Holly Cairns
Ceist:6. Deputy Holly Cairns asked the Minister for Health the steps he is taking to recruit more staff for the out-of-hours GP cover, SouthDoc, in counties Cork and Kerry. [18353/23]
Ceisteanna Eile - Other Questions
General Practitioner Services
The Minister will be aware of the major pressures GP out-of-hours services face across the country. SouthDoc, which is the Cork and Kerry service, is having issues with recruiting staff, especially in rural areas. That has resulted in some of the services not running. Local GPs and their staff are already overstretched and they cannot be expected to also provide out-of-hours cover. What is the Minister doing to address this issue?
GPs are contracted under the GMS scheme to make arrangements for their patients to be able to make contact outside of normal practice hours. Commonly, GPs are working with co-operatives to do this. SouthDoc provides an excellent and important service to people in counties Kerry and Cork. I acknowledge the commitment of the nurses, doctors and other staff providing urgent out-of-hours care in Cork and Kerry, as well as those who are working with GP out-of-hours services throughout the country.
Nevertheless, I recognise what is implicit in the Deputy's question, namely, that coverage is not perfect and there are concerns. I know, for example, that around Castletownbere there are difficulties in recruiting locum doctors. Sometimes that means that patients have to travel further than is ideal for the use of SouthDoc services. I am also aware of concerns about provision in Fermoy, although I am assured that there are no plans to change the service there. I think there are some local concerns that there will be a diminution of the service.
SouthDoc is a private entity which has more than 500 GPs, 26 treatment centres and 19 vehicles. To address the Deputy's question, as a private entity, it is up to SouthDoc to hire as many GPs as it can. There is, however, more we can do. At the IMO conference in Killarney, some doctors involved in out-of-hours services asked me to convene a national forum on out-of-hours services so they can come together to share what is and is not working. We are now kicking off the strategic review and out-of-hours services will be part of that. Some parts of the country are receiving an excellent service. In some parts of the country, services are finding it difficult to recruit. In some parts of the country, to be honest, the services are probably run in a more productive manner than in others. We want to ensure we have consistently good coverage across the country.
I acknowledge the Minister's statement about the forum, which is great, but I wonder when it will happen. I am not feeling a sense of urgency from the Minister in relation to this matter. There needs to be a greater priority given to recruiting and retaining doctors in these services, especially in rural areas like west Cork. As the Minister said, I previously raised with him the case of the Castletownbere service, which has been completely unavailable on multiple occasions due to staff shortages. The regular GP staff are doing all they can.
In reply to a parliamentary question, the HSE told me that due to the reliance on locum doctors and the significant shortfall in their availability, there may be occasions when this additional support is not available. For people in Castletownbere, the nearest SouthDoc service is almost an hour away, either in Bantry or Kenmare, on quite bad, narrow country roads. The Minister can imagine how difficult it would be for someone with a sick child or an elderly parent.
Another case is the Kinsale service, which was closed a number of years ago, despite huge local opposition. Kinsale is a large and growing town which should have a dedicated service.
I fully acknowledge that, particularly around Castletownbere and other areas, it is a great worry for parents or anybody else that getting to a GP could involve a long and difficult drive at night. That is not something we want to see. There are several things we are doing which will take time but will make a big difference. For example, we are trebling the number of GPs in training. That will take time to deliver the number of GPs we need but it will result in a substantial increase in GP numbers.
What can we do in the meantime, over the next one to four years? We are working with the Irish College of General Practitioners on international recruitment. For example, it has a project to bring in GPs from South Africa and other countries and it is targeting, in particular, rural areas such as Castletownbere and many other areas in Deputy Cairns's constituency. We can do more, including bringing together a forum and seeing what else can be done through the upcoming strategic review.
This matter needs to be more of a priority because this service provides vital care and is needed by people not just in west Cork but in other rural areas. I understand these things can take time but there is also a lack of joined-up thinking and utilisation of resources, which can be frustrating for people in those areas.
SouthDoc services are under pressure and, at the same time, Bantry General Hospital's medical assessment unit only opens from 9 a.m. to 4.30 p.m. Extending the opening hours of this unit is not only important in itself but would help relieve the stress on SouthDoc services. The absence of those services, in turn, adds strain to the few ambulances operating in west Cork. Between Bantry, Skibbereen and Castletownbere, three ambulances are ordinarily operational but they might go somewhere else and then travel elsewhere from there. One rapid response unit operates between 7 a.m. and 7 p.m., after which it no longer operates. Each of those systems is under-resourced, which puts additional strain on all the healthcare workers in the area. We need to take a more holistic approach to this. SouthDoc needs more staff, Bantry General Hospital's medical assessment injury unit needs to be open for longer and we desperately need more ambulances.
