Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions

Cancer Screening Programmes

Stephen Donnelly


33. Deputy Stephen S. Donnelly asked the Minister for Health the risks posed to women by the increase in waiting time of up to 20 weeks or more to receive CervicalCheck screening results, the failure to transfer all samples to slides within the six weeks required and the colposcopy waiting lists now being over one year in some areas; and if he will make a statement on the matter. [51152/18]

I am taking this question on behalf of my colleague, Deputy Donnelly.

The delay in receiving smear tests results which has arisen as a result of out-of-cycle smears and a general increase in uptake is a priority concern for me, my Department and the HSE. The HSE is working to source additional capacity, notwithstanding global challenges with cytology capacity and resources, and also works closely with the laboratories in maximising their capacity to deal with the demand. This issue will take some time to resolve.

On the Deputy's direct question about the risks posed to women, we should hear from some of the medical voices on this matter. I note the comments of Dr. Mary Short, director of women's health at the Irish College of General Practitioners, who said there should not be undue concern about the delay. I raise her comments not to minimise in any the genuine challenge but to try to provide some reassurance for women. Dr. Short has said the smear test is not a diagnostic test but rather is used to look for pre-cancerous cells that can be treated in a colposcopy clinic, that the timeline between pre-cancerous cells and cancer can be more than 20 years and that, therefore, there should not be undue concern about the delay.

On the transfer of smear test samples, the subject of the second part of Deputy Donnelly's question, I have received confirmation from the HSE that since the end of July, this has been happening in the vast majority of cases. Between April and October, there was a 0.29% rate for expired samples and vials, similar to the rate for the same period last year when there was a rate of 0.25%.

There may be a small number of cases where the vial used to contain the sample expires, or where a sample may be insufficient. In such cases, a woman and her GP are advised by letter of the need for a repeat smear test after three months.

I can also reassure the Deputy in relation to colposcopy waiting times. While clinics have experienced a surge in activity due to increased demand, in October 89% of women referred to colposcopy, who were classified as having high-grade abnormal cells, received appointments within four weeks. That is just below the national target of 90%. Similarly, 92% of those who had low-grade cells were seen within eight weeks, exceeding the target of 90%. CervicalCheck has advised that it is unaware of any woman waiting a year for an appropriate referral to colposcopy.

I wish to deal with a couple of aspects of the Minister's response. The waiting time to get one's screening result back is up to 20 weeks. Many of the women were part of the CervicalCheck disaster or issue that arose and they are having a repeat smear test because they are worried. They are worried because they think that their previous screening may not have been done correctly or that their cancer may have been missed. The Minister made a political promise that women could have access to additional smear tests. He did not resource that promise fully or properly and now the wait has increased from five or six weeks, which was the normal waiting time, to sometimes in excess of 20 weeks. Those women who are waiting, who are concerned or worried, are now having to wait a considerably longer time to get the reassurance the Minister promised them. I have spoken to some of the women who are waiting on their results.

In addition, if one gets a smear result that is of concern or is abnormal, one is then referred to a colposcopy clinic. We do not have enough histologists to examine the biopsies so there is a backlog. There is then a wait of up to 18 months to see a gynaecologist or to have further treatment. A problem is brewing for the Minister and it is only going to get worse. Could the Minister please advise to the House what additional resources he will provide and when we will have them?

It is important to remember why I took the decision, which was widely supported in this House, of offering people a repeat smear test. That is because one of the number one queries coming in on the helpline to CervicalCheck was women saying they had a smear test and they would like another one. It is also important to say I did not offer it without a GP consultation so the GP had to feel that as part of the reassurance process the woman would benefit from it.

I assure Deputy Lisa Chambers that it is not a resourcing issue in terms of a financial resource; whatever resource is required financially will be provided in budget 2019. I have made allocations for such resourcing. It is a capacity issue. There are conversations going on as we speak between the HSE, between Damien McCallion, the acting national director of CervicalCheck, and the laboratories to see what additional capacity can be put in place. I am optimistic that we will have additional capacity to reduce the time. Based on the medical advice available to me I am saying that while the wait is undesirable, in particular for women who are understandably concerned after all of the attention on this issue, the medical advice is that it is not necessarily dangerous and poses a very low risk to women. I need to say that as a reassurance to women.

