Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Tuesday, 19 Oct 2021

Vol. 1012 No. 7

Ceisteanna Eile - Other Questions

Mental Health Services

Claire Kerrane


91. Deputy Claire Kerrane asked the Minister for Health if an update will be provided on the staffing levels and range of services being provided currently in a facility (details supplied); and if he will make a statement on the matter. [50829/21]

Will the Minister please provide an update on the staffing levels and the current services available in the e-mental health hub in Castlerea in my constituency? This hub, as the Minister knows, was opened in June 2020. No funding was provided from January of this year. This is an issue I have raised repeatedly. Funding was put in place in July. Has it been spent?

I thank the Deputy. I acknowledge the fact she has raised this several times. The Government remains committed to the development of the Castlerea mental health hub.  This project was announced in June 2020, comprising a new child and adolescent mental health service, called the CAMHS Connect day hospital and a psychiatry of later life day hospital.  In 2020, €800,000 was provided for refurbishment works and staff recruitment by the HSE.  In 2021, 14 posts were approved and €1.4 million allocated for this. Staffing for the CAMHS Connect day hospital includes a consultant psychiatrist, a non-consultant hospital doctor, NCHD, an advanced nurse practitioner, a senior social worker, a clinical nurse specialist, a senior psychologist and an occupational therapist. The consultant, NCHD, advanced nurse practitioner, and senior social worker for this team have been recruited. The remaining three posts are at an advanced stage of recruitment.

Staffing for the psychiatry of later life day hospital incudes a consultant psychiatrist, an NCHD, an advanced nurse practitioner, a social worker, a clinical nurse specialist, a senior psychologist and a senior occupational therapist. All these posts are going through recruitment at present and will be filled as soon as possible. Funding will be allocated to the local mental health service for these as staff are appointed.

The services now available from the CAMHS Connect team are: CAMHS multidisciplinary clinics, including a monthly mental health intellectual disability clinic; diagnostic assessments; cognitive behavioural therapy, CBT, and family therapy; and outreach support, and the CAMHS group work is being run to deliver therapy to young people. I assure the Deputy I will continue to monitor the roll-out of this vital service.

Just to confirm, three posts remain unfilled in the CAMHS Connect and none has been filled for the psychiatry of later life service.

I ask the Minister of State to confirm that is the case. It is deeply disappointing to learn this.
The hub was opened in June 2020 and the psychiatry of later life was an important element of it, given what was closed, which was the Rosalie home for very vulnerable residents with dementia. They were promised that they could see out the rest of days in the Rosalie home but that promise was reneged on, so the psychiatry of later life element of this facility is really important. I ask the Minister of State to confirm that the sum of €1.4 million was not allocated until July. In July, she said that the funding was imminent. I ask her to provide a breakdown of the €1.4 million. What has been spent to date and will the full amount be spent by the end of the year? Finally, will we be in a situation in January, February or March next year where no funding is provided for this service?

I have a lot of control over certain things in mental health but I cannot control recruitment. I just cannot do it and unfortunately, it can take up to 50 weeks to recruit to a consultant's post. We also have to backfill the post that he or she is vacating. There are lots of difficulties with regard to recruitment. As I have said, 14 posts have been approved with €1.4 million in revenue allocated. The Deputy is correct that there are three posts outstanding but those remaining posts are at an advanced stage of recruitment.

All posts in the psychiatry of later life day hospital are going through the recruitment process at the moment and will be filled as soon as possible. I am fully committed to this outreach programme. It is a fantastic initiative combining supports for children and young adolescents with support for the psychiatry of later life. An online service will be based in the new CAMHS hospital, which will be important for those who live in areas that are not close to Castlerea.

I appreciate that recruitment is not something the Minister of State can control but perhaps if recruitment had started in June 2020 when the service was opened rather than seven months into 2021, we would not have much of an issue now. While I acknowledge that significant investment went into opening this facility in the first instance, funding did not carry through until earlier this year. I raised this repeatedly and only in July was it announced that funding would be put in place. It was only then that recruitment could begin when it should have begun in June 2020. I ask the Minister of State to give a commitment to me and to the people of Roscommon and further afield, who will rely on this crucial mental health service for young and older people, that we will not have to wait seven months for funding for the service. Will funding be continued into 2022? I ask her to provide a guarantee in this regard.

Online services are important but I understand that a number of screens were installed in Castlerea last week that require efibre. There is no efibre network connection to the building at the moment and I ask the Minister of State to look into that as well.

When this was opened with fanfare in June 2020 we were given assurances that the psychiatry of later life service would be developed there. It is unacceptable that it will now be 2022 before any older person will be able to avail of a service at Castlerea.