I am very happy to look at the situation in Bantry General Hospital. We are expanding access to the medical assessment units as part of an expansion in urgent care. If there is a shortage of fleet in the Deputy's area, I will talk to the National Ambulance Service about that. We have invested a significant amount of money in the service this year and last year. It is expanding and modernising its fleet and hiring and training many more paramedics and advanced paramedics. The ambulance service is not there yet but it is rapidly moving in the right direction. I will raise the concerns with the National Ambulance Service.
Significant investments are being made in Cork University Hospital, Kerry University Hospital and the Mercy University Hospital. This will also help a great deal in the Deputy's constituency. While these hospitals are not located in rural areas, increased capacity in them will make a difference at a regional level in terms of the more localised services the Deputy referenced. I will certainly raise with the HSE the issues the Deputy has outlined.
Mental Health Services
Pa Daly
Ceist:7. Deputy Pa Daly asked the Minister for Health what reviews are currently taking place with respect to north Kerry child and adolescent mental health services, CAMHS; and how they differ from the announced national audit of cases. [17949/23]
I am taking this question on behalf of my colleague, Deputy Daly. I ask the Minister of State at the Department of Health what reviews are currently taking place with respect to the north Kerry CAMHS and how they differ from the announced national audit of cases.
I was expecting the Deputy's colleague, Deputy Ward, who is seated beside her, to take this question on behalf of Deputy Daly.
Following the publication of the Maskey report, in order to gain assurance about the quality of the CAMHS service being provided in north Kerry, the HSE confirmed a planned sample file audit of 50 files in north Kerry CAMHS would take place. This was a random audit of files and represents approximately 10% of the caseload of the north Kerry CAMHS teams. I make that point to ensure there is no confusion and we all understand the situation that ensued in relation to south Kerry and the Maskey report. As a result of the Maskey report, concerns were raised that there may have been a crossover between north Kerry CAMHS and south Kerry CAMHS. That is why we are discussing this today. This audit was undertaken by a team of ten consultants from across the country, with oversight provided by the national clinical adviser and group lead for mental health.
On 21 January 2023, the local HSE received a final report from the team of CAMHS consultants who carried out this audit in north Kerry. The audit team raised potential concerns regarding the standard of care received by a small number of patients. The audit team recommended that a further review be carried out of all cases currently open to the service. Based on these concerns, HSE community healthcare organisation, CHO, 4 took immediate action by beginning the process of setting up a look-back review. I gave a commitment at the time that if any issues were raised in north Kerry, we would move to a look-back review. The HSE has advised the Department of Health that in preparation for the first phase of this north Kerry look-back review, the files of current cases are being profiled in order of urgency and risk.
Discussions with a proposed senior clinician to lead on the review are ongoing and the draft terms of reference have been developed. The review is separate from the audits arising from the Maskey report, more specifically the national prescribing audit, which focuses on prescription practices in CAMHS, and the national audit of compliance with the CAMHS operational guidelines.
As I said, I am asking this question on behalf of my party colleague. The results of the reviews that have so far taken place, whether by the HSE or the Mental Health Commission, are clear that serious lapses in standards of care took place, with devastating consequences for children and teenagers in Kerry and their families. At the time of the publication of the south Kerry look-back review, the Taoiseach admitted it was a serious matter, yet we have seen little progress on the urgent restructuring that is needed within mental health services in Kerry. The status of the north Kerry review, which the Minister of State touched on, is also unclear. Of what value is it for families in the context of the wider audit?
I understand Deputy Daly also asked separately how many families had come forward. Any information the Minister of State might have in that regard would be appreciated. In the immediate aftermath of the scandal breaking, families, children and young people were left without any support and with a local service they understood had let them down. The families feel as though the progress made leaves a lot to be desired.
I know the Deputy is asking this question on behalf of her party colleague but I do not agree the status is unclear. It is crystal clear. On 21 January 2023, the local HSE office received a final report from the team of CAMHS consultants who had carried out the audit. When concerns were raised by the audit team in respect of individual children, immediate contact was made with the families and clinical reviews and open disclosure meetings were facilitated as appropriate. Contact was also made with the families of the remaining 34 young people reviewed by the audit team advising that their files were part of the north Kerry CAMHS clinical audit and that the audit had found no evidence of harms. The audit looked at 50 files and 34 families were contacted, thankfully, to say there were no issues, while between 14 and 16 cases warranted a look-back.
Last week, I travelled to Ballincollig in Cork and met families of children who had been affected by the debacle in Kerry CAMHS. It is important to keep in touch with the families affected.
I thank the Minister of State. I will relay that information to Deputy Daly. Some of it might be new information, not least the reference to meetings she held last week. Deputy Daly made the point that the latest figures show 4,314 children are awaiting CAMHS appointments, 88% of them since the start of 2020. More than 600 of these children have been waiting for more than one year, with the majority in Cork and Kerry.