The large majority of women whom Deputy Lisa Chambers says have been referred to colposcopy clinics are being dealt with in a speedy manner. A total of 89% of women who were referred to colposcopy, who were classified as having high-grade abnormal cells, received their appointments within four weeks and 92% who had low-grade abnormal cells received their appointments within eight weeks, which is above the national target. I accept there is a challenge here and it is one we are working our way through but it was a necessary step to try to reassure women.

No one is suggesting that it was not a good thing to offer the additional smear tests but I take issue with the fact that the Minister did not resource them properly or provide the necessary capacity to deal with them. The GP system is already overwhelmed. The waiting time has increased from six weeks to 20 weeks. Even if one can get a colposcopy appointment within four or eight weeks, one is still waiting 20 weeks to get the smear test result back, which means the wait to get the biopsy done is far longer. When the biopsy is done, one needs a histologist to look at the sample and we do not have enough histologists to examine the samples, which means the waiting time for colposcopy results are increasing. After all of that one must try to get an appointment to see a consultant to get treatment.

The big scandal with CervicalCheck was mainly to do with disclosure and not telling people about their misdiagnosed smear test results. What we have now brewing is the possibility that somebody waiting a significant additional time to get results back from a smear test could find themselves waiting much longer to get a colposcopy, have their biopsy looked at and a far greater time wait to see a consultant. All of that does pose a risk to women, even if it is to a small number of them; it does not matter if it is only one. Having conversations is not really an adequate response. Where are those conversations going and when will the Minister have additional capacity? When will we see the waiting time reduced from 20 weeks back to the five or six weeks that used to be the case?

We came within hours of the collapse of the cervical screening programme because laboratories did not want to be involved in screening in this country any more in a situation where contracts were due to expire the following week. That would have meant we would have had a pause on screening. That was the priority issue to resolve for the HSE. I pay tribute to those involved, in particular to Damien McCallion for the work he did in ensuring screening could continue.

Deputy Lisa Chambers is correct. I do not intend to in any way minimise the concerns and anxiety that any wait would have on the result of a smear test. We are actively working night and day to try to increase capacity in that regard. I genuinely assure the Deputy that is the case. I also assure her that there is no resourcing issue in the sense that any finances that need to be made available will be made available. It is a capacity issue. I expect that the HSE will make progress in the coming weeks in terms of additional capacity, but this will take some time to work through. The encouraging thing is that even after all of the very important issues that were raised about CervicalCheck, more women are now using the programme than before. Women who had not engaged with the programme previously are now engaging with it so we are seeing some good come out of a very difficult situation in that women who had not signed up for them before are now getting smear tests.

HSE Planning

Louise O'Reilly


34. Deputy Louise O'Reilly asked the Minister for Health the status of negotiations between his Department and the representatives of healthcare workers for the rolling out of additional winter measures; and if he will make a statement on the matter. [51000/18]

I note the publication of the winter plan. It was late but I suppose it is a case of better late than never. Other states and jurisdictions publish theirs in September. It is unfortunate that we wait until winter to do so. However, the plan is of no use and will be of no benefit unless there is commitment from the staff involved to engage with all of the changes and to make sure that it is rolled out. My question is a very simple one about the status of negotiations between the Minister and his office, the HSE and the people who will be delivering it on the ground.

I may have interpreted the question wrongly. I think there are two aspects to it: one is the winter plan but also how we are engaging with the staff, I presume in relation to the roll out of the winter plan, as opposed to more broadly. Ensuring that services are planned to meet critical periods of demand is a core operational function of the HSE. My Department has engaged extensively with the HSE throughout the year to ensure the most effective response to the challenges faced by the health service this winter. As part of this process, integrated winter preparedness plans have been developed by hospital groups and community healthcare organisations to meet the anticipated surge in demand for healthcare services during the winter months. The plans are designed to optimise existing resources and encompass operational management of patient flow and maintaining public health. The recent patient experience survey found that 81% of people surveyed said that they were always treated with respect and dignity in the emergency department and ensuring the values of patient dignity and respect are upheld at all times will remain a key priority.

