Vol. 1028 No. 2
75. Deputy David Cullinane asked the Minister for Health if he will outline his strategy for addressing the collapse of general practice and primary care out-of-hours services; and if he will make a statement on the matter. [52298/22]
We have a crisis in general practice. We have had reports in recent days of GPs and trainees seeking to emigrate. They are seeking to leave this State because they do not feel they will have opportunities here. The Minister will be aware that while I support the extension of free GP care, some concerns have been expressed by representative bodies about the capacity. We know out-of-hours GP services are not what they should be. What is the Minister's plan for general practice in the coming months and the coming years to build up that capacity?
I thank the Deputy for raising the issue. Like him, I recognise that there are challenges facing general practice in terms of capacity, including out-of-hours services, and importantly therefore for the people who matter in all of this, which is their patients and the communities they serve. Historically, out-of-hours services have been something that GPs have provided. We know that more and more GPs are now opting out of that provision and are looking to the State to provide it, for reasonable reasons relating to work-life balance and so forth, but it does create a very significant additional task for the State to provide services where in the past GPs might have provided them.
I would love to hear more balance, not from the Oireachtas on this but from the representative bodies. The GPs and their representative groups quite rightly demand new capacity and we are providing that. I would like to hear more - perhaps debates like this help - about the capacity that has already been added. For example, since 2019, three years ago, baseline funding for general practice has increased by more than €211 million, approximately 40%. As Deputy Cullinane will be aware, the budget for next year will provide significant additional funding for general practice in terms of extra capacity. I want to see a big expansion in the roles of practice nurses. There is much more we can do in terms of patients being supported and seen directly by practice nurses and in administrative supports and IT supports.
The roll-out of enhanced community care and direct access to diagnostics has been very well received by GPs this year. We estimate that approximately 200,000 scans will have been referred directly by GPs themselves. We provided funding of €25 million last year, €35 million this year and €45 million for next year. I will continue with the responses.
Obviously, I welcome any additional funding that goes into general practice, but I have also engaged with the representative bodies in recent years, in particular in recent weeks and months, since the Government's announcement. There are solutions. What GPs say to me is that we need to train more GPs and we need to increase the number of training places. I agree about practice nurses and that we need protected funding for training in order that we can have a better skills mix within general practice. We must also provide practice nurses with the option to become specialist nurses. We must consider employing GPs directly to provide out-of-hours locum support, but also to provide the out-of-hours services that GPs are perhaps not covering. We should have a blended mix of independent GP practices and directly salaried GPs who can do some of that work, but we also need a new, modern, fit-for-purpose contract. The contract itself is quite archaic in terms of the staffing subsidy. There is a lot that can be done. If that is done, and we put the infrastructure in place, then we can expand free GP care. There is a fear that if we try to go too quickly and the infrastructure is not there, we will end up with waiting lists for GPs, which I am sure the Minister does not want, I do not want and patients do not want.
I am very open to the idea of the HSE directly employing GPs. It is something we should pursue. We know there are some areas in particular that are affected, such as rural areas. For example, I am involved at the moment with an issue in certain parts of Galway concerning out-of-hours GP coverage. There is a role for directly employed GPs in some urban areas, in particular areas that are less well-off where the GPs are struggling.
There has been a significant expansion of training places. In 2010, there were 109 training places. This year, there are nearly 260, and we are on our way up to 350. We can go further. There is room for radical thinking. The Deputy may have heard me say recently that we should probably be looking at doubling the number of college places for healthcare professionals right across the board and increasing the training places to support the placements for the college places.
Saying it and doing it are two different things. Unfortunately, right across the healthcare system we have not seen the ratcheting up of training places that we need. In Sinn Féin's alternative budget I set out what we would have done this year, namely, 1,500 additional graduate and undergraduate positions across all the fields of study and increased GP training. Having a workforce planning strategy is very important and increasing training places is central to it. That must be done. When the Minister talks about increasing GP training, if he listens to GPs, which I am sure he does, many of them coming out of training places are opting to emigrate. Perhaps the reason is that independent practice is not for them, which is why we should offer the option of salaried GPs in the public system and provide the necessary out-of-hours GPs. As the Minister will appreciate and understand, that in turn will take pressure off acute hospitals and emergency departments. We have far too many people attending emergency departments who should be cared for elsewhere. Some of them simply cannot get access to out-of-hours GP services and end up in accident and emergency.