I can only deal with the here and now and with the situation as it pertained when I came into post last July. We should look at the positives. This facility will be fully staffed by early 2022. It will be the first of its kind nationally and that has to be acknowledged and accepted. It will form the core of the new Castlerea mental health hub across HSE west and beyond. Having listened to both Deputies, one would think nothing was happening in Castlerea when in fact CAMHS multidisciplinary clinics are operating there, including a monthly mental health intellectual disability clinic. Diagnostic assessments are taking place, while cognitive behaviour therapy and family therapy services are being provided. Outreach support is also being provided and CAMHS group work is being run at the centre to deliver therapy to young people. I would hate people to think that there is nothing happening in Castlerea because there is a huge amount happening.

It is important to look at the history of the facility as well-----

I did not interrupt the Deputy. There is a huge amount happening and the €1.4 million that was allocated this year will be provided for staff.

Hospital Services

Johnny Guirke


92. Deputy Johnny Guirke asked the Minister for Health if the emergency department at Our Lady’s Hospital, Navan will be downgraded from 24 hours to 12 hours; and if he will make a statement on the matter. [50826/21]

Darren O'Rourke


107. Deputy Darren O'Rourke asked the Minister for Health if the emergency department and the intensive care unit in Navan hospital will close; and if he will make a statement on the matter. [50516/21]

I ask the Minister for Health if the emergency department at Our Lady's Hospital in Navan will be downgraded from a 24-hour to a 12-hour service and if he will make a statement on the matter.

I thank the Deputy for his question. Many elected representatives are keenly involved in this issue, including the Ministers of State, Deputies Thomas Byrne and Damien English, and Senators-----

Is the Minister taking this question with No. 107?

He has to finish naming all of the Government Deputies first-----


I thank the Deputy for the question. The point I am making is that this is a serious issue, which is very real for the local community. It is something that has been discussed with me by Oireachtas Members in opposition and obviously, in government as well. I am aware that the HSE initiated a process of planning for changes to the services at Our Lady’s Hospital, Navan. I am also acutely aware that any proposed changes to health services can be a source of great anxiety and worry for communities affected and for the people we all represent and in this case, the people Deputy Guirke represents. I am determined that any consideration of changes to services at Navan must be happen in consultation with the local community in the first instance, through their elected representatives.  I have, therefore, instructed the HSE to pause any such movements and to engage in a comprehensive manner with the elected representatives on behalf of the community.

I would like to set out for the Deputies the context for the proposed changes. In 2013, a smaller hospitals framework was published. It included a list of nine designated model two hospitals, including Our Lady’s Hospital in Navan. Eight of the nine have transitioned and Our Lady's in Navan is last on the list. The HSE has advised that the proposed changes to the services at Navan, in line with the Government decision, are necessary to support safe service delivery on a sustained basis and to address some very real clinical concerns.

The HSE's planning envisages the development of a 24-7 acute medical assessment unit, along with a 12-7 local injuries unit, and an extended role for the hospital in areas such as day and ambulatory surgery. I am advised that this would see the significant majority of current footfall continue, with the hospital in the future providing more care rather than less. Of course, this would have to be supported by the necessary investment.

I want to see the details of all of these proposals and I want those details to be shared with the elected representatives. I also want the proposals to be discussed in detail with the elected representatives. If it is the clinical view, and I am advised that it is, that what is being proposed will save the lives of the people Deputy Guirke represents, then I want us all to hear that from the senior clinical team on the ground. I want them to tell us that. If they believe this is going to save lives, and I am advised that they do believe that, then we need to hear it directly from them. If part of this is dependent on serious investment, then let us make sure we know exactly what level of investment is being proposed and how it is proposed to spend that investment. I will then need to make sure that funding is allocated so that these are not promises about things that could happen in the future but are specific, tangible, funded investments. Ultimately, what we all want is to make sure that if there are to be changes to systems, and healthcare systems go through reconfiguration all of the time, then they must be absolutely and clearly in the interests of the local community, they must be about saving lives as well as improving the quality and accessibility of healthcare. Critically, any such process must be done in consultation with the people affected through their elected representatives.

I hope consultation with elected representatives includes Opposition Deputies.

We did not get the meeting with the Minister that we were supposed to get. It was promised by the Minister of State sitting behind him the last time we raised this issue. While we welcome the temporary reprieve for the accident and emergency department and ICU in Navan hospital that the Minister announced today, we still need more clarity. I understand what the Minister said about being in consultation with the HSE but what is the long-term sustainable plan? The accident and emergency service and ICU capacity is critical to the future of the hospital. To downgrade or close these services would be to rip the heart from the hospital and would endanger patient care. Meath has a population of 210,000 and is the fifth largest county in the State. Neighbouring hospitals, namely, Drogheda and Connolly hospitals, are at full capacity. We need a clear and unequivocal commitment from the Minister to maintain and put the necessary resources into Navan hospital and build on the excellent services provided by it.

