no information leaflet. When she asked, she was told that was because she was getting fewer than 100 tablets. If it is 99 tablets or 1,000 tablets, the risk is the same. The risks are known. In advance of any reports, since we know the potential risks to women of child-bearing potential - the HSE's phrase - who are taking this drug, the Minister should instruct his officials to ensure that information is communicated. The woman in question communicated with the pharmacy, part of a large chain. It has apologised but it is not fair to ask patients to police this.

The Deputy has a fair point. In advance of my departmental officials meeting with the FACS forum on 23 November, I will ask them to give consideration to this issue.

The HSE's medicines management programme launched its sodium valproate toolkit, an online resource consisting of a patient information booklet, a summary guide for prescribers and a patient-prescriber checklist. This information highlights that sodium valproate should not be prescribed to girls or women of child-bearing age or pregnant women unless alternative treatments are ineffective or not tolerated. The management programme is in contact with the HPRA regarding the EMA's review and any further safety recommendations which might arise from that work.

The Deputy made the point that there should be action now. I will ask my Department to contact the HPRA to discuss the matter in advance of its meeting with the FACS forum on 23 November. I would be happy to discuss the outcome of that meeting with the Deputy.

It is welcome that such an instruction would go out. We are not saying the medicine is necessarily dangerous but it is in certain circumstances. The more awareness there is, the better. The actions being taken now are somewhat for the future.

I have met some of the women affected and their children, some of whom are adults. They have been profoundly affected by this drug. I am not a scientist or a doctor. I cannot make that equivalence but I have met them. These children suffer from a range of conditions.

As the Minister is aware, it can give rise to spina bifida, heart defects, breathing difficulties, overlapping fingers, clubfoot, hip dislocation and distinctive facial characteristics, all of which contribute to making life extremely difficult for these women. I have met them. They are fighting very hard for services but there is no recognition of what has caused them to need the additional services. The Minister should not forget some families who have already been impacted by the issue and also need to be looked after. It cannot just be a project for the future.

That is a fair point. We must ensure that all appropriate information and advice is followed but the Deputy raises the legitimate issue of what to do in respect of affected children. The Health Products Regulatory Authority, HPRA, advice notes that up to 10% of children exposed in utero to valproate are at risk of a congenital malformation and it is further estimated that up to 30% to 40% of such children are at risk of serious developmental disorders. The European Facts Forum estimated that up to 400 children in this country could be affected. A paper published in 2016 indicates that the use of sodium valproate in pregnancy has declined between 2008 and 2013 and an analysis of HSE pharmacy claim data from January 2014 to August 2016 indicates a decline from roughly 2,000 to fewer than 1,700 women aged 16 to 44 who were dispensed sodium valproate medicines under the community drugs scheme in that period.

The service needs of these children should be the primary purpose of the meeting on 23 November. Health services are available regardless of diagnosis or condition but if there is a sense that there is not a proper understanding or realisation of the needs of these children I hope that can be teased out at the meeting.

Ambulance Service Provision

Pat Casey


31. Deputy Pat Casey asked the Minister for Health the proposals in place to expand the ambulance service in south and west Wicklow; and if he will make a statement on the matter. [48197/17]

Is there a proposal in place to expand the ambulance services in south and east Wicklow because, as the Minister is aware, both areas suffered a reduction in service in 2012?

I thank the Deputy for raising this issue concerning a county I know well. The National Ambulance Service has embarked on a strategic reform programme to reconfigure the management and delivery of pre-hospital emergency care services. The programme aims to deliver a service that is safe, responsive and fit for purpose through the development of a modern, clinically driven and nationally co-ordinated system supported by technology and data.

The National Ambulance Service capacity review was published in 2016 and examined overall ambulance resource levels and distribution against demand and activity. It made several recommendations to improve performance and indicated the only practical way to improve first response times in rural areas is through voluntary community first responders schemes. It is interesting that the first external review of our ambulance service specifically discussed voluntary community first responders schemes. There are 22 such groups linked to the National Ambulance Service operating across Wicklow and I thank them for all their work.

The programme for Government commits to additional annual investment in ambulances, personnel and vehicles. A total of €7.2 million in additional funding was provided in 2016 and an additional sum of €3.6 million was made available in 2017. I am happy to confirm that increased funding will be made available for more ambulances and paramedics in 2018. The national service plan is due to be published in the coming weeks and the detail of the increased funding will be set out therein. I appreciate the need for additional ambulance resources in the parts of Wicklow the Deputy referenced. That will be considered by the National Ambulance Service in the context of putting together its plan for 2018. The Government is providing additional funding.

