Duncan Smith
Ceist:5. Deputy Duncan Smith asked the Minister for Health if he will commit to meeting transgender advocacy groups to discuss the provision of transgender healthcare; and if he will make a statement on the matter. [1975/24]
Ceisteanna Eile - Other Questions
Departmental Meetings
My question relates to transgender advocacy groups and the Minister's engagement, or lack thereof, with said groups. It is a request that he and senior officials in the HSE commit not only to having one meeting but holding a series of ongoing engagements with the relevant transgender advocacy groups.
I do not think that dig is fair. I respectfully disagree with the Deputy on that. I am happy to meet the stakeholders. I have met TENI and other groups before and I am happy to meet them.
I am meeting a constituent of mine soon who was in contact. She is the parent of a transgender child who wants to talk through some of the issues that they are facing, which I am familiar with and I am very sympathetic to. I am committed to the development of a model of care that delivers proper services for this group of people. It is a very small and very vulnerable group of people and they need to have access to proper, appropriate and integrated care, including acute care and community care. Quite frankly, as we all know, they do not have access to that in Ireland right now and I am not satisfied with that. To be perfectly honest with the Deputy, I am also not satisfied with the pace at which this is progressing. There has been a hold-up for a long time in appointing a psychiatrist to lead the new model of care. What I can share with the Deputy is that an offer has now been made to a person. However, that process is not complete yet so that is all I can say at this point.
The HSE is going to consult widely with stakeholders, including TENI and others, in the development of the new model of care. The HSE is working to identify new pathways. As we know, the Tavistock centre has now been decommissioned and the UK health authorities have opened different centres on the back of the Cass report. Ultimately, we need those services available to people in Ireland and that is the objective. Of course, I am happy to continue meeting with stakeholders.
In terms of the appointment of the HSE clinical lead, while the groups are obviously aware that they have no formal role in such an appointment, given that this is a small and vulnerable group of people, they feel that engagement regarding that role or position would be important. This community has insights in terms of who provides the specialist care and who would give confidence in the provision of the care that is needed. The National Gender Service, NGS, at the moment is not national. It does not reach many corners of the country at all and is not operating as a gender service in the context of healthcare in any way, shape or form. The Minister has acknowledged that an awful lot more work needs to be done. Trans Healthcare Action and TENI believe they need more engagement and I also believe they do and that such engagement has to be ongoing. They do not feel they are getting the engagement they need. We really need to see that to provide confidence to these groups and to this community that they are being listened to and being heard.
It is disappointing but very useful to hear that feedback. On the back of this discussion, I will talk to the Department and the HSE. Of course, I can meet the groups and am happy to do so again but ultimately they need to be talking to the people who are designing the model of care. Of course, it can be useful to talk to a Minister but really, they need direct input into the model of care that is being developed.
I am happy to say that we have allocated funding for this year, a sum of €100,000, for the establishment of a new team, which is important. The HSE is working on an interim solution, an alternative pathway for children and young people who are experiencing protracted waiting times. They are waiting too long and the current situation is not where we want to be. Discussions are under way with paediatric endocrinology in Children's Health Ireland and with our psychology services to put an interim solution in place until we have what these young people need and deserve, which is a fully dedicated multidisciplinary service.
Regarding the model of care, the NGS states that patient support and advocacy organisations will be involved in governance and service development. However, after five years there is still no member of the trans community on the NGS governance committee and no member has been invited to participate in the development of the service. These are some of the tangible improvements that could be made to increase confidence. Across the NGS, the Department of Health, and among senior figures, including chief clinical officers, in the HSE, we need that level of engagement. This is something to which I will return. I accept the Minister's bona fides in terms of wanting to get this service right and wanting to deliver, but we need to see action and engagement to engender confidence in the community. It is a community of which I am not a member but when I speak to advocacy organisations, I hear what they are saying and I think the Minister hears them too.
I take that feedback very seriously. We cannot have a situation where we are developing a model of care for a group of people who are not involved and whose voices are not heard. We are trying, although it does not always work and we are not always successful, to move to a situation where the patient voice is front and centre in everything we do. We are embedding it in legislation in the Patient Safety (Notifiable Incidents and Open Disclosure) Act and through new regulations within the HSE. We are not getting it right all of the time and clearly, if the trans community feels that they are outside the door and nobody is listening to them, then whatever is happening is clearly not working and needs to be looked at. I commit to going back to the Department and the HSE on this. I will also ask them to revert to the Deputy with a note on what actions can be taken.
Hospital Services
Pauline Tully
Ceist:6. Deputy Pauline Tully asked the Minister for Health the level of additional core expenditure for new developments, excluding funding for carryover and otherwise maintaining existing levels of service, which has been allocated to Cavan General Hospital for 2024; and if he will make a statement on the matter. [2071/24]
I ask the Minister to outline the level of additional core expenditure for new developments, excluding funding for carry over and otherwise maintaining existing levels of service, that has been allocated to Cavan General Hospital in 2024.