What I am hearing from the Minister is that he is not happy with the way these changes are being implemented. He said it is not acceptable for the changes to happen in the manner reported but ultimately what I am hearing is that the destination is the same. The accident and emergency department and ICU in Navan are going to close. It is only a matter of when. We might have the opportunity now, on the back of the Minister's intervention, to do a bit of talking about it but we will stand before clinical leaders and they will tell us why these changes need to happen. It is fundamentally the wrong basis for the conversation because at the root of this is a chronic under-investment in our acute hospital system, ICUs, accident and emergency departments and elsewhere. It is very real. There are solutions to address real clinical concerns that do not involve the closure of the accident and emergency department and ICU.

I understand that this is a very serious issue for the local communities. My own community was involved in exactly this small hospital framework with regard to the hospital in Loughlinstown. Changes were made. I backed those changes from the Opposition and I will tell the Deputies why I did so. I and the other four elected representatives from the constituency met the senior clinical team and I asked them if it was their unanimous view that this would save lives. We were all told that this would save lives and the real story, in fact, was how many lives not doing this earlier had cost. That is what I heard as an Opposition Deputy. Based on that, I said that if the experts and doctors were telling us this was going to save lives then it was something I would back. Ultimately, that was the right call and it has saved a lot of lives but the process was not done properly because people like the Deputies and I were left to explain it to the public. The clinicians were nowhere to be found.

We do not want to be back here every couple of months, which is what will happen if there is not a long-term solution. The people we are talking to are telling us that what is needed is for the Minister for Health to overturn the HSE decision to close Navan accident and emergency department and the ICU once and for all, and not pause it. We need the Minister to remove from the HSE policy documents that Navan accident and emergency and the ICU will be closed or downgraded in the future and we need the necessary investments in Navan hospital that are so badly needed in order to have a fully functioning hospital. That is what we are hearing. That is what the people on the ground are telling us is needed for Navan hospital.

Ten years ago, Deputies Naughten and Feighan were in the same place having the same conversation about Roscommon hospital. Two weeks ago the Leas-Cheann Comhairle, Deputy Connolly, had a Topical Issue debate with the Minister of State, Deputy Feighan, about the failures at the accident and emergency department in Galway. That is what the people in Navan and County Meath are faced with now. I worked in Our Lady of Lourdes Hospital. I have council colleagues who work in Connolly Hospital. They were on the picket line last week because they do not have sufficient staffing there. They are in a dangerous, precarious position. The suggestion is that it would be safer to close the capacity we have in Navan and move it to those already overstretched facilities. We have seen this in Roscommon, Dundalk, Mallow and Ennis. It is not going to be repeated in Navan.

Deputy Cullinane wants to come in briefly.

I was in Navan today with my two colleagues. I met a number of different groups as I wanted to see and hear for myself at first hand what was happening in Navan. In the spirit of the offer the Minister made to work with Oireachtas Members from both the Government and Opposition in the constituency, as the main Opposition health spokesperson I want to work with him on this as well. If it is about saving lives and quality of care, then we can all work together to make sure we get the best outcome for the people of Navan. The difficulty the people of Navan have when they hear about the ICU and the emergency department closing is where they will go. If it is Drogheda, there are capacity problems there and if it is Connolly Hospital there are capacity problems there as well. The Minister might have seen nurses from the Irish Nurses and Midwives Organisation protesting outside that hospital last week because of capacity issues in ICU. That is the fear and concern people have. I want to work with the Minister to resolve this issue for the benefit of the people in Navan.

I again thank the Deputies. I am listening to them and to my Government colleagues very carefully. The debate we are having right now is an important one. I would expect nothing less. I want this debate to happen with the HSE management and the senior clinicians in the room because they need to answer these questions, not just from the Opposition but from the elected representatives of the community. I have been through this process in Wicklow and while ultimately Loughlinstown became a great success story, it was not done properly and the community was left misinformed and scared. Without prejudice to any outcomes to this situation, I want all of us to meet and we can do that more than once. Let us meet the HSE and the senior clinical teams and let us have exactly this conversation with them.

Mental Health Services

Pat Buckley


93. Deputy Pat Buckley asked the Minister for Health the detail of work to improve the responsiveness of the HSE to reports regarding the conditions of mental health facilities and to provide oversight and accountability in this regard. [50595/21]

I ask for the detail of work to improve the responsiveness of the HSE to reports regarding the conditions of mental health facilities and to provide oversight and accountability in this regard.

