Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Tuesday, 29 May 2018

Vol. 969 No. 7

Priority Questions

Hospital Beds Data

Stephen Donnelly


37. Deputy Stephen S. Donnelly asked the Minister for Health if the Sláintecare estimate of 2,590 for new acute beds and which is provided for in the capital plan will be updated based on the ESRI's analysis suggesting that approximately 4,500 new acute beds are in fact required. [23764/18]

My question relates to the number of beds that are being budgeted for over the coming years based on the Department's capacity review which came out earlier this year. The capacity review put a lower estimate of 2,590 beds which has been reflected in the capital plan. The ESRI has figures, as do various other groups, that give a broad range of what might happen. Given that there are numerous, very reputable organisations providing us with a wide range of the number of new acute beds we may need, will the Minister take that into consideration and perhaps review the capital plan with this additional analysis in mind?

I thank Deputy Donnelly for the question. As the Deputy knows, the Government committed to undertaking a health service capacity review in A Programme for a Partnership Government, and this was published last January. This was the first thorough assessment of capacity needs across the health service for more than a decade. In the following month, 2,600 acute beds and 4,500 social care beds were provided for and fully funded in the national development plan, based on the capacity review findings. This is the first commitment to invest in significant additional bed capacity in many years and replaces a trend whereby, even before the troika were in town, we were reducing the number of acute hospital beds in this country.

The review process was robust. It was led by a high level steering group and drew on significant stakeholder engagement and available international and national evidence. Its methodology and findings were then validated by an international peer review group. The projections were based on examining current demand for services and projecting forward on the basis of demographic and other demand factors. The analysis also took account of the potential impact of health and well-being initiatives, a shift in the provision of certain care services from the acute to the community sector and productivity improvements in our hospitals. We all know that major improvements in these areas are needed and outlined in our Sláintecare report, and it is important that capacity is planned around a new model of service delivery and not the current one. I think we agree that if we just increase the bed capacity and do not reform the model of care, the beds will just fill up and we will not manage to create the health service we need to.

The ESRI report referred to, which was funded by my Department, is a valuable addition to our knowledge base for health policy. It contains projections of future demand for health services but does not contain any projections for capacity such as acute beds. The ESRI methodology also takes no account of future changes in models of care or in productivity improvements. It is not possible therefore to get from the ESRI model a figure comparable to the 2,590 in the capacity review report. The baseline projections for demand in both reports, however, are broadly aligned across the range of services examined. I should point out that the ESRI sat on the steering group for the bed capacity review that said we needed 2,590 more acute hospital beds.

I have stated before that I do not believe that capacity increases alone will bring improvements in our health services, but the national development plan investment programme must be matched with a programme of reform to deliver real change. To that end, work on a Sláintecare implementation plan is advancing in my Department and I expect to bring these proposals to Government in the coming weeks.

I thank the Minister for his response. Here is the problem. The capacity review says that we will need somewhere between 2,600 and 7,150 new beds. The ESRI analysis does not give us a bed number but it does give us a bed day number, so it is quite easy to turn that into beds. The Department's capacity review says somewhere between 2,600 and 7,150. The ESRI report broadly agrees with that. The capacity review says the following: "In practice the achievable shape of the future health system is likely to lie somewhere between the two extremes set out in this Capacity Review." That would mean 4,900 new beds if we take the midpoint. It describes the 2,600 as an extreme.

Is the Minister worried that the capital plan, which is being published by the Government and which states 2,600, is essentially taking the best possible conceivable outcome, an outcome that the capacity review itself describes as one of the extreme ranges and which has been provided for? Are we not setting ourselves up for continuing crisis if we assume we will only provide for the lowest number of beds that the PA Consulting report has come up with?

I thank Deputy Donnelly for the question. I welcome that there is now a political consensus in this House that we need more acute hospital beds. That was not the practice in the past, even during the previous economic boom where, and I do not mean this in a party political sense, there was a view, even within senior levels of health service management, that we had too many hospital beds in this country. Clearly, that myth has been dispelled.