I thank Deputy Tully for her question and assure her that I am fully committed to the development of Cavan General Hospital and to all of our regional hospitals right across the country. When I received the Deputy's question I asked for a note on the recent investment in Cavan hospital. It is all well and good with me saying what might happen in the future but I wanted to establish that real investment has been happening over the last few years and I have to say, the response is very encouraging. The budget in the lifetime of this Government has gone up by €16 million for last year. The full budgets for this year will obviously be agreed through the national service plan. Probably more importantly, since 2020 there has been an increase of nearly one quarter in the workforce. To me, that is always the most important bit because it is healthcare professionals, ultimately, who treat patients. That equates to 259 extra staff in Cavan hospital, which is a very clear commitment to the future growth and investment in the hospital. On top of that, the Deputy will be aware that a number of capital developments are in progress, which are going to be very important. One, of which Deputy Tully will be very aware, is the new three-storey extension block which will house a new endoscopy unit and an 18-bed ward. That is currently at detailed design stage and I want to see that progress because it will make a big difference to patient care in the area.
Recent initiatives in service expansion also include the establishment of a medical assessment unit, the feedback on which is very positive, and the further development of a geriatric assessment unit. The latter is something that we are rolling out across the country and the feedback around the country has been very good, particularly in terms of emergency department avoidance and receiving the appropriate care locally. Following the announcement of the budget allocation last year, I issued a letter of determination to the HSE. That kicks off the process for the national service plan and the detailed answer to the Deputy's question in terms of 2024 and the hospital will be available through that national service plan.
It goes without saying that the staff in Cavan General Hospital are excellent but they are under pressure. The Minister has said that there has been an increase in the number of staff and I appreciate that but there has also been an increase in the number of people using the hospital. There are insufficient numbers of front-line staff, particularly therapists. I was talking to a therapist recently who told me that her caseload for one day was 30 people. That is not sustainable. In the end, because there were only two therapists doing the job and they were each facing heavy caseloads, she ended up quite ill herself and had to take time off because she was so worn down.
Cavan General Hospital, like all hospitals, is currently facing issues because of high flu and Covid numbers. Advisories have been issued to stay away from the emergency department if at all possible and I am concerned about that. While I know the hospital is not referring to genuine emergencies, people are actually afraid to go to the emergency department even when they really do need to go. If something could be done to reduce the number of patients on trolleys and alleviate the overcrowding in the emergency department, that would be very welcome.
Morale in the hospital is quite low. I have talked to staff who feel they are under pressure and that it can be dangerous for themselves and patients when there are insufficient numbers of nurses on wards, for example. Constituents have also contacted me about cancelled or delayed appointments.
With regard to emergency departments, I am sorry I do not have the figures for Cavan. However, last year we moved to an all-year-round approach to urgent and emergency care to get away from this annual cycle of winter plans. To the great credit of our healthcare professionals, we have seen a very important reduction. I am not for a moment diminishing the fact that the numbers are still way too high and some emergency departments in some hospitals are under huge pressure. Approximately seven hospitals account for about half the number of patients on trolleys. I am sorry that I do not have the Cavan figures to hand but our healthcare workers achieved a 22% reduction in the number of patients on trolleys for the second half of last year versus the previous year. For those most at risk, namely, the over-75s who are in emergency departments for more than a day, the number has fallen by nearly 40%. We are by no means where we want to end up but, thanks to important work, things are getting better. I will ask the Department to revert to the Deputy with a note on the figures for Cavan emergency department.
I know from meeting with hospital management that they are very proactive and are trying at all times to alleviate pressures. Sometimes, constituents contact me to say they have an appointment in maybe six months for a hernia or something. When I talk to them further, it turns out the appointment is only an initial one to see the consultant. It does not take into account the time they will have to wait on a waiting list for an operation. That is too long. Some of them will end up using the cross-border directive but they should not have to do that, as it can place a financial pressure on them because they have to pay upfront for it, although I know they will recoup the money.
Another lady came to me who was threatened with a miscarriage on a Friday. She was just over three months pregnant. When she went to the hospital it was Monday before she could be scanned to establish whether she was having a miscarriage because no sonographers were there to operate the machines over the weekend. She was not the only one. The woman concerned ended up having a miscarriage. Another lady went to the hospital with a bleed but it ended up that her baby was safe. However, it is terrible to have to wait a whole weekend to establish that. That is not okay. The woman made the point to me that if men were having babies, that probably would not happen. She felt she did not get the care she deserved. She was even examined in a room that was not a ward. It was not even private; it was a storeroom.
I am obviously not familiar with the case but it does not sound right. We are in the middle of a very fundamental shift in healthcare provision in respect of exactly the situation that woman found herself in. We are moving from a five-day week service to a seven-day week hospital service. Of course, hospitals are open at the weekends but, exactly to the Deputy's point, all the services are not always available at weekends. The new consultant contract is part of that, as is the hiring of 25,000 more staff. It takes time. It is a huge shift from five days to seven days but it is essential for all the reasons that lady the Deputy described seems to have experienced. Certainly, the Deputy should rest assured we will continue investing in Cavan hospital, continue growing services and the workforce, and seek to move to, and achieve, seven days a week so that patients can get the services they need. As she said, people need that kind of care seven days a week and not just five.
Information and Communications Technology
Aindrias Moynihan
Ceist:7. Deputy Aindrias Moynihan asked the Minister for Health in what areas in acute hospital settings AI technology is being considered; and if he will make a statement on the matter. [2032/24]
Gabhaim buíochas leis an Leas-Cheann Comhairle. Athbhlian faoi mhaise di. The use of artificial intelligence in healthcare settings can offer very exciting possibilities, and also present challenges and various considerations. Will the Minister give an outline of the use of AI in medical settings throughout the country, as well as the various considerations he has had of its use?