There are lots of things that we can do. What we need in the first instance is a new contract that is fit for purpose. The Minister must look at the staffing subsidies and increasing the training places. Once we see the infrastructure build up then we must, aggressively and robustly, roll out free GP care. That is what I want to see. I am very fearful that if we do not do that, we could end up with waiting lists for GPs and longer wait times, which nobody wants to see.
We are in agreement that we need more GPs. It is relevant that the number of places for GPs has more than doubled in the past decade and we are continuing to increase it. That is going to go some of the way. In part, that will provide more GPs and more cover, which is needed and, in part, it will allow for a different work-life balance for GPs. What younger GPs say to me is that in the past, in their parents' generation, GPs sometimes worked 60, 70 and 80 hours a week. They covered on-call and if somebody got sick in their community, they went out on Sunday night. GPs coming in now say they do not want that. In a lot of cases, they do not want to work on their own. They want to be part of multidisciplinary teams. They want a decent work-life balance. They are dead right. That is exactly what we need to do. We are increasing college places and training places. We are looking at providing rural GP supports.
I also agree that we do need a new GP contract. We are in the middle of several negotiations with the Irish Medical Organisation, IMO, at the moment. We are talking about non-consultant hospital doctors, NCHDs, the new consultant contract and many other issues. There have been some good additions to the GP contract such as chronic disease management and so forth. I agree that when we can find a bit of clear space, which will be soon, we can sit down with the IMO and start looking at a modern, fit-for-purpose GP contract.
76. Deputy Seán Canney asked the Minister for Health when St. Brendan's day care centre in Loughrea, County Galway will be reopened for use; and if he will make a statement on the matter. [51142/22]
I want to raise a very important issue that has arisen in the past year in Loughrea, County Galway, where we have a purpose-built community nursing home with a day case centre as part of it. When Covid came, the day care centre, Seven Springs, was closed. To date, there has been much confusion as to what is happening there. The service in the centre has been resumed one day a week and on the other three days it has been transferred to a local hotel.
There is great concern. I was at a meeting last Monday night that was attended by more than 75 people, mainly those who use the service. They will protest in Loughrea tomorrow morning on the basis that the service being provided is not fit for purpose and because they are being thrown out into the street.
I am taking this question on behalf of the Minister of State, Deputy Butler. Day care centres are fundamental to the health and well-being of our older population. They play a key role in enabling older people to live independently in their own communities. Their reopening has been a priority for my colleague, the Minister of State with responsibility for mental health and older people, Deputy Butler, since their necessary closure in 2020. This process began in the second half of 2021 and continues into 2022. By the end of October, it is expected that 304 centres will have reopened, representing about 91% of day care services for older people.
The Deputy asked about his local centre. In budget 2023, the Minister of State secured an additional €4.1 million to ensure the continuation of older persons and dementia day services to a high standard. The St. Brendan's day care service in Loughrea is open one day per week for a maximum of 14 attendees, as per HIQA stipulations. In addition to this, the HSE has an interim arrangement, as the Deputy outlined, to operate a service for three days a week in the Lough Rea Hotel. This arrangement commenced in September and can cater for a maximum of 24 attendees. The service operates weekly on Mondays, Tuesdays and Thursdays.
Unfortunately, the community nursing unit is not an option as a long-term location for the St. Brendan's day care service. The HSE is looking to identify an alternative site on the St. Brendan's campus.
HIQA has no remit over day care centres. Why has somebody decided that the existing Seven Springs site is suitable one day a week? If it is suitable on Wednesday, why is it not suitable on Tuesday, Monday or Thursday? What is the logic in this? As I understand it, there are capacity issues in the nursing home and the people who are using the day service have been moved out to facilitate that. Administrative staff are now using the day centre and that is not good enough. The HSE is talking about providing an alternative site within the St. Brendan's campus. How long will that take? When will a proper service be up and running?
There is also an attitude issue. Some of the HSE replies to a local councillor, Geraldine Donohue, who raised the issue, suggested that what patients had been getting was a very enhanced service, as if to say they should now get less and be thankful to be getting it.
As I said, the HSE is looking to identify an alternative site on the St. Brendan's campus but, unfortunately, the community nursing unit is not an option as a long-term location for the St. Brendan's day care service. In the interim, the HSE is operating a service three days a week.
The Deputy raised some interesting questions regarding the capacity issue and the fact that the site is being used by administrative staff. He asked how long the process will take, and while I do not know, I will find out. This issue needs to be resolved and perhaps we will try to get all the stakeholders around the table to resolve it because it seems what the Deputy is looking for is quite reasonable. If he wishes to send me an email, I will bring the matter to the Minister of State's attention.
