Vol. 1039 No. 5
1. Deputy David Cullinane asked the Minister for Health his plans to enable seven-day rostering across the health service; his plans to address the workforce requirements to enable this while achieving safe staffing levels; and if he will make a statement on the matter. [26968/23]
There has been much discussion on the air waves over the last number of weeks about a seven-day rostering service across our health services and, obviously, that is ideally something we would all want to get to. I tabled this question to give the Minister an opportunity to set out his perspective on this. What plans are in place? What talks and negotiations with representative bodies have or will take place? Could the Minister set out his views on how this can be made happen?
I thank the Deputy for his supportive comments in terms of moving in this direction. I want to start by acknowledging the really extraordinary dedication our healthcare professionals have shown. To the Deputy's question, we have seen an unprecedented growth in that workforce. One of the things we must do, obviously, in moving from five to seven days is increase the workforce. As the Deputy will be aware, we have added nearly 21,000 additional healthcare professionals into our health and social care services since 2020. In spite of this, we are still seeing an unacceptable number of patients waiting on trolleys in too many hospitals. While there have been important reductions in the waiting list, much more needs to be done to achieve the targets to which we all signed up.
Government has been very clear in supporting an unprecedented expansion of capacity within our health service in parallel with fundamental reform of how that care is delivered through the regional health areas, chronic disease management, moving care into the community, e-health and so forth. I acknowledge that there are hospitals, such as in the Deputy's constituency in Waterford, that are already rostering staff right through the weekend. This is different to being on call. We need to acknowledge that many staff are on call over the weekends anyway. This is about rostered staff. The Deputy and I are both aware of the very positive effect that has had on the lack of patients on trolleys. Really, achieving that across the country and accelerating the reduction in the waiting lists is what we are seeking to do by moving from five to seven days.
The Deputy will be aware that nurses and junior doctors are already rostered. If any of us were to go into a hospital at 3 a.m. on any given night, we would find junior doctors and nursing staff already there. The new consultant contract is another piece of this, and there needs to be engagement with the health and social care professionals. The chief executive officer, Mr. Bernard Gloster, and I, for example, engaged with Fórsa recently at its annual conference in Galway on exactly this discussion.
As I said, it is a laudable objective and one I support. Obviously, there must be dialogue and buy-in from healthcare staff. We need to recruit as many healthcare professionals as we possibly can. Even though additional numbers have come into the health service, the State has not achieved the recruitment targets we set ourselves with regard to the big numbers we need. Obviously, therefore, there are recruitment and retention issues.
I see huge benefit in this with regard not just to acute hospitals but what is happening outside of hospitals and how that will help in terms of discharging patients and alternative care pathways at weekends for patients, particularly older people and those with chronic pain who really should not be going to emergency departments. Sometimes, if the alternative care pathways in the community are not there at the weekends, that adds pressures in our emergency departments, as we know. Diagnostics is another area where we need that seven-day rostering system as well. We need to speed up diagnostics in hospitals. For all those reasons, I want to see this happen. What dialogue is there with the representative bodies? That is the question I asked. Does the Minister have any timeframe as to how we can get to a point where this can be moved on?
The answer is "Yes". There are informal discussions going on. It is something I discussed with the Irish Nurses and Midwives Organisation, INMO, when I was at its conference, and the chief executive and I raised it when we spoke at the Fórsa conference. Most importantly around this, the people I hear supporting this are the healthcare professionals themselves. They are fully aware that this is where we need to go. I had a meeting with emergency department consultants from around the country in the last two weeks. The point several of them made was that in hospitals which are achieving this, such as Waterford, Tullamore, Portlaoise and others, with senior decision-makers onsite but, critically, with access to radiology, discharge teams in the hospitals and, to the Deputy's point, community teams working as well - it does not mean that every service has to be running through Saturday and Sunday but it is around patient flow - it really is making a big difference.