In general in respect of CAMHS, we need a properly staffed CAMHS team to address the waiting lists and ensure we will not face the same issues again. The crisis was fundamentally an issue of proper supervision and oversight, with a lack of adequate workforce planning at its heart. It is true of all CAMHS services that we want to see them work well, given we are talking about children and young people. What plan has been brought forward to resolve the issues and start the process of rebuilding trust with vulnerable children and service users? The Minister of State touched on some of this in her initial reply.
Since the Maskey report was published, the emphasis has been on Kerry, and rightly so, given the chronic mistreatment of children there. Deputy Funchion cited figures from February but they have increased again since March. I have figures to hand that show the national figures in CAMHS increased by a further 3% between February and March. A total of 4,434 children are waiting for a first appointment, while 682 have been waiting for more than a year. CHO 4, where the emphasis should have been, has the longest waiting list. When the Maskey report was published, 764 children were waiting for a first appointment, whereas that figure is now 888. Some 343 of these children in CHO 4 have been waiting for more than a year, amounting to 50% of the national total in that one CHO area.
I raised this issue yesterday with the Minister for Health at a meeting of the Joint Committee on Health and he indicated he would refer it to the Minister of State. If I am being realistic, I know I am not going to get that answer straightaway, so I will not put her on the spot, but I will ask her the same question I asked the Minister yesterday. What is being done to address this? The figures do not lie. The waiting lists are going up and up and CHO 4 seems to be an outlier in the context of these bad figures.
I thank both Deputies for their questions. As I was going to say in response to Deputy Funchion, we are all very aware of the challenges we have in CAMHS throughout the country and of the fact waiting lists are going in only one direction, which the Minister and I are very unhappy about. We speak about it constantly.
One thing Deputy Ward did not mention is that there were 33% more referrals to CAMHS in the past two years than ever before, and the teams saw 21% more children than ever before. The number of referrals coming in is unprecedented-----
If they got the appropriate primary care, they would not need them.
If I can answer, 225,000 appointments were given to children in the care of CAMHS last year. Ninety-one people were added to mental health staffing between December 2021 and December 2022. It is not that we are not acting.
To drive CAMHS reform, I am holding a series of roundtable discussions with key CAMHS stakeholders. The first meeting, to be held this afternoon, will involve the College of Psychiatrists of Ireland, the HSE and the Department. In the next two weeks, there will be further meetings with NGOs relating to psychology and mental health reform - across the board - to see how we can address this issue. I am very concerned about the waiting lists.
Covid-19 Pandemic
Gino Kenny
Ceist:8. Deputy Gino Kenny asked the Minister for Health what plans the HSE has for holistic, neuro-focused, multidisciplinary long Covid clinics; if he will tackle the long waiting lists for long Covid appointments; and if he will make a statement on the matter. [17659/23]
What plans does the HSE have for holistic, neuro-focused and multidisciplinary long Covid clinics?
I am very aware that despite all the progress on Covid, long Covid is causing a great deal of suffering for people. We heard some testimony earlier on "Morning Ireland", which the Deputy may have heard, from people who are suffering from long Covid. We also heard, however, from the clinical leads about what is happening, and it is clear services are being put in place, as they must be.
To ensure people who need the care get it, the HSE has developed a plan for national long Covid services, which are being rolled out. The model of care provides a framework for how the services are designed and delivered. It has an holistic focus on service delivery, provided through GPs and community-led interventions, with specialist consultant-led clinics where appropriate.
The investment in this service has trebled this year, so we are taking it seriously. To date, six long Covid clinics have been established as well as six post-acute Covid clinics, while two further post-acute clinics are due to become operational shortly. As well as that, a dedicated neurology clinic is being established in St. James's Hospital to provide specialist assessment, diagnostics and treatment planning for patients who have persistent symptoms, as was mentioned by the clinical leads this morning. The service is led by a consultant neurologist. In addition, the HSE has developed online resources for the self-management of symptoms. Critically, there is additional training for healthcare workers, including GPs, who are trying to support their patients.
Recruitment is ongoing to fully staff the new long Covid service. Staff include consultants in infectious disease, respiratory medicine, psychiatry and neurology as well as health and social care professionals and clinical psychologists. In total, an additional 39.4 staff have been recruited to date and further recruitment is under way.
I thank the Minister. We welcome that. A conference on long Covid is due to be held today. We are only beginning to understand the evolution of long Covid. Many have been affected by this extremely debilitating condition. We probably all know someone who is suffering from it. In some circumstances, it has changed their life and put it on hold. Some people who had been very healthy contracted Covid and their lives changed, although the good news is the vast majority will recover from long Covid. People who are in that position want to access the best interventions possible in respect of not only respiratory issues but also cognitive impairment.