I thank the Deputy for the question. The Government is firmly committed to developing all aspects of mental health services nationally. Both the Government and the Department of Health recognise the need for continued service improvement across the country.  The Mental Health Commission is the regulator for mental health services in Ireland and is entirely independent in its operation. As part of its work, the commission’s Inspector of Mental Health Services regularly inspects mental health facilities, including those operated by the HSE.  As part of the inspection process, the HSE and the inspector may agree on corrective actions to be taken to enable a facility to operate in line with regulations. Where such actions involve the conditions of facilities, the HSE estates department may be engaged to inform appropriate responses, in conjunction with senior community health organisation, CHO, management.  A decision might be made to undertake works to ensure they meet Mental Health Commission standards and regulations and are safe for both residents and staff.  For example, the department of psychiatry in St Luke’s Hospital Kilkenny has benefited from capital funding upgrades, and works to upgrade Galway CAMHS at Merlin Park will be completed in early 2022. On occasion, if a facility might be deemed a safety concern, a decision may be taken to close that facility. At all times, patient safety and dignity is a priority for the HSE.

Sharing the Vision recommends that capital investment should be made available to redesign or build mental health units in acute hospitals which create a therapeutic and recovery supportive environment.  In 2021, €15 million is available to the HSE for major capital works in mental health, including approved centres, and €13 million is available for minor capital works and refurbishments.  A national improvement project to develop and roll out a HSE ligature risk reduction policy and audit is also under way. This will meet Connecting for Life recommendations.

I welcome the Minister of State's reply. This issue has to do with the Mental Health Commission but it also has to do with the HSE. There have been reports about this in 2016, 2018 and 2020, as well as two reports in March 2021 making recommendations that were due to be completed in 2016. The HSE does not seem to have the accountability to stand over its own buildings. This goes back to the Owenacurra centre. The HSE is saying the building is not fit for purpose. I want all the Ministers and Ministers of State to hear this. The Mental Health Commission went there.

It is like the national car test, NCT. If a person fails something in an NCT, he or she goes to the garage, gets it fixed and then the car passes the test. The HSE has shown nothing short of total arrogance and ignorance when it comes to any Mental Health Commission report. It said in all those reports that the proprietor, which is the HSE, had ignored all the recommendations. Why are we now closing a mental health centre in Midleton in the middle of a pandemic?

I knew from the Deputy's question that he was talking about the Owenacurra approved centre in Midleton being closed. We have had many conversations about this issue and I have met the Deputy to discuss it. As he knows, the Owenacurra centre is a long-term residential centre with 19 residents but also accommodates a mental health day service.

As the Deputy will be aware, in March of this year - I do not have the exact date - the Mental Health Commission contacted the fire officer in Cork County Council to say it was concerned about a fire risk in the Owenacurra centre. Obviously, straight away the HSE would have to look at the challenges in that regard.

At the end of June, the HSE notified the Department of its decision to close Owenacurra by the end of October. The current building is not fit for purpose. The HSE carried out a report but the Deputy will be aware that it also commissioned two independent reports, which we have all seen. Many issues were raised with regard to fire safety and asbestos. Even though works commenced, the HSE informed us that no matter how much money was spent on the premises, it could not be brought to the standard needed.

I thank the Minister of State for her reply. I have a copy of the report from 2016. I have been trying to say that the HSE was told back in 2016. In 2016, 2017, 2018, 2019, 2020 and 2021, therefore, it was okay for people to live in the centre but now it is unsafe. The Minister of State is blaming the Mental Health Commission, which is there to improve services. The HSE has ignored all those requests for services and we now have a centre that is threatened with closure. It is causing immense stress.

We have no clarity from any HSE department on what has happened with patient safety. The Minister of State mentioned it but I can tell her that patient safety is not paramount within this. I know the way families have been treated. I spoke to patients there who came out on a rally with us last Saturday to try to garner support to keep the services in east Cork and, particularly, Midleton. I recall one gentleman told me that he thought it was going to be his forever home and that he was going to die there.

We cannot lose the services. I appeal to all the Minister and Ministers of State to come and have a look at it. As one resident said, "Don't move us; improve us". That is what we need in east Cork and in the Owenacurra centre.

I am very conscious as we speak tonight that this is home to 19 residents. I am very conscious of that in case anybody was listening. There is no blame game here, however. One person is not pointing the finger at the other. The situation is very clear. The premises, as all concerned have admitted, is not fit for purpose at the moment. At the moment we are making sure that every single resident has been consulted.

As the Deputy knows, the HSE is currently trying to secure a house in Midleton town to support five of the residents who are embedded in the community. As I told him last week, there were five residents in the nursing home whose physical health has deteriorated to a stage that they were not fit to stay in a mental health facility. Those five residents are, therefore, moving to nursing homes under the fair deal scheme. Two other gentlemen have been relocated to high-level mental health hostels in Cork because that is their will and preference. It is important to recognise that. I spoke only yesterday to the area lead for mental health, who today visited a premises to try to secure a day care centre for mental health in the area.