In Wicklow town there are two emergency ambulances during the day from Monday to Sunday, two during the night on Mondays, Tuesdays, Fridays and Sundays and one during the night on Wednesday and Thursdays. In Arklow there is one emergency ambulance during the day on Mondays and from Wednesday to Sunday and one during the night from Monday to Sunday. In Baltinglass there is one emergency ambulance during the day from Tuesday to Sunday and one during the night from Monday to Sunday. I am very eager for that to be increased and approved, as the Deputy can imagine. I expect the National Ambulance Service will outline the details of its plans for 2018 when it publishes its report.

I thank the Minister for his response. I wish to put on record my understanding of and appreciation for the work done by the 22 first responder groups in Wicklow. They do an incredible amount of work and are a huge benefit to the health service.

Arklow and Blessington-Baltinglass both lost a half-day service in 2012. Under new rostering arrangements they have lost 136 day hours service. It is disappointing that there is a two-tier ambulance service in County Wicklow. The Minister knows the geography of west Wicklow as well as I do. The cover for that area is provided by ambulances in Tallaght and Naas. However, the service in Tallaght is closed on the same day as that in west Wicklow and the area is, therefore, relying on Naas at those times. If one lives in the centre of the county one might have to wait up to an hour or an hour and a half. In my area of Glendalough an ambulance will sometimes come from Naas even though it is not meant to cover that location. Although efficiency needs to be considered, there needs to be a level playing pitch across the county.

I agree with the Deputy. There is an issue of geographic inequity depending on where one lives in Wicklow, with west Wicklow often experiencing more geographical challenges than other parts of the county. It is not just the Deputy and I, as persons from County Wicklow, who understand that. The National Ambulance Service capacity review found there was a need in the eastern region, which covers Dublin, Kildare and Wicklow, for additional emergency resources, primarily rapid response vehicles. Therefore, I expect that following the implementation of the national capacity review, the ambulance service will act upon that in the context of the forthcoming service plan because it is important we have an evidence base for all we do and the National Ambulance Service capacity review is very clear on the need to plug deficits in the eastern region, which includes County Wicklow and west Wicklow.

The Deputy is right to praise the community first responders groups. Wicklow has led the way in that regard, with 22 such groups in operation there. Three community engagement officers have been appointed to the National Ambulance Service operational areas in north Leinster and the west and south of the country to support the existing community first responders network. The number of such community first responders groups has increased from 133 in January 2016 to 158 at the end of September 2017. We thank those groups for all they do. It is a very important component of the health service.

I thank the Minister for his contribution. There was an accident during a football game in Arklow involving a boy who broke his leg. The air ambulance had to be called for him because there were no ambulances available from Arklow, Wicklow town or west Wicklow. There was a very sad incident involving a fatality in a car park that is only 50 m from the ambulance base in Arklow. However, because it was a Tuesday, there was no service at that base and an ambulance had to come from Wicklow town. This is why we question the system that is in place. There needs to be fairness. I appreciate the Minister's commitment to trying to achieve that. It is in all our interests for the Minister to sort out this issue before the next general election because if he does not, he might not be allowed to canvass in west or south Wicklow.

I will bite my lip in respect of all the partisan comments I could make. I have too much time for Deputy Casey.

He is correct that there are deficits in the eastern region, which comprises Dublin, Kildare and Wicklow. That was identified by the national capacity review, which was the first report to land on my desk when I became Minister for Health. It was carried out by Lightfoot Solutions and was the first external review of the ambulance service. It discussed putting more resources into the ambulance service. However, it also noted that even were that done, a community first responder network also would be needed because of the layout of the country and that is why we are trying to support that network. Since I received the report, I have increased the ambulance service budget at every opportunity available to me. I will again do so in 2018. I expect that the National Ambulance Service will address some of the deficits in the eastern region, including Wicklow, based on the evidence base in the capacity review.

In terms of technology, a "nearest available to the incident" system is being used, which means that the nearest ambulance to an incident, regardless of where it occurs, is sent to the location. That is a clever way of ensuring an ambulance gets to a patient as quickly as possible, no matter where in the country he or she is.

Mental Health Services Provision

Eamon Scanlon


32. Deputy Eamon Scanlon asked the Minister for Health when he expects the number of community child and adolescent mental health services, CAMHS, posts in CHO 1 to reach the level recommended under A Vision for Change. [48217/17]

To ask the Minister for Health when he expects the number of community child and adolescent mental health services posts in the CHO 1 area to reach the level recommended by A Vision for Change. Deputy Marc MacSharry and I have recently met several concerned parents in the region. There is a lot of frustration among parents of children who need to avail of these services which, unfortunately, are unavailable to many people.