There are a number of options to get where we want to get to. I know that a call has been put out for people voluntarily to take up rosters at weekends. Obviously, that is something people may or may not do. The Minister pointed to Waterford and other hospitals that have done this. The former manager of the hospital in Waterford is now head of community services and is trying to bring the same level of energy into those community services that was brought into addressing problems at University Hospital Waterford. Therefore, I get the logic and it is one I buy into.
However, we are then looking at a fundamental shift because as the Minister said, nurses and junior doctors have what are called five over seven contracts. It is not that people work seven days; they work five days but over a seven-day period and the rosters will reflect that. What are called five-seven contracts will be a new departure for some professionals, however. Is it the Minister's view that in those specialties he talked about in community services and other areas of the health system in hospitals, we are looking at five-seven contracts in future as opposed to five-five contracts?
Yes, it is. One of the big groups we will rely on to work in this way, for example, who typically are not on the five-seven contracts yet, are the health and social care professionals. My view is that as part of the upcoming round of pay talks, certainly from a health perspective, that is something at which we would be looking.
To the Deputy's point, a lot of the workforce are already on these. Junior doctors and many nurses already have contracts like this. The new consultant contract moves from rostering 40 hours per week to 80 hours per week. Really, it is about pulling the service together to do all this.
We set up a working group led by the former chief the South-Southwest Hospital Group. That has been established within the HSE to put a national framework together for how we achieve this. The Deputy will be aware that the chief executive asked for this on a voluntary basis over the coming weekend, which is exactly the right thing to do.
Is that Mr. Gerry O'Dwyer?
Yes. We are now looking at putting a formalised framework around this so that we can transition to this and that it becomes the norm.
2. Deputy Duncan Smith asked the Minister for Health if he will provide a detailed update on his plans to end hospital overcrowding and accident and emergency wait times; and if he will make a statement on the matter. [26950/23]
May saw 11,856 people, including 300 children, waiting on trolleys. What plans does the Minister have to end hospital overcrowding and accident and emergency department wait times, knowing that the numbers in May were higher than the numbers in January when we had triple the respiratory threat?
I will start by acknowledging the enormous distress the overcrowded emergency departments are causing, first of all to patients and their families and second to our healthcare workers. I am regularly in emergency departments meeting with patients and their families and our healthcare workers.
Part of the answer to the question lies in the discussion Deputy Cullinane and I just had. One of the things we must do is move to a seven-day service. We are all aware of the pattern in that the hospital gets cleared on Friday and, therefore, beds become available. The best day, if you like, in a hospital is Saturday morning because the emergency department has beds to send patients up the house to. It then fills up on Saturday, Sunday and Monday again and we have this weekly pattern. To be honest, for those working in hospitals in emergency medicine as well as the patients, it is an exhausting pattern. When I met the emergency department leads around the country in the last two weeks, there was strong support from them to say that yes, the emergency teams need to be there, but they need the support of the hospitals and community groups.
The answer lies in doing two things at the same time. An unprecedented level of investment in workforce and infrastructure is required while, at the same time, we move to this new way of working. I will give the Deputy an example. I was in University Hospital Galway last Friday. That hospital's emergency department regularly deals with difficult situations. I was there on a Friday, when it should have been easier but there were patients on trolleys going up both sides of the main corridor. The conversation I had with the team in Galway was to say the Government is going to invest in more beds, a regional cancer centre, a new emergency maternity and paediatrics block, new laboratories and an elective hospital and outpatients department in Merlin Park. We are going to do all of this but it will only work if the hospital and community service also start working in a different way and move to the seven day per week patient care.
The Minister mentioned that Saturday is the best day, and I know what he means. However, the average figures are such that even when we get to Friday and Saturday, the numbers are still far too high because of the carryover from the weekend. In respect of the seven-day roster, a number of unions, such as the Irish Nurses and Midwives Organisation, INMO, has said it is willing to talk. The Minister said in an earlier reply that he is setting up a working group. Will he articulate in more detail which groups are reluctant or more resistant to come to talks? Where are the blockages? Where can political pressure be applied to elements of the health service that are not moving as quickly towards a seven-day working roster that we all agree is needed to help tackle this ongoing crisis?