Health Services

Denis Naughten


94. Deputy Denis Naughten asked the Minister for Health his plans to address the chronic waiting lists within the health system; and if he will make a statement on the matter. [49955/21]

As I stand here, our people have been waiting three and a half years in acute pain for an orthopaedic appointment and a whopping four and a half years for a respiratory appointment while we are in the depths of a respiratory pandemic. Appointments for services in the community are not much better, with waiting list of two to three years for occupational therapy appointments. We urgently need to do things differently and address these appalling waiting times once and for all.

I agree with everything the Deputy just said. Therefore, where do we start? We start as a Parliament and a Government by saying that the waiting lists before Covid-19 arrived were completely unacceptable. They are higher now because of Covid-19 and a cyberattack. The current situation is completely unacceptable. We must, therefore, act. It is my absolute priority as Minister for Health and a priority for all Ministers of State in their respective areas.

Right now, we have 760,000 patients on the acute hospital inpatient day case, outpatient and gastrointestinal scope lists. A higher figure of approximately 900,000 is often quoted, although this includes people who have appointments for scheduled care cancellations and suspensions and so forth. On top of the National Treatment Purchase Fund, NTPF, list, however, as the Deputy rightly said, there are people waiting in the community. People are waiting on mental health and disability services and on diagnostics. The situation is very serious indeed.

At the beginning of this month, I published an acute waiting list action plan. The plan was drawn up between my Department, the HSE and the NTPF. It is using the €210 million access to care fund that I allocated for this year to improve access immediately. The plan is to fund an approximate additional 150,000 interventions for people who are on those lists. As I know the Deputy will appreciate very well, the waiting lists are continuing to rise and the no-policy change numbers go up a lot. The first thing we must do, therefore, even though we are dealing with a pandemic and a rise in Covid-19 again, and even though our hospitals are under pressure, is to stop the increase and then use every resource available to the State to bring it down. I can tell the Deputy that all four Ministers with responsibility for health are absolutely committed to doing everything that can be done in their respective areas to get people the treatment they need.

I appreciate the Minister's comments. Next year, we will spend €40,000 every minute on our health service. We have seen in the past, however, that just throwing money at our waiting lists does not work within our health service. We need to see structural reform and not just reward those who work within our private hospitals.

In the programme for Government in 2016, for example, a commitment was secured to look at expanding the Sligo hospital cataract surgery model, which had slashed waiting times by providing the follow-up care in the community by ophthalmologists. Five years later, the only expansion of that service has been to Letterkenny University Hospital where today, just 32 people are awaiting cataract surgery. Is it not ironic that two of the closest hospitals to Northern Ireland have slashed their waiting lists and people from Munster have to travel as far as Belfast to get cataract operations?

Money is not the only answer but it is part of the answer because without money, this is not going to move. Next year, I have allocated a total of €350 million. The Deputy will be aware that I am appointing a ministerial task force to look at this issue. We are taking the learnings from the very successful vaccine task force and bringing them to bear. As the Deputy quite rightly said, we are going to do this differently. We are going to use all of the capacity we can, first of all within the HSE but then also within the private sector. That €350 million is a lot of money and can do a lot of good. I could not agree with the Deputy more. It is not enough. Using that kind of money can be effective in terms of dealing with the backlog but we must bring the day-to-day capacity of our public health system up to a point where it can meet the day-to-day demand. Only then can we seriously talk about universal healthcare and exactly the kind of reforms about which the Deputy spoke and that are needed, including the cataracts model in Sligo.

I will give the Minister two more examples. Take the rapid access haematuria clinic, that is, the blood in urine clinic at Roscommon University Hospital, RUH, where 10% of patients have been diagnosed with cancer. It treats 70% of patients in one visit and 100% of patients - all of them - are seen within the 28-day target time for urgent cases, and yet this has not been rolled out anywhere else. Look at the state-of-the-art theatre sterilisation room that was constructed in 2016 at RUH. It has been used for storing beds and wheelchairs for the last five years because the HSE will not approve funding to equip the facility in order that we could fully utilise the two theatres in that hospital and reduce waiting times across the west. Of course, if we did that and reduced waiting times across the west with regard to our waiting lists, that would undermine the case for the new elective hospital in Merlin Park. It is, therefore, better to spend money on treating patients in private hospitals than supporting public hospital innovation, which can make a real difference in the long term to waiting lists.

If we are going to get this right and we have to get it right, we have to be able to identify exactly the kind of projects the Deputy has referenced. We have to replicate and scale them. All over the HSE, brilliant initiatives are happening. Tallaght hospital has been running advanced nurse practitioner-led community teams in various disciplines such as neurology and urology and the results are spectacular. I may be wrong, but I am pretty sure the Sligo model the Deputy mentioned is referenced in the programme for Government. It is an example I brought into those talks having met opticians and ophthalmologists in Wicklow who raised this with me. We have to do things differently. We have to bring care closer to the patient. When we see examples of excellence such as those the Deputy referenced, we will have to get better at replicating and rolling them out across the system.