We have fully funded the 2,600 beds, which is ultimately the recommendation. I take the Deputy's point because the bed capacity review does talk about lots of different figures, but it does recommend that this is the figure that would be used if a programme of reform were to be put in place also. When I talk to people across the health service and look at the document that the cross-party group, the Sláintecare committee, produced, it does say "Yes" to more hospital beds but it also says to move more into the community. If we put all our attention on a hospital-centric model, we will be lulled into a false sense of security in not needing to move more services into the community.

It is important to say also that we are not just talking about the 2,600 acute hospital beds. We are also talking about the elective only hospitals which will provide about 600 further beds, which creates more capacity, and about 4,500 social care beds, which provide transitional care opportunities. I agree that we need to front-load now and we need to look at the opportunities to get some of these beds in now, because whether it is 2,500 or a different figure, the health service cannot wait a significant period to get those beds. I will discuss with Government colleagues in the coming weeks and months how we can front-load some of those beds, be it by modular build or another form.

I thank the Minister. I will return to the numbers. The PA report does not recommend 2,600 beds. What it says is, given their assumptions, the lowest conceivable number of beds we would need is 2,600. It makes various technical assumptions, some of which are incorrect. The 2,600 assumes massive investment in primary care and post-acute care and 2,600 beds. The Irish Medical Organisation, IMO, estimates the figure is 7,000. The Irish Hospital Consultants Association believes that we are short more than 2,600 beds today. Between the Irish Hospital Consultants Association, the IMO, the ESRI and the Department of Health, no one is saying we need 2,600 beds. That has now been hardwired into the capital plan, so the Minister would appear to be providing for what his own report describes as an extreme in terms of the least possible number of beds we would need.

Is the Minister prepared to go back to the Department and to PA Consulting, if needed, and ask them, in light of the fact we have provided in the capital plan a certain amount of money for 2,600 beds, how much money would be needed if various reforms do not happen? The PA Consulting report, for example, assumes a one-to-one transfer between acute beds and primary beds. For every primary care bed that is put in the community, one less bed is needed in the acute system. Many experts say that is not a realistic assumption. It would be useful for us, as we move to implement Sláintecare, to say that while we have provided for 2,600 beds at a cost of several hundreds of millions or billions of euros, the midpoint is 4,900 beds and for that we would need an additional sum, €2 billion or whatever, that we have not provided for.

Would the Minister be able to come back to the House and the committee to provide that information to us?

We all did not get time for supplementary questions.

I am flexible with every Deputy.

That is why we had the law thing going on for hours longer.

We allow flexibility. The Deputy has abused the flexibility himself.

Deputy Kelly never ran on.

Many times. Pot. Kettle.

I would appreciate if the Acting Chairman withdrew the word "abused".

I thank Deputy Donnelly. The Economic and Social Research Institute, ESRI, confirmed to me today that at no point did it refute the capacity review figures and it was represented on the steering group of the review. It has confirmed also that it is very clear that the projections on the two exercises were not comparable. The Deputy is not suggesting they are as the ESRI one did not factor in the model of care or productivity improvements.

The national development plan, the capital plan, is for the next ten years which brings us to 2028. The bed capacity review runs to 2031. We have fully funded the 2,500 three years ahead of schedule. There are three years at the end where it will be possible to do more. I am happy to always keep this under review. If we deliver this additional capacity it will be the largest increase in bed capacity in a hell of a long time, if not ever, in the Irish health service.

The Deputy made a point about costing the reform, if we are serious about making this shift to primary care and moving more services into the community. I will be putting costs on that as part of the Sláintecare implementation plan which I expect to bring to Government in the next few weeks.

Health Services Data

Louise O'Reilly


38. Deputy Louise O'Reilly asked the Minister for Health if he will report on the decrease in the number of community nurses in community health organisation, CHO, areas nationally; his views on the impact this is having on the delivery of health services in the community; the steps being taken to increase these numbers; the number of nurses working in the community setting in each of the years 2007 to 2017, inclusive, and to date in 2018, by CHO area; and if he will make a statement on the matter. [23454/18]

I listened to the Minister and the Deputy having a wee chat about the reform of the model of care, which I assume means a shift to the community, making my question very timely. I am sure the first thing the Minister will do is thank me for it but I will dispense with the need for that.

