Vol. 1022 No. 7
6. Deputy Brendan Smith asked the Minister for Health when additional healthcare professionals (details supplied) will be recruited in view of long delays for children receiving appropriate therapeutic interventions and supports; and if he will make a statement on the matter. [26865/22]
There is a very urgent need to recruit healthcare professionals such as speech and language therapists, occupational therapists, physiotherapists, psychologists and social workers across Cavan and Monaghan. At present, we have totally unacceptable delays in children with special needs and children with a disability receiving assessments and follow-up treatment and support. Progress in the recruitment of such healthcare professionals is absolutely essential and must be progressed without further delay.
I will take this question on behalf of the Minister of State, Deputy Rabbitte, who sends her apologies to the Deputy.
The HSE acknowledges that the Cavan and Monaghan children’s disability network teams are currently operating their services with reduced staff numbers due to recruitment issues being experienced locally and nationally. The HSE advises that it is currently in the process of recruiting for vacant posts in the areas of speech and language therapy, occupational therapy, physiotherapy, psychology and social work. It is acknowledged that there are significant challenges in the recruitment of staff due to the availability of options for candidates across the health and social care sector. Senior management in CHO 1 are currently examining a range of options to attract staff.
At present, there are a number of initiatives currently supporting efforts to provide timely therapeutic interventions in the area. There is a joint children’s disabilities and primary care autism spectrum disorder, ASD, diagnostic wait list initiative. This joint initiative has been allocated funding to complete 130 private provider ASD assessments for those waiting longest in Cavan and Monaghan.
The Deputy will be aware that the Cavan children’s disability network team is based in the Hillside facility at Rathcorrick, County Cavan. The lead agency for the team is Enable Ireland. The team has a whole-time equivalent staffing allocation of 24.2 posts, but at this time there are only 15.3 posts in place, with 8.9 vacancies - one can say there are nine vacancies. Having looked at the figures, I note that there were five resignations and there are two people on maternity leave at the moment. This is having a huge impact on these services. The service is currently in the process of recruiting to the vacant positions but it is proving difficult to backfill these positions with minimal interest, if any, in any of the positions advertised.
I thank the Minister of State, Deputy Butler. I also appreciate the interest of the Minister of State, Deputy Rabbitte, in this area. Along with Oireachtas colleagues and parents from Cavan and Monaghan, I met the Minister of State, Deputy Rabbitte, on Tuesday last. The stories those parents told to the Minister of State that day were really heartbreaking. I had met the parents previously as they have been seeking better services for their children.
It is most disappointing that there is a total of 18.4 full-time equivalent healthcare professional therapy and social work posts vacant in the two children's disability networks in Cavan and Monaghan. As the Minister of State, Deputy Butler, has said, it is proving difficult to recruit. There has been a deterioration in services, and particularly in the past five to six years. Far too many children have not yet had assessments. Far too many children, unfortunately, did not get early intervention when they needed it. Parents are paying for private assessments. They are really stretching themselves financially to try to get private assessments to ensure their children can get access to special teaching units and ASD units. What is happening is just not acceptable.
I am aware that the Minister of State, Deputy Rabbitte, has been engaged with the Deputy and in various areas in the State. The Minister of State has taken to the road and is holding public meetings in different CHO areas to see what actions can be taken. As the Deputy recognises, it is not for the want of the Minister of State trying.
The occupational therapy and physiotherapy wait list initiative is managed by primary care services in Cavan and Monaghan. It offers assessment and brief intervention to children who are waiting for occupational therapy and physiotherapy. The initiative has commenced in 2022, with the HSE aiming to reduce the number of children on the waiting list over a 12-month period.
Those are two different initiatives that are under way, the primary care autism spectrum disorder waiting list initiative targeting the 130 children and this one. As the Deputy knows, it cannot come soon enough for the parents.
One thing the parents have highlighted to me in meetings and correspondence is that there has been no international recruitment for such healthcare professionals. The Minister, Deputy Donnelly, might take an interest in this as well. There was success in recruiting nurses over the years from the Philippines and elsewhere. Some parents put forward a suggestion regarding international recruitment. Is there an issue with permits for people with the relevant qualifications? I do not think the National Treatment Purchase Fund, NTPF, is being used in this area either. There is a question mark over the recognition or status of reports from private practitioners. This area needs to be addressed. If there is capacity within the private sector to buy in that necessary work and expertise, we need to do so urgently. Are there proposals to increase the number of places in our colleges to train such therapists? One other possibility that has not been considered, to my knowledge, is final-year students doing some practical work while they complete their studies.
The Deputy has raised some good points. I will talk to the Minister of State, Deputy Rabbitte, about encouraging people from outside the EU to come and work in these areas. We are looking at that with regard to home care as well. Everybody knows there is a shortage in the workforce. The Minister of State has been speaking to the Minister for Health about funding to buy private capacity. That capacity was bought in for assessments of need 12 months ago and it reduced that waiting list significantly. A lot of the children were then placed on further waiting lists as a result but the assessment of need was done. Primary legislation will be required in order to access the NTPF for psychiatry and psychology services. I had a meeting about this yesterday. It is quite complicated. If someone is referred for a cataract or hip operation, it is a once-off procedure but for children with psychology, psychiatry or therapy needs who require multiple sessions, it is a lot more complicated. We are looking at it.