Something is missing here. If HIQA has a role in day care services, did it approve the current location? I have seen a citation from the grandson of one of the service users. On her first day at the new location, she rang him at 11 p.m., crying and asking to be brought home. There is something fundamentally wrong here. This day service was purpose-built as a day centre; it was not amalgamated with a nursing home. It has been open for only about ten years. It is a modern building and it had all the services that were needed. It was doing exactly what the Minister of State suggested day services should be doing, but what we have now is not right. The attitude and the communication in respect of all this is totally wrong.
Tomorrow at 11 a.m., old people will march in Loughrea. Something is fundamentally wrong when something like this is happening in this day and age. There is a great loss here that has to be rectified, and not by someone telling us what is going to happen in the future. It has to be resolved now. The Seven Springs day centre needs to open and if there are issues within the community nursing home, they need to be dealt with separately.
I understand the Loughrea centre is open one day a week for a maximum of 14 attendees and, according to my notes, this is due to a HIQA stipulation. There are 23 services in Galway, of which 22 are open, so the Deputy's local service is the only one that remains closed. The HSE has assured the Department that it is actively looking to identify an alternative site on the St. Brendan’s campus and I hope this can be resolved. I will convey the Deputy's views to the Minister of State.
77. Deputy David Cullinane asked the Minister for Health when he will publish a multiannual waiting list strategy; and if he will make a statement on the matter. [52299/22]
The Minister recently stated, presumably in response to a journalist, that if there were 2 million people on waiting lists, Sinn Féin would not be happy, which is obviously a political charge. At this point, 1.3 million people are on hospital waiting lists. That does not make me happy; in fact, it makes me angry and frustrated because, like him, I deal with patients every day who have concerns about how long they have been awaiting access to care. Approximately 900,000 people are on acute hospital waiting lists and a further 500,000 are awaiting a diagnostic scan or are on a community waiting list. What more can the Minister and the Government do to tackle the very long waiting lists?
Before I respond, I welcome to the Gallery the girls and boys from sixth class in the Harold School.
When I made that comment, I was not referring to Sinn Féin, although I stand to be corrected. We all focus on the total number of people on waiting lists but my point, which I imagine the Deputy will agree with, was that the number that matters is the number of people who have been waiting for too long. The example I gave was that if 2 million people had been referred for care but were waiting a matter of days, that would be a healthy, well-performing healthcare system. What we have to look at is the number of people who have been waiting for too long.
I might outline for the Deputy some numbers I received just last night. The focus of the waiting list action plan, in the first instance, is to provide care for patients who we all know are waiting too long. In the year to date, the outpatient waiting list - we are starting with those who have been waiting for more than 18 months - has fallen by 23% and is continuing to fall. Over the past four weeks, a further almost 7,000 patients were taken off the outpatient list. It is now at its lowest level this year, which I am sure the Deputy, like me, will welcome. In terms of inpatients who have been waiting for more than 12 months, the numbers so far this year have fallen by 14%. Obviously, we have a long way to go but that is very good to see, not least in the middle of a pandemic. The most impressive figure relates to those awaiting a scope for more than 12 months. That number has fallen this year by 74%.
Of course, a lot more needs to be done. The waiting list action plan for this year is year one of a multiyear approach to this. The National Treatment Purchase Fund, NTPF, has taken on a very ambitious programme of providing care for patients waiting for inpatient care for 15 high-volume procedures. Those who have been waiting for more than six months will have their care arranged. More than 80% of those patients have been contacted and have care authorised. I am delighted to say the NTPF is now looking at moving the wait time from six months to five and increasing the number of high-volume procedures from 15 to 20.
Of course, I welcome any reduction in the length of time people are awaiting care and I acknowledge the slight drop in that this year, but it is not just about people who are being treated. According to my latest figures, 60,000 patients were taken off the waiting lists through a process of validation. I do not disagree with that - it needs to be done because the waiting lists have to be fit for purpose - but they are not all people actually being treated. Some of it relates to the fact that we are cleaning up the waiting lists, which does need to be done.
The Minister stated in an opinion piece published last February that he wanted to ensure people would not have to wait more than 12 months for any hospital procedure or 18 months for their first appointment by the end of this year. In my view, that is certainly not going to happen. A total of 120,000 people have still been waiting more than 18 months for their first outpatient appointment and 13,000 have been waiting longer than that. I have spoken to hospital managers and they need more beds in some hospitals.
