Vol. 1042 No. 4
1. Deputy David Cullinane asked the Minister for Health if a handover and substantial completion date on the new Children’s Hospital has been agreed between the Development Board and the developer; and if he will make a statement on the matter. [40785/23]
A minute's reflection is very long. We never quite make it. That was about 15 seconds.
My first question relates to the national children's hospital. Related issues have now come to light in respect of children's healthcare, which I will raise shortly. My fundamental question is whether a handover date has been agreed between the board and the developer. Can the Minister of State confirm what that new handover date for the children's hospital will be?
The Minister, Deputy Stephen Donnelly, unfortunately cannot attend this morning as he is at the United Nations. The Minister of State, Deputy Butler, and I will take some of his questions.
Timely completion of the new national children’s hospital, NCH, is a Government priority. Everything is being done to ensure it is completed as soon as possible. It is 90% complete against contract value. Substantial completion is informed by the main contractor's, BAM, programme outlining how and when it will complete the last 10%. The last programme update received from BAM suggested substantial completion could be achieved by May 2024. Frustratingly, construction progress has been significantly behind BAM’s programme. After months of engagement with BAM, an updated programme was submitted on 18 July. This is currently under review by the employer’s representative to determine compliance with the contract. The employer’s representative is the independent body responsible for enforcing the contract. The programme outlines how BAM proposes to complete the more than 40,000 separate activities required to finish the project. Given this welcome level of detail, it will take time to verify and validate.
The National Paediatric Hospital Development Board, NPHDB, has been clear that it will not be commenting on any details until the employer’s representative has determined it to be a compliant programme. This includes any potential updates to the substantial completion date. Once construction is complete, the hospital will be handed over to Children’s Health Ireland, CHI, for commissioning. This will ensure the hospital is ready for patients and staff and is expected to take at least six months.
In advance of the handover, the pre-commissioning phase is already well advanced to ensure the smooth, safe and efficient transition of services to the new children’s hospital. This includes a significant body of work to integrate the three hospitals from a clinical and operational perspective, and the build of a digital hospital system and a new electronic healthcare record system. There remains a shared ambition among all parties to see the NCH opened as soon as possible for the benefit of children and families. To achieve this, the Minister for Health urges and expects BAM to resource and deliver against its own programme.
It is quite incredible that we still do not know what the handover or completion date will be and, even though an updated programme of works has been submitted to the board, that date has not been made public. It is in the public interest to do so, given all the controversies relating to this issue. We know that one of the big advantages of the new national children's hospital will be protected surgeries, especially for children with scoliosis and spina bifida. The Minister of State will know that there is now a major controversy at Temple Street hospital where services have been suspended. That has taken place not only at Temple Street but at Cappagh hospital. I also find it incredible that the Minister for Health left the country knowing this scandal was going to break and, it seems, did not inform either the Taoiseach or Tánaiste about the seriousness of these issues.
We have demanded statements in the House on that very important issue, which we need to have as quickly as possible. We should have had them today but now more than ever, given what has happened at Temple Street, we need this hospital built as quickly as possible. It is in the public interest for the Minister of State and the Minister to tell us what the new completion date is and when this hospital will be open.
I reassure the Deputy that the Minister will come before the House next Tuesday regarding that issue. I reiterate the importance of the completion of the children's hospital. The NPHDB, which entered into the construction contract with BAM on behalf of the State, is doing everything it can to hold the contractor accountable for its delivery programme. There is continuous engagement between officials within the Department of Health, the HSE, the NPHDB and Children's Health Ireland. The Secretary General of the Department has recently written to BAM setting out his expectations of BAM to complete the hospital without delay. The Minister has also directly engaged with the NPHDB, the CHI chairs and the chief officers on the project so that he can be assured everything possible is being done. It is to be welcomed that all stakeholders have expressed a shared ambition to achieve this completion date as quickly as possible. However, I will reiterate and pass on the Deputy's concerns to the Minister.