I will do that a special courtesy to the Deputy..

Perhaps he could get to the figures on, and explain where, all the nurses will come from to provide all this marvellous service in the community that we all want to see. Unfortunately, however, the decrease in staff numbers does not bode well for any great shift to the community.

I find it unusual to have to apologise for being courteous to the Deputy but I will take her at her wish. The Deputy is correct in that if we look back to 2007 and compare the figures then to the latest figures, there has been a reduction in the number of community nurses. If the question is pitched in terms of the timelines as the Deputy has done she is correct the figure is down. This reflects the fact that the recruitment moratorium that was in place across the public service from 2007 had a real and lasting impact on staffing levels in the health service. I acknowledge that and I also acknowledge that if we are talking about new services we need to staff them. 

Nonetheless, it is important to recognise that there has been a reversal in the trend of declining numbers in more recent years. Since December 2014, there has been a year-on-year increase in community nursing numbers which have risen from 14,539 to 15,175 as of April this year. That is 636 extra nurses. The Deputy has asked for a great deal of statistical data and I will of course arrange for it to be provided in tabular format.  

Past staffing levels may have added to the pressures of delivering services but the commitment and flexibility of front-line staff, combined with innovative ways of working, have ensured the focus has always remained on patient care. There are several recruitment and retention initiatives in place to assist in further bolstering nursing capacity, including offering permanent posts to graduate nurses, continuing the process of pay restoration and offering new opportunities for career development.

Also, in recognition of the need to increase capacity in public health nursing, the number of sponsorships for post registration education will rise to 160 by 2019. This year there will be 150 sponsorships, that is, 42 additional places since 2016. This reflects the commitment to improve recruitment and retention in nursing and midwifery.

As I heard very clearly when I addressed the Irish Nurses and Midwives Organisation, INMO, conference in Cork only a few weeks ago, it is very eagerly awaiting the outcome of the Public Service Pay Commission negotiations. We have specifically asked the commission to consider issues regarding recruitment and retention of healthcare staff, including nurses as a new tranche of their work. We will be guided by their recommendations on how we assist with the Deputy’s question about recruitment and retention.

Let us be honest that more of the same will not work because it is not working. The Minister is offering nurses a permanent contract in a health service that has become an unattractive place to work. I am sure the INMO members told him that at their conference - in fact, I am certain they told him that. I acknowledge the damage caused by the recruitment moratorium introduced by Fianna Fáil in the health service two years ahead of everywhere else. I campaigned against it at the time. We warned about the impact but notwithstanding that we need to face the fact that in my area, in community health organisation, CHO, 9, the nursing numbers are down by 175 since 2007. That is in the area with the fastest growing population in this State. If we are to see the shift to primary care and if it is to become a reality we will need to see an absolute increase in the numbers and we are not seeing that increase. We are not seeing a year-on-year increase in anything like the numbers we will need. It calls into question the Government's commitment to the Sláintecare report because the staff will not be there to effect the necessary change.

We are not proposing doing more of the same, hence specifically as part of the public sector pay agreement, the stability agreement, there was another agreement with the INMO that issues relating to recruitment and retention of health care professionals would be the first thing to be considered by the second phase of the Public Service Pay Commission’s work. That work is under way. It is nearly concluded and we will be guided as a Government by its findings. The unions have had an opportunity to put their views on what could help with recruitment and retention issues as well. I accept that we have a way to go to get back to pre-crisis figures for people working in nursing and community nursing. The Deputy is correct in the data she gave in that regard.

In December 2014, there were 14,539 community nurses; in December 2015, there were 14,789; in December 2016, there were 14,826; in December 2017, there were 14,874; and in April 2018, there were 15,175. I will circulate these figures. We are seeing an increase and we need to see a further increase. When I talk about offering permanent jobs to graduates, the HSE has appointed 861 which is 80% of the 2017 nurse graduates. I take the point that when we appoint them, we need to keep them in the country. It is not just a question of recruitment but also of retention.