They need more diagnostic capacity in public hospitals, not more outsourcing. They need more community beds and recovery beds in order that they can discharge patients and speed up that process. Crucially, they need more supports for people being cared for in the home and those with chronic conditions who are being cared for in the community. All of these measures are part of the solution.
Unless we have a long-term plan that beds in public investment rather than short-terms plans that are about outsourcing more and more, I do not believe we will actually get to a point where we really tackle the waiting lists. By the way, 1.3 million people waiting for care is far too many people.
I agree in terms of capacity. The hospitals, community care and the HSE all said we need record levels of investment and we need to add record levels of capacity, which is exactly what has happened. By the end of this year, compared to the start of Covid-19, there will be more than 1,000 extra hospital beds in the system. We will have funded approximately an extra 250,000 diagnostic scans and added more than 15,000 or 16,000 extra workers. We will have built an entire system of community care that did not exist 18 months ago.
The Deputy and I are agreed that record investment and record capacity is required in our public healthcare system. All of that is happening, which is why the waiting lists are now falling in spite of the massive challenges Covid-19 still presents to our healthcare professionals. I would be delighted to send Deputy Cullinane some of the lists of individual hospitals that are doing really well, including University Hospital Waterford in his own constituency. We just need to encourage them and keep going with the momentum.
University Hospital Waterford is one of the hospitals that has performed very well. I know that senior officials from the Department visited the hospital last week. There has not been a patient on a hospital trolley in 18 months, or maybe longer, in Waterford. We need to learn from best practice.
The reality is, however, that many of the beds that were promised still have not been delivered. Of course, while I welcome the additional 1,000 beds, 1,200 beds were funded. My understanding is that there are approximately 350 beds of the 1,047 that were committed in 2020. Then, there were additional beds in last year's national service plan. Approximately 350 beds have still not been delivered. It is expected that approximately 140 of those beds will not be delivered until the end of next year. These are beds for which the HSE was given funding.
Part of that goes back to the fact that we cannot recruit the staff quickly enough. Again, the Minister will acknowledge that 10,000 staff were to be recruited. There were approximately half of that last year. Hopefully, we can recruit more next year. All of that goes back to being able to plan and having the capacity needed to put into the hospitals in the first place. Without that, I am afraid that if we do not have a medium to long-term plan where we continue with the sustained investment we need, we will continue to see these long waiting times.
I agree with that, with one caveat, which is that we have a long-term plan. The Deputy will be aware that as part of the waiting list action plan, the chief clinical officer, Dr. Colm Henry, is leading out on 37 new models of care. The Deputy and I have discussed the need for record investment in capacity, which is happening. However, I think we are also probably in agreement about the need for modernisation of pathways for patients closer to the home and in the community. People should be going into the hospitals only when they need to be in there. We are also doing that.
The teams in the Deputy's constituency in Waterford deserve great credit. The latest figures as of yesterday are that the total outpatient list in University Hospital Waterford in the last 12 months has fallen 21%. That is a huge endorsement of the people in that hospital. Better still, the total number of patients waiting for outpatient clinics for more than a year and a half has, believe it or not, fallen by nearly 60% in the last 12 months. That is the kind of success we are beginning to see around the system. That is kind of success we need to spread and see happen in every hospital in the country.
78. Deputy Peter Fitzpatrick asked the Minister for Health when a psychiatrist will be made available on the HSE team in counties Louth and Meath for children with a dual diagnosis of autism and a moderate learning disability (details supplied); and if he will make a statement on the matter. [52629/22]
Families of children with autism and moderate learning disabilities who are due diagnoses are in a crisis situation in counties Louth and Meath. I am aware of 15 families who have adolescent children with autism and moderate learning disabilities who urgently require a psychiatric review but have been told by the HSE that the service is not available as there is no psychiatrist on the HSE team. When will a psychiatrist be made available on the HSE team in counties Louth and Meath?
The total allocation for mental health services in budget 2023 is more than €1.2 billion. This significant investment will enable implementation of many of the short-term and medium-term measures in our mental health policy, Sharing the Vision. We are enhancing mental health supports across a broad continuum. These range from mental health promotion, prevention and early intervention to acute and specialist service delivery. The mild mental health needs of adults and children with intellectual disabilities are generally best met in services such as HSE primary care or disability services. People may have moderate or severe mental health difficulties in addition to their intellectual disability, however, which can mean treatment needs are more complex.
