Violet-Anne Wynne
Ceist:7. Deputy Violet-Anne Wynne asked the Minister for Health if he will reinstate an accident and emergency department at Ennis Hospital; and if he will make a statement on the matter. [9591/24]
Ceisteanna Eile (Atógáil) - Other Questions (Resumed)
Question No. 6 taken with Written Answers.
I have raised this with topic with the Minister and his Cabinet colleagues on many occasions. There has been considerable consensus on those occasions that the reconfiguration failed. I would be grateful if the Minister would put on the record of the House whether he intends to reinstate the accident and emergency department at Ennis Hospital
I thank the Deputy for the question. I visited Ennis Hospital not that long ago and must say I was hugely impressed, especially by the work carried out by healthcare professionals in the injury unit and the medical assessment unit, MAU. We are investing at a significant rate in Ennis Hospital, including in urgent and emergency care. In 2022. I provided €2 million for the Ennis injury unit, which has gone from strength to strength. Currently, one in three unscheduled care cases received treatment in the mid-west injury units.
Last year, we allocated funding of €1.6 million to extend the opening hours of the medical assessment unit in Ennis. In February of last year, a 999 pathway was introduced for the medical assessment unit. This allows for the transfer of patients who meet the agreed clinical criteria for treatment in Ennis
In June of last year we launched the Pathfinder service, which I know is very important and has been welcomed by the Deputy's constituents. It was extended to Clare. It helps the NAS support older people living at home. All of these measures have been put in place to alleviate the pressures on people in Clare seeking urgent care and by association, the very significant pressures we are all aware of in University Hospital Limerick.
I am very aware of the calls for a full emergency department to be opened in Ennis. To that end, I spoke directly with the chief clinical officer. We will both be aware that the clear clinical advice over many years has been that it would not be safe to open an emergency department in Ennis. The thing to do is to invest in the injury unit and in the MAU. In my response, I can give the Deputy some of the response I got back recently from the chief clinical officer on the issue she has raised.
I thank the Minister. I would like to receive that information. I had a recent response from the HSE on the expansion of the injury unit. It seems it is not possible to expand it any further than has been done up to now. There were 121 people on trolleys this morning in UHL during morning rounds. This is 50 patients more than the next most overcrowded hospital in the State. There is consensus that the reconfiguration failed and yet, as far as I can see, no significant action has been taken on Ennis emergency department.
The Minister has mentioned the investment in Ennis up to this point. The decision at the time to close Ennis was a political one, based on the Hanly report. The report actually recommended updating the facilities, but instead Mary Harney closed it. It is a matter of urgency that the Ennis emergency department be reinstated. I acknowledge what the Minister has said about clinical advice but what about the golden hour, which we know from trauma studies is essential to limit morbidity and mortality? We cannot have people coming from Carrigaholt. They are not going to make is within that hour to UHL
I thank the Deputy. She raised two really important issues. One is the unacceptable level of pressure for patients and healthcare workers in UHL. It is not acceptable. On any given day now, UHL can make up one in five, or even one in four of the number of patients on trolleys in the entire country. At a national level, the good news is that the number of patients on trolleys fell very significantly last year, particularly in the second half of the year . The pressures are now in a smaller number of hospitals, Limerick regularly being number one or number two. A huge amount of resources have been allocated there. I am working very closely with the HSE and my Department to help drive the necessary reforms in UHL. If I may Deputy, I will come back in my next response on the response I got from the chief clinical officer in terms of the emergency department. My view on this is that political decisions are around funding but in terms of urgent and emergency care, we have to be led by the clinical view as to what is in the best interest of the patients. I will revert with that information .
The Minister has mentioned increased investment in UHL but as it currently stands, we still need the revenue to provide the first 96-bed block and the capital and revenue for the second 96-bed block to be progressed as a matter of urgency. The Minister could be building capacity at Ennis but instead the surgical hub is located at an old school in Limerick city. The HSE has told me in replies to a parliamentary question recently that there is no intention to expand stroke, cancer or coronary care in Ennis. Why not? Ennis is a fantastic facility and we should be expanding capacity there. We should also be expanding the services that are already on site. Last year, the House passed a motion to have 24-hour MAUs and injury units. Before Christmas, the CEO of the HSE told me that this is not currently possible because of recruitment and retention issues. I accept that but what I do not understand is why we cannot roll out 24-hour services in MAUs and injury units in Ennis, Nenagh and St. John's in the short term, until the Minister for Health of the day sees the writing on the wall and reinstates Ennis accident and emergency department. We are the only CHO served by a single model 4 hospital. This is a teaching hospital and is not backed up by a model 3 hospital. We could reduce the number of people on trolleys in UHL by half.