When I said more of the same, the Minister read out statistics. I asked for them so I am not criticising him for that. They showed a rate of increase, and I am not brilliant at hard sums, such that by my reckoning it will probably take a decade or more to get back up to the level we were at before the crisis. That is before taking account of the fact that we are moving away from a hospital-centred model, supposedly, although we obviously are not because we do not have the staff to do it. We are also dealing with an increased population. My area of north Dublin is an example. It has the fastest growing population in the State and the number of nurses has declined. At the rate of increase many of those people who are living in my constituency will be shuffling around looking for their pensions before they will see anything even approaching adequate community services. Meanwhile the pressures on the acute hospital sector will not be alleviated because we do not have the staff in the community.

My mathematics are not brilliant either but the Deputy said she is in the CHO 9 area and I have done a rough calculation. There were 1,971 community nurses there in December 2017 and that had risen to 2,074 in April 2018, which I think is an increase of 103 nurses. I accept the point and am not contesting that we need to continue to do more to get back to where we want to be in respect of people working on the front line of our health service. We also need to make sure that we provide more attractive working opportunities for nurses in the community. We have a draft policy for community nursing and midwifery which is a response to an integrated model of care. This model of care proposes one that offers the individual family and community a range of choices and will be facilitated through a variety of changes to the model so that we can have a proactive rather than reactive model of care. The policy proposes to meet service users choice and needs as close to home as possible.

In addition to dealing with the traditional ways of recruitment and retention, we are considering the career opportunities and satisfaction for community nursing. I accept we have more to do in this area and a significant amount more to do to get back to where we were in 2007 but I contend we are beginning to make slow progress on this. There has been an increase in recent years. I read out the figures for the Deputy and I will circulate the table to her. I look forward to the outcome of the Public Service Pay Commission negotiations and being guided by its recommendations.

Mental Health Services

James Browne


39. Deputy James Browne asked the Minister for Health the way in which he plans to deal with the lack of suitable medium to long-term inpatient units for children and adults suffering from severe mental illness and mental disabilities. [23765/18]

How does the Minister for Health propose to deal with the lack of suitable medium to long-term inpatient units for children and adults suffering from severe mental illness and mental disabilities?

I thank the Deputy for his question. 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, building on service user and social network resources to achieve meaningful integration and participation in community life. As the Deputy will be well aware, one of the key principles of A Vision for Change was a fundamental move from institutional care to community-based care. The policy advocated for a move towards predominantly community-based care delivered by multidisciplinary teams. In line with this policy a number of old psychiatric hospitals has been closed due to the outdated nature of such facilities. However, the Department recognises that there will always be a need for acute beds. As such, there are currently 1,018 approved acute beds within the HSE.

Investment continues to take place to modernise this area of service and the HSE remains committed to improving rehabilitation services for people with severe and enduring mental illness and complex needs. This includes the new 170-bed national forensic mental hospital complex now under construction at Portrane, to replace the Central Mental Hospital, CMH, along with new facilities such as a forensic child and adolescent mental health service, CAMHS, unit and an intensive care rehabilitation unit, which will open in 2020. The HSE also intends to open an additional ten beds in the Central Mental Hospital as soon as possible once all necessary staff are put in place. New acute and high observation units have also opened in Cork and Drogheda in recent years, with an additional facility in Galway set to be operational in June 2018.

Many of those with severe mental illness and complex needs are discharged from acute inpatient units to a community residence, most often a high support hostel with 24-hour nursing staff available. Community residences provide a structure and support that this group of service users most often need after discharge. They offer an ideal place for further active rehabilitation for those who can acquire sufficient skills to become fully independent and live in their own accommodation. However, for some service users a more intensive inpatient rehabilitation service is required.

In January 2017 a national project was initiated which included developing a model of care for people with severe and enduring mental illness and complex needs. The model of care describes a specialist rehabilitation care pathway that ensures that the requirements of people with severe and enduring mental illness are met.

In 1950 there were 7.9 psychiatric beds per 1,000 of our population. The Health Research Board records that the rate of involuntary admission in 2016 was 48.4% involuntary admissions per 100,000 of our population. In England, the rate in 2015-16 was 120. It is almost 2.5 times our rate. EUROSTAT reports that Ireland has the third lowest number of psychiatric beds per 100,000 of the population in the EU. The EU average is 72 psychiatric beds per 100,000 of the population and in Ireland the average is fewer than half that at just under 35 psychiatric beds per 100,000 of the population, a figure questioned by Professor Kennedy only last week to the effect that it might be artificially high. Professor Brendan Kelly states: "These are stark differences and strongly suggest that Ireland has insufficient psychiatric beds to serve our population."