I thank the Deputy for the question. I heard this morning that AI is front and centre at Davos as well. It is certainly coming to the fore very rapidly. It will have potentially radical benefits, be they in diagnostics, in some advanced care, or robotics for procedures, and as we move forward with genetics, genomics and genome sequencing. AI will move more and more to the fore. What is critical for Ireland is for us to make sure that we capture these benefits for patients. We must have state-of-the-art e-health and digital infrastructure in place. The reality is Ireland is not just a laggard but a significant laggard in the EU and the developed world in this regard.
To that end, we have been doing a lot of work on a new e-health and digital strategy. I will launch that strategy this year. It is being finalised at present. It will be a six- or seven-year strategy. We have had a lot of consultation with experts and potential providers to see what platforms can be used. We are doing it in parallel with the health information Bill, which I will bring to the Government shortly and will include the matter of unique patient identifiers. It will establish a central agency that will be able to collate data because, ultimately, AI is data driven, as I know the Deputy knows very well.
There have already been one or two projects, despite the lack of national infrastructure we need. Last December, the Mater announced it was the first hospital to use AI for patient scans. I might give the Deputy more detail on that in my response.
I note the Minister referred to the Mater. I understand it was one of the first, and probably the first, to integrate AI in its radiology department. I understand it allowed the hospital the opportunity to go through large numbers of results very quickly, and possibly not just to identify different issues but to get people additional tests while they were still on-site. There are real possibilities in that regard. If there are other examples of where AI is being used in a healthcare setting in Ireland, I would be very interested in the different ways that it can be used.
The Minister referred to the way that AI can also be used to look at large numbers of people, preparing the various records and having electronic records for that. One of the big challenges is that security and confidentiality will be needed, and buy-in and consent from patients for their data to be used in that manner. Has that been examined? Is there an update on that?
It is such a good question. There are many parts to this. One is general cybersecurity. It can be imagined, following the cyber-breach we had, there has been very significant investment in and strengthening of cybersecurity across our health services.
There are many subtleties to AI, for example, ethical AI. We would be handing over some form of advisory capacity, decision-making capacity, or whatever it might be, to algorithms. There has to be appropriate oversight of that. Not only that, there has to be appropriate input to the design of that in terms of ethical AI guidelines. A framework for ethical AI guidelines was brought to the Government very recently. It is something we have to approach carefully.
The Mater project was clinically led. It trialled the use of AI software and looked at 15,000 patient scans to assess the potential to speed up care in the emergency department. Early results indicate improved diagnostic accuracy, streamlined workflow and reduced time required to provide life-saving treatments, so initial indications are very positive.
I understand that AI can also be used to customise care plans for people, looking at how they may respond to different therapies and customising the treatment or medicine from there. Have such considerations been looked at in any settings in the country?
I return to the huge issue of consent and the whole ethical question. If we are looking at having a huge store of people's data and running AI over it to predict where different populations might be impacted by various conditions, we need buy-in from people, trust in AI and consent for the use of their data.
There is also the question on the having it safe and stored securely as well.
It is an ongoing process and it is a rapidly emerging field. There are areas we are looking at very closely such as cybersecurity, as we discussed, ethical AI and the guidelines on the use of that, patient consent, and full information on how information may be used. We can do population-based analyses with or without AI. Having that population-based information will be invaluable for public health responses and investment in public health. There is no doubt AI can enhance that. There also would be AI applications for individualised care around genome sequencing and matching potential treatments to potential conditions that people have. This area will need very clear consent and regulation. The health information Bill is very significant legislation and a lot of the regulatory framework for digital health and e-health will be contained within that.
Ambulance Service
Peadar Tóibín
Ceist:8. Deputy Peadar Tóibín asked the Minister for Health the number of ambulance drivers recruited to the National Ambulance Service and the number of ambulance drivers who have left the National Ambulance Service in each of the past ten years; and if he will make a statement on the matter. [1894/24]
The average ambulance response time in this country has been increasing significantly in the past few years, so much so that one particular and heartbreaking statistic is the number of times a patient was dead when an ambulance reached the person. In 2019 that figure was 700 and in the past year that has increased to at least 900 deaths. This is a very serious statistic that shows lives are being put in danger as a result of late ambulance arrival.
I thank Deputy Tóibín for the question. We must endeavour to do everything we can to make sure the responses are properly triaged and then the response times are such that where they really do need to be there very quickly this is achieved.
I acknowledge the commitment of the national ambulance service and all of those working in it to delivering this on behalf of patients. We have invested more than €219 million in the National Ambulance Service since 2019. It represents a €50 million increase. It is has been a very significant investment to ensure we have the best possible ambulance service. The increase in staff has been important. If we look back to 2015, over the past eight years the number of staff has increased by more than one third. We have 600 more people working in the service than we had in 2015. To be clear, just last year 228 of those were added. There was a big increase in the number of people working in the national ambulance service last year. The majority of those were hired late in the year.
On the Deputy's points specifically on the response times, which I fully appreciate, the Deputy will be aware of the ECHO and the DELTA response times and the targets. The target for the ECHO calls, which includes cardiac, is 75% within the time period. To November of last year they were at about 73%, which is 2% off the target. The DELTA calls had a target of 45%. They were at 44.5%, so nearly there. They are not yet hitting those targets. I interrogated this matter further on the back of the question submitted by the Deputy. The good news is that the majority of those several 100 extra staff were hired very late last year and so the benefit of those extra staff for increased response times will not have been seen in the 2023 figures. We have, therefore, an ambition this year not just to meet the response time targets but to exceed them.