A Vision for Change, published in 2006, set out a ten-year policy framework for Ireland's mental health services. It recommended that interventions should be aimed at maximising recovery from mental illness and building on service user and social network resources to achieve meaningful integration and participation in community life.

The Government is committed to increasing the mental health budget annually, as evidenced by the substantial additional funding of some €200 million provided for mental health from 2012 to 2018.

The implementation of A Vision for Change has been given specific priority in recent years with the additional ring-fenced funding specifically aimed at modernising mental health services in line with the programme for Government commitments. A key focus has been approval of some 1,550 additional posts to strengthen community mental health teams; enhancing specialist community mental health and forensic services, increasing access to counselling and psychotherapy; and developing suicide prevention initiatives. These posts are directly facilitating the policy of moving away from traditional institution-based care to a patient-centred, flexible and community-based mental health service. Staff recruitment and retention have been a challenge for the HSE for various reasons, with approximately two thirds of these posts filled so far in certain CHO areas. Recruitment continues and the HSE has also prioritised in particular the staffing of CAMHS units and community-based CAMHS teams.

CHO 1 serves a population of 103,778 people aged from zero to 18 years. Adjusted for population changes, A Vision for Change recommendations would result in a total of 107 whole-time equivalents being required across all community CAMHS teams. There are currently 75 whole-time equivalents in post, and a further seven whole-time equivalent approved and funded posts undergoing recruitment, that is, 76% of the recommended level. CHO 1 continues to work with the HSE mental health division to influence the prioritisation of additional funding for ongoing investment in CAMHS teams. The commitment to the continued programme for Government funding will support implementation of the Vision for Change recommendations.

According to the written response I got to a question about the number of posts, in 2016 there were 60 posts, and in 2017 the number had fallen back to 57. A Vision for Change recommended in 2006 that the number of posts for this area be 108. We are fortunate enough to have a consultant who is dealing with the cases as best he can. Quite recently he had to write to all the general practitioners in the area to ask them not to refer any more young people to him as he was not in a position to deal with them. As the Minister of State can well imagine, this puts significant pressure on parents trying to deal with a difficult situation. I know employing people is an issue, but something will have to be done about this because it is at a very serious stage.

I again thank the Deputy for his focus on this matter. Any focus he puts on this area is always welcome, and we all want to work together towards achieving the best outcomes we can. A Vision for Change was a very ambitious document for its time. It was formulated in 2006 in a very different Ireland that had a strong, burgeoning economy. We were very ambitious back then, and rightly so. That is how it should be. We are 11 years into that ten-year plan, and to be at 80%, or almost 80% in CHO 1, is not the worst case scenario. Significant progress is being made on this. It is not enough, and I would be the first to agree with the Deputy on that and to share his concern, but it is a significant development towards that journey in that period. I am not being political or facetious about this, but one should consider the journey we have come through in those ten years and the crisis with which we had to contend as a nation, losing the financial means to do so many things. Then we had mass emigration, unemployment and so on so we lost much of our talent pool. To be at 80% is therefore not the worst case scenario. I am not saying that defensively; I am just putting a little perspective on our position. We are at almost 80% in CHO 1 with the CAMHS team. I would like to see improvements in other areas, including this area. It is not just about money. If it were, it would be great. In fairness, the Deputy acknowledged that in his contribution.

The Minister of State will have another minute.

I thank the Minister of State for his response. It is very easy to criticise, but if I might make a suggestion, could a 24-hour helpline be introduced for GPs when young people - young children in some cases but also young adults - with their parents present with suicidal tendencies? At present these young people are referred to an accident and emergency department, which is totally unsuitable. Nine times out of ten they are sent back home with their parents, which causes serious anxiety. A helpline for GPs could be put in place whereby someone would be qualified enough to speak to these people. Perhaps that is all it takes sometimes. Might the Minister of State consider this into the future?

I certainly will. I am already working on a mental health helpline for more appropriate referral. The Deputy makes a very good point about GPs having access to 24-hour guidance and direction on what to do in such a situation. We will actively consider that and are considering it at present. Skype is also a very useful tool as people can talk in real time to very qualified people. There need not be a qualified consultant psychiatrist at every crossroads. It can be someone on Skype with whom people can communicate. Everyone has an iPad now. There are many ways we can look at how we do what we do, and I very much welcome the Deputy's suggestion. This is the kind of politics I like to see us engage in here, that we are all actively pursuing better ways of doing what we do rather than the traditional demands for more money and more resources and so on. I will add the Deputy's suggestion into the mix.

Mental Health Services Staff

We move to the final question, in the name of Deputy Thomas Byrne. I ask the Deputy to forfeit the 30-second introduction to the question. Doing so will give him an opportunity to ask a supplementary question.