The closure of inappropriate psychiatric beds in Victorian hospitals was supported in A Vision for Change and rightly so, but are we gone too far in the other direction? Has decongregation effectively become an ideology or a method to cut costs? We are now putting people out of centres into the community where there are not the necessary services in place nor the proper step-down beds or the proper assisted living supports for them.

The Deputy has made a very interesting point. There is no absolute answer to the query he raised as to whether we have enough inpatient beds. Change is always difficult and the change that was envisaged in A Vision for Change was very dramatic, namely, to move away from inpatient care to community care. As the Deputy will be well aware, it is proving to be an ongoing challenge to ensure we have the supports and staff necessary to provide the care that is needed.

The review of A Vision for Change is ongoing. An oversight group is examining that and we are reviewing it. I am due to meet the group which is reviewing it, I believe, on Wednesday of this week. The question the Deputy raised is still being posed. There is the question of whether we have gone too far or have we gone far enough and, I suspect, the answer lies somewhere in the middle. The provision of inpatient beds is probably being chased from the top. I am trying to refocus the system and have more interventions at an earlier more localised level, whereby we could prevent illnesses escalating and the need for beds at the top. Sometimes when we talk about beds, it can be like treating the symptom, and we can keep producing more beds when we may need to examine what is sending all those people up into the acute space that requires inpatient treatment for mental health.

As Professor Kelly stated, the statistics are quite stark and we seem to be going even further down the direction of closing these beds. He stated: "As a result, the key human rights issue in Irish psychiatry today is not disproportionate denial of the right to liberty due to over-custodial care, but, rather, issues concerning the right to access to an appropriate level of care when it is needed, including inpatient care." One of the most common situations with which I deal is just such cases, namely patients who may no longer need to be in an acute unit in a psychiatric department but who are not fit to be discharged. I have dealt with patients who have serious dual-diagnosis issues. They are discharged from acute care, they then go to the county council and may be put into bed and breakfast accommodation over a pub. The interim beds that are required are not in place. We have also seen complaints from the forensic mental health services at the central mental hospital where people are being kept in prisons because there is not enough beds there either. There is a serious question to be addressed in that decongregation, in certain respects, is going too far and it needs to be very seriously considered. It is about appropriate care, not blindly applying a particular policy.

I could not agree more with the Deputy. When we look at international comparisons and count the number of beds per 100,000 of the population it can be very misleading and unhelpful to the debate. That suggests that a one-cap-fits-all approach works. Countries have different cultures, sources and resources. We have secure hostels with 24-hour staffing and that is a good model that works well. It is a step-down model; it is not one where we take somebody from acute care and put them straight into the community. It is a transitional care arrangement. There is a crisis house down in Tipperary. There are a number of different models in place that can work. We have day patient hospitals and they may be the way to go in the future. People come into the hospital and avail of treatment and supports during the day and return to their homes in the community in the evening. There are a number of different models. A one-cap-fits-all approach would be wrong. If we are to continue to measure our success or otherwise within the health system by using an international yardstick and just counting the number of inpatient beds, that could be very dangerous and could miss the point.

Cancer Screening Programmes

Alan Kelly


40. Deputy Alan Kelly asked the Minister for Health if he has full confidence in HSE management and its practices and, in particular, those in charge of the national screening programme both past and present. [23798/18]

There are many people watching these proceedings for the Minister's answer on this question. It relates to the National Cancer Screening Service and the management of it, particularly of CervicalCheck. Has the Minister confidence in the way the HSE has handled this? Has he confidence in the current management? Has he confidence in the management who were over CervicalCheck during the period in which this crisis developed and who are still operating in the HSE? It is very important that the answer the Minister gives today is something the people who are watching, who have been affected by it, can understand and be very clear about. I do not have confidence in those people and it is very important to say that. I ask the Minister to make a very clear statement today on this matter.