Health Services

Jennifer Murnane O'Connor


95. Deputy Jennifer Murnane O'Connor asked the Minister for Health the number of persons currently awaiting an assessment of need under the Disability Act 2005 in each local health office area in CHO 5; the corresponding figures for each area at the end of June 2020; and if he will make a statement on the matter. [50605/21]

How many people are awaiting an assessment of need under the Disability Act 2005 in each local health office area in CHO 5 and what are the corresponding figures for each area at the end of June 2020?

I thank the Deputy for raising the question and for the opportunity to answer it. In August 2020, additional Sláintecare funding of €7.8 million was provided to the HSE to address the issue of overdue assessments of need. The funding was provided on a once-off and strictly time bound basis to eliminate all assessments of need overdue by 30 June 2020. While the number of overdue assessments of need stood at 6,558 in June 2020, through a combination of different measures, by the end of September 2021, approximately 6,040 children have had their assessment completed, which is an overall reduction of 92%.

I am pleased to inform the Deputy that six CHOs, including CHO 5, which had 643 overdue assessments of need at the end of June 2020 have now cleared their backlog. The breakdown of the 643 overdue assessments were 80 in Carlow-Kilkenny; 111 in Tipperary south riding; 168 in Waterford; and 284 in Wexford. The number of overdue assessments at the end of June 2021 in CHO 5, which is the latest figure available, was reduced to 180. There were 19 in Carlow-Kilkenny; 54 in Tipperary south riding; 59 in Waterford; and 48 in Wexford. The Deputy will also be aware 91 children’s disability network teams will be reconfigured in the coming weeks.

In budget 2022, we are providing additional funding for the recruitment of therapists and administrative staff. As the Minister said, our focus in on changing to a more agile approach in how we will do the interventions. While we have cleared the assessments of need, now it is all about intervention with occupational therapists, physiotherapists and speech, language therapists and psychologists and us all working together as a collective team within health to ensure backlogs start to clear and waiting times for the delivery of services are reduced. I am confident with the €10 million the Minister has allocated to me in budget 2022 that work will start now and the HSE is ready to deliver it.

I welcome the funding of €7.8 million, which is crucial. The reduction of 92% in the waiting list nationally is impressive and I know this is something to which the Minister of State has been committed. I welcomed her to Carlow where she had given that commitment. I welcome the reduction, especially in my constituency of Carlow-Kilkenny. The challenge is to build on that and ensure those who have been assessed for a need get the service they need as quickly as possible. We all know there have been significant waiting lists for speech and language assessments and therapy, and occupational therapy. We all know of the waiting lists for young children. This is so important. What are the Minister of State's plans with her Department to do this again? Does she have a timeframe, because, with children in particular, timing is crucial?

Let us be very clear. In budget 2021, I secured 100 therapy posts and halfway through the year, because of the way the progressing disability services model, PDS, was rolling out, I was fortunate, along with the Minister, to secure an additional 85 therapists posts. Coming out of budget 2022, we have secured 190 therapist and administrative staff. They will be added to the 91 teams and we are adding the administrative staff. The purpose of the administrative staff is I have speech and language and occupational therapists and physiotherapists filling out their paperwork. I need them delivering the intervention and the service. The purpose of having those administrative staff will ensure our therapists are delivering the service. I am confident with the €10 million, my action plan will start to reduce the waiting list and backlog and the number of people getting those horrendous letters. It is important for me to say the horrendous letters the HSE send out without having a full assessment done is very unfair on parents.

I welcome the Minister of State's comment that the letters sent out by the HSE are very unfair on parents and that is unacceptable. That is something she said she would also address and I welcome that. I also welcome all the 190 new therapist posts the she has secured. That reflects pure dedication and commitment and I know how committed she is. Will she set targets for assessment and treatment? If someone was to contact his or her occupational therapist or whatever, will be there be a timeframe? I acknowledge how committed the Minister of State is. Communication is vital for the parents and children, but the HSE also needs to play a bigger part in this. There has been a lack of communication and I ask the Minister of State to work on that. I thank her for getting all this funding in the budget, because, I know how hard she has worked to secure this.

I am a stickler for timelines. Key performance indicators will be set. Let there be no doubt about this. I will know exactly how many are on each team. I will know what the caseload is and I will meet with HSE officials on a monthly basis, with each of the CHOs and out of that, I will have the team leads and they will tell me exactly what they are delivering in respect of occupational therapy, speech and language therapy, physiotherapy, psychology and behavioural therapy. I will monitor them on a month-by-month basis. Once a month, I will sit down with all the team leads in disability services. There will be no hiding on the delivery of service. There will be no hiding under the rock from knowing what will be done. There will be open transparency and I will save every Deputy the trouble of tabling a parliamentary question wondering exactly where we are, because, I will release the figures on a monthly basis. There will be no hiding on this. We need to ensure there is complete and utter delivery of service for the families and, most important, the little ones who need that access-timely intervention. That is why I have been allocated the €10 million to which I am grateful to the Minister for having received.