Sometimes the latter is lost in all the intervention that we are talking about regarding long Covid.
I agree with the Deputy on all that. The good news, as he said, is that for the vast majority of people, a relatively short amount of rehabilitation and health support leads to full recovery.
I have met patients whose lives have just been turned upside down. I have met patients in my own constituency. I have met patients in Tallaght hospital who are being treated in the long Covid clinic there and they are just devastated. They have gone from healthy active people, and, in some cases, healthy active mums and dads, to not being able to get up the stairs or get to the shops. For those whom long Covid affects badly, it can be absolutely devastating.
Obviously, it is an evolving area. HIQA conducted a thorough review last year to inform the model of care that we are putting in place but this will be an evolving area. The HSE has a new survey in place and the European Commission is also putting together a high-level informal network so that member states can learn from each other and update the service provision for people as we learn more.
That is all welcome. It is important that the State recognises that long Covid is prevalent and the vast majority of people will make a full recovery as long as they get the intervention, which is most important.
A major concern is waiting times for those suffering from long Covid. At present, it can be up to a year before they can get that intervention. That is probably not good at all because of the evolution of long Covid. It can last longer than even a year but generally the symptoms, if somebody is to make a full recovery, will probably just go beyond nine months to a year. That is generally the trend of long Covid but the waiting times are a huge concern for those who want to access those multidisciplinary interventions that they should receive.
We do not want anybody waiting long for this for obvious reasons. Part of what we are doing now with these new clinics around the country is staffing having them. We will have 14 clinics, and then the St. James's facility as well. People can also get initial treatment from their GP, which is an important message. Where more specialist care is required, we are putting these new services in place. They are still hiring. We want to, and our aim is, put in enough capacity that we can make sure people get quick access.
For reference, the long Covid clinics we have in place now are in St. Vincent's, Beaumont and Galway hospitals. The post-acute clinics are in Galway, the Mater and Connolly hospitals. We have combined ones in Tallaght hospital, St. James's Hospital and Cork University Hospital. There are two more coming, which, I believe, are in Limerick and Letterkenny hospitals.
Níl na Teachtaí anseo agus tá mé ag bogadh ar aghaidh.
Question No. 9 taken with Written Answers.
Question No. 10 taken after Question No. 13.
Questions Nos. 11 and 12 taken with Written Answers.
Healthcare Infrastructure Provision
Éamon Ó Cuív
Ceist:13. Deputy Éamon Ó Cuív asked the Minister for Health the steps he is taking to ensure more speedy delivery of capital projects by the HSE; the policy changes he is introducing to ensure this; and if he will make a statement on the matter. [18202/23]
Just in time, JIT, díreach in am. The question is very simple. The Government and the Minister have the money but we are not getting delivery of big and small health projects as speedily as we need it. We can go into this in more detail in the supplementary questions. What has been done to speed up procedures so that we can get necessary health facilities in place? The old barriers are gone but if we eliminate old barriers, we always seem to arrive at a new one.
I fully agree with the premise of the Deputy's question.
Before getting into what we are doing to speed it up, it is important to state that in spite of an extremely cumbersome process that leads us to being able to put new infrastructure in place, the Government has over the past three years expanded infrastructure and added critical care beds, diagnostics and primary care centres at a rate that has not been seen since, and likely long before, the HSE was founded. We need to give credit, dare I say, "to Government" for allocating the money, to all of the Oireachtas for supporting the allocation of that money, and to the Department and the HSE and their partners because there has been a substantial increase in infrastructure. Nonetheless, it takes far too long to build infrastructure in this country.
I am happy to be able to share that, working with the Taoiseach, the Tánaiste, the Ministers, Deputies Michael McGrath and Donohoe, we have recently agreed some important changes. We have agreed that the limit where the public spending code - the public spending code being this extraordinarily detailed 17-step process - kicks in be moved from €100 million to €200 million. That means that most bed projects in the country will no longer have to go through the code. That will speed projects up.
Second, in the Deputy's own region and in the Leas-Cheann Comhairle's region, there is a massive investment planned for Galway. We are looking at putting in the eight-storey emergency department, ED, women's health block. The Deputy will be aware we are sanctioning detailed design now for the cancer centre for the region. We are looking at putting in place the new laboratories. We are looking at putting in place the new elective hospital. I am working with Government for these very large projects to reduce the number of steps required. The key number of steps required for many of these, the smaller projects, has been brought down from five to three and then we will be looking at the bigger projects to see how they can be accelerated as well.
I am reasonably happy that the four big projects are going ahead. I have a specific question on that. Is the limit of €100 million per individual project? Will the elective hospital be taken as one project, the ED as another and the cancer and the laboratories as another or is it a cumulative €200 million between the four projects put together even though they will not be physically conjoined together?