The overall winter plan, which runs until 31 March 2019, was endorsed by the emergency department task force, which as Deputy O'Reilly knows is co-chaired by the Irish Nurses and Midwives Organisation, INMO. The plan includes a four-week period of focused action from 17 December to 13 January. During this period nine key hospital sites of concern will be targeted with a suite of enhanced actions including extended opening hours for local injury units, minor injury units and key primary centres; winter-ready clinics in the community targeting at-risk groups; increased diagnostic access for GPs and extending hours of service in hospitals so people do not find themselves delayed or stuck in a hospital while waiting for a diagnostic test; and enhanced senior decision-making across the hospitals.

A central component of the plan which is already under way is the provision of an additional 550 home care packages over the winter period to help patients return home from hospital with the supports they need. The winter plan will also seek to increase bed capacity in quarter 1 of next year. Over the past 12 months, we have added an additional 240 beds and work is nearing completion on a further 78 beds which are due to open in the coming weeks. In addition to winter funding, €10 million is being made available in 2019 to increase acute bed capacity. Further details will be included in the national service plan. Taken together, these initiatives will increase the number of available inpatient beds in the acute hospital system to more than 11,000, a threshold last seen in 2009, showing that the lost decade is perhaps now over.

The HSE advises that a briefing for the staff panel on the overall winter plan will take place this week and any clarifications required will be provided in this forum. The INMO has been very much co-chairing emergency department task force meetings. My understanding is that the plan will be published by the HSE tomorrow.

I was a member of the emergency task force. It is not an industrial relations forum and the HSE was always very clear with us about that so participation or otherwise does not indicate agreement by any trade union or representative group with regard to what is planned.

The Minister is talking about enhanced actions and clinics among other measures. It should be said that we do not just have a crisis in the winter: thanks to this Government we now have an all-year crisis, but let us just deal with the winter crisis for the moment.

I asked specifically whether there had been negotiations because what the Minister is citing here is significant changes in work practices, people moving out to winter ready clinics and enhanced actions. I asked the HSE some very pointed questions about this and it was not able to point to any level of engagement. It is not sufficient to say there will be a briefing two weeks after the plan has been published. I am asking about the status of negotiations. Can the Minister say now that the representative groups for all the people who will be involved in the plan are fully signed up to it and that he has the staff to deliver it?

At the emergency department taskforce meeting last week we heard from HSE management, as the Irish Nurses and Midwives Organisation, INMO, would have heard at the meeting that it co-chairs, that there was significant buy-in for this plan from health service staff, including its own members around the country. It is important to point that out. Much of what we are asking people to do is a core part of the responsibility to make sure we can deal with increased demand. I do not think it involves protracted negotiations with the unions. I do not think planning for the winter period should involve that. There will be a briefing for the staff panel by the HSE on the overall winter plan this week. Clarifications required will be provided.

I thank the staff who have been involved in formulating these plans in individual hospitals and community healthcare organisations, CHO, and are very much signed up, bought in and invested in these plans. People in our health service work extraordinarily hard. I am very proud of the work they do and it is important that staffing levels in the hospitals, the emergency departments, diagnostics, community and primary care services are sufficient. That is part of proper rostering, which management is paid to do. I have no doubt that is happening at individual sites around the country. The emergency department task force is not an industrial relations forum and I am glad to hear the Deputy make that point. I very much agree with it but there will be a briefing for the staff panel this week. I do not, however, envisage a difficulty in this regard. I do envisage many health care staff working extraordinarily hard over the winter period as they do all year round and I am very grateful to them for that.