7. Deputy Jennifer Carroll MacNeill asked the Minister for Health when the clinical review of fatal foetal abnormalities since January 2019 will commence; the terms of reference of the review; and if he will make a statement on the matter. [26018/22]
I raise this matter on behalf of Rebecca Price and Pat Kiely, whose baby Christopher was wrongly diagnosed with a fatal foetal abnormality in Holles Street in March 2019. Baby Christopher's life was ended wrongly in 2019. The family has sought a review to make sure this does not happen to anybody else and that no other family grieves in the way Rebecca and Pat do on behalf of their baby and with their baby. The family has met the Minister and his officials. I would like an update on the review of fatal foetal abnormalities to ensure this does not happen to anybody else.
I thank the Deputy for raising this matter. In 2019, the HSE recognised the need for increased awareness surrounding the correct identification and diagnosis of fatal foetal anomalies. The clinical review of termination services, as provided under section 11 of the Health (Regulation of Termination Pregnancy) Act 2018, was commissioned by the chief clinical officer of the HSE. From notifications I receive under this Act, I understand that termination services are provided under section 11 in approximately 100 cases each year.
The HSE has confirmed that the clinical review group met for the first time on 29 April 2022. The terms of reference were ratified by the review oversight group in advance of this meeting. I will ask the Department of Health to provide the terms of reference directly to the Deputy. The HSE has advised that the clinical review will identify the requirements to enhance the provision of termination services under section 11 of the Act. It will work collaboratively with stakeholders and there are quite a number of stakeholders involved. This will cover both the delivery and management of termination under services regarding fatal foetal anomalies and-or life-limiting conditions diagnosed during pregnancy. The group will engage with service users so their experience of the service is central to the process. It is essential that we hear not only from the clinicians and scientists but from the women themselves and the people involved in using the services. Recommendations will then be made and submitted to the HSE oversight group.
The HSE has stated that the review will examine areas including screening, diagnostics services and genetics in the context of fatal foetal anomalies and life-limiting conditions. It will also examine access to the multidisciplinary expertise that is required and which is being invested in, including clinical genetics and other specialties, counselling services and genetic counselling, which must be put in place, bereavement and other service user supports.
I am very glad to hear the Minister mention the role of clinical genetics. If they had been utilised in this case, this simply would not have happened. If there had been an external review, the parents would not have felt the need to go to the High Court to highlight the circumstances of this case. Hospitals cannot be allowed to review themselves.
I thank the Minister for expanding the number of public interest directors in the new national maternity hospital. That is an important response to cases like this and many others, where parents highlight problems within maternity hospitals and where maternity hospitals do not listen and do not allow for external review. That is essential. This happened in 2019, the parents met the Minister in July 2021 and the terms of reference are from 29 April 2022. It is essential that clinical genetics are included in the review. Parents need to have sight of that and I am not clear as to whether Rebecca and Pat have had sight of that on foot of the correspondence with the HSE. I see that a letter has been sent to their solicitor but I am not sure whether they have had the detail that is appropriate.
I will engage this morning with the HSE and the Department to make sure they have full sight of this. The HSE has acknowledged that this has taken a long time to put together. A very eminent chair, Dame Lesley Regan, has been appointed to this work. She is a professor of obstetrics and gynaecology at Imperial College London. She was identified as suitably qualified to lead the review and is an independent person, which is one of the things that was requested and is very important. Professor Regan was also president of the Royal College of Obstetricians and Gynaecologists in the UK from 2016 to 2019 and is currently honorary secretary of the International Federation of Gynaecology and Obstetrics. It has taken a long time to put this together and the HSE has acknowledged that. One of the positives that has come out of this is the HSE has identified an eminent international independent expert to lead this review. I have no doubt she will bring very important international expertise to this important review. To answer the Deputy's other question, genetics and genetic counselling will be included.
That is essential. We have very eminent geneticists in this country as well. Dr. Willie Reardon, who was involved in this case, is a very eminent geneticist and has been a great support to Rebecca and Pat. I thank the Minister for confirming the appointment of Professor Lesley Regan. Rebecca and Pat have looked to meet with her and I hope that can be facilitated.
Something going wrong in a maternity hospital is a tragedy for any family, from which it is very difficult to recover. Where something goes wrong, such as the death of a child or an injury to a child that could have been avoided, it is even more difficult to recover from than other cases. I know the Minister is aware of that. All the parents want is to ensure it does not happen to anyone else. That has been the motivation behind Rebecca and Pat's campaign, to make sure this can never happen to any other family who want a baby in the way they have wanted a baby, as lots of people do.
It is also essential that there is oversight of private fertility clinics. They are covered by the clinical indemnity scheme but it is not clear what is happening around notification to the incident management scheme with the State Claims Agency. I have raised this at the Committee of Public Accounts. It is essential that these clinics are overseen. If they are to receive the benefit of the clinical indemnity scheme, they must be overseen in every way too.