The conversation has moved in a positive way in recent years. I recall when we had these sorts of discussions at the health committee four years ago and there was quite a lot of resistance. The idea that we would move from five to seven days was not being entertained. However, the engagement I have had right across the board has been very positive. The new consultant contract moves from 40 hours to 80 hours, which is a fundamental change. I meet other representative bodies and their members in community settings and hospitals and there is broad acknowledgement that this is what we need to do. Nurses make the point that they are already rostered in the hospitals 24-7. Junior doctors are already rostered 24-7. We now have a new consultant contract in place. The next areas that will help, and the conversations I am having with those concerned are very positive, include health and social care, community care, discharge teams and, critically, access to regularly scheduled radiology on weekends.
The emergency department task force, which is co-chaired by the HSE and the INMO, warned this week that we could have another winter with RSV, Covid-19 and other respiratory challenges. Given everything the Minister has said and offered, and everything in the pipeline, is he considering specific targets? He does not have to mention those targets on the floor of the Dáil but is he considering targets on a month-by-month basis, leading into the winter, and the reduction he wants to see in emergency department waiting lists? Is he considering the matter in those terms or is he hoping the investment that is going in will deliver results? What sort of planning and target setting are being done to combat the trolley waiting lists?
The next question, in the name of Deputy Cullinane, relates to exactly that matter. We have two plans, which are the short-term plan and the multi-annual plan. The direction I have given to the Department and HSE is clear. We must have structural change such that, month by month, the trolley numbers we are seeing come down. What happened last year because of the impact of Covid - and I have spoken to health ministers from around Europe who have experienced the same things in their countries - was that demand went up. There was unmet need; there were probably late diagnoses. There was an enormous level of additional presentation to emergency departments. That was the case here and in other countries. The numbers went up and up every month such that by the time we got to October, November and December, the system was simply overstretched. We are looking to trend downwards towards winter not just through one-off funding but with structural changes so that we go into the winter in a better place.
3. Deputy David Cullinane asked the Minister for Health when he will publish a multi-annual plan to resolve the crisis in emergency departments; when he will publish full details of all elective centres; and if he will make a statement on the matter. [26973/23]
In the first quarter of this year, people waited on average 11.7 hours in emergency departments for access to a bed. Unfortunately, people over the age of 75 waited on average 13.8 hours. For children, the average waiting time was 13.3 hours. We are hearing horror stories, to be frank, every day of every week about older people and children being left to wait even longer than those averages. Will the Minister tell us what more can and will be done to ensure we deal with the crisis in far too many emergency departments?
I agree that the current situation in too many hospitals, although not all, is unacceptable. I think we all agree that it is especially the case in respect of older people who are waiting too long. As the Deputy quite rightly said, those figures are averages and do not include the people who are waiting on trolleys for 24 hours, 48 hours or longer. It is not an acceptable situation.
The HSE is now, at my request, finalising two planned approaches to urgent and emergency care. The first is a plan for the rest of this year and through the winter of next year. We will publish that in the coming weeks. It will be published this month, as it is now June. A three-year improvement plan to build on that will be published in the autumn. Overcrowding, as we are aware, is now a year-round challenge and these programmes are looking to make sustainable change and not just the addition of one-off resources for the winter. We are looking at fundamental structural change here.
The Deputy's question also alludes to elective centres. The national elective ambulatory care strategy was agreed in 2021 to try to decouple emergency care from scheduled care to the greatest extent possible. As he will be aware, we are proceeding with stand-alone elective hospitals in Cork, Galway and Dublin. The business cases for Cork and Galway were approved last year and the business case for Dublin will be with me very shortly. The Departments of Health and Public Expenditure, National Development Plan Delivery and Reform and the HSE are proceeding with parallel processing so we can move to sign off on the detailed design as quickly as possible this year before moving out to tender so we can get diggers on site as quickly as possible.