"Signed up, bought in and invested", that is certainly not what individual health care workers are saying. With regard to the plan my question was specifically about the status of negotiations. The Minister is saying that he does not think negotiations will be required, that there will be no changes in work practices and if there are no changes in work practices and everything will be as it was we can expect there to be 500 odd people still on trolleys plus whatever number for the winter surge. Is that what the Minister is saying because if there is to be a change in work practice that should be negotiated? If there is not to be a change in work practice it will be the same as before and nothing changes and everything gets steadily worse in the way it has continued to do.

I asked about negotiations, not about whether there is some good feeling towards having a plan, late as it was. There probably is good feeling towards having a plan. Have the changes in work practices that the Minister outlined when he spoke about the new clinics and the potential changes in rosters been agreed with the staff? The emergency department task force is not an industrial relations forum. We were told repeatedly that it is not but every time the representatives of nurses and other healthcare workers tried to raise industrial relations issues at it we were told there is an industrial relations forum. That is not a briefing, that is engagement, which fuels industrial relations. I am curious to know, if there have been any negotiations, what is their status and if not, I can only expect that there will be no change in work practices.

I do not want to speak for the INMO but my recollection of its request at the emergency department taskforce last week, which it co-chaired - that is an important point - was that there would be a meeting of the staff panel. That is happening this week as a result of its request. We were also told at the emergency department taskforce that staff around the country had volunteered for alternative rostering, put their names forward and put their hands up to play their part this winter in dealing with what is a significantly busy time. I accept that there are challenges all year round but this is a particularly busy time.

We are delivering a winter plan this year that will see in 2019, for the first time since 2009, more than 11,000 hospital beds operating throughout the health service. We are trying to take a different approach this year, considering all of the winter but particularly the period from 17 December to the middle of January when there tends to be a particular surge. The HSE is considering a clinical lead, as we had for the papal visit, so that we can co-ordinate this. I do not believe there is a particular animosity or disagreement between the health service and the unions. I certainly have not been made aware of any.

I assume the staff are meeting at the national joint council. That is an industrial relations forum. The Minister said that staff have volunteered for change of roster and work practices and have added their names to lists. Could he please advise who is co-ordinating those lists? Is it being done centrally or on a site by site basis? Who advised the Minister of all these volunteers, the HSE or the representative bodies?

This matter came up at the emergency department taskforce meeting co-chaired by the HSE and the INMO which I attended last week in Dr. Steevens' Hospital. The response from the HSE was that at individual site level rostering was being addressed. It was satisfied rostering was being addressed but, as appropriate, it was seen as beneficial to brief the staff panel this week, which is exactly what is going to happen. I do not think there is an issue here. I thank the staff for developing their own plans. These are not centrally handed down plans but individual sites, hospitals and CHOs have developed their own plans. That is right and proper. It gives people ownership of the plans and I am very pleased that we are in a position as a Government to enforce them.

Neuro-Rehabilitation Policy

Margaret Murphy O'Mahony


35. Deputy Margaret Murphy O'Mahony asked the Minister for Health when an implementation plan for the national neurorehabilitation strategy will be published; and if he will make a statement on the matter. [51153/18]

When will an implementation plan for the national neuro-rehabilitation strategy be published and will the Minister make a statement on the matter?

The national policy and strategy for the provision of neuro-rehabilitation services in Ireland, 2011-2015, was published in 2011. Its focus is on achieving best outcomes for people by providing safe, high quality, person-centred care at the lowest appropriate level of complexity. This must be integrated across the care pathway and provided as close to home as possible or in specialist centres, where necessary. A national steering group, with representation for all relevant stakeholders, was established to oversee the writing and execution of an implementation framework for the strategy.

The HSE recently finalised its implementation framework in respect of the recommendations of the national neuro-rehabilitation policy and strategy. I welcome the completion of the framework, which I received on 20 September. I greatly appreciate the work of the HSE and the national steering group in finalising the framework and I look forward to its roll-out in the coming years.