The figures quoted by the Minister are obviously from a baseline in 2015. The Minister will accept that 2015 was probably during the complete collapse of investment, post austerity, into the health service. The figures being taken as a baseline are from the lowest level of staffing within the National Ambulance Service, which obviously will make the Minister's figures improve. It is very important. In 2019 there were 750 people dead by the time the ambulance arrived. In 2022 that figure was 900. The average response time for an ambulance over that period of time in 2019 was 18 minutes. In 2022 it was 27 minutes. That is an incredible figure. In the western region in 2022 one individual waited 22 hours for an ambulance to arrive. This too is an incredible figure. In the first two months of last year one person in the south of the country waited 13 hours for an ambulance to arrive. The figures are getting worse, given the real life experience of patients, and it is having a material detrimental effect on their health and lives.
Neither I, the Deputy nor those working in our ambulance service would stand over or defend those individual cases where people clearly have waited far too long. Nobody would defend that. On the response times, the core targets the service works to are the ECHO and the DELTA times. They were very close to those times last year.
I hear the Deputy's point about going back to the 2015 figures. This is why I wanted to give the Deputy just last year's figures. Of the 600 new staff, 228 of them were just last year. I understand the Deputy's point. This is also why I wanted to say that most of these 228 were hired towards the end of last year. We do want to improve those figures.
The question tabled by the Deputy was about retention, the numbers joining and the numbers coming in. I will answer that directly in my next response.
If I may I will add some practical solutions on this. One of the big situations we see on a regular basis is that an ambulance arrives at the accident and emergency department with the patient but due to the jam in the accident and emergency department because of overcrowding, or simply because there are not enough trolleys there, the ambulance has to stay at the entrance to the accident and emergency department for one, two or three hours. We then have incredible situations such as in Drogheda hospital one year ago where ten ambulances had to wait for five hours because they could not off-load their patients. I have recently heard of another hospital in Mayo where eight ambulances were stuck there. When those ambulances are stuck they obviously cannot get to the rest of the region to pick up new patients. A very simple thing would be to have just enough trolleys so when the patient is moved into the accident and emergency department from the ambulance trolley there is another trolley there. The ambulance can then be freed up to travel. I am aware this is not the case in every situation and in many situations one needs the necessary medical staff to be able to deal with the patient for the patient to be accepted but that is one of the major pinch points where ambulances are stuck at the accident and emergency departments and are not free to go about their work.
I certainly know the ambulance service can take that under advisement and will do everything they can to increase the turnaround times. They have been innovating over the past few years. The clinical hub now has hear and treat and see and treat services they did not have previously. The Deputy will be aware of the pathfinder model, the medical assessment unit pathways, the community paramedic scheme, the ED in the home and various other issues. The ambulance services are to be commended for their innovation. I am not detracting from the fact there are still significant challenges.
On the Deputy's specific question about those joining versus leaving the service, I am very happy to say the ambulance service put in place a human resource plan two years ago in 2022. Their turnover rate is now 1%, which was for quarter 3 of last year versus 2.4% for the HSE. Essentially, twice as many have joined the service as have resigned or retired from the service in previous years. They are clearly doing something right. We in Government and in the Oireachtas need to continue to support them and to continue investing in them. They are showing that it is money very well spent on behalf of patients.
Health Promotion
Kathleen Funchion
Ceist:9. Deputy Kathleen Funchion asked the Minister for Health if he will ban tanning sunbeds outright, given the serious and increased risk of incidences of skin cancer. which is supported by scientific evidence linking skin cancer and tanning sunbed usage; and if he will make a statement on the matter. [1874/24]
My question is in relation to skin cancer and the link that we now know relates to tanning beds. This has come to my attention primarily from a woman in the southeast, from the same neck of the woods as the Minister of State, Deputy Mary Butler. I want the opportunity for us to discuss this further.
I thank the Deputy for tabling this question. The National Cancer Registry Ireland reported that about one quarter of all cancers diagnosed between 2019 and 2021 were non melanoma skin cancers.
Melanoma of skin accounted for one in 20 of the remaining invasive cancers diagnosed and one in 50 of cancer deaths every year. It is very important that anyone who has any concern should contact their GP. I am engaged directly with the dermatology services, which are a critical part of this, as are oncology services, to make sure people get rapid access.
To respond to the Deputy's point, it is acknowledged there is no safe limit for exposure to ultraviolet radiation from sunbeds when it comes to risk of cancer. The national skin cancer prevention plan, which runs from 2023 to 2026, sets out the national actions to tackle our high rates of skin cancer. It uses a multidisciplinary approach through education, public awareness and behavioural change. Under the public health sunbeds legislation, a range of measures are enforced by the HSE.
In addition, as Deputy Funchion is aware, the EU is looking at this. Its response to tackling cancer is set out in its beating cancer plan. Action 18 is relevant to this discussion. It has measures to prevent exposure to ultraviolet radiation and this includes sunbeds. These are being considered by the EU. Departmental officials are working with the European Commission subgroup on cancer under the public health expert group. My understanding is that the recommendations are expected to be published prior to the end of March.
I thank the Minister. I acknowledge a particular woman, Laura, who brought this to my attention. There are also others who campaign with her. It is probably an issue about which we do not speak a lot. When we say it people ask what is the problem. We can look at how much we now know about smoking and cigarettes and their links to cancer. We have the images on packaging now. With regard to sunbeds, however, while I acknowledge there are some measures it is widely felt that often they do not go far enough. Are they actually being implemented? Among the suggestions is to have a database to which everyone running a sunbed facility must sign up. Sometimes people go into one particular place for ten minutes and then go down the road somewhere else for another ten minutes. We know this happens. If there were a database to which people had to sign up it would limit usage. With regard to ID there is still an issue with very young teenage girls. I will discuss this in my next supplementary question.