I cannot accept that everything possible has been done given that under freedom of information, FOI, requests and information submitted to me, we found out that the Minister did not meet with the board for the entirety of 2022, or for the first and second quarters of 2023. He had informal conversations with representatives of the board, which is not acceptable given the seriousness of these issues. There is not a person outside this Chamber who has any confidence in this Government's ability to deliver this project on time and at cost. Nobody. The Government has completely lost control of it, as has the Minister, and given the seriousness of the issues he should be having regular meetings with the board. Even now, an updated programme has been submitted to the board despite the fact Oireachtas health committee members, who will meet next week, asked that we would get that programme when the board got it. We are all, the public and the Opposition, being kept in the dark. It is just incredible that we still cannot be told when the public will be informed of the new completion date and what that completion date will be.
I assure the Deputy this is an absolute priority for the Minister and the Government. As I said, there is continuous engagement between departmental officials, the HSE, the NPHDB and CHI. The Secretary General has written to BAM outlining his expectations around the completion date. We will keep the Deputy updated on this matter. It is an absolute priority.
2. Deputy Duncan Smith asked the Minister for Health what efforts he has made to resolve the pay parity gap in section 39 organisations funded through the health budget in order to improve recruitment and retention in these services; and if he will make a statement on the matter. [40547/23]
I ask for an update on the efforts of the Minister and his Department regarding what has been done to help resolve the pay parity issue in respect of section 39 organisations, which are predominantly funded from the health budget and provide such an important service in buttressing and supporting our health service in the community.
I am taking this question on behalf of the Minister who, as the Deputy knows, cannot be here.
It is important to acknowledge the vital role that section 39 and section 56 organisations and their staff play in our health and social care sectors.
They continue to have a key role in providing services to people with disabilities, vulnerable children, older people and in other social care settings.
The Government has a clear interest in ensuring the stability and sustainability of these services. The Department of Children, Equality, Disability, Integration and Youth is the lead Department on this topic, as the majority of the organisations in question fall under its remit. Officials in the Department of Health are working closely with their colleagues in the Department of Children, Equality, Disability, Integration and Youth on this matter. I am aware that they have been engaging extensively with the unions over recent months under the auspices of the Workplace Relations Commission, WRC, and have been supported in these discussions by officials from the Department of Health, the HSE and Tusla. This process culminated in an offer being made in line with that accepted by the same trade unions in other sectors across the wider public sector in recent months. The offer to workers in this sector amounted to a 5% increase in funding for pay, effective from November 2023, with 3% backdated to April 2023, and a commitment to re-engage with trade union representatives following the next public sector pay agreement. Unfortunately, this offer was not accepted by trade union representatives. It is disappointing that their members were not afforded the opportunity to vote on whether they wished to accept the 5% increase in pay funding and that the unions instead elected to ballot for industrial action. As such action would impact negatively on people who rely on these services, I urge all parties to work on resolving any disputes through the appropriate forums and uphold industrial peace in the interests of people who use our health service. An announcement regarding the result of the ballot and any plan for industrial action is expected to be made by the unions at a press conference on Monday, 25 September. As this is an ongoing industrial relations matter, it would be inappropriate to comment any further at this point.
The offer from the Government was designed to fail. It was nowhere near what was needed to resolve the pay parity and pay justice issue. Even management in section 39 organisations has been saying that. On the back of what we are seeing with St. Michael's House, which is a section 38 organisation, with young adults coming out of the school service and having no service available, where does the responsibility for that service go? The section 39 organisations are being asked to meet that requirement. These section 39 workers, as well as the section 56 workers and others outside of that in drug and alcohol services, are shouldering the burden. I am thinking of Prosper Fingal in my constituency, which is unable to meet the demographic pressures of operating in such a young, fast-growing constituency such as Dublin Fingal. Never mind the organisation being able to grow its service, it is struggling to sustain it. The Government's offer was designed to fail. No leadership is being shown here. We, the trade unions and the workers believe there is no real desire on the part of the Government to solve this issue, despite the healthy state of the State’s finances.
I reiterate that section 39 and section 56 organisations and their staff play a vital role in our healthcare and social care sectors.