The final piece, as the Deputy will be aware, is the surgical hubs, the locations of most of which I announced last Friday. One of those will go into University Hospital Waterford. Based on the impact of surgical hubs in Tallaght hospital, I believe they can be of substantial benefit to patients and, critically, in a much shorter time than it will take for the elective hospitals to start treating patients.
Like the housing crisis, we debate the trolley crisis time and again in this Chamber. We want to get to a point where we deal with it comprehensively but it seems to be getting worse. As the Minister said, it is now a year-round problem. The figures for the waiting times for those on hospital trolleys, which are presented to us every day of every week by the INMO, are exceptionally high. The waiting times are far too high. We need to do a lot of things. The seven-day rostering will absolutely help but there is also a need to invest in hospital capacity. We need more hospital beds, more diagnostics, more surgical theatre capacity and more radiography capacity. All of those capacity deficits exist in some hospitals.
We also need to mandate best practice. If things are being done right in some hospitals, that needs to be shared and mandated across all hospitals. It is crucial to resource the community space. Enhanced community care from community intervention teams and all of that, which provides alternative care pathways, is also crucial. There is real frustration that despite all of the money we are spending in the health service, the numbers of patients on trolleys is not going down but up. People cannot for the life of them figure out why the situation is getting worse when we are spending more money. Why is that the case?
That is a frustration. We have seen an unprecedented expansion in capacity. There are nearly 21,000 extra people and 1,000 extra beds, with another 500 on the way. We are progressing new hospitals. There are new operating theatres and outpatient departments. We have built an entirely new community care service in the past two years. What we are seeing here is reflected in what other countries around Europe, and further afield, are seeing. We have an aging and growing population, as the Deputy is aware. There is extra demand as a result of Covid that is difficult to quantify. One of the things the HSE is doing in preparation for the urgent care plan is to understand as well as possible why so many extra people are coming in. Who are they and what can be done? I will give the Deputy one example from the Mater hospital, the emergency department of which I was in recently.
The emergency department team said they have a lot of patients undergoing cancer treatment coming in - they are getting quite sick during treatment. The solution to that is not to bulk up the emergency department; it is to make sure they have direct access to the oncology services. That is the kind of work that is going on to address exactly the questions the Deputy is raising.
The patterns in the rest of Europe do not match with what is happening here in all areas. There is no good reason so many people are on trolleys if one hospital can arrive at a position where people are not on trolleys. Waterford is a very busy hospital serving a population of nearly 500,000. It has additional pressures now because of what happened in Wexford. If it can be done in one hospital, surely it can be done in others.
Undoubtedly, there are capacity issues in other hospitals. We will get a chance to talk to the Minister about University Hospital Waterford and capital plans that are not being expedited, which need to be expedited shortly as well. These are real issues.
Three things need to be done. First, the culture of how some hospitals are run and managed has to be changed. The seven-day rostering is only part of that. Much more needs to be done. Workforce planning is also crucial. Much more needs to be done in ratcheting up training places. Crucially, capacity, both in hospitals and community care, is needed.
People need to see the benefits of the additional investments because it frustrates and angers them when patients are waiting as long as they are in emergency departments.
I agree with all of that. The hospitals need to take a zero-tolerance approach to patients on trolleys. We have seen it. For example, Tullamore hospital is a very good case study where a new management team came in, they were on the ground in the emergency department and challenging why this patient and that patient were on trolleys and following that up right through the hospital. They determined, for instance, that a patient was on a trolley because other patients had not been discharged and asked why had those patients not been discharged. They had not been discharged because the short-term transition bed had not been made available in the community and they decided to go out and talk to the providers. They took a zero-tolerance approach. In Tullamore Hospital today, lines of patients on trolleys will not be seen in the emergency department. Three or four years ago, they would have.
I agree that we cannot expect hospitals and community services to do this on their own. We are expanding capacity at an unprecedented level. At the same time, we need the hospitals to take this very proactive challenging zero-tolerance approach to patients on trolleys accepting that they cannot solve all of those problems on their own and that we in the Oireachtas and we in government have to help them with extra capacity.