I thank Deputy Funchion. It is something on which, between the legislation we have and the EU's ongoing work, we can go further. As I said, one in every four diagnosed cancers is a non-melanoma skin cancer. It is a significant issue. When I was a much younger man with a full head of hair I went to Australia and lived in Bondi Beach. There was a level of awareness there about skin cancer that did not exist in Ireland. To this day we do not have the level of awareness they had 28 years ago when I was there. More can be done. This is why we launched the recent plan.
Sunbed businesses are regulated here under a 2014 Act. The Department tells me the regulations we have are among the most comprehensive in the EU but there is a question as to whether enforcement could go further and whether awareness could go further.
I am glad to hear the Minister acknowledge this because it is very important. I agree it probably is an enforcement issue, certainly with regard to ID and some of what I suggested regarding having a database. We could also do a lot more with schools and transition year and use this opportunity to educate and create awareness. Many people think there is no harm in it. There is still the myth that it rains most of the time in this country so how could a little bit of sun be that detrimental. However, given our levels of skin cancer and the number of people who pass away from it, we need to do an awful lot more.
Will the Minister consider meeting the group I mentioned? It is a small group, mainly of women, who feel very strongly because they were not told all the negative aspects. To this day they are finding tumours that they are being told are very much linked to sunbed use in the past. Will the Minister consider meeting them to discuss ideas and suggestions on this? I know they would like to see a straight outright ban. We would probably have to take steps. I welcome that the EU is taking measures. If the Minister could speak more on what steps the EU might be taking I would appreciate it.
I thank the Deputy. With regard to the EU's recommendations we need to wait to see. However, the general sense is that it is considering restricting access for high-risk groups, the mandatory supervision of the commercial use of sunbeds, the provision of mandatory eye protection, and increasing awareness by providing information on the risks associated. I have asked the Chief Medical Officer and her team to engage in a new public health strategy, including prevention. This would be one of the parts of this. There is the legislation we have and the EU recommendations that will be coming out. Ongoing preventative work, with a refresh of Healthy Ireland and a greater emphasis on prevention in Ireland, which we have to achieve, could fit in quite well to this.
Medicinal Products
Bernard Durkan
Ceist:10. Deputy Bernard J. Durkan asked the Minister for Health the extent to which new modern, effective and safe drugs can become available here once approved by the EU authorities; and if he will make a statement on the matter. [1817/24]
This question seeks to ascertain the extent to which new, effective and safe drugs are made available for use by Irish patients as soon as they become approved at EU level.
I thank the Deputy for the question. We spend a lot of money on medicines in this country. Last year the medicines investment was more than €3.2 billion. This is a sizeable amount. The vast majority of the €2.8 billion was spent on the medicines themselves. There was also money spent on administration and payments to pharmacists for dispensing amounting to just over €400 million. Our public spend on medicines is, believe it or not, €1 in every €8 that we spend on healthcare. There is an unprecedented level of investment. Deputy Durkan is aware that over the past three years we have invested almost €100 million in new medicines. It was badly needed. It has led to the provision of almost 150 new medicines or extended new uses for medicines that we have. Spending on these medicines is estimated to have been almost €330 million to the end of 2023. There has been a sizeable investment when we factor in the full year costs of new development funding.
As per the 2013 Act, a company has to submit an application to the HSE to have a new medicine added to the reimbursement list. We sometimes forget that Ireland is a small country and a small market. We are not always prioritised by companies in the first stage. It is something that we are working on, and we have some multilateral agreements in place as well through Beneluxa.
For this year the HSE will have €30 million for new medicine spend. This comprises €20 million that I have allocated from the December additional new development funding and we are targeting a €10 million reduction in the €3.2 billion spend through a rapid switch to generics and biosimilars. This will provide another €30 million this year for new medicines, which is obviously going to be very important. In my next response I will come back to Deputy Durkan on the process he asked about.
I thank the Minister for his reply. What is the extent to which references come from the pharmaceutical sector on the ready availability as soon as these drugs are made available? For instance, what might be the time lag between approval in the European Union and in this country?
I accept that we are a smaller country but we are a member of the European Union. As a member of the Single Market, we have the same rights to new medicines and new drugs and any other service available to the European Union as there is anywhere else, including London as used to be the case once upon a time, Paris or Rome. I heard reference made on a radio programme recently to the theory that as we are a small member state, we should come further down the list. I do not accept this. We must accept that the European regime prevails. If we accept anything less than this we will run ourselves into trouble.
I thank the Deputy very much. I agree with him. I do not accept that either. We are a nation whose population deserves rapid access to these medicines. We have to strike a balance. We hear advocacy from the pharmaceutical industry regularly citing lengths of time. It has a particular view. Obviously, it wants Ireland to spend as much money as quickly as possible on its products. When I talk to people working within the service, the view is more nuanced. They say Ireland does quite well in accessing some drugs, and is well ahead of other European countries, but that it is not universal in terms of access to all medicines. To that end, the Deputy will be aware there was a Mazars report done some years ago which looked at the process and it found several ways we could improve it. One is around transparency of the process. I do not believe transparency has been where it needs to be for patients or indeed for the industry, and the other is in the speed with which we can approve the new medicines.