I will ask the Department to revert to the Deputy with a note on the current oversight situation. She should feel free to get in contact with me to discuss the matter when she has received that note. Two additional things are happening that are relevant. First, in this year's budget I have allocated €1.5 million specifically to perinatal genetic services. We know more needs to be done and that we need more expertise in this area so €1.5 million has been invested in the national women and infants health programme, NWIHP, to grow that service. Second, as the Deputy may be aware, Dr. Peter McKenna, who was leading the NWIHP, is now leading an adverse incidents team and will be looking at cases around the country where things have not gone as they should have. Specifically to the Deputy's point, this will make sure we have very quick feedback, for all the reasons she has laid out.
Would Dr. McKenna meet me?
I am sure he would.
8. Deputy John Lahart asked the Minister for Health the status of the situation regarding medical scientists; and if he will make a statement on the matter. [26798/22]
20. Deputy Paul Murphy asked the Minister for Health if he will work with the Department of Public Expenditure and Reform to ensure that an organisation (details supplied) is granted pay parity with other laboratory colleagues that they have been seeking for 21 years; and if he will make a statement on the matter. [26950/22]
21. Deputy Neale Richmond asked the Minister for Health if he will address the issues raised by medical scientists; and if he will make a statement on the matter. [25997/22]
My question relates to medical scientists, who were on strike last week, on Tuesday and today and who then called off the strike to enter into discussions with the Department of Health and the HSE. We debated this yesterday morning in the House with our motion. Does the Minister agree the expert group recommendations should be implemented and that these workers should get equal pay for equal work and pay parity with biochemists?
I propose to take Questions Nos. 8, 20 and 21 together.
I hope the Deputy will accept my bona fides when I say I want to let all sides engage without interference from the Government, Ministers or whatever it may be. What happened yesterday was welcome and I commend the Medical Laboratory Scientists Association, MLSA, on agreeing to suspend the industrial action because it was having a very significant impact on patient services. As I said yesterday in response to the Deputy or his colleague Deputy Boyd Barrett, I know that not a single medical scientist who went on the picket line wanted to be there. They, more than any of us, are acutely aware of the disruption to patients, sometimes for quite urgent care, and the last place they wanted to be was on a picket line. It is noticeable, as several colleagues referenced, that it has been a long time since they felt compelled to take such action. I commend them on suspending the action and going to the Labour Court yesterday. We now know more than we did when we were debating this yesterday morning, and there has been a very positive and constructive development. All sides have agreed to go back to the Workplace Relations Commission, WRC, for three weeks. All issues will be put on the table and all sides represented. They have also agreed that if, as we hope, that three-week process in the WRC is all that will be required and an agreement can be reached that works for all sides, any outstanding issues will revert to the Labour Court and all sides will be bound by that court's decision. It is a very positive move.
Turning to the Deputy's very reasonable question, this issue was identified in 2000. Thereafter, the report was received in early 2001, and through a benchmarking exercise in 2002, the matter went in a different direction. It was further noted, although not acted on, in 2007. I want to see a resolution to this that will work for all sides. Nevertheless, Deputy Naughten made an important contribution yesterday when he made the point that as science, technology, genetics and personalised medicines come more and more to the fore, the role of medical scientists and other scientific grades and groups within the public health system will come more and more to the fore of medicine for patients.
Not only, therefore, do we need a resolution to this issue, which is essentially a pay dispute, we also need an ambitious pathway for medical and laboratory scientists into the future. Dr. Colm Henry, the HSE's chief clinical officer, is instigating a review and looking more broadly at the profession and where it can go. I am pleased that work is being done on advanced practice. Advanced practice nurses and midwives are, effectively, autonomous clinicians. This is one of the most important and radical changes we are seeing in healthcare in Ireland. Ireland is becoming one of the leading countries in this and work is under way looking at advanced health and social care professional practitioners, one category of whom comprises medical scientists. We need to resolve the current situation and then be ambitious about what is possible for the profession.
As a general point, many of these workers were in the Public Gallery yesterday watching the debate, and the Government line, which is the usual Government line, suggested it has nothing to do with the issue. The Minister stated he wants to resolve the dispute without interference from the Government and so on, but that is as though the Government is not a party to the dispute. The Government, fundamentally, is these people's employer and I do not accept the idea it needs to take a hands-off approach. It can resolve this with a clear statement about pay equality and by finding the funds for it.
The Minister responded to Deputy Boyd Barrett yesterday by highlighting a line in the countermotion relating to “insufficient funds”, which I accept. Does he accept that any resolution of this dispute will have to be agreed outside the framework of Building Momentum, for example?
Finally, why has the MLSA not been invited to participate in the Dr. Colm Henry review?
To the first claim, about the hands-off approach, our approach is quite the opposite. Officials from my Department were in the Labour Court yesterday, along with officials from the Department of Public Expenditure and Reform. The people involved in these negotiations comprise officials from the Departments of Health and Public Expenditure and Reform, the HSE and the MLSA, so I am not for a moment suggesting this has nothing to do with the Government - of course it does. Nevertheless, given all parties have agreed to go into talks, it is appropriate to let those talks happen and respect that process, and I hope that will work well.