There are two sticklers for time here. We will move on to the next question.

Home Care Packages

James Lawless


96. Deputy James Lawless asked the Minister for Health the number of older persons on the waiting list for home care support in each local health office area in CHO 7; the corresponding figures for each area at the end of June 2020; and if he will make a statement on the matter. [50709/21]

I am taking the question on behalf of Deputy Lawless. Home care enhances the experience for many older people in the later stages of their lives. However, there seems to be many obstacles to providing it. I know from speaking to families throughout County Carlow that they are being put through great hardship in applying for and being granted home care packages. How many older persons are on the waiting lists for the home care support in the local health office area? My area is CHO 5 and Deputy Lawless's is CHO 7. I understand if the Minister of State does not have my figures today.

I thank the Deputy for her question. She has raised this issue with me on many occasions. The Government has prioritised improved access to home support services through an additional investment of €150 million in 2021 for these services, which has been maintained under budget 2022. Estimated data indicate more than 13.2 million home support hours had been provided between January and August which is approximately 2 million more hours compared against August 2020. The number of people assessed and waiting on funding has significantly reduced through 2020 and 2021.  This has mainly been as a result of validation of waiting lists and availability of funding. I have the CHO 7 figures. Some 250 people were waiting for funding approval at the end of August 2021, including 21 from Dublin south city; 98 from Dublin south-west; 53 from Dublin west; and 78 from Kildare and west Wicklow. However, at the end of June 2020, 1,232 people were waiting, and therefore, there has been a significant reduction.

The HSE will continue to work towards increasing home support provision.

However, there are difficulties recruit with recruitment and retention of staff, with certain areas experiencing increased pressures. This can lead to delays between the approval of funding and the delivery of home support hours. When I came into the post, more than 7,200 people were waiting for approval of funding for home care supports. That figure has fallen by 88%, but now we have another challenge, which is the recruitment of home care workers. I am in a situation now where I have the budget to pay for it, but we are having difficulty in recruiting the home care workers. As a result, the Department is committed to establishing a strategic workforce advisory group with involvement of key stakeholders. I will talk more about that in a minute.

I thank the Minister of State. Again, I compliment the Minister of State for fighting hard in the budget to get €150 million for the home care packages. We are all living for longer now. Please God, we are all for living longer. Going forward, many families will want to keep their mother or father in their home. It is important they have that choice. We can see that the issue is recruitment. That is the biggest issue. We have the funding, yet we do not seem to have the staff. What does that mean in that case? Are we looking at putting it on a statutory basis? It is in the programme for Government that there will be a timeframe for this to become a statutory scheme. Maybe the Minister of State can explain that. One of the biggest issue we as Members face is where families ring us all the time looking for home care packages and they just cannot get them. One of the biggest issues that probably will face any Minister going forward is to try to get staff to make sure families who want to keep their parents at home will be able to do so.

The whole premise of Sláintecare is the right care, at the right time, as close to home possible. All I ever want to do is listen to the voice and choice of older people and make sure we can support them with the correct wrap-around supports at home. As I have said, we are spending €666 million on home care every year. That is the budget. That was increased by €150 million this year. To have the budget but to be short of carers is very disappointing. We are putting in place the strategic workforce advisory group, with the involvement of key stakeholders, including representatives from the sector. I have recently met with Home and Community Care Ireland, HCCI. There is involvement from education, because carers come in at a level 5 FETAC. There is obviously also engagement with the Government. The group will provide forum for practical action and collaboration, but we need to address things such as recruitment, retention, pay and conditions, skill development and sustainability of employment into the future. I want to see that first meeting happening as soon as possible.

I thank the Minister of State. Recruitment will be crucial. I also wish to ask, because I know she has been working on this, what extra supports there are in home care packages for those with dementia. I have spoken to the Minister of State several times about dementia. Will we see more funding for that? What supports will be there for that? It is very important. As the Minister of State said, the budget has been and gone and I know how hard she fought. However, I can only say that it is so hard on the people who have been ringing my office and have been trying to contact community nurses and the HSE, crying for extra supports at home. I ask only that we look at recruitment and funding and make sure we can recruit as soon as possible. I know that is out of the Minister of State's hands, but getting the staff when she has the money is going to be crucial for families now.

Before the Minister of State comes back in, I call Deputy Ó Murchú.

I have had previous interactions with the Minister of State about right home care. We all accept we need a solution to this because families are desperate to gain home care packages so they can keep their loved ones at home. CHO 8 is one of those pilot areas, and we are still having difficulty. The representations I send in are still being returned. We have difficulty in getting people recruited. I did welcome the strategic workforce advisory group when I first heard about it. I am aware the first meeting has yet to happen, but what element of work has been done? The Minister of State has spoken about looking at almost every possibility, whether that be permits, tax breaks or whatever. Where exactly are we in delivering a solution, especially for those who cannot get home care, particularly at weekends? It has become a huge difficulty for many families.