Regarding the urgency in respect of the availability of certain medicines, new medicines in particular, in this country should a safety assessment now be carried out in addition to the general European safety assessment or does the State go along with it?
I will ask the Department to revert to the Deputy with a detailed note on the full process involved in the health technology assessments because there are various parts to them. What I can say is that for this coming year there are going to be some important improvements. One is that we are going to have a medicines tracker for the first time. This is something that Rare Diseases Ireland, patient groups and the industry have asked for. They say that at a minimum we need to know where the medicine is in the process. There is going to be more transparency as well around the criteria that are used. For example, when we are considering orphan drugs, there are additional criteria used because they do not fit into the normal cost-benefit criteria that are used for the more mainstream drugs. Second, I have allocated funding for a sizeable increase in the teams working in these areas, which is going to help speed up the process. Third, we must have new medicines funding as well, and that is why that €30 million for new medicines is going to be very valuable for this year.
Health Services
Violet-Anne Wynne
Ceist:11. Deputy Violet-Anne Wynne asked the Minister for Health his views on the availability of homebirth services; and if he will make a statement on the matter. [1839/24]
I would be very grateful if the Minister could give me his view on the availability of homebirth services across the country with specific reference to my constituency of Clare.
I thank the Deputy very much. I put women's healthcare services front and centre in this Government in terms of investment and expansion. I believe we have to make up for many decades of lack of investment. The House broadly agrees that thanks to the work of our healthcare workers there has been important progress over the past three years. We will launch a new women's health action plan later on this year for the next two years. The first two years – 2022 and 2023 - are done.
Specifically in response to the Deputy's question about maternity services, there was investment of €16 million in 2021 and 2022, which got the national maternity strategy going again. Core to that strategy is the question raised by her of choice for women in terms of whether they want a consultant-led approach in the hospital, a midwife-led approach in the hospital or a midwife-led approach in the community and at home. Choice for women in terms of options for birth is core to all of this.
There is a disagreement between the consultant body – maybe not all of them but I am speaking in generalisations here – and the midwives. I met with a fantastic group of midwives at the INMO conference some time ago. Their view is that the time to the hospital – the current policy is set at 30 minutes – should be longer and they gave very good reasons for that. I also met very experienced obstetricians who said why they believe that 30 minutes is the right way to go from a patient safety perspective. Obviously I am not qualified to comment on that. There is an ongoing discussion on whether it should be 30 minutes or longer and what resources need to be in place for that to happen. I can tell the Deputy what I and the Government want to facilitate from the perspective of the direction of travel. It is the greatest possible options for women, but with an obvious caveat that those services need to keep women and their babies safe.
I thank the Minister for the information. I raise this matter with him today on behalf of my female constituents in County Clare. He may be aware of the case of one particular lady, as I have previously written to him about her. She is due her second child in July and as he may be aware there are already extremely limited options for birthing in the county. She wrote me a letter and I am going to share some of it with the House this morning:
While trying to organise a homebirth it transpires that the midwives who previously served and wish to serve in our area, have been forced to private practice. This service, provided by the organisation Private Midwives, costs around €6,800. The national maternity strategy highlights choice as a key priority for low-risk women. It identifies homebirth as a choice. [As the Minister would know] An alongside birth centre does not exist in our area. Homebirth is the only alternative to the maternity hospital. This is a women’s healthcare prerogative that needs to be addressed.
While delivering her first child, active labour lasted less than one hour so she is a perfect candidate for a homebirth. The current reality is that my constituent can register as a patient in University Maternity Hospital Limerick, UMHL, our closest maternity hospital then pay privately for a homebirth and transfer to UMHL during labour, if needed. For her family to pay privately would put them in financial hardship. UMHL's suspension of homebirth services in the Limerick-Clare-north Tipperary region, leaves less privileged women in the area without access to a service that is provided by all other maternity hospitals.
I cannot comment on the individual case. I am not familiar with it. However, as the Deputy referenced, there was an incident in June 2022 when the HSE notified my Department of a maternal death in the mid-west following a home birth. At that time those services were then stopped. A review is being commissioned, which needs to happen quickly. I discussed this with a group of very experienced midwives who made the following point on exactly this to me: they said there are also maternal deaths in acute settings and we do not shut down the hospital maternity services. Their view was that they felt pretty strongly about that. Again, I am not qualified to make judgments on patient safety. We need this review to happen and to be concluded to take the expert advice. to listen to the voices of the women who want these services and to get to a point where we can provide the greatest possible choice while ensuring there is an appropriate level of patient safety there as well.
I again thank the Minister. I appreciate what he has stated. The stipulation of 30 minutes would really restrict services in County Clare because of the distance involved, which would limit the service to very small pockets of the county from which women would be able to get to UMHL within that timeframe. It is important to mention that to the Minister. There is a major concern that there would be a two-tier system within maternity healthcare.
The HSE recommendation to limit homebirths to women who live 30 minutes from a maternity hospital will restrict the options for women and families in County Clare, in particular for those in rural parts of the county. It is also contrary to the national maternity strategy's priority to ensure "women have access to safe, high quality, nationally consistent, woman-centred maternity care". It is important to note that this recommendation was developed with no input form midwives, clinicians, or women's health advocates. I firmly agree with the midwives association's call for a reconsideration of this policy by engaging all stakeholders. Will that be included in the review? Women were second-class citizens in this State for long enough. We should not be further restricted. Instead, we should be supported in making our own informed choices about our maternity care.