I thank Deputy Kelly for the question and for his work on this important issue in recent weeks and months.

I want to say first that in regard to the HSE as a whole, I do not believe the current governance structures are appropriate. I believe the HSE is far too bureaucratic and is not accountable enough. I believe we need to move quickly as an Oireachtas to put in place an independent board to improve governance and accountability and strengthen the oversight and performance of the HSE. We have known we needed to do that but the national screening programme has made that even clearer. What has arisen in regard to CervicalCheck has made that very clear as well.

I have now published a general scheme of the Bill. This will provide for a nine-person non-executive board, including a chairperson and a deputy chairperson. I want this board to include patient advocates as well. The board will have the authority to perform the HSE's function and will be accountable directly to the Minister of the day. The HSE will have a chief executive officer, CEO, rather than a director general, who will be accountable to the board for the performance of his or her functions. I look forward to working with the Deputy and other Members of the Oireachtas to bring this Bill through these Houses urgently. I have taken on board the Deputy's suggestion in regard to looking at appointing the chair of that board to have a role in the recruitment of the new CEO rather than doing it the other way around.

In regard to CervicalCheck in particular, I made my views very clear on a number of occasions that I was not happy and that I had serious concerns about the way this situation had been allowed to unfold. Recent events have shaken the confidence of many people in the programme. That is why I acted quickly and tried to act with colleagues across this House to put an independent inquiry in place.

The inquiry is led by Dr. Gabriel Scally, Professor of Public Health at the University of the West of England and the University of Bristol. I am aware that many of the people whose confidence in the CervicalCheck programme has been shaken are very happy with the way he is going about his work. He is working with an international expert on women’s health and will also be advised, as appropriate, by Dr. Hugh Annett and Professor Julia Verne. The Scally inquiry will examine all aspects of CervicalCheck and involve engagement with the women and families affected. The Deputy is aware that the terms of reference are very comprehensive and reflect the cross-party engagement. A website, scallyreview.ie, has been set up and went live on 23 May. It will enable the inquiry to communicate progress, including with the women and their families who have been impacted on.

Rather than being judge and jury, I want to await the outcome of the inquiry. Dr Scally is due to provide a progress report on his work in the first week of June. The full report is due by the end of June. I will make my adjudication on specific questions on the basis of the full report.

The Deputy is also aware that I have agreed to establish a commission of investigation. Serious lessons need to be learned. We have asked an international expert to come and get to the bottom of it; of who knew what, when and where and if people acted appropriately. I am satisfied to wait for those few weeks to let this international expert do his job, engage with the women and their families and report back to us.

We are five weeks into this process and while I accept the details of what the Minister has said about the report which is due next week, I want a guarantee that Dr. Scally will make quick decisions on how it happened. We are dealing with people who are in line management positions in the service. I do not have confidence in them. The people who are watching do not have confidence in them either. From the revelations in emails from the Minister's Department which were given this week, the Department did ask extra questions to make sure it was not a patient safety issue. It was a patient safety issue. The HSE did not fundamentally understand, comprehend or get the seriousness of the issue and it is getting worse. I am intent because while we consider it to be a live issue, the women affected are unable to get the findings of the reviews. I hold in my hand one example. The 209 women affected are not obtaining the documentation they require. I want a guarantee from the Minister that the HSE will give all documentation and audit review findings to the women in question by the end of this week. They are going to meet their consultants and being told to go through official lines to get the documentation. This is treating women who have been treated very badly with further disdain. That is why I do not have confidence in management.

We are all aware that Dr. Scally is independent in his work, which is right and proper. We also all agreed to the terms of reference, which are very clear on the work Dr. Scally is to set about doing. He has shown himself to be well able to get to the bottom of serious issues. While I can absolutely understand how people who have been so badly let down cannot have confidence in elements of the health service and while I cannot speak for them, it is fair to say they can have confidence in the work of Dr. Scally, who is also engaging with them directly. What the Deputy has referred to is not good enough in any way. It disgusts me to hear it. Immediately after we conclude priority questions in the Chamber I will get my Department to make direct contact with the HSE to ensure all documentation and review findings - information that belongs to the women in question - will be provided for them without any bureaucratic hurdle whatsoever. I give the Deputy my word that I will follow up on that matter now.