With regard to the MLSA and the future of the review, there is no question but that the association will be involved in that and I have no doubt Dr. Henry will talk to its representatives. It is essential that it be part of that process.
I apologise for not reaching the Deputy's final question. He might remind me of it in order that I can follow-up in my second response.
The third question was whether the Minister accepts that if this is to be resolved, it will have to be resolved outside of the framework of Building Momentum.
The strike was not just about pay equality, although that was the dominant issue, but also about a lack of people coming into the profession and a lack of clear career progression. There are very few roles beyond that of medical scientist. Workers have to go into management if they want to progress, which means they will not get to work as a front-line scientist in the way many people want to. Deputy Barry made a point yesterday about the role of clinical medical scientists in the UK National Health Service, NHS, which seems to provide a natural career progression. Would the Minister be open to that?
There are a few stories I did not get to raise yesterday during the debate on the motion. People have told me about their co-worker in Tallaght who lives in Belfast and drives to Dublin every day to work - just incredible. As a result of low pay and the cost-of-living crisis we are experiencing, those are the kinds of conditions in which, unfortunately, some of these people are working and living.
There are five grades at the moment for medical scientists, namely, basic scientist, senior scientist, chief scientist, specialist scientist and laboratory manager, ranging from €34,429 to €95,320. There is an anomaly, as we discussed yesterday, although it applies only in the first year. The grade of medical laboratory aide was moved up at a time when that of medical scientist was not, so there is an overlap. It amounts to only €82 for the entire year, which is very small and applies only for the first year. Nevertheless, it is an anomaly and these issues need to be examined.
To the wider point, many people in the country face very serious pressures, such as those relating to inflation and housing. There are many wider aspects to this. In the realm of healthcare at least, we want to see a resolution to this that will address the various issues raised by MLSA members.
9. Deputy Mark Ward asked the Minister for Health his views on a study by the Maynooth University centre for mental health and community research that has led to calls for the implementation of a family focused approach to treatment in cases in which parental illness is identified and if the Government has plans to introduce a family focused approach to mental health treatment. [26279/22]
What are the Minister of State's views on a study by Maynooth University’s centre for mental health and community research that has led to calls for the implementation of a family focused approach to treatment in cases where paternal mental health illness has been identified? Does the Government have any plans to introduce a family focused approach to mental health treatment?
I welcome the research findings of Maynooth University’s centre for mental health and community research into family focused interventions where there are parental mental health difficulties. The study is known as the PRIMERA programme, the findings of which I launched last week. The university's research programme findings recommend a family focused approach.
This was funded by the HSE at a cost of almost €500,000. The centre did a huge amount of research over the last five years. It is estimated one in four people will experience mental health difficulty in their life. Parental mental health can typically affect the entire family. It is estimated one in five children have a parent with a mental disorder. Where there are parental mental health difficulties, the risk of children themselves developing mental disorders and impaired lifetime outcomes is higher.
It is recommend that a Think Family policy and practice approach be developed and incorporated urgently as part of the routine adult and child and adolescent mental health services. This programme identified, implemented and evaluated family focused interventions for families with parents with mental illness. One of the evaluations was that when there was a six- to ten-week programme - this was trialled with I think with 136 families - of between six and ten interventions and meetings with the families and young people involved, the outcome was absolutely fantastic. It is therefore really important we develop this programme and include it in Sharing the Vision.
I thank the Minister of State. I am a graduate of Maynooth University so I welcome the report by the centre there. I have worked in community mental health services and always found the inclusion of family members, loved ones, or both had much more positive outcomes. That holistic approach always works. As the study said, when a parent has mental health difficulties it can typically affect the entire family. I use the analogy of throwing a stone into a lake and seeing how the ripples go outwards. Those mental health difficulties touch everybody who is close to the person. As the Minister of State mentioned, the report said 23% of all families have at least one parent with mental ill health and that increases the likelihood of the children having a lifetime risk of mental ill health by 41% to 77%. This could be a really early indicator. We have had the debate around early interventions loads of times. Is this something that will be looked at going forward?
The Deputy and I are on the same page here. It is hugely important. The centre spent five whole years looking at the effect mental illness of a parent has on the family. Family involvement, as the Deputy said, is very important in the recovery process and it is aligned with Sharing the Vision which, as the Deputy knows, is a ten-year plan. To show how important family involvement is I recently set up a reference group to support the work of Sharing the Vision’s national implementation monitoring committee. The group will represent the voice of the service users. There are family members, carers and family supporters on it. The group will ensure that the values of recovery and person-centredness espoused in Sharing the Vision are prioritised in all aspects of the implementation of the policy. It held its first meeting two weeks ago. The organisation Shine is providing the format for it as well as the secretarial support. I attended the very first meeting and met all the group. Group members were so delighted the voice of the family, the voice of the service user and the peer support is all being included.