We have discussed the issue of homebirth and we need an answer to this that works for women in terms of choice and safety. While that is being progressed, significant improvements are happening across maternity care. Through the strategy we have hired an additional 465 staff who were very badly needed and who are making a big difference.
I have been in many of the maternity units and I have seen the upgrades to the birthing suites. There are pools there now, for example. The midwives are saying that things that might be considered small, cosmetic changes are making a huge difference to women and the experience they have. The clinical outcomes are getting better and better. A very comprehensive system is in place. One of the areas where we actually do well in e-health is in the maternity services.
Just last year, five new postnatal hubs opened at hospitals in Cork, Kerry, Sligo, Ballinasloe and Carlow-Kilkenny. While we will, therefore, resolve the issue the Deputy has quite rightly raised, he should rest assured that we are going to continue to invest in growing all of the maternity services to ensure they really can be seen as some of the best around the world.
State Bodies
Richard Bruton
Ceist:12. Deputy Richard Bruton asked the Minister for Health if he will outline the membership of the commission on ageing; and how the public will be able to engage with it. [2082/24]
I am taking this question on behalf of Deputy Bruton. This question seeks to obtain information regarding the membership of the commission on ageing and now the public will be expected to interact with it and, as a result, influence it.
As the Deputy will be aware, in furtherance of the commitment in the programme for Government, in October this year the Minister for Health and I sought the establishment of a commission on care and we got approval from the Cabinet. Subsequently, a budget of €1.24 million was allocated to support this important initiative. The commission will examine the provision of health and social care services and supports for older people and make recommendations to the Government for their strategic development. Subsequently, a cross-departmental group will be established under the auspices of the commission to consider whether the supports for positive ageing across the life course are fit for purpose and to develop a costed implementation plan. It is really important that we have this because we often see documentation that proposes many measures, but these must be realistic as well and we have to be able to fund them.
I suppose we are coming from the perspective that everyone is ageing. We have one of the largest ageing populations in Europe. It is also important to point out, though, that thanks to all the very good work done daily we have the highest life expectancy in the EU, as deemed by the World Health Organization, WHO, at 82. It is also important to acknowledge that Ireland was the first country in the world to achieve age-friendly status in 2019 from the WHO.
If we speak to older people, they will tell us that their preference is to be able to age in place in their own house in their own home community with the correct wrap-around supports. It is very important, therefore, that this commission will look at all of these options.
The commission will be independently chaired. In December this year, Professor Alan Barrett, chief executive of the ESRI, was appointed as chairperson of the commission. I met with Professor Barrett before Christmas. I will respond further after the Deputy's next question
I thank the Minister of State for her detailed reply. We are all conscious of the fact that as people get older they require a greater level of services and better or improved services, and this changes too as time goes by. Has the membership of the commission been determined and, if so, who are those members? In respect of their interaction with the community, how will a means be found to ensure there is a ready change of information and dialogue to allow the commission and older people throughout the country to avail of and benefit from it?
The membership of the commission has yet to be determined. We are working on it now and had a meeting on it yesterday. It is envisaged that in line with the commission's approved remit, its members will collectively provide expertise across the areas of geriatrics, gerontology, health economics, health policy and management, health ethics, health technologies and ageing and disability. Stakeholder engagement, including with the public, will be central to the work of the commission. As I said, it will be established in early 2024.
The commission will report in three modules. We will have the first six-month module, which will be completed by the summer. We will then move to module two, which will take another six months. Module three will take longer because of the amount of work that will be involved in it. Engagement and collaboration with stakeholders will be a central component of this endeavour. We will be looking forward to announcing the membership of the commission very soon.
Given we have a longer life expectancy now, and the information the Minister of State gave us in this regard is welcome, we must be conscious that some people now carry on work until an older age than they did in the past, and rightly so. In fact, the classic example is the need to recruit people who have experience and are available to continue at work. These are all welcome.
There is, however, also the question regarding the fact that we might sometimes overlook the obvious in the course of all demands in front of us. For example, it is not so easy for older people who may have mobility issues to go shopping. I acknowledge that various types of assistance are available whereby they shop online, etc. Nonetheless, it is important that the various challenges older people are likely to meet be borne in mind.
The Deputy is quite right. The first two modules of this work will focus on the provision of health and social care services and supports for older people. We know, for example, that we have 323 day centres operational. We also have an additional 52 dementia-specific day centres, which are really important for people who have a dementia diagnosis but still want to be able to live in their own homes.
Today, more than 56,000 people will receive home care in their homes. It is hugely important to be able to support people to be able to age in place. The Deputy spoke about transport. We know that Local Link, especially in the local areas, is an important facet to support older people. I also wish to mention organisations like Meals on Wheels. More than 2 million meals were delivered in 2023 to approximately 50,000 people. It is so much more than the meal itself. It is the knock on the door and the social connection, like the postman coming.
The commission's envisaged work is very ambitious but it is very timely that we do have a commission on care for older people. We are all ageing day by day. We are all only going in the one direction and everybody wants to be able to live well in their own communities.
I thank the Minister of State.
I call Deputy Tóibín to ask the next question. We will probably not be able to get the full question dealt with.
Emergency Departments
Peadar Tóibín
Ceist:13. Deputy Peadar Tóibín asked the Minister for Health the number of persons who died while waiting to be seen in emergency departments in the State in each of the past ten years; and if he will make a statement on the matter. [1893/24]
On that previous issue, in the context of HSE-funded home care, there is a refusal to bring older people for walks. Where people have dementia, they are being allowed to leave the house unaccompanied because of this refusal to bring people for walks. This is an extremely dangerous decision by the HSE.