One Taoiseach said that it is the little things that catch you, and we have that syndrome. I can name for the Minister some health centres, an ambulance base and a community nursing unit, CNU, that seem to be going on forever and not getting built. These are small projects. These should be done in a matter of two or three years. There is no big principle involved in them. We are promised them. They are needed but they are not happening. Is there anything that can be done to speed up these small projects that are not held up by any Government guideline but just need to get done?
In answer to the Deputy's first question, each of those projects is a separate project in terms of the €100 million versus €200 million. It will not come as a surprise to any of us that several of those projects will cost well in excess of the €200 million but, critically, even where they will, and where the public spending code to date has five separate approval stages and I have had to bring memorandum after memorandum to Government, for example, on the elective hospitals, much to the frustration of everyone in government, it has been agreed with the Ministers, Deputies Donohoe and Michael McGrath, that the five stages is brought down to three. That will help with all of those projects.
When it comes to the smaller projects, be that an ambulance base or a primary care centre, or, indeed, another project we did not mention to go into Galway, which is another bed block the hospital needs as well, that might well fall under the €200 million. That might well be the kind of one I am looking to bring in if I can get agreement on the 1,500 rapid-build beds.
To give an example of what we face in practice on the ground, there was a health centre planned and planning permission for Inishbofin in the 2000s. It never happened. They are trying to move site but it is going on forever. More than two years ago, the Minister might remember the need for the ambulance base in Connemara. We got the ambulance and we got the staff within four months. They were to convert an old health centre into an ambulance base. We seem to be running into all sorts of problems even though it is within a 60 km/h zone, or a village zoning, with everything from parking space to planning and whatever.
On the CNU, the Minister has heard the saga of Clifden hospital, which the Minister of State, Deputy Butler, will be more than familiar with, and St. Anne's. We were promised repeatedly - the Leas-Cheann Comhairle knows all about this - a new community nursing home unit. The reality is it has not even gone to planning yet.
Much as I would like the Deputy to go on, we are over time.
These are the kinds of issues. I could give the Minister a list. I note the Leas-Cheann Comhairle is absolutely dying for me to go on because she is as interested in this subject as I am.
I am, but I have to keep the time.
I will not delay the Leas-Cheann Comhairle but I would say that we need a rapid way of dealing with these problems. It might also need issues such as planning and so on to be fast-tracked where there is an obvious need for health reasons.
I also want to raise a serious situation in my own constituency, where construction work continues to be halted on a multimillion euro primary care centre in Ballyhaunis, County Mayo. Construction work was halted in early 2022. I have written to the senior HSE management in community healthcare west. Management outlined that it remains on hold as the landlord agrees costs to completion with the contractor and his subcontractors. This is totally unacceptable. This centre was due to be opened in early 2021. The community in Ballyhaunis requires essential services that these fantastic primary care centres provide and it is in no man's land with regard to when construction will recommence. I have written to the Minister about this matter. I ask him to intervene and provide reassurance to the people in Ballyhaunis that this primary care centre will go back into construction and that it can be fully completed.
I will add to what previous speakers have said. In particular, where new building projects are happening, the Minister needs to insist that accommodation is co-located with major new builds for nurses and doctors who work in a hospital environment. I recently tabled a parliamentary question to ascertain where there was old nursing accommodation that is not being used in each hospital group. There is a little of it. Some is being transformed for office space. Where it exists, we need to seize the opportunity to reconvert it and retrofit it for nurses to use. The Minister's counterpart, the Tánaiste, yesterday told the Department of Defence that there was to be no more getting rid of old barrack accommodation because we have a housing crisis. The same needs to happen in the health service. When new build projects get under way, they must be co-located in hospital environments.
Notwithstanding all those interventions, the Minister has one minute to respond.
I will try to give each 20 seconds. Regarding Galway and the smaller projects, I fully agree that is an issue in Galway and right across the country. It takes us too long. A few things need to happen. Capital allocation needs to be sufficient and, second, there needs to be much more efficient processing of these. I could not agree more. We are working with the HSE. I am engaged directly with the chief executive on exactly that.
Let me get Deputy Dillon an update on Ballyhaunis. If I need to intervene, I absolutely will. I know we have discussed this matter here previously. I acknowledge that Deputy Dillon has been advocating on this for some time. The primary care centres being built across the country are a huge good news story. I am opening three tomorrow in counties Sligo and Donegal. They are transformational for the local communities. I will revert on Ballyhaunis.
On the question of accommodation, I agree. Healthcare services and hospitals have previously had accommodation blocks for nurses. There is room for that. It is something we can look at. I have spoken to individual hospital chief executives who already have their eye on various pieces of land or existing property they would like to retrofit for exactly that reason.
We are going to run out of time. I hope to squeeze in three questions, with Deputies' co-operation. I ask Deputy Ó Murchú for his co-operation.