Officials in the Department and the Department of Children, Equality, Disability, Integration and Youth are waiting on the result of the ballot. Officials from both Departments remain available to re-engage with unions at any time in an effort to bring this matter to a resolution. It is also important to remember that these are private employers and, as such, the Government has no authority or ability to change the terms and conditions of these workers. I appreciate that there are many organisations with staff who have similar or equivalent roles to workers in the HSE. However, it must be noted that there are more than 1,500 organisations within the sector. As the State is not the employer, we have a limited ability to verify the position. Attempting to increase the pay of workers in this sector by 9.5% may result in further disparity. The Government has little or no information in relation to many of these organisations and the terms and conditions of their employees. I reiterate that officials are ready to engage with unions at any time to resolve this issue.
The unions have never been backwards in wanting to engage with the Government on this. The Government is not meeting the basic asks these workers require. However, we are where we are. We do not yet have the results but we know there will be a mandate for industrial action, up to and including an all-out strike. If that happens, it will be a hammer blow to communities. The difference in this case is that the families involved, and even the management of these section 39 organisations, support the workers and their call. Everyone in the community is behind them because people know they provide a vital service to their service users. We have been speaking about this issue now since I was elected to the Dáil more than three years ago. Unfortunately, this campaign does not seem to be registering with the Government. We need reform of the sector and proper pay for the workers in it. Otherwise, the bottom will fall out of the sector. If it does, it will spell disaster for the most vulnerable in our society.
I am at one with the Deputy that we need to ensure the stability and sustainability of this sector. It is important that this matter is brought to a resolution. As I said, the Departments are willing to re-engage with the unions at any point in this process. It is absolutely vital that these services continue. The Deputy has that assurance. There are mechanisms in place that need to be gone through. We need to wait for the result of the ballot on Monday and see where we are from there. However, our commitment to ensure these services continue is clear.
3. Deputy Mark Ward asked the Minister for Health for an update on the Government’s response to the Mental Health Commission’s reports into CAMHS; if the Government will accept and implement the 49 recommendations made by the Mental Health Commission; and if she will make a statement on the matter. [40786/23]
Since the recess, there have been several reports by the Mental Health Commission on child and adolescent mental health services, CAMHS. They have highlighted a failure in governance, risk management, clinical governance, staffing and access to treatment, among other matters. Overall, the reports are a damning indictment of how we care for vulnerable children. I ask for an update on the Government's response to the Mental Health Commission's report on CAMHS? Will the Government accept the 49 recommendations made by the Mental Health Commission?
The Mental Health Commission report is a welcome contribution to a common objective of improving CAMHS services. As the Deputy will be aware, and as I have said previously, when Dr. Susan Finnerty and the Mental Health Commission informed me last year that they were about to look at CAMHS, I asked them to expand their review. I also funded what was necessary in this case.
I welcome the reports. Of the 49 recommendations, many are already being progressed under work streams arising from the Sharing the Vision Implementation Plan 2022 to 2024, the Maskey report, the CAMHS operational guideline, COG, audit and the national audit of prescribing practices. The programme for Government commits to improving all aspects of CAMHS in line with Sharing the Vision, our national mental health policy, and Connecting for Life: Ireland’s National Strategy to Reduce Suicide 2015 - 2024. While challenges and issues have been identified in the community healthcare organisation, CHO, reports, is important to note that across each CHO, the hard work and dedication of the many staff working in the front-line service are acknowledged and recognised by the Mental Health Commission.
Three recommendations sit with the Department of Health, with a further two recommendations requiring departmental review and input. In relation to the recommendation requesting that there be a national clinical programme and clinical lead for the mental health of asylum seekers, refugees and migrants, I am not in a position to support this recommendation. It is important that appropriate supports and expertise are available throughout our mental health service to anyone who requires them. I am not in favour of a segregated approach.
In relation to the immediate and independent regulation of CAMHS by the Mental Health Commission, a key element of the mental health Bill will be the expansion of the commission’s regulatory remit to include community residences and services, including CAMHS services. There is a clear process in place for the development of the mental health Bill and its introduction in the Oireachtas as a priority. It is currently receiving priority drafting for the third time and four drafters are working on it. I will elaborate in my next contribution.
I want to give the Minister of State some facts. Waiting lists for initial assessments for CAMHS have almost doubled since the Minister of State took the reins in mental health. Hundreds of children have been waiting for more than a year for an appointment with CAMHS. The report also shows issues around monitoring of anti-psychotic medication. In some areas, only 50% of children had appropriate levels of monitoring of their antipsychotic medication. There are no national standards for monitoring this medication.