4. Deputy Róisín Shortall asked the Minister for Health if he will provide an update on the new home care tender, following an offer of €31 being issued to providers on 25 May 2023; if this offer is based on the current living wage of €13.85 per hour; the details of the other elements of this offer; how this figure was arrived at; the means by which travel expenses will be paid; the rationale for continuing with the fastest-finger-first commissioning model; and if he will make a statement on the matter. [26967/23]
A related topic is the question of home care. There is a crisis in home care. While the HSE provides home care staff with proper pay and conditions, the reality is that in much of the country that essential service has been outsourced to the private sector. The people working in those services are at a serious disadvantage to those who are employed by the HSE. What are the various elements of the latest offer for home care workers in the private sector?
The existing tender for home support was extended by the HSE to 30 June. The process of developing the new tender is at an advanced stage. Engagement has been ongoing between the HSE and the provider representative bodies. The HSE published stage two of the process on 25 May.
I am pleased the proposed indirect hourly core rate includes a number of significant reforms that can stabilise the market and improve the terms and conditions for workers. This rate is subject to the new tender, including provision for sectoral reform, including travel time, addressing the living wage and reforming legacy rates, as recommended by the strategic workforce advisory group.
The Deputy asked about the commissioning of services. In the first instance, the authorisation scheme will be client-centred. She often raised with me previously about the fastest-finger-first approach. It will operate on a client choice basis, putting the service users' needs first. How that will work in practice is the HSE will provide a list of providers requesting that the client indicates his or her preferred provider. If the selected provider cannot deliver the service, the HSE will issue an email alert to all community healthcare organisation, CHO, specific approved providers. The HSE recommends that email alerts issue at a standard time each day to facilitate providers in managing responses because we heard larger companies had more economies of scale in having more staff available to do this. The first provider to respond with confirmation of a named home support worker to deliver the service will be awarded the contract for that client. This process is adopted to meet the support needs of the client and in the interests of fairness to all providers.
Through the strategic workforce advisory group, we are able to deal with the living wage, the travel time and also the sectoral reform in relation to legacy rates. Many different legacy rates had built up over many years.
I would like some specifics. I set those out in the question.
When the Minister of State talks about the living wage, is that €13.85 per hour, which is the current living wage? What arrangements are in place for increases to that living wage? There is a system for determining that and it is increased on an annual basis. Will the contract cover those increases? I would like confirmation of that first.
What about the question of continuity of income for staff? If a client goes on holidays or is in hospital for a few days, what about the home care worker's income in those circumstances? Will there be continuity or will it be left to chance? What exactly is the Minister of State proposing to do regarding travel mileage?
If she could clarify the situation regarding those issues first, I will come back to the commissioning model.
As agreed by Government, the national living wage will be set at 60% of hourly median wages in line with the recommendations of the Low Pay Commission. It will be introduced over a four-year period and will be in place by 2026, at which point it will replace the national minimum wage.
The first step towards reaching a living wage will be the 80 cent increase to the national minimum wage from 1 January 2023 to €11.30 per hour. This will be followed by gradual increases to the national minimum wage until it reaches 60% of hourly median earnings. In 2023, it is estimated that 60% of median earnings will equate to approximately €13.10 per hour.
Regarding the Deputy's question on the continuity of incomes, where we are talking about private companies here, they all will have their own terms and conditions with their own employees in respect of how many hours they are rostered for per week. My understanding is that travel time is being discussed at present
Sorry, mileage.
No. It is travel time we are dealing with in this. We are not dealing with mileage as well.
My question is about mileage.
Mileage is not included. Travel time is included at €2.99 per hour.
That is really disappointing. In the context of us having a crisis in home care at the moment, does the Minister of State realise 6,500 people, mainly older people have been approved for home care but services are not being provided to them? We were discussing earlier the problems of people inappropriately arriving at hospital emergency departments. A major element of that relates to older people who do not have the necessary care at home. What the Minister of State is proposing is a far cry from what was recommended in the expert report.