The framework will guide the reconfiguration and development of neuro-rehabilitation structures and services at national and local level. It proposes the formation of managed clinical rehabilitation networks, with the set-up of one demonstration network suggested as the first step. The delivery of the national neuro-rehabilitation policy and strategy remains a priority for me and is a commitment under A Programme for a Partnership Government. As I stated, the implementation framework is now completed and has been signed off by HSE management. Publication of the framework, and this is the key point, is a matter for the HSE. I am advised, as late as yesterday, by the HSE that the framework will be published in the coming weeks.

I ask the Minister of State to make sure that this does happen. The national policy and strategy for the neuro-rehabilitation services 2011-2015 was published by the Department of Health and the HSE almost seven years ago to the day, on 16 December 2011 with an implementation plan promised within six months. Seven years on, however, this four year plan has no implementation strategy. The Minister of State announced in February 2017 that the plan would be published before the end of that year. A Dáil motion debated and approved this time last year called for it to be published this year. We are nearly at the end of 2018 now and nothing is happening. No date is available for the publication of the plan even though I understand the Minister of State received a completed plan from the HSE in July. Can he confirm this please?

I share the Deputy's concerns but it will happen. According to my information, as of yesterday, this plan will be published in the coming weeks. In my diary that is before Christmas.

Of course we have to be very careful about ensuring we have a plan and strategy particularly for people in these situations. The main premise underpinning all rehabilitation service delivery is the model of care.

We need a person-centred approach to patient care, the development of appropriately resourced interdisciplinary teams, outpatient and community based specialist rehabilitation teams across the country, case management of patients, and management of clinical rehabilitation networks. That is the model of care, but we must also include the implementation aspect. That is centred around the development of local implementation teams, the development and enhancement of neuro-rehabilitation services at each level of the network, the configuration of services into a managed clinical rehabilitation network and governance structures, including all leadership and accountability aspects. This is an issue we have to push and I expect to have further details in a matter of weeks.

I will hold the Minister of State to that. He will forgive me for being slightly suspicious that this may not happen. We have been given several dates already and I will hold him to this one. There are only a few more sitting days before the House adjourns for Christmas. Time is flying and I ask the Minister to do his best to work on this matter.

The national policy and strategy for the provision of neuro-rehabilitation services was published in December 2011. Since then, there has been no new investment in community neuro-rehabilitation services. At least one team should operate in each of the nine community health organisations. However, we still have only three teams, the same number as in 2011, and they are only partially staffed. The HSE has established a critical pilot project for the development of neuro-rehabilitation services in CHO 6 and 7 and appointed a project manager. However, that project cannot proceed effectively without dedicated funding in 2019.

I confirm that I received the framework on 20 September. I accept the Deputy's point. I am informed that the HSE will publish it within weeks.

I work very closely with the neuro-rehabilitation services. I visit many of the centres and meet many of the people involved in them. One of the first groups I thought of last Friday when the Minister for Health, Deputy Harris, and I announced changes to the medical card system to give effect to the key recommendation of the Make Work Pay report for persons with a disability was the young men and women I have met in the past three years, particularly those with physical disabilities. I was delighted to be part of the announcement that the earnings disregard for persons in receipt of disability allowance will be substantially increased from €120 to €427 a week. That is an increase of more than 250% in the earnings disregard for people with a disability.

We have to drive this issue. It is very important that we support the rehabilitation strategy and plans. That is a priority for me and I will drive forward this project in the next couple of weeks.

Maternity Services Provision

Bríd Smith


36. Deputy Bríd Smith asked the Minister for Health the way in which he will ensure that women have access to healthcare, including the right to abortion services, at the proposed maternity hospital on the grounds of St. Vincent’s Hospital in view of concerns in relation to the possible influence of a religious ethos on the provision of these services; and if he will make a statement on the matter. [50770/18]

This question concerns the urgency with which we need to find out what is happening with the national maternity hospital in terms of the ethos being applied to it. Is the plan to have the building go ahead as soon as possible on track and, if not, what is the reason for that? According to newspaper reports, there is some kind of cold war under way between the Department and the boards of the national maternity hospital and St. Vincent's Healthcare Group. Does the Minister believe that the step to ensure the St. Vincent's Healthcare Group is set up as a charitable status must be taken? If this step has not been taken, when will it be taken? Is the Minister fully satisfied that the hospital will be protected from being dominated by a Catholic ethos in a newly secular Ireland?