The report also states, "there has been a growing recognition in most European countries of the need to support families in order to protect children, but Ireland lags well behind", so we are playing catch-up at this stage. One of the recommendations of the report is, "Increased collaboration between traditionally segregated adult and children’s services", for example, mental health services and schools. I met the Irish Association for Counselling and Psychotherapy two days ago. Association representatives have spoken to the Minister of State before. They spoke to me about their proposal for providing counselling and psychotherapy in secondary and primary schools. They say this service is going to be outside the scope that is already there for guidance councillors and would be on the recommendation of the school. This report could be a way of identifying children who need early intervention. Would this be something the Minister of State might work at? Could it be done in a cross-departmental way with the Department of Education?
It is interesting the Deputy has raised this today. Deputy Lahart raised it with me last night as well. The association has obviously been meeting with quite a few Deputies around the House. There would have to be collaboration with the Department of Education. We have collaborated previously when I sent out the leaflet on supports available to young people. The situation has changed, as we all know. The day is gone that when children present to school they just come to learn to read, write and do maths. Children are presenting with so many complex needs at the moment. I was in Mount Sion Primary School in Waterford, which Deputy Cullinane knows well, last week. I was there to speak about the supports offered to children, especially children with complex needs. Teachers know first-hand the supports children need. They have them for six hours every day. A collaboration between our Department and the Department of Education must happen. It is happening at some level but we must accelerate it.
10. Deputy Fergus O'Dowd asked the Minister for Health the way that he proposes to address the large shortfall of homecare assistants nationally through better pay and working conditions and through specific recruitment drives; and if he will make a statement on the matter. [25454/22]
Older people are being encouraged to stay in their homes as long as they can, especially as they age and get sick. The demand for home carers has never been greater and neither has the funding. However, the fact is every week we find people who have been assessed as needing home care for whom there is no carer available. At the end of March over 5,458 people nationally had been assessed as needing a home carer but not having one. There were 90 patients in acute hospitals awaiting discharge with nobody to look after them. How does the Department intend to recruit adequate and appropriate care for these people and keep them out of long-term care?
I thank the Deputy for his question and his continued interest in this particular sector. We have had many conversations on it. He is right the demand for home support has never been higher and its importance as an alternative service to long stay care has grown considerably over the past number of years. It is also a much more cost-effective way for the State to support people compared with them being in acute hospitals or nursing homes. In budget 2021 I secured additional funding of €150 million to progress the development of a reformed model of service delivery to underpin the statutory scheme for the financing and regulation of home support services and to provide 5 million additional hours of home support. I am delighted this funding has been maintained into 2022.
Last year we delivered 20.9 million hours, which is up 2.9 million on the previous year. That is a huge increase. We are currently supporting 55,000 people on a daily basis but there are challenges. On the figures the Deputy referred to, we had three areas that were especially problematic, namely, CHOs 4, 5 and 7. This week alone I had meetings with the chief officer and the older person's lead in both CHO 4 and CHO 7 to see what more I can do to help them. One thing we have done is I have put in place a cross-departmental strategic workforce advisory group. This group has met all the key stakeholders. We are trying to make home care an attractive, viable option as a career choice. That group is working well. There will be significant recommendations out of this I will bring to the Minister and with his support these can be brought to Cabinet. We will be looking for funding in next year's Estimates because this is a serious piece of work. The second piece I discussed with the Minister of State, Deputy English, yesterday concerned working outside the EU to encourage people and to make permits available so those outside the EU might come to Ireland to provide home care.
I very much welcome the initiatives but they do not change the fact that home care was provided by the State through the HSE and that has changed now. I get glossy brochures regularly from big companies that are moving into this area and treating it as a market rather than what I believe it should be, which is a career for people.
My point is I do not see any sign of a national recruitment drive. I see no ads on the television. I do not hear it on the radio. I welcome the Minister of State's initiatives on visas for people coming from abroad or outside the EU but we are not doing enough. We must tackle it. We must make it a career. It was a career in the health service; it was respected and was acknowledged as a very important one. We need to recruit full-time carers into the HSE, pay them and give them a career. The people want and need them. It keeps them out of inappropriate care and acute hospitals. As I said, 90 such people were in acute hospitals at the end of March taking up beds because they could not go home. I welcome the Minister of State's initiatives but we need more action.
The Deputy is quite right in what he says. A national recruitment drive is really important. As he knows, we have nine CHOs and they vary. CHO 9, which covers north County Dublin, delivers all its supports through both voluntary and private.
There is no HSE. It is something that evolved over many years. Its waiting list is the lowest in the country with 50 people waiting. Yesterday, I met with CHO 4, which is Cork-Kerry, and 75% of its home care is provided through the HSE and 25% is provided through the voluntary and private sectors. It is important to consider the voluntary sector here. Last week, I met with Northside Homecare Services in north County Dublin. It is a voluntary, not-for-profit organisation and it delivered 900,000 hours last year. It is doing phenomenal work.
However, I agree with what the Deputy said. We are doing a rolling recruitment campaign in certain CHOs, not all of them. The terms and conditions provided by the HSE include €16 per hour plus mileage. They are attractive compared with some in the private sector, but I agree with the Deputy and my meeting yesterday was focused on that.