Thomas Byrne


33. Deputy Thomas Byrne asked the Minister for Health when he expects the number of community CAMHS posts in CHO 8 to reach the level recommended under A Vision for Change. [48225/17]

The Government is committed to increasing the mental health budget annually, as shown by the substantial additional funding of €200 million for mental health from 2012 to 2018. The implementation of A Vision for Change has been given specific priority in recent years with the additional ring-fenced funding specifically aimed at modernising mental health services in line with the programme for Government commitments. A key focus has been the approval of some 1,550 additional posts to strengthen community mental health teams; enhancing specialist community mental health and forensic services, increasing access to counselling and psychotherapy; and developing suicide prevention initiatives. These posts are directly facilitating the policy of moving away from traditional institution-based care to a patient-centred, flexible and community-based mental health service. Staff recruitment and retention have been a challenge for the HSE for various reasons, with approximately two thirds of these posts filled so far in certain CHO areas. Recruitment continues and the HSE has also prioritised in particular the staffing of CAMHS units and community-based CAMHS teams.

There are currently 12 CAMHS teams in CHO 8. This represents 80% of its target resource set out in A Vision for Change. In recent years there has been a significant increase and investment in staff in the CAMHS service. CAMHS teams will continue to benefit from development funding in the coming years, supporting the implementation of Vision for Change recommendations.

The HSE national service plans of recent years also highlight the broad range of ongoing reforms in mental health services, including CAMHS. The Department of Health is currently advancing a review of A Vision for Change. Having commissioned an expert evidence review, completed in February of this year, an oversight committee was established to begin the process of updating our mental health policy.

If we were to listen to the Minister, the position regarding child and adolescent mental health services is absolutely fantastic and could not be better. That is not the experience of those in a crisis and those who need support in various aspects of dealing with their mental health. Figures provided to my colleague, Deputy Kelleher, at the Oireachtas committee showed there are ten community CAMHS posts available in CHO 8, as the HSE likes to call the region in which I live in Meath and Louth, Laois-Offaly and Longford-Westmeath. Under A Vision for Change, and allowing for demographic changes and the population changes with which we constantly seem to be playing catch-up, there should be 179 posts in place, so we are way below where we should be. Ten are in place; there should be 179. There are just not enough. There is a massive shortage in the north east and the midlands and it is having a really adverse effect on children's and young people's mental health. We are not living up to A Vision for Change or its recommendations. The Minister of State can talk about reviewing A Vision for Change, but it is not enough. We want in place what we need now to deal with the children and adolescents who need the services.

I am not sure which Minister the Deputy was referring to when he referred to a Minister who says everything is fantastic and wonderful and so on. No one is saying that. I am saying we need to acknowledge how far we have come with a view to improving and building on that further. We cannot always focus on the negative. That is merely the point I am making.

The answer to the Deputy's question is the very same as the answer I gave to his colleague. I am more focused on how we do what we do and more appropriate referrals of people to CAMHS and other such services. There are many inappropriate referrals. Many people are left on waiting lists and are not appropriately referred, unreferred or sent back down, and on a continual appraisal and priority basis they are being deemed not appropriate for a consultant psychiatrist. Not everyone with a mental health issue needs to see a named consultant psychiatrist. Many lower-level interventions that can happen can be just as powerful and appropriate for individual cases. I will continue to work with the Deputy and his party to make sure we reform how we do what we do to bring the CAMHS up to the standards to which we all aspire.

I call on Deputy Byrne to make a final short supplementary. Our time has expired.

The bottom line is, whether or not people are appropriately referred, in every case they are referred by their GP, so presumably a GP deems it necessary that they be put on the CAMHS list.

Has the Minister of State intervened to take people off the child and adolescent mental health service, CAMHS, list because a general practitioner, GP, was wrong? Has he put himself in a position to do that? Many children are missing out and much more has to be done to make sure they can get these services. We cannot say that we need to do things better and that people may not need a psychiatrist or consultant. These children and young people are missing out on a service that their GPs recommended as being necessary for their mental health. A more substantive answer than that is required, with an acknowledgement that we cannot just move this to voluntary organisations, if that is the Minister of State's plan. A certain amount of people need to see consultant psychiatrists or doctors in the CAMHS system.

I could not agree more. A certain amount of people will always need to see a consultant psychiatrist. My job is to ensure that people are appropriately referred and where they are not appropriately referred, my job is to ensure that we have policies so that does not happen and that those people do not clog up the system and prevent those who really need to see a psychiatrist from doing so. My job includes much more than just looking at negatives. I have to look at the whole picture and to realise the best system I can for the constraints we operate within.

Written Answers are published on the Oireachtas website.