The current living wage is determined to be €13.85 per hour. The Government is talking about bringing that in over a four-year period. The Minister of State is doing nothing about improving the mileage rate and she is passing the buck completely on continuity of income. If a client goes into hospital or if a client is away, who covers the cost of that for the person providing the service? This falls far short of the recommendations in the report that she commissioned and committed to implementing.
With all due respect, the Deputy was previously a Minister of State in the Department of Health. She understands that I am constrained by my budget. My budget is €723 million for home care this year, which is a significant amount. She mentioned failures but 56,980 people will receive home care today. A total of 3,524 new applicants are funded but are waiting for supports while 2,908 people are already receiving supports, but not the maximum hours advised. It is important to put that on the record.
With regard to the tender, we are dealing with legacy issues that have been there for many years. This is one of the issues that all the organisations brought up when I met with them. The Deputy asked me to meet an organisation from north County Dublin, and I did.
On travel time and the living wage, we have to work with the budget we have to deliver the hours we have.
I think we have made significant changes to the tender.
We should reflect the reality of the situation. It is not a matter of what the Minister of State thinks. She committed to implementing the expert report that she herself commissioned. As the figures have been validated by Grant Thornton, there is no dispute about the costs. Why is the Minister of State not prepared to meet the costs of providing home care? Approximately 6,500 people are awaiting home care and that number has remained stubbornly high. Despite all those elements to which she has committed, it seems now that she is not prepared to follow through on ensuring they will be included in the new offer of €31. We cannot provide the services on the basis of those figures the Minister of State gave. She talked about phasing in the living wage. There is a figure for the living wage now, which will increase each year, and the Government needs to commit to doing that. This falls far short of what is required.
In respect of the commissioning model, what I hear the Minister of State saying is that she is putting the responsibility back onto the client to make the choice. The commissioning should reflect the level of need but it is not doing that, judging by what she said. It is really disappointing that she has welched on this.
Targets rose from 18.67 million hours in 2020 to 22 million hours in 2023, while the delivery of hours rose from 17.55 million in 2020 to 20.78 million in 2022. As of 31 March 2023, 5.2 million hours had been provided in the year to date, and this was an increase-----
Those figures are meaningless.
I did not interrupt the Deputy. This was an increase of about 250,000 hours on the same period in 2022. I thank Home and Community Care Ireland and Joseph Musgrave for their interaction with the HSE as we develop this tender. A huge number of hours have gone into putting it and the recommendations of the advisory group in place. I am delighted to say the statutory instrument authorising the assurance of 1,000 emergency permits for home care workers was signed in December, with 68 permits issued to date.
5. Deputy Mark Ward asked the Minister for Health if he plans to reduce the number of child and adolescent mental health service, CAMHS, teams from more than 70 to 50, as suggested by the chief executive officer of the Health Service Executive at a meeting of the Oireachtas Joint Committee on Health on the 24 May 2023; if he can guarantee this will lead to better outcomes for young people; and if he will make a statement on the matter. [26974/23]
During the meeting of the Oireachtas Joint Committee on Health of 24 May, Mr. Bernard Gloster, CEO of the HSE, stated in reply to me that the HSE had "a serious question to ask as to whether we continue to maintain more than 70 partially staffed [CAMHS] teams or reduce them to 55 or 50 full teams". Are there plans to reduce the number of child and adolescent mental health service teams from 75 to 50? What discussions has the Department had on the matter?
I recently completed a series of high-level round-table discussions bringing together the Department of Health, the HSE and the College of Psychiatrists of Ireland in the first instance. The second meeting included representatives of all the NGOs that provide supports in the community, while the third related to the National Educational Psychological Service, NEPS, primary care psychology, disability and CAMHS. A lot of it involved brainstorming to see what we could do to improve access to CAMHS and to see how we could build capacity into it.