I welcome this question because it provides me with an opportunity to debunk a few myths. I am not giving any hospital to the nuns. With regard to people handing out flyers stating that I am giving the hospital to the nuns, let us debate facts in politics and not try to demonise each other. I am a strong advocate for the separation of church and State and respecting the role of each while not allowing the role of either to cross over and interfere with that of the other. I saw a newspaper headline at the weekend quoting an anonymous source in some hospital which stated that I was meddling in the development of the new hospital. The definition of the word "meddling" is to interfere in something that does not concern one.

I want to be very clear. The people of this country think it is right and proper that their Minister for Health should be concerned with the development of any new national maternity hospital and should want to know that the hospital will have robust governance, will be able to operate independently and that the State will have a seat at the table when decisions are made by the board. I am very confident that we can reach an agreement that ensures such robust clinical governance. It is important to point out that, notwithstanding Deputy Smith's view or my view on how the world should be, both St. Vincent's Hospital and the National Maternity Hospital, Holles Street, are voluntary hospitals. However, the State is the funder of the capital project and the staff and the custodian of health policies with responsibility for their development.

I assure the Deputy that the hospital will operate with full clinical independence. I note the excellent letter from Dr. Rhona Mahony, the outgoing master of Holles Street, and Dr. Shane Higgins, the incoming master, in The Irish Times this week in which both of them, being strong advocates for women's health with impressive track records, stated:

The new NMH will operate in accordance with the law of the land, not canon law - just as it does now. It will have no religious ethos. As the outgoing and incoming Masters of the NMH, we would not countenance supporting anything other than the continued clinical independence of the NMH.

There will be no religious ethos in the new hospital. I agree with Deputy Smith that there must be absolute certainty about the charitable status. I am aware that St. Vincent's Hospital and the nuns have given commitments in that regard. We need to build this new hospital as quickly as possible, but we need to get it right.

I do not believe people are accusing the Minister of not delivering the goods. What I think is going on is that nobody knows what is happening. That is the reason I am asking the Minister straight questions. Why has the St. Vincent's Healthcare Group not yet registered as a charitable organisation? We have been talking about this for 18 months or more and it still has not been done. People suspect that some kind of meddling is going on and that there is, at the heart of this, a cold war between the Minister and the two organisations concerned. If that is not the case, I want the Minister to use this opportunity to explain to us what is happening with the negotiations. When can we expect this group to register as a charitable organisation? I remind everybody that almost €400 million of public money will be spent on this project. Apart from the financial aspect, this is a step forward not just regarding women's reproductive health but in how we see ourselves as a society. We have moved on and become secular. We are a different kind of country and it is important for everyone that we leave behind the advocates of Mother Mary Aikenhead.

The National Maternity Hospital, Holles Street, is an excellent institution providing wonderful care for women in this country. The current facility is not fit for purpose. The idea of having stand-alone maternity hospitals is not in compliance with our national maternity strategy or best international norms. It makes sense to co-locate maternity hospitals with adult acute hospitals for the times when, sadly, things go wrong during pregnancy.

There are three issues that need to be addressed. The Deputy is right that the charitable status of St. Vincent's Healthcare Group must be sorted out, giving effect to the fact that the nuns have said they are leaving. I cannot comment on where that is at, but the matter needs to be resolved. The second issue is making sure there is a robust and modern governance system in place that sees the State having a seat at the table. The third issue is public ownership. We need to know who owns the building to ensure there are safeguards in place because, frankly, they are not in place today. In that way, if the Minister of the day or any future Minister has any concerns, and I am not envisaging they would, they can say to the taxpayer and, more important, to the women of Ireland who are also taxpayers, that they have the powers and leverage that people would expect them to have in a 21st century republic.