I support the Minister of State with regard to community care and voluntary organisations. However, it is not possible in some communities to do that, particularly as towns grow to become cities and people are not as neighbourly. They do not know their neighbours as well as was previously the case and that community benefit is lost. I am delighted that it is there. Could the Minister of State let me have a note on how much is paid to private providers nationally and the number of hours they provide? They appear to have a significantly greater payment for the individual service they provide than the individual worker. However, it has to be a career, and it has to happen now.
The other point is one on which we all agree. There is a large number of people who are inappropriately in nursing home care. They do not need to be there and they are charged a fortune. In many cases they are getting excellent care, but in others they are getting very poor care. They need that care at home. That is the place to be. All supports we can provide there would be very welcome. I look forward to the Minister of State's national recruitment drive and I welcome her involvement with the Minister of State, Deputy English, with regard to access for people outside the EU.
We have spoken previously about this issue in home care. We all welcomed the work of the workforce advisory group. It has to look at the issues of visas and tax breaks. Pay rates have to be on the table, as well as expenses. There are anomalies among the various CHOs. However, we need a timeline. Beyond that, there is the wider issue of workforce planning to ensure we will have enough people to be able to cover what needs to be done because there are families under significant pressure as they cannot get people to provide adequate hours for their loved ones so they can stay in their homes.
We have had many conversations about home care, and I know everybody feels the same. I am in a unique position as Minister of State in that I have a budget of €672 million to deliver home care. Every one of those packages, apart from what comes in rolling over ten or 14 days, is funded. The other ones will be funded very quickly. The issue is not funding.
One issue we have, and I provided money in the Estimates last year and again this year for it, is that some of the CHOs, not all of them, are still working on a paper basis. They do not have a fit-for-purpose information technology, IT, system. We piloted an Irish company, which I will not name, in CHO 3, which is the area of Limerick, Clare and parts of Tipperary. This pilot has worked extremely well. I wrote to Mr. Paul Reid last week to see if it can rolled out across all nine CHOs. All the chief officers are very supportive of it. Trying to work a paper system for home care in 2022 is not fit for purpose. The IT system would also be way more effective with regard to waiting lists.
I will provide the note requested by Deputy O'Dowd.
12. Deputy David Cullinane asked the Minister for Health his plans for arresting the collapse of the dental treatment services scheme; and if he will make a statement on the matter. [26379/22]
This question is about the dental treatment services scheme, DTSS. I am aware there have been talks between the Minister and the Irish Dental Association, IDA, over the last number of months and that some movement has been made. Unfortunately, from the association's perspective, it does not appear to be enough. I am seeking an update from the Minister on the current position. Does he believe we can attract more dentists into the DTSS given the impact it is having on medical card holders?
The Government and I have been concerned for some time that medical card patients in some parts of the country have been experiencing problems in accessing dental services. The problem became particularly acute over the last couple of years as a significant number of contracted dentists chose to opt out of the DTSS. I secured an additional €10 million in budget 2022 to invest in the scheme. That is a combination of an increase in fees and the reintroduction of scale and polish.
To address the concerns of contractors about the viability of the scheme, I have also used approximately €16 million of an underspend in this year’s Estimate to increase the fees as well. Essentially, the spend on the DTSS last year was approximately €40 million and this year we are allocating €66 million. It is an additional €10 million and an allocation of a projected underspend of €10 million to an increase in fees. It is a very significant projected increase in the DTSS this year. Following consultation with the Irish Dental Association, the measures came into effect from 1 May. I am happy to talk through the increases if that is useful.
I hope this substantial investment and significant increase in the fees will encourage more dentists to stay in the scheme and, indeed, encourage dentists to return to it. However, that is not enough. These are interim measures. What is required is a root-and-branch reform of the scheme. The scheme was put in place many years ago and it is not fit for purpose now. This year, the Department, the HSE and the IDA will be involved in a fundamental review of the scheme to look at a scheme that is fit for purpose for today and into the future.
It looks like it is root canal treatment.
A sticking plaster solution is not going to work. I welcome the fact that funding has been increased. However, additional funding can be provided, and we have just discussed home care supports where the funding is available, but we cannot get the staff to provide the service. Telling people that the funding is there is no comfort to them when the service is not being provided. Obviously, we have to fix the scheme and get dentists back into it.
There is a wider issue here as well, and it is happening across primary care. We are at the mercy of independent GPs to deliver universal GP care if that is where we want to go. It is the same with independent dentistry. Obviously, there is a role for independent practice, but we also need to consider directly hired dentists to work in the public system if we want to guarantee services for medical card holders. What has happened here is that medical card holders have been left high and dry, and I am sure the Minister will accept that. In many parts of the country people who have medical cards cannot get access to dental treatment simply because the scheme has collapsed. We have to examine new and innovative ways to address that.