On 9 September last, the Minister of State, Deputy Butler, launched the new child and adolescent mental health services, CAMHS, intellectual disability model of service. This will ensure that children and adolescents with intellectual disabilities have equal access to mental health care. A child and adolescent mental health service and mental health intellectual disability consultant is being sought at present for Louth-Meath mental health services. The HSE has advised the Department that it has to date been unsuccessful in filling this position. The HSE is again proceeding with recruitment. No date has been identified so far for when the post will be filled.
A common threat for children with autism who are transitioning to adolescence is high anxiety levels and obsessive-compulsive disorder, OCD, behaviour. Many of those adolescents are non-verbal. They display their anxiety through OCD, self-injury behaviour, hitting themselves with force, property destruction, poor sleeping patterns and assaulting others. Many of these families live in constant fear of attack from their adolescent child. They live in houses that have been significantly damaged by their adolescent child.
In one situation, an adolescent child flooded the house by pulling the radiators off the wall, and architraves were pulled away from the doors. The same family has no doors on their bathrooms due to destruction. In addition, many of these adolescent children have younger siblings who are in danger of being hurt. This situation cannot continue.
People cannot get a psychiatric consultant in counties Louth and Meath. There must be something seriously wrong. It is not acceptable. These families need help. I ask the Minister of State to come to County Louth to talk to these families. They are in a terrible position at the moment. For me to ask the question on their behalf and get the answer that no one is available makes no sense whatsoever.
I am taking this question on behalf of the Minister of State, Deputy Rabbitte, to whom I will bring back the Deputy's views.
Seemingly, a CAMHS mental health intellectual disability consultant is being sought at present for Louth-Meath mental health services. The job was originally advertised for Louth-Meath and Cavan-Monaghan, with Cavan-Monaghan having governance. The post was interviewed for and offered to only one candidate who met the criteria. Unfortunately, the post was declined.
Louth-Meath mental health services were then advised to recruit a consultant separately for the area. We are proceeding with this recruitment campaign with the post going through recruitment at present. Unfortunately, however, there is no date as yet from when the post will be filled. I have heard the Deputy's concerns loud and clear and I will bring them back to the Minister of State as soon as possible.
In addition to no psychiatrists being available, the only pediatrician available in Louth-Meath is Dr. Maeve McCormack, who will only see children who are aged 16 years or younger. There is a four- to five-month waiting list to see Dr. McCormack. CAMHS will not see teenagers who are due a diagnosis and those adolescent children cannot be seen by mental health teams until they are 18 years of age. I am sure this is not only happening in counties Louth and Meath. These families are crying out for help. Apart from the patients themselves, this also affects the families and siblings. This situation should not be happening with the amount of money that is being spent on our health budget, especially next year with €23 billion.
I cannot understand the situation at the moment. How did we let ourselves get into this situation with no psychiatrists and no paediatricians? Is there a problem with County Louth? I have met with representatives from the HSE on numerous occasions and, in fairness, they are doing an absolutely fantastic job in Louth County Hospital. These families and children need help, however. This should be a priority. I will ask the Minister of State once more. Will he or someone from his office please come and meet some of these families to realise first-hand the problems they are having?
I agree with Deputy Fitzpatrick. People with intellectual disabilities should have access to supports for mental health services in the same way as the general population around the country within a framework that is multidisciplinary and catchment area-based. Teams should have the appropriate training and expertise and should be suitably resourced.
As the Deputy will be aware, 3.8% of the population has intellectual disabilities and there is an increased prevalence of mental health problems. Up to 25% of those with mild to moderate intellectual disabilities and up to 50% of those with severe to profound intellectual disabilities experience mental health problems.
There is an issue with recruitment, in that the HSE has gone out to recruit but has not been successful. However, I will bring the Deputy's concerns to the Minister and try to get the position filled as quickly as possible.
79. Deputy Mattie McGrath asked the Minister for Health the number of drug support workers in County Tipperary; the supports available for young persons with drug addictions in County Tipperary; the steps that will be taken to address the growing drugs crisis in County Tipperary; the measures that his Department is taking to work with An Garda Síochána and other bodies to break the cycle of more young people falling into addiction; the number of people being supported with drug addiction in County Tipperary; the supports available to meet the cost of addiction counselling and rehabilitation; the supports that can be made available to help those who have come through rehabilitation and are facing homelessness, bringing greater risk of falling back into addiction without appropriate housing; and if he will make a statement on the matter. [52630/22]
How many drug support workers are there in County Tipperary, what supports are available for young people there, and what actions is the Minister of State taking, along with the Garda, to deal with the growing drug and mental health problems, which are intrinsically linked, in Clonmel and across the rest of Tipperary?