I believe this matter can be resolved and we can reach agreement in the coming weeks. However, I will not be backed into a corner by anybody who suggests that I should ask for anything less for the State or women, particularly after all that has happened in this country in the past year.

I am delighted to hear the Minister say he will not be backed into a corner by anybody but we are still not getting answers. That is very concerning. Groups are forming and they will protest at 2 p.m. this Saturday at the Spire, not because they cannot stand the sight of the Minister but because they are genuinely concerned about what is happening. Why has charitable status not been registered? The Minister spoke about public ownership and proper safeguards not being in place. Why has he not secured those safeguards? This has been going on for a long time. The Minister says he cannot comment. Why not? This is public money and involves the public interest and a public hospital. We need answers. I would like the Minister to explain what he means by the State having its feet under the table.

A seat at the table.

What does that mean in terms of the State's influence? Does it mean the Minister will get a golden seat and will have the absolute say in terms of what goes at the board? There is no clarity on that.

The Minister should not be surprised that people are protesting and giving out leaflets. We are concerned, having fought long enough to make changes in this country. While I acknowledge the Minister's role in that regard, we need more answers. We need the truth. This is, after all, a public issue which involve public money. Is someone messing about and delaying this project because there are rumours in the newspapers that it has to be signed off on by the end of the December? Will the Minister clarify what exactly is the problem?

The issue is very straightforward. The Mulvey agreement was negotiated between St. Vincent's University Hospital and Holles Street Hospital. Many people, in particular women, made their views very clearly known to me, loudly and articulately, that they were not satisfied that it was robust enough on the issues of governance and ownership. In effect, they asked me to revert to seek more assurances and protections and that is what I have been doing. I have had my senior officials engage with both hospitals. It is a statement of fact that they are voluntary hospitals with their own governance structures. It is like the road from County Kerry, of which it is said, "I would not start from here." I disagree, however, with the assertion that we are gifting hospitals to nuns, which I have heard put about at protests. It is very important that we get this right. There will be no gifting of any hospital to nuns. No one is blocking this, but I want agreement. I have made very clear to both hospitals what I expect on the ownership of the building and the governance model. I expect that we can make progress in the coming days. The ministerial representatives on the board of Holles Street Hospital were appointed by Barry Desmond who was Minister for Health a long time ago. The Archbishop of Dublin nominally chairs the board, on which the parish priest sits. We need to change that structure to provide for modern, fit-for-purpose governance of our national maternity hospital. That is what I am going to deliver.

Services for People with Disabilities

Joan Collins


37. Deputy Joan Collins asked the Minister for Health if staff and resources will be provided to resolve a situation (details supplied) regarding the Dublin south-west school age team. [50999/18]

There are 298 children on the Dublin south west school age team's waiting list. A further 18 are awaiting transition from the early intervention team to the school age team's waiting list. The waiting time to see the school age team is 41 months which is growing monthly in circumstances in which the team does not have the capacity to safely take on additional cases. There has been no movement on the waiting list in the past ten months. This situation has developed in the past few years. The limited human resources to address waiting lists for intervention, coupled with demand and high deprivation in the area, have been widely reported on. I ask for immediate intervention to resolve this shameful situation.

I thank the Deputy for raising this very important issue. The HSE and I acknowledge that waiting times to access the school age team for children with disabilities in CHO 7 which covers Dublin south, Kildare west and Wicklow are unacceptably long. It is due to high demand for services and challenges in staff recruitment and retention in the area. The Dublin south, Kildare west and Wicklow community healthcare organisation area has a growing population, with an increase in the number of children with a disability. The population of the area has increased by 33,175, or approximately 5%, since the 2011 census. In addition to the increase in population, a high proportion of children presenting to disability teams have a diagnosis or suspected diagnosis of autism spectrum disorder. A typical ASD diagnosis can take more than 30 hours to complete.