There are dentists employed directly by the State in community health centres across the country. I brought my child to one quite recently. It is an interesting proposal. Should we look at substantially increasing that with more directly employed dentists? It is certainly something I would not rule out and it could be examined. In the meantime, however, the vast majority of care is provided by contracted dentists.
I am not sure I would characterise it as a sticking plaster. If we are moving from a €40 million investment to a €66 million investment in one year, that is more than a sticking plaster. It is a very significant interim measure. The reality is that the scheme we have was designed in the 1990s. It is not fit for purpose and has to be examined. The cost of care has to be examined as well as part of that.
It is a sticking plaster solution if the money is not spent. That is the point. I welcome the fact that the Minister has committed the additional funding. He has gone some way to address some of the issues. I am not blaming all this on the HSE or on the Minister. I want all parties to come to the table to resolve this issue. The people I am focused on are the medical card holders who cannot get access to care. We can tell them we have provided more funding and there is a pot of money available, but if their dentist is not providing the service it is no use to them. Many of them do not have access to a public dentist to provide the treatment they need. The access does not happen in most areas because we simply do not have enough dentists.
We have to do the root-and-branch reform the Minister mentioned. I appeal to the Irish Dental Association and to dentists to engage with the Minister and the HSE and to come back into the scheme. However, from their perspective, it has to be on the basis of the root-and-branch reform taking place and a clear commitment that it will happen.
More needs to be done. It will be a sticking plaster solution if people cannot get access to the services I am talking about.
There is no doubt that more is needed. We have this short-term measure and the review, but more needs to be done. We are also looking at training and retention of dental graduates. We are looking at the numbers graduating and the mix between EU and non-EU graduates who are coming in and training. That has to be looked at. We are looking at that for medical students as well, as I know the Deputy will be aware. Ultimately, I agree with the Deputy. We need a new, sustainable, long-term scheme that makes sure everybody, whether on a medical card or not, can get access to affordable, high-quality oral healthcare when they need it. Unfortunately, at the moment, that simply is not the case for too many people.
Before we move on, cuirim céad míle fáilte roimh na ndaltaí scoile thuas staighre.
13. Deputy Richard Boyd Barrett asked the Minister for Health his plans to address the delays in assessments of need and the subsequent roll-out of services to children with developmental delays; and if he will make a statement on the matter. [26977/22]
Frankie is two. His parents, very worried, came into my office this week because a paediatrician and their own observation established that Frankie has very serious developmental delays, is non-verbal and is showing all the signs of severe autism. They got a letter stating he would be assessed within the legally required time, and then they got a phone call shortly afterwards from the disability network team stating it would be two years before Frankie would be assessed. That is a disgrace.
I thank the Deputy for raising this question. I offer my apologies on behalf of the Minister of State, Deputy Rabbitte, who is not able to be here. We hear stories such as Frankie's all the time, and the Minister is acutely aware of the current situation.
The new standard operating procedure for assessments of need was implemented for all new applications for assessments of need from 15 January 2020. Since then, approximately 10,000 preliminary team assessments have been completed. In quarter 1 of this year, the data indicate there were 1,719 assessment of need reports completed. The recent judgment of Mr. Justice Phelan in the High Court directed that the preliminary team assessment approach does not fulfil the requirements of the Disability Act. The judgment states a diagnosis is required to determine the nature and extent of a person's disability. The implications of any ruling from the Court of Appeal in respect of other relevant cases will be considered as soon as that becomes available. The HSE will now implement a process for a revised approach to assessments of need. In developing this, the HSE has engaged with a wide range of stakeholders, including families, providers, staff and representative bodies, in an intensive consultation to develop a pathway for assessment of need that seeks to comply with the requirements of the Act but also protects the commitment to the provision of intervention and principles as set out above.
It is important to note that what is different now that was not there before is that children do not require an assessment of need and may be referred directly to their local children's disability network team. The Minister of State, Deputy Rabbitte, would be able to speak about this subject much better. She has worked so hard on this, receiving funding through the Minister to make sure the assessments of need are carried out. Many children are then referred on to waiting lists, and there are huge issues in receiving these therapies.
I ask Deputy Boyd Barrett to refer the case that has been brought to his attention to the Minister of State, Deputy Rabbitte.
I certainly will refer it to the Minister of State, Deputy Rabbitte. I have also been talking to one of the barristers who is taking many of these cases and the situation is very bad. This story suggests the establishment of the disability network teams is not making any difference; it is just another layer. We have assessments of need, disability network teams, CAMHS and NEPS. It is all fragmented. In reality, while they might tick certain boxes, they are not actually doing the assessments or getting the services. The point is Frankie's future and the future of many thousands of other kids are at stake. If Frankie gets the early intervention and the supports now, he will be fine. Despite developmental delays and so on, he can flourish. If he does not get that, his future will be seriously jeopardised, as will the future of many other children. There are new layers of bureaucracy. Disability network teams, by the way, are 28% understaffed. That is the problem.
I will talk in a minute about the psychologists and the lack thereof. We need the law to be upheld and the rights of Frankie and other children to be upheld.