One issue we discussed concerned the fact there are currently 75 CAMHS teams in the country and we await the outcome of the Mental Health Commission review and the results of the HSE independent audit into CAMHS teams. While we were discussing that, much of the discussion related to whether we would be better off having a hub-and-spoke model in some areas, especially rural ones, and reducing the number of teams to perhaps 50 or 55 in a scenario where they were fully staffed and funded and able to offer the supports families want. We discussed whether it would be better to ask a family to travel an additional 20 or 30 minutes to be assured the supports they needed would be available to them. A total of 40% of referrals to CAMHS are ADHD related and the majority of teams are well equipped to deal with that, but in the case of young people and adolescents presenting with extreme eating disorders or suicide ideation, self-harm, depression or anxiety, we are very conscious we have seen 31% more referrals to CAMHS teams in recent years.
As I said on the floor of the House last week, I am going to hold a meeting with the Deputy and others to discuss what we can do and what the best plan is. At the moment, we are at the talking stage.
I accept that, but we are getting mixed messages. For example, when Mr. Gloster said what he said at the health committee meeting, that was the first I had heard of it, although I had heard inklings on the grapevine. The Minister of State now indicated that the number of CAMHS teams might be reduced from 74 and that parents might be asked to drive a little further to get a full service but I got a response from the HSE yesterday stating there were no active plans to reduce the number of CAMHS teams nationally. Mixed messages are at play.
Are the HSE and the Department on the same page on this? Parents have a right to know exactly what is happening. If the hub-and-spoke model works, the Minister of State will get my full support on it. Parents want to see better mental health outcomes for children who have to attend CAMHS. I will touch on the increase in the number of referrals to CAMHS in my follow-up response. I know that has an impact on waiting times for CAMHS as well.
There have been discussions generally over recent times with a view to possibly refocusing CAMHS teams, not least given the staffing difficulties, although the HSE has no plans at present to do this. A new assistant national director, AND, has accepted the post in the HSE and a new clinical lead has also accepted that post and will be in place shortly. I look forward to interacting with both the AND and the clinical lead in regard to which model they feel is in line with best practice. I want to ensure young people and adolescents who need the support of CAMHS in their community area will be able to access that support.
Currently, there are actually 75 teams, given a third team has gone into north Wexford, but when we get the audit and the review, we will hear that not all those teams are fully staffed. We are trying to see what will be the best way forward to ensure children can get the supports they need.
The Minister of State rightly mentioned the increase in the number of CAMHS referrals, which amounted to more than 300,000 in the past year, according to what she told me the previous time we spoke. I want to put on record the good work CAMHS staff are doing, despite the challenges, to provide all these appointments. Even so, the number of children who are awaiting their first appointment with CAMHS has doubled, to 4,500, and that is under the Minister of State's watch. CAMHS is only for children with acute and moderate mental health problems, but children with less acute mental health issues are not getting the primary care they need.
A separate response I received earlier indicated that more than 15,000 children are awaiting primary care psychology appointments, and more than 9,000 of these were on the list when the Minister of State came to office. That is an increase of 6,000. Further information I received from the HSE shows there is no additional funding for eating disorders or early-intervention psychosis. Does the Minister of State accept there is a direct connection between children not getting basic primary care and the increase in the number of referrals to CAMHS?
As the Deputy will be aware, in regard to the number of referrals relating to primary care psychology, progressing disability services, PDS, teams and CAMHS, getting 33% more referrals is massive for any system. I compliment all the teams on the ground because they saw 21% more children last year with the same levels of staffing and issued 225,000 appointments. CAMHS is there for children and young people with moderate to acute mental health needs and they need a primary diagnosis to avail of it. Some children will have a secondary diagnosis of autism, an intellectual disability or something else.
As for primary care psychology, we have been running over the past two years a targeted initiative to remove long waiters from the list, but for every child for whom we do that, two more present in their place. Their needs are more complex, so it is taking more time for them to come through the system.