While the CHO 7 school age team is operating without a dedicated team manager, recruitment to fill the post is under way via a national recruitment process. It is an essential appointment in managing resources and waiting lists within the team. The HSE is engaged in a reconfiguration of existing therapy resources to provide geographically-based teams for children from birth to 18 years. The intention is to roll out an integrated care model which will allow children, whatever the nature of their disability, to be seen as close to home and school as possible. The team manager appointment is key to facilitating the reconfiguration. Funding for an additional 100 therapy posts was secured for children's disability services as part of budget 2019, in which I was glad to be involved. Some of the posts will be allocated to CHO 7. The additional posts, with the reconfiguration of services and other innovative approaches, will have a significant positive impact on waiting times for assessment and therapy service delivery over the course of the next year.

I thank the Minister of State. This situation has developed in the past two to three years. The team in CHO 7 has flagged the pressure it is under and the fact that waiting lists have been stagnant for the past 41 months. In reply to an earlier question I was told that there had been no movement on the waiting list in the past ten months owing to the volume of children transitioning from early intervention services, capacity caseloads among team members, delays in the filling of vacancies and maternity leave positions not being filled. The reply also stated the team was operating without a dedicated manager, which is crucial. There is a lack of services. The resources are as follows. One staff grade educational psychologist post has been filled, but the person in question is soon to move on on promotion. There is a staff grade psychologist. However, because of engagement with psychological initiatives, the person in question is only available at the rate of 0.6. Staffing levels are dire and must be addressed. The children waiting for these services need them today, not next month or next year.

I accept completely that it is important to intervene as early as possible. I take that point at a personal level. I also accept that the waiting lists are unacceptably long. However, there is difficulty in filling some of the positions. That is the bad news. The good news is that in recent months I have noticed that a lot of occupational and speech and language therapists who emigrated during the austerity years are returning to Ireland and that some of them are filling these posts. The recruitment of a further 40 occupational therapists is nearing completion, while the occupational service improvement working group is reviewing options in the allocation of posts across CHO areas. This is being done having regard to the occupational therapy service report on improvements in primary care. Funding for an additional 100 therapy posts was secured in budget 2019 and they will have an impact. The reality is that we have to focus on getting people in place in order that we can provide services. There has been a huge increase in the numbers of families and children presenting in CHO 7 with autism spectrum disorder. That is something to which we are trying to respond as quickly as possible.

I take on board the Minister of State's point about problems in recruiting staff to fill these positions. I took up the issue initially on behalf of a young lad with severe autism in foster care. He went through the Cheeverstown House process and Abacus special school and was discharged to the school age team in Chamber House in Tallaght and placed on its waiting list three years ago. He was put on the waiting list at the age of five years. He is now eight years old and still waiting for basic services. He cannot even get into Chamber House. He is just one of the 298 children on the Dublin south west school age team waiting list. There must be a radical rethink. While I understand there are problems in recruiting, this issue was flagged a long time ago. I am not saying the Minister of State is directly responsible; he has a legacy he is addressing. However, there has to be a radical approach. I am sure CHO 7 is not the only area in which this is happening. I am sure it is also happening in other parts of the country. We have to think radically, given that 298 children are waiting.

I do not dispute the issue. There are problems in the Deputy's area, as well as in counties Kildare, Kerry, Wexford and Cork. That is the reality. What we must do is try to put the resources in place and fix the problems. I managed to secure an extra €150 million for disability services in budget 2019. I give the House a commitment that we are sitting down to finalise the HSE's service plan for 2019 and that I have put early intervention and speech and language services among my top five priorities. Of course, I face issues such as the provision of emergency residential places and personal assistance hours, but I have put the issues of assessment of needs and speech and language therapy services at No. 1 in the discussions. That process will be completed in the next week to ten days and we will I hope have something in that regard. We have an issue that we must resolve. We must ensure there is investment and that staff are provided. The earlier one intervenes for a child with any disability, the better it is in the long term. It is good for the family and the child, but it is also good for the Exchequer in the provision of public funding.