I wish to point out an important point. The assessments are being done. There have been 10,000 assessments done over the past two years. Obviously, the court ruling has challenged that. There were 1,719 assessments done in the first quarter of the year. My understanding is the assessments are being done and that children are being referred on to different multidisciplinary teams and the supports are not there.
Since 2019, funding has been provided by the Government for approximately 475 new development posts, enhancing the network teams throughout the country, with a similar situation being seen in a lot of the multidisciplinary teams. The teams are not full - we know that - and there is the same issue with recruitment and retention. The Minister of State, Deputy Rabbitte, has taken to having meetings in the various community healthcare organisations, CHOs, to listen to parents and to hear from those who are providing supports. I met with the psychologists recently. I will come back to that in a moment.
A preliminary assessment is not an assessment of need. That is the point and that is what the judge ruled on. It was a way of appearing to tick the box of assessment without actually giving the assessment necessary or the diagnosis. I see the Minister shaking his head. Why do Frankie's parents get a letter stating they will get their assessment by May? This is a tick box the law requires of them. This was earlier this year. The box is ticked, but then they get a call from a human being in the disability network team who says it will be two years before Frankie gets assessed. This is the difference between ticking boxes and actually doing assessments and then providing the services that are needed. I am not a psychologist. I have raised this so many times. If the Department wants to staff the teams, it should remove the barriers to psychologists being qualified and getting their doctorates such as extortionate fees. I know that is not a matter for the Department of Health, but we need joined-up thinking. There is no funding for educational or counselling psychologists. It is impossible for people who want to do psychology and who want to help children like Frankie, vulnerable children, to get qualified. Barriers are put in their way.
Deputy Boyd Barrett has spoken about the fact we need early interventions. I raised a Topical Issue matter on this and spoke about Louth and Dundalk and the lack of occupational therapists, OTs, and speech and language therapists in the area. There are people who have been assessed and who are being told they will not get services for a year or two years. Obviously, that is not on. I am back to the same issue. It is a matter of ensuring we have the throughput of training and we remove all obstacles. Beyond that, we need to do a serious amount of workforce planning, because otherwise we will fail these people, children and families, and the impact long term will be devastating.
It is acknowledged there are serious challenges in the filling of therapy posts due to the availability of new opportunities across the health and social care sector. As I have said, 475 posts have been developed since 2019. I reiterate that assessment of need reports will no longer be issued on the basis of a preliminary team assessment, and the HSE will engage directly with the families of those who received a PTA to establish if they wish to receive a further assessment under the terms of the Disability Act.
As for little Frankie, to whom Deputy Boyd Barrett referred, the Deputy is completely right that early intervention is key. Two years is not an acceptable wait time for any child or his or her family. If the Deputy sends on those details to the Minister of State, Deputy Rabbitte, I will discuss the matter with her.
We have a couple of minutes left. I could allow Deputy Connolly's question to be answered briefly.
14. Deputy Catherine Connolly asked the Minister for Health the status of the remedial actions that have been taken to date pursuant to the October 2021 inspection by the Health and Safety Authority of University Hospital Galway, including the temporary emergency department, as reported in an article (details supplied); and if he will make a statement on the matter. [26797/22]
This is a very important matter for Galway. I know the Minister is aware of it. I am raising the issue of the accident and emergency department and the recent report by the Health and Safety Authority and its background. Where is the new accident and emergency department?
If we cannot conclude, if we run out of time, I will make sure the Deputy gets a detailed note.
If the Minister wants to save time, I have the response.
The privileges of the Chair.
I have been advised by the HSE that the HSA conducted the unannounced inspection in University Hospital Galway, UHG, on 21 October of last year.
I understand the issues that were raised during the inspection were immediately addressed by the hospitals and that any obstructions, for example blocking the fire exits, were actioned to ensure continuous on-site safety. Following subsequent engagement between the hospital and the HSA, the hospital has implemented corrective measures, including in relation to ventilation, fire escape routes and safety signage. The hospital provided a comprehensive written response to the HSE in December of last year to address the issues that were raised. I have been informed that there was a follow up inspection of 7 April and that a formal report from the Health and Safety Authority, HSA, has yet to be received.
There are a number of ongoing and planned capital projects for University Hospital Galway, UHG. The Deputy and I have discussed these before. The development of the new emergency Department will address the current challenges in terms of capacity, infrastructure and patient experience times. The project is in its early stages and a strategic assessment report is being developed by the HSE. It is expected to be received by my Department in the coming months.
I can say to the Deputy that I was in UHG recently. There, I discussed with the senior management and the senior clinicians just how important this new four-story block, with which the Deputy is very familiar, will be. Because it will cost well in excess of €100 million, it must go through a laborious public spending code. However, following my meeting in UHG, I have raised this particular capital project directly with the chief executive of the HSE. I have asked that it will be prioritised by the HSE. While we have to adhere to the legal requirements of the public spending code, I have asked that there will be no more delays. I was told in the hospital that they have been talking about this build for about eight or nine years.
Deputy Connolly may give a very brief response.
I am stickler for time.
I could not accept that in 2015 it was unfit for purpose and yet here we are in 2022. I will follow it up elsewhere again.