The report also pointed out the long waiting times between referrals and assessment for high-risk factors, which include deliberate self-harm, suicidal intent, suicidal ideation and eating disorders. Children were waiting for more than 200 days, or more than half a year, after being referred for suicidal ideation. Children were also waiting 100 days for a referral for eating disorders. Children were waiting in some areas for more than 190 days after a referral for deliberate self-harm.
I will ask the Minister of State again about the 49 recommendations. Does she accept this report in its entirety? Which of the 49 recommendations will she implement?
I will address a couple of points. The Deputy stated the waiting list had doubled. It has, and there are now 3,900 children on the waiting list, although it reduced in July. What the Deputy did not say is that there were 33% more referrals to CAMHS during the Covid-19 period, that the teams saw 21% more children and that there were 225,000 appointments last year.
It is important to put that on the record of the Dáil.
In response to the Deputy's question on antipsychotic medication, we now have a new clinical lead for CAMHS, which we never had before, namely, Dr. Amanda Burke, who has 30 years' experience. She is an executive clinical director. She took up her post in August and I have met her several times already. As of Monday of this week, we have a new national youth mental health office. That was never the case in the HSE previously. Dr. Donan Kelly took up the post on Monday. I look forward to meeting him next week.
The Minister of State mentioned 33% more referrals to CAMHS. She is right that there have been more referrals but there were also more children referred to CAMHS and not accepted because they did not meet the criteria. That is right across the board. It is different in different CHO areas. In one CHO area, the acceptance rate will be 60% or 70% but in the neighbouring CHO area, the acceptance rate will be an awful lot lower. We need to have uniformity of care because a postcode lottery of care has developed under this Government.
I am going to talk about just one of the recommendations, No. 1. It is that: "The immediate and independent regulation of CAMHS by the Mental Health Commission must be put in place to ensure" that the Mental Health Commission has the statutory powers to oversee CAMHS. The Minister of State mentioned that in her previous intervention. People cannot wait. Children cannot wait for this legislation. Deputy Cullinane and I have submitted legislation to the Bills Office and it will come before the Oireachtas very soon. Will the Minister of State accept recommendation No. 1 and support us on this matter?
Recommendation No. 1 relates to the immediate and independent regulation of CAMHS by the Mental Health Commission. As I said, a key element of the Mental Health Bill will be expansion of the commission's regulatory remit to include community residences - about 1,200 people live in community residences all over the country - and services, including CAMHS services. That has been agreed and the Mental Health Commission is aware of it but we need legislation to put it in place.
I have the legislation.
A clear process is in place for the development of the mental health Bill. Recommendation No. 2, which follows on from No. 1, states that the implementation of these recommendations must be monitored by the Mental Health Commission. The commission intends to publish a yearly report on progress of implementation. While I welcome the focus on service improvement in CAMHS, it is the role of the Department of Health to ensure that key performance metrics for HSE services are met. The functions of the commission, as set out in section 33 of the Mental Health Act, do not include a function to oversee or monitor performance. I want to get the legislation in place as soon as possible and I also want the Mental Health Commission to have oversight of the CAMHS teams.
4. Deputy Róisín Shortall asked the Minister for Health to provide an update on the significant underfunding of the HSE national service plan; the current projected deficit to year-end; the reason his Department did not address this matter when its implications were highlighted by the HSE at the start of 2023; how he will address this deficit up to the end of 2023 in a way which ensures service capacity, activity volumes and access times are not adversely impacted for patients and service users; and if he will make a statement on the matter. [40910/23]
We knew from early in the year that there was a black hole in the funding for the HSE national service plan, NSP. This was identified by a board member of the HSE, Mr. Brendan Lenihan, who is the chair of the audit and risk committee. He said he was not prepared to go along with this messaging, which was trying to cover over the fact that there was a serious shortfall in funding for the service plan. What is happening in that regard and where do we stand with the deficit?
Budget 2023 saw a record allocation of €24 billion to the health Vote. This increased funding reflects the Government's ongoing commitment to resourcing the HSE to deal with a range of pressures and includes a range of new investments to deliver on the Sláintecare reform agenda.