I appreciate the Minister's last comment. I am sure the House agrees that all of the women deserve all of their documentation after five weeks. They also deserve all of the audit review findings. There is one solicitor who is representing many of the women. A total of 90% of the women he represents have not yet received their documentation. After five weeks they deserve it. I will lose confidence in the management structure in the HSE if management does not deal with the issues appropriately. It let the quality assurance director of the HSE go on holiday during what was the biggest crisis in decades. There is also a conflict between what the State Claims Agency stated at the Committee of Public Accounts and what CervicalCheck stated about informing women, an issue to the bottom of which we will get this week. On top of that, we are aware that there is further bureaucracy in the provision of documentation to which the women in question are entitled. I understand the terms of reference for the Scally inquiry. I understand that by next week Dr. Scally is to make certain decisions on what he has found. If that does not happen, I will be shocked. Because the issue is live and because of the fact that the women in question are not being provided with documentation to which they are entitled by the HSE, I do not believe that for some decision making we can wait until the end of the process, if Dr. Scally does not do what we expect him to do by next week.

I agree with the Deputy on the documentation and review findings required. I will follow up on the matter directly immediately after priority questions. For those who are watching and to have confidence in the screening programme and that information will be given, it is important to say two things. First, there has been a huge volume of calls in the last few week to the CervicalCheck helpline. I am pleased to note that the overwhelming majority of the callbacks were by women asking for a clinical consultation to talk to a nurse or a doctor about their situation. The overwhelming majority have been concluded, which is welcome. It was a big body of work, but it was important to get through it in the interests of answering the questions of many thousands of women. More than 11,000 required callbacks.

On the issue of supports and the practical measures we have put in place to try to help people, we have put public health nurses in place in each of the CHOs throughout the State to directly meet the women and their families from the group of 209 - if I may refer to it as such. I understand that work is ongoing.

My very clear understanding from the terms of reference is that Dr. Scally will provide a progress report in the first week of June. I look forward to hearing exactly what progress he has made. He will provide the full report by the end of June. I look forward to engaging with colleagues when we receive it.

Hospital Waiting Lists

John Brassil


41. Deputy John Brassil asked the Minister for Health the action he will take to address the long waiting times for ophthalmology services, both in primary care and acute hospitals [23766/18]

I thank the Deputy for his question.

Reducing waiting times for patients for hospital operations and procedures is a key priority for the Government. Cataract surgery is among the most common surgical procedures carried out in the ophthalmology specialty. Through the work of the National Treatment Purchase Fund, NTPF, and the HSE, the overall number of patients waiting for cataract surgery has fallen by 22% since July 2017, while the number of patients waiting for more than 12 months has declined by 71% in the same period. This is one of the areas where we are making significant progress as a result of the investment made through the NTPF.

For 2018, under the inpatient-day case action plan, all clinically suitable patients waiting for more than nine months for a cataract procedure will be offered treatment this year, with 5,000 additional NTPF funded procedures planned in public and private hospitals. Last year funding was allocated to provide additional capacity at the Royal Victoria Eye and Ear Hospital and a cataract theatre is now operational there. This year, in line with the action plan, the HSE is planning to open a dedicated cataract theatre in Nenagh hospital in July. This will also benefit patients from Deputy Brassil's constituency.

In primary care the HSE published the primary care eye services review group's report in June 2017. The report sets out the way forward for a significant amount of eye services to be provided in a primary care setting. The recommendations made in the report are to be implemented on a phased basis. To support implementation of the report, funding of €1 million was allocated this year to establish new primary care eye support teams in south and west Dublin and further develop the primary care eye team in north Dublin to help to alleviate waiting lists. We are making progress in this area, but we need to continue to make progress. There were 10,304 people waiting for cataract procedures in April 2017. In April 2018 that number had dropped to 7,818. We are, therefore, seeing the benefits of the investment to reduce cataract surgery waiting lists. The opening of the cataract operating theatre in Nenagh hospital in July will make a real difference. It will provide a service for patients from counties Limerick, Laois, Kerry, Clare, Offaly, Kilkenny and Tipperary. We have begun the roll-out of the new primary care eye support teams, but, clearly, we need to see them being spread throughout the State. I look forward to seeing the impact of the new €1 million investment.