Hospital Services
Ruairí Ó Murchú
Ceist:10. Deputy Ruairí Ó Murchú asked the Minister for Health when it is expected that adequate resources for genetic services in Our Lady's Children's Hospital, Crumlin, will be provided; and if he will make a statement on the matter. [18497/23]
When is it expected that adequate resources for genetic services in Children's Health Ireland at Crumlin, formerly known as Our Lady's Children's Hospital, Crumlin, will be provided? Those living with rare diseases can sometimes wait over two years for a diagnosis and referral for genetic testing. Sometimes, they can be treated for the wrong condition. These are services that are required, so the sooner they are provided, the better. When exactly will this happen?
I was reviewing the Deputy's question yesterday and was not sure whether he was specifically interested in the new genetics strategy, in the heel prick test, or in some other localised services. I asked the Department to make contact with the Deputy. I do not know if that happened. I apologise if my answer does not exactly reflect where the Deputy wants it to go.
The Minister should cover all of it.
The Deputy might clarify in his response and I will try to be more useful. I will answer about the new genetics and genomics strategy, which will address exactly the issues the Deputy has raised. A number of important developments are under way. I start by acknowledging the premise of the question, which is that Ireland's genetics and genomics services are not where they need to be. We need to expand the heel prick test. Les Martin and others have done significant work on that. We need to expand our capacity for genetic sequencing, personalised medicine, foetal medicine and in various other areas. A number of developments are under way.
Last year, I launched the first national strategy for accelerating genetics and genomics medicine. It aims to build a strong patient and family-centred service. For this year, I approved just under €3 million to implement the strategy. In fact, I was just talking to the chief clinical officer about that this morning. This includes a national office for genetics and genomics, 16 new staff, a national director, a bioinformatics laboratory director, genetics counsellors and genetics consultants. Another important step in improving genetics services is understanding the genetic staffing needs and genetic testing capacity. This will be achieved through the creation of a national testing directory for genetics and genomics. It is subject to live procurement. It will map the current genetic tests conducted across Ireland, allowing for more transparent referrals. I think this will address exactly the point I hope the Deputy is raising.
It is specifically about genetic testing capacity and making this happen sooner rather than later. The Minister is talking about new staff, which is obviously positive. When will they be in place and where will they operate from? Are we talking about Our Lady's Children's Hospital, Crumlin? I imagine we are. We all know, as I say, that 300,000 people are living with a rare disease. At this point in time, they are not being served well. The major issue is that we do not have the capacity to deliver what can be delivered in a comparable health service, where one can generally get that testing done at in and around 12 weeks. When will the Minister have those people in play? Will this deal with the issue? What is the timeline? What will the timeline be for somebody being referred for genetic testing, getting the testing and then diagnosis?
Regarding how many staff have been recruited and the plans to scale up the service, I will ask the Department to revert about its thinking and aims on that. The Deputy asked a question specifically about Crumlin. Children's Health Ireland at Crumlin is a hospital which currently provides genetic tests. The genetics lab conducts cytogenic analysis and molecular genetic analysis. I am aware of a recent campaign to increase the facilities, resources and services for patients at Crumlin. Inevitably, as we move to the new children's hospital, where there is significant additional capacity and space to expand and provide these kinds of services, that will happen. In the meantime, the question for all of us is whether more can be done for patients and families in the intervening period.
That is most certainly what is required. The Minister spoke about the Get Rare Aware campaign. It comes back to the same question about the timeline for these people being in place. Where exactly will they all be based? What will be the capacity for genetic testing? The crux of the matter is when this new plan will be in play, when the people will be in position and what the timelines for testing and diagnosis will be, given that some of these conditions can be very rare. The sooner the intervention can be made, the better. It is obviously vital for those people and their families. Can the Minister give me an answer on that?
I will ask the Department to revert to him on the intended timescales.
Hospital Services
Cathal Crowe
Ceist:14. Deputy Cathal Crowe asked the Minister for Health if he will provide an overview of how the new admissions protocol relating to the medical assessment unit at Ennis General Hospital has functioned since January 2023; how he proposes to further enhance the functionality of this facility; and if he will make a statement on the matter. [17943/23]
My question relates to Ennis General Hospital and the new protocol introduced in January of this year whereby patients could be brought to the medical assessment unit by ambulance to alleviate the pressure being felt at the time at University Hospital Limerick's emergency department. I would like an update on how that has worked so far and what other plans the Minister has to improve this facility and indeed emergency healthcare in the mid-west.