I thank the Deputy for raising this issue. I have been to the county, including Clonmel, and seen the great work that the services there are doing. National drug treatment data show that 380 cases were treated for problem drug use in Tipperary in 2021. Of those, 114 were treated for cocaine as the main problem. Separately, there were 294 cases treated for problem alcohol use. Drug services in Tipperary are provided by the HSE, regional drugs and alcohol task forces and section 39-funded community and voluntary groups. I am providing a comprehensive report on these services for the Deputy.
The Government's health-led response to drug and alcohol use is set out in the national drugs strategy, Reducing Harm, Supporting Recovery. My priorities for the strategy are to strengthen the prevention of drug and alcohol use and the associated harms among children and young people and to enhance access to and delivery of drug and alcohol services in the community. In budget 2023, I secured €4 million in new development funding to expand the provision of drug and alcohol services to meet changing patterns of drug use and emerging trends. This investment will expand community-based drug and alcohol services, ensure the sustainability of residential treatment services and increase their capacity, mitigate the impact of drugs on children, families and communities, and strengthen drug monitoring and harm reduction. Full details are set out in the budget fact sheet.
I am committed to a health-led approach to drug use, one that promotes a compassionate and humane approach to people who use drugs, with addiction treated first and foremost as a public health issue.
Every town and city in the country has been plagued by drugs, but the drug crisis in my town of Clonmel, which is a fine town, has almost gone out of control over the past 18 months. This is sad. We have no mental health supports. We do not have one long-stay bed. Crack cocaine and heroin are openly available on the main street and its curtilages and unfortunate souls are seen begging, falling over, out of their minds, being physically or verbally abused and fighting among themselves. They are destroying themselves, but this is also intimidating shoppers and, therefore, has a significant knock-on effect on business in the town.
For those who manage to make their way into rehab, there is a considerable risk of falling back into drug use, given the level of availability. Drugs are in nightclubs and everywhere else. It is alarming. We do not have anywhere near enough support workers. At last week's meeting of the joint policing committee, JPC, the chief superintendent said that he wanted to see more drug support workers working in liaison in the Garda. We need an all-hands-on-deck approach and support from various sectors of society.
A great deal of good and necessary work is being done and I thank all of the stakeholders - the drug and alcohol task forces and everyone providing a service - in this difficult situation. We secured €7 million for new developments. Some €1 million of that will go towards strengthening the monitoring of emerging drug trends and expanding community-based services as part of the community services enhancement fund.
Recently, I announced an allocation of €1.5 million for a three-year drug prevention and education programme. This is the first time that national funding has been made available for drug prevention. This programme is a key deliverable under the national drugs strategy to strengthen the prevention of drug and alcohol use and related harm among children and young people. A great deal of good work is being doing with schools, families and the general community. I thank all of the stakeholders for the great work that they are doing to prevent drug use as much as possible.
I accept that good work is being done up and down the country, but we do not have the resources. We have to try to break the cycle. It is sad when more and more young people fall back into drug use after going through rehab. The housing and drugs crises are inextricably linked. This is a well-known fact and is accepted by all who review this matter. We must try to impact schools, which are doing their best. After 17-year-olds and 18-year-olds leave school, though, they seem to be left to the mercy of the waves.
There is a major problem. I wish I could stand up and speak about something more pleasant this morning, but the situation in Cluain Meala is appalling. It is a fine town with fine people and is the second largest inland town in the country, but we do not have the resources. The Garda does not have the resources but could not do this work alone anyway. We need support workers who are active and visible if we are to deal with this problem, get it off the streets and, above all, get these people out of their drug-taking habits and back into rehab so that they can get their lives back on track again. It is sad to see unfortunate souls on the streets who do not know where they are or what they are doing, falling over and intimidating others. It is desperate. They are all human beings and we need to look after them and provide some modicum of safety to them as well as others who share the street space with them.
The Government's health-led approach to drug and alcohol use is set out in the national drugs strategy, Reducing Harm, Supporting Recovery. My priorities for the strategy are to strengthen the prevention of drug and alcohol use and the associated harms among children and young people and to enhance access to and delivery of drug and alcohol services in the community.
The Deputy has raised an issue that is impacting many cities, towns and villages around the country. We have to strengthen drug monitoring and harm reduction measures and mitigate the impact of drugs on children, families and communities. I thank the various stakeholders across many Departments, section 39 workers and voluntary workers for their incredible work. The Deputy is right, in that there must be compassion for people who use drugs. There must be a way forward. I am blown away by the great work that is being done by communities.