As part of the planning for service delivery for 2023, extensive engagements took place between the Department of Health and the HSE on managing the financial risks for 2023 and areas for savings and efficiencies were identified as part of that process. However, both demand and inflationary pressures have been high across the health sector and, in particular, in our acute hospitals. This combination of price and volume increases, reflecting demographic and post-Covid impacts, has led to increased costs in the provision of health services and contributed significantly to the HSE deficit, which was €642 million, or an overspend of approximately 6.8%, at the end of June.
Building on the areas identified in the NSP for savings, specific targeted measures have already been introduced to achieve reductions in the deficit. We are seeing increased levels of activity in comparison with the same period in 2019. Emergency department attendances are up 8%. Emergency department attendances by those aged 75 and older are up 21%. Admissions from emergency departments are up 7.5%. Admissions by those aged 75 and over from the emergency departments were up 15%.
Another cost driver is the significant impact of inflation across health in 2023. Core inflation is a reasonable general indicator for health, as it reflects products and services and removes energy and food. It has been increasing throughout 2023 and stood at 6.4% year on year in August, even as headline inflation began to decrease. The ESRI warned that core inflation may be harder to subdue and lead to upwards revisions in the inflation outlook for next year.
I do not accept what the Minister of State has said. I know who writes this stuff and it is not true. It does not reflect reality. There is a three-month delay in approving the national service plan and we know why that was. It was because there were serious concerns about underfunding of the plan. We have known for a long time that the population is increasing and ageing and that there is growing demand for services. It was spelt out very clearly last March that the budget provided was not sufficient to meet demand for services. Stephen Mulvany of the HSE had heated exchanges with the Secretary General, as he was not prepared to engage in the pretence that there was enough money there. What he and Mr. Lenihan predicted has been borne out.
I asked if the Minister of State could tell me the current projected deficit to year end. What deficit is expected and how is it going to be met?
As I said, based on the figures that have been made available to me today, the current deficit was €642 million-----
No. That is not what I asked.
I know that. I am answering the question. The current deficit was €642 million to the end of June. That is the publicly available figure at the moment.
I can tell Deputy Shortall what actions are being taken to address the HSE deficit. An initial minimum target reduction of 10% on agency costs has been brought in, with effect from August, across both the acute and community settings. There is a pause in the growth of management and administrative grades. A target has been set of reducing management consultancy costs by 30% by the end of 2023. Covid acute and community expenditure has reduced, from a high of €1.116 billion in 2021 to €701 million in 2022, with the 2023 equivalent forecast to be below €300 million.
The Department got notice of this question. I asked what the projected deficit for the end of year was and the Minister of State has not been able to provide that figure. She should have been supplied with it. I ask her to go back to the Secretary General, get that figure and send it on to me. We should have had it today. Everybody's fear is that there will be a delay in recruitment and that that is how the deficit will be addressed and what the Department will propose. We know the implications of that. It is service cutbacks or planned service improvements not taking place. A projected 6,000 staff were due to be recruited this year. How many of them have been recruited at this stage? What are the other means by which the Department will close the black hole of €2 billion identified at the start of the year?
The black hole of €2 billion referred to by the Deputy has not been verified. As I stated, the figure up to the end of June-----
I am sorry, but it is set out in the service plan. All of the shortfalls are identified in the service plan.
Will Deputy Shortall let the Minister of State finish?
Thank you, a Leas-Cheann Comhairle. The deficit has been verified at €642 million up to the end of June. As I stated, the HSE is taking significant actions to address this. For example, a State claims task force has been established to reduce the overall cost of claims.
I heard that. What about recruitment?
I do not think this is a back-and-forth discussion. Deputy Shortall got her opportunity to ask a question.
I did, but I want answers.
The Deputy should not interrupt.
Extensive efforts are being made to recruit across all sectors. Deputy Shortall needs to be fair as well. The main overrun is across acute services and emergency departments. Spending on disability services, mental health and older people is not over budget at all. The over budget spending is in the acute sector where the demand is overwhelming for many hospitals.
How many of the 6,000 staff have been recruited?
Gabhaim buíochas leis an Teachta.