I thank Deputy Murnane O'Connor for the question about home support specifically for people with dementia. Yesterday, I travelled to Kerry to open the 30th memory technology room for people living with dementia. This was the first purpose-built room in Ireland. We have 29 others. It is fantastic to see the money that was so hard fought for in the budget delivering on the ground. It makes such a difference.

Last year in the budget I secured €250,000 for home care services ring-fenced specifically for dementia. These services were gone by July of this year, which is unbelievable. That will tell you the demand that exists for home care. This year in the budget, working with the Minister, Deputy Donnelly, I was able to secure 11% of the five million extra hours for next year, which is in excess of 550,000 hours, specifically for dementia. As well as this, I secured another €7.3 million to roll out different dementia-specific supports to help people live at home. We want people to age well at home. That is our focus.

Hospital Overcrowding

Violet-Anne Wynne


97. Deputy Violet-Anne Wynne asked the Minister for Health the contingency plans in place to deal with the severe lack of capacity at University Hospital Limerick (details supplied) as the winter season approaches; and if he will make a statement on the matter. [50924/21]

What contingency plans has the Minister for Health in place to deal with severe lack of capacity at University Hospital Limerick as winter season approaches? We are very concerned about that.

I thank the Deputy for the question. I acknowledge the scale of the challenge facing our emergency departments in what will be a difficult winter. We all appreciate that many of our front-line staff are exhausted from the effects of the last 19 months. I thank our emergency department staff throughout the country for their ongoing commitment and their work.

It is accepted that acute bed capacity shortages in the mid-west are a contributor to overcrowding at the emergency department in University Hospital Limerick. The Deputy will be aware of the significant investment in University Hospital Limerick in recent years to address this, including a new emergency department which opened in 2017. A total of 132 additional beds have been provided in the past year, which I know the Deputy will welcome. It includes additional capacity in the new 60-bed ward; a 24-bed, single-room, rapid-build ward; and the reconfiguration of the 14-bed high dependency unit, HDU. In addition, the new 96-bed inpatient ward block, which is 4 x 24 beds, has now progressed through the detailed design stage and is due to go to tender in the coming weeks. While this is welcome and is having an impact, the increase in attendance in recent months, along with the challenges of providing Covid-19 care, is challenging.

The hospital is actively managing discharges and using the model 2 hospitals and community facilities to ease the pressure. The Government provided significant additional funding for this year of €1.2 billion to increase capacity and services, develop the alternative pathways, and support reform. This level of investment is being maintained and built on for the budget for next year. In short, while much capacity has been added, I am aware there are still significant pressures that need to be looked at.

I thank the Minister. To clarify, I understand that only half the beds in the 96-bed unit will be new beds and the rest, 48 beds, will be taken out elsewhere. Therefore, there will not be 96 additional beds, unfortunately. I agree with the Minister that there have been a number of beds put in there. However, last week I met the CEO of the hospital and some of the clinical directors there. I also met some of the trade unions which deal with the workers.

In October, there has been an average of 76 patients per day on trolleys in University Hospital Limerick. October 2021 will be the worst month ever in the hospital. That is saying a lot, because we have had historic highs. Already we are at almost 1,000 people. We have nine more days to go. It will, unfortunately, be the highest figure historically in the hospital. Winter is coming and capacity is stretched. It was predicted, although in fairness it was before the Minister’s time, that it was going to increase. I believe there is already in 2021 a 22% increase on 2019 figures. We do not have the beds to deal with it. It is a disaster. I got a phone call yesterday from someone who was in an emergency department and there were 150 people in there at the time.

We have run out of time.

Can I have one second?

Literally one second, as we are out of time.

There is an average of about 48 Covid-19 patients in University Hospital Limerick at the moment.

That is contributing to the number of people on trolleys in University Hospital Limerick, with more than 70 on average. Money has been put aside to reduce waiting lists in the budget, with more than €50 million available. Will the Minister look at expediting the waiting time at University Hospital Limerick?

I thank both Deputies. They have raised this issue with me and we are looking at it as a priority. Many resources have been invested in Limerick. For example, up to the end of August, University Hospital Limerick had an increase of over 340 staff compared with December of last year.

It is having the worst month ever.

I appreciate that. I am not trying to brush that aside. I am saying that there has been significant investment in many of the things that are being looked for, including additional staff, additional beds, and as the Minister of State, Deputy Butler, said, additional home care for discharge. I fully accept and appreciate, and the HSE is aware, that more needs to be done. The hospital is following escalation procedures at the moment. The Deputies can rest assured that all additional requests for resources will be taken seriously.

Written Answers are published on the Oireachtas website.