As we have no clock for the moment, Deputy John Brassil has one minute in which to respond.

I might demonstrate to Deputy Alan Kelly how he should use one minute and not complain to other Deputies when he goes over it.

He went into the Minister's time.

There is an issue in the Cork-Kerry region which has the longest waiting list in the country for cataract operations, at up to 60 months from the time of referral to the carrying out of the operation. One can often wait up to 24 or 36 months before even being seen. People with such difficulties attend my clinic on a weekly basis. It is the Minister's colleague, the Minister of State, Deputy Jim Daly, who has to deal with the social aspects that result from, for example, a person who was once able to drive to the local town now being unable to do so, with all of the related isolation issues. This matter needs to be tackled. Given all of the reports and offerings, for example, from the National Treatment Purchase Fund and the Association of Optometrists Ireland, there is a potential solution, but elements are falling between the stools. In a recent reply to a parliamentary question it was pointed out to me that the primary care eye service review group's report offered interesting and progressive solutions, but I am told that no extra funding has been provided to implement the report in my area.

I agree with the Deputy that we need to do more about this issue, but I will give some figures, given the considerable commentary on the matter in recent months. We are making significant progress. In the 12-month period between April 2017 and April 2018, the total number fell from 10,304 patients waiting to 7,818, a decrease of more than 20%. On the length of time people have to wait, 744 were waiting for 18 months or longer, but that figure has decreased to 326. There were 950 waiting for 15 to 18 months, but that figure is down to 175. There were 1,297 waiting for 12 to 15 months, but that figure is down to 295. There were 1,468 people waiting for nine to 12 months, but that figure is down to 893. I am giving a commitment that, through our work and investment, we will ensure that by the end of the year no one will have to wait for a cataract procedure for longer than nine months.

The Deputy is right, in that we could do more on two fronts. First, we must ensure we are using all of the capacity within the acute hospital setting. That is why I am eager to do more in Nenagh. Second, we have started to roll out the primary care eye service review, albeit in the locations I mentioned, but I want to see it spread throughout the country.

I will concentrate on the Association of Optometrists Ireland. In my day we used to call them opticians. There are 352 registered optometrists who are willing to get involved and provide much needed community backup for an overloaded system. We recently heard a presentation by the association in Buswells Hotel. It is more than willing to get involved, particularly in screening for young people. Squints and lazy eye syndrome are easily dealt with. If they are, such cases do not go on to clog up the system further down the line. However, there is resistance somewhere in the system to allowing optometrists to get involved in solving the problem associated with public waiting list. The Minister needs to use his good offices to get to the bottom of the matter and stop it. There is enough work for everyone in the system. When a body is willing to get involved and help, we should facilitate it.

I will take the Deputy up on his offer. I do not want anyone to work in a silo. There is enough work to go around. Given the ageing demographic profile, demand for ophthalmological services will only increase. The report of the primary care eye service review group is a good body of work, with people working in the community and acute hospital settings coming together to draw up what was effectively a model of care. We have started to roll it out, albeit only in south, west and north Dublin, with the development of new primary care eye teams. I want to see the project rolled out. It will be my next challenge to deliver in the area of ophthalmology.

We have seen significant progress being made in dealing with inpatient day case cataract waiting lists. People were waiting for far too long and we will see more progress this year. The investment in the new Nenagh clinic will see activity ramped up as we increase staff numbers there. The clinic will see up to ten cases a week for the first 12 weeks and 30 cases a week for the remaining 12 weeks. In 2018 the service will carry out up to 500 cataract procedures. From next year, it could carry out 2,500 additional cataract procedures per annum. The level of activity proposed in Nenagh will not just meet demand in the mid-west, it will also provide additional capacity to support patients from counties Limerick, Laois, Kerry, Clare, Offaly, Kilkenny and Tipperary. There is much more we can do in dealing with this matter and I look forward to making progress on it.