I acknowledge the Deputy's ongoing advocacy for Ennis Hospital to improve resources and, ultimately, services for his constituents. The medical assessment unit, MAU, pathway for 999 patients was introduced in Ennis Hospital on 9 January and Nenagh Hospital on 7 February. This pathway allows patients who meet agreed clinical criteria to be transported to an MAU rather than an emergency department. It is resulting in patients in the mid-west receiving treatment in a hospital closer to home. It is ensuring that patients can receive less complex care without the need to attend an emergency department. The aim is to reduce patient presentations primarily, in this case, at University Hospital Limerick, UHL, and release ambulances more quickly to respond to other calls.
The HSE has advised me that, to date, 72 patients have been referred to Ennis and Nenagh hospitals via this pathway, which is already helping to reduce emergency department presentations at UHL. The MAU at Ennis Hospital continues to operate seven days a week and the MAUs at St. John’s and Nenagh hospitals are also now operating seven days a week. Recruitment is in progress in the MAUs nationally for an additional 51 staff, who will be whole-time equivalents, WTEs, across a range of specialties. As these staff take up their posts, the number of assessment slots available for patients will increase. Once all staff are in post, the effect of this investment will be the creation of an estimated just over 7,000 additional assessment slots per year across the three MAUs in UL Hospitals Group.
I thank the Minister. When the protocol was introduced, it was quite positive. It was at a time when we were at an all-out crisis at UHL. The figure of 72 patients between Ennis and Nenagh hospitals is a combined figure. I would love to hear a figure for Ennis in particular because, in the first month following the protocol, we were still down to single-digit figures for how many were coming in there. We would love to be transformative but there is a huge caveat: this cannot be at the expense of those waiting for day surgery at Ennis. It cannot tie up other hospital capacity. We would love to hear what is happening in that regard and how the two are being separated. How do the two coexist so the hospital is able to function day to day?
The Minister might offer some commentary on the additional funding for Ennis, Nenagh and St. John's hospitals announced the other day. That was a bundled figure. We would love to hear that the MAU - the local injuries unit - will move to more hours per day, although it already runs on a seven-day basis. Perhaps it could move to 18 hours per day, eventually moving up to a 24-7 facility.
I will correct what I said. The 51 WTEs are not a national but a regional deployment. It is just within the hospital group. Ennis Hospital will see an additional 20 WTEs just for this programme. It is a very significant increase in investment. The hospital group has been approved for more than €5 million in funding to essentially extend the opening hours, as the Deputy quite rightly said. This is part of an ongoing investment in Ennis Hospital. The Deputy will be very aware of the new €2 million minor injury unit that opened in April of last year to replace the existing unit, which had been in the main building for a very long time, since around 2013. As these extra 20 staff are brought in, relevant staff in Ennis Hospital will be in discussions with the HSE and the hospital group to see whether the hours can be expanded further and if patient demand warrants it.
I do not blame the Minister for the woes of the mid-west health crisis. I blame certain decisions taken by previous governments, particularly the 2009 decision to reconfigure acute hospitals in the mid-west region to deliver centres of excellence that have never materialised. If someone had said 12 or 18 months on that we were working towards excellence that might have been credible, but we are now 14 years on. The Minister is doing a damn good job in trying to build capacity but it has to be admitted on the Dáil record that the 2009 decision was a major mistake.
I would love to know more about those opening hours for Ennis. It has been alluded to that the opening hours of the MAU will improve but we would love to hear whether it will be 18 or 24 hours a day. That is really what people want to hear today.
An application for the University of Pittsburgh Medical Centre, UPMC, to have an elective hospital in the region has been on the Minister's desk for a number of months. Will he tell us where that is at? We see that as being a game-changer in unburdening some of the day and elective surgery cases from UHL. For the record, because it is often put by Sinn Féin that this is for profit, this is not for profit. It is a charitable hospital that will take huge pressure off public healthcare in the region.
I thank the Deputy very much for that. There has been and will continue to be ongoing investment in Ennis Hospital. We will need to see exactly what the final opening hours for the MAU will be. Local clinicians will gauge patient demand. If we are to have staff there at night, patients need to be coming in to warrant them being there. Otherwise, we would employ them during the day to provide patient services. At this point, the important thing is there is very significant investment in expanding the team at Ennis. To have an extra 20 people there is a very significant advance. We will keep a close eye on that.
The new outpatient department at Ennis Hospital has been equipped with X-ray rooms and other diagnostics. The redevelopment of Ennis Hospital is at phase 1b. That will make a big difference. There are also redevelopment works on the two replacement theatre-supporting facilities, including theatre suites and other redevelopment works at the hospital.
The Deputy asked a broader question regarding UPMC that I will come back to him on.
Mental Health Services
Violet-Anne Wynne
Ceist:15. Deputy Violet-Anne Wynne asked the Minister for Health further to Parliamentary Question No. 347 of 9 March last, the reason that all CAMHS appointments in County Clare take place in the same venue; and if he will make a statement on the matter. [18587/23]
I raise the issue of CAMHS in County Clare, specifically further to the reply I received from the HSE regarding a question I submitted. Will the Minister of State please explain why all the CAMHS appointments in County Clare take place in the same venue in Ennis? Will she make a statement on the matter?