Turning to the issue of hospitals now, the crisis there really bubbled up over Christmas. There have been really worrying trends regarding how many people are suffering on hospital waiting lists, in accident and emergency departments, etc., due to the recruitment freeze. It is important that we start to analyse how many people are suffering as a result of this situation and how many people are losing their lives in accident and emergency departments now in this State.
Not for a moment am I going to downplay the real pressures in too many of our hospitals for too many of our patients in accident and emergency departments. However, it is really important that as an Oireachtas we acknowledge the progress our healthcare workers are making. I can tell the Deputy, and I know he will have seen this himself from talking to them, they are working so hard to bring down the number of patients on trolleys in every hospital. There has been a national response to this situation. Looking at the second half of last year, which is when the new approach was rolled out, we can see there has been a 22% reduction in the number of patients on trolleys. Regarding the most high-risk group of people, who are central to the Deputy's question, there has been a nearly 40% reduction on the figures for the previous year. We have all seen a very important reduction in the number of patients on trolleys through Christmas and the new year and, so far, in January of this year. I am not for a moment suggesting this issue is fixed but it is really important that we acknowledge that the work, the blood, sweat and tears our healthcare professionals are putting into this is working.
The Deputy should rest assured that we are going to continue. We are focusing, in particular, on the hospitals where the greatest delays are. Approximately seven hospitals account for approximately half the patients on trolleys.
More hospitals are now reporting no patients on trolleys and, more importantly, more hospitals are beginning to report that, at the 8 a.m. count, there were no people aged over 75 have been waiting for more than 24 hours. Those are two of the most important things that have to be achieved. To the Deputy's question, approximately 32,000 people die in Ireland every year. Approximately 13,500 of those deaths occur in hospitals. I will come back to the specific numbers regarding emergency departments in my next response.
I 100% acknowledge the work that the staff and medical professionals within hospitals are involved in. My critique is of the lack of Government investment and the lack of reform in the HSE. The newspapers are full of this. Today's Irish Examiner states, "A woman has told how she watched as her husband tried to resuscitate their 21-year-old daughter after she collapsed at home just hours after being discharged from University Hospital Limerick." RTÉ's website reports today that the HSE has "apologised to the mother of a boy over injuries he suffered after a battery was stuck in his throat for nine days before an X-ray was carried out". Another headline from RTÉ this week stated, "Woman died after surgery by two trainees". On Twitter, we see a disability advocate, Courtney Manning, had metal plates put into her leg that her body has rejected and that she needs removed. She is in constant pain and is vomiting due to morphine but the National Orthopaedic Hospital has said that she is no longer its patient. She has resorted to sending pictures of her body, which is rejecting these metal plates, to politicians.
We see from talking to family and friends, from our constituencies and communities and from newspapers, television and radio that there are serious problems with people suffering adverse incidents in hospitals and with people waiting for so long that they are not getting the necessary treatment. We need to get to the bottom of this to make sure this does not happen in our hospitals in future.
There are two things I would like to say on this. I am fully in agreement with the Deputy on the cases in which people do not get the care they need. That can lead to catastrophic outcomes. A recent example is the report into the tragic death of Aoife Johnston in Limerick. Unfortunately, these things do happen. Sometimes they may be preventable and sometimes they may not but we have to do everything we can. I fully agree with the Deputy that there are too many incidences of people not getting the care they need as quickly as they need it, sometimes leading to catastrophic and heartbreaking outcomes.
I also want to provide a bit of balance. How many people arrived in our emergency departments last year? It was 1.5 million. What we almost never see on social media or reported by RTÉ is the people who went in, were triaged quickly, were seen, got great care, perhaps had their lives saved, got fantastic treatment and went home. We never hear about them. Some 1.5 million people attended but what we hear about, for reasons we all understand, is the unacceptable cases where people have not gotten the care they need. I fully agree that we need to do more to have those catastrophic events become something that never happens. I just want to say that 1.5 million people attended our emergency departments last year. A lot of excellent care was provided. We need to keep going with the reduction in the number of patients on trolleys because that is how we will get to a point at which these kinds of reports are a thing of the past.
Táimid críochnaithe. Níl go leor ama againn,
Tógfaidh mé cúpla soicind. There are serious problems and they are not arising independently of Government. Government is making decisions on funding and recruitment freezes. I know of a nurse who returned to Ireland two months ago but who was unable to get back into her old job because of the recruitment freeze here. Lives depend on the ability of doctors and nurses to have the necessary capacity and resources to deliver the health service properly. Those resources are not there and people are suffering as a result. Will the Government make sure that we have the necessary investment and reform of the HSE so that we can have a health service that does not let these people suffer so tragically?
Let us talk about what is actually happening here. In the lifetime of this Government, more than 1,100 beds, approximately 1,000 consultants and 25,000 healthcare professionals have been added to our health service. We are by no means where we want to be as regards everyone getting the right care at the right time but it is absolutely and undeniably the case that this Government has invested in our healthcare service, has grown it and is reforming it at a level we would have to go back quite a long way to see. Of course, there is more to be done but waiting lists are falling and the number of patients on trolleys is falling. More than half of the population has access to free GP care. Women's health services have been revolutionised. Really important things are happening thanks to the extraordinary efforts of our healthcare workers backed up by investment from this Government.