I thank the Deputy for raising this matter. The mid-west CAMHS leadership team works in partnership with clinical directors for the national clinical programmes to develop new models of practice to meet the needs of children and families in the mid-west. The HSE has advised my Department that the mid-west community healthcare mental health service has one CAMHS centre in Ennis, which is used by both the Clare west and Clare east CAMHS teams. There are a couple of reasons behind this. As the Deputy knows - I do not have to tell her - Ennis is the largest centre of population in County Clare. Therefore, the CAMHS facility is optimally located for a large proportion of the county’s population. In addition, it also offers parking and is conveniently located to public transport. Notwithstanding that, the HSE has advised my Department that it is also progressing a CAMHS outreach facility at Inisgile, Parteen. This will facilitate appointments in the east Clare area, providing a service close to people's homes in that area of the county. It is intended that this centre will be operational in the first quarter of 2024, which is a little away.
However, I will tell the Deputy another piece of good news,which is that a CAMHS hub has commenced and is being developed in the mid-west. We have several of these CAMHS hubs throughout the country. The hub is a national clinical programme for which the mid-west is a pilot site. It is intended that the hub and associated pathways will provide an alternative to inpatient care providing children and young people with acute treatment at home or in the hub day hospital, which will be located in Limerick city. What happens in these cases is that when a young child or adolescent gets a diagnosis on being seen originally by the multidisciplinary team, he or she can then opt to have some supports provided online. There will always be a person with them for this - for example, a parent - which is very important. To answer the Deputy's question, we are trying to make CAMHS supports easier for people living in various areas of County Clare.
This is my second time, two days in a row, that I have raised the issue of CAMHS in County Clare in the House. Yesterday, I raised the issue of the significant deficit in staff. The Minister for Enterprise, Trade and Employment, Deputy Coveney, was unfortunately unable to give me a direct reply as to what aggressive recruitment strategy was being undertaken by this Government. Today, I am fed up. The Department of Health has under-profile spending of €22 million in the first quarter of 2023. Public underspending translates to underachievement. Meanwhile, we have 168 children and adolescents in the mid-west who are waiting more than a year to be seen by CAMHS. An independent review into CAMHS mid-west cases identified, in January this year, 140 children and young people who experienced delays in receiving follow-up care. That is atrocious.
The Government talks about the recruitment and retention crisis as though it is some external force and not in any way affected or influenced by the Government. Why can the underspend of €22 million in the past three months not go into training allowances or incentives to encourage graduates to work for CAMHS?
What is the plan in that regard?
My budget does not run for only three months of the year. It runs from 1 January to 31 December and much of the spending happens throughout the year as we recruit. For example, last year we recruited 91 new people to mental health services. Some 10,362 people were working in mental health services in December 2021 and in December 2022 the number was 10,453. The budget runs for the whole year. It is important to acknowledge that there were 33% more referrals into CAMHS supports in the past two years. The total number of referrals in the area the Deputy referred to was 1,928 in 2022 and the waiting list is currently approximately 85 children and adolescents. Waiting list initiatives are under way across six CHOs, including in the Deputy's area.
On the issue of the review into open CAMHS cases I mentioned earlier, I would appreciate if the Minister of State would inform me of the steps that have been taken to follow up with the 140 children and young people who fell between the cracks and, crucially, what steps have been taken to ensure that never happens again. I do not think I can underscore enough the fundamental importance of early intervention in the case of a young person who is suffering with mental health difficulties. We need to support young people and their families throughout Clare and the mid-west.
I welcome the news of the hub the Minister of State mentioned. It is positive information. Again though, it is in Limerick city and for people who live in west Clare, which is more than 45 km from Ennis, it is a greater distance for them to travel. My concern is about distress being caused for individuals and their families in trying to make an appointment for supports and services relating to mental health. I highlight that the HSE's response to my parliamentary question mentions, as the Minister of State also mentioned, the outreach accommodation being sought in west Clare and that is welcome. However, I note that there is no mention of west Clare. Why is that? There is a primary care centre in Kilrush which would be ideal. Why has space not been sought there?
The whole purpose of the CAMHS hubs is to prevent people having to travel if they have this option. That is what we are trying to do, to give parents and children more options. With respect to the follow-up of the 140 cases the Deputy referred to that were classed as lost, the team in Limerick informed the Mental Health Commission that it had a significant staffing issue at that time. It was down three consultant psychiatrists. They have now been put in place. We now have a full complement of seven consultant psychiatrists in CHO 3. My understanding is that all of the 140 cases were contacted. In a few cases they had left the area and it has proven more difficult. Some had left the country.