I would also like to speak on this parliamentary question. A shameful political decision was taken in 2009 to downgrade Ennis, Nenagh and St John's hospitals. The intention was to make UHL a central of excellence but this never materialised. It was a failure in 2009 and has become a woeful failure for the people of the mid-west every year since. This did not happen on the Minister's watch. I commend the Minister on taking a lot of action during his tenure to address this issue. He has beefed up capacity in the mid-west but we need to look at the issue, which is that many hundreds of thousands of people cannot be funnelled through one accident and emergency department. In the 1980s, the mid-west had five accident and emergency departments with around half of the population. It is now all going through one 24-hour facility at UHL. Addressing the UHL problem, which gets spotlighted every day of the week, has to happen. It also has to happen in the satellite hospitals of the region. I also support the call for Ennis to be upgraded again to have a 24-hour hour accident and emergency department. The Minister mentioned safety issues highlighted by the clinical reports he referenced. What are those issues and what can be addressed? We do not expect short-term outcomes but we would love the Minister in the medium to long term to say "Let us do this and let us pave a pathway that would see it reopening again".
I thank both Deputies for this. I fully appreciate where they are coming from in the context of how the people they represent are genuinely worried about going to the emergency department at University Hospital Limerick. I get that.
We have to do two things. We must continue to invest in Ennis Hospital. We have been investing in it year on year, we have expanded its opening hours, its urgent care capacity and its medical assessment unit capacity and we will continue to invest in it. At the same time, we must fix the emergency care situation in UHL. This is not a capacity issue; we were asked to invest additional capacity and we have done so. Some 192 beds are being built on site and we have already added many beds. Believe it or not, we have increased the staff in UHL by 1,000 in the lifetime of this Government. There has been vast investment but, unfortunately, that investment has not been mirrored with the requisite reforms, such as through the weekend discharge and the rostering of senior decision-makers - I do not refer to them being on call, but rostered - in the evenings and at the weekends. I refer also to the kind of co-operation we need between community care and acute care, such as that which we are seeing in other parts of the country.
I will finish on this point. I can assure the Deputies that we are we are building those 192 beds. Those beds will be staffed. We will continue with very significant investment, including the surgical hubs and more capacity to get the situation resolved.
I have the letter from the chief clinical officer and I did not read it out. I apologise to the Deputies. I will arrange for my Department to share the letter with the Deputies.
I thank the Minister.
Medicinal Products
Aindrias Moynihan
Ceist:8. Deputy Aindrias Moynihan asked the Minister for Health if the new drug, Veoza, can be made available on the drugs payment scheme (details supplied); and if he will make a statement on the matter. [9695/24]
There are women who are cancer survivors who are not able to use hormone-based drugs during menopause. The new drug, Veoza, offers a non-hormone option to them but the cost is prohibitive. Can this drug be made available to them on the drugs payment scheme?
I thank the Deputy very much for the question. I will start by acknowledging his ongoing advocacy in terms of new medicines, including rare diseases, but obviously, this is not one of those cases. As the Deputy is aware, the HSE has statutory responsibility for decisions on the pricing and reimbursement of medicines. However, it is incumbent upon all of us, as public representatives, to engage with patients and clinicians and to understand where the real opportunities are for future medicines.
Veoza is a very new development in the treatment of moderate to severe vasomotor symptoms associated with menopause. As the Deputy will be aware, the Government is prioritising women's healthcare, including through the provision of hospital-based services for menopause. He will be aware that critically, in terms of accessing new medicines for this year, we have ring-fenced €30 million with €20 million of this from new development funding and €10 million from savings from the existing substantial medicines budget of €3.2 billion.
Veoza was authorised by the European Medicines Agency in October, which was just in the last few months. The company that markets it submitted its application for reimbursement to the HSE on 8 February. The company therefore just put in its application in the last two to three weeks. It is now at the first stage of the process, which is a rapid review by the National Centre for Pharmacoeconomics, NCPE. My officials and I will obviously be following this assessment with great interest, both in terms of the benefit this drug can provide and because it fits with our push for women's healthcare and our ambitions to have the best possible women's healthcare right across the country.
I first wish to acknowledge that significant work has been done on women's health across a range of different services. That is very positive. I refer to IVF, gynaecological services, for example, in Cork, and menopause clinics. This measure would complement the great effort that has been advanced through menopause clinics. A small number of people are involved in this and they have very limited options, if any at all. This is their first opportunity to have an option available to them because it is non-hormone-based drug. Their options are limited because of their cancer treatment, which means they will not be able to use any hormone-based drugs. Can the fact that very limited alternatives are available to these people inform the decision? Can it inform and expedite the decision to put it on the drugs payment scheme at a manageable price?
I thank the Deputy. I will walk through the steps regarding where this is now and where it is going. As I said, the company applied for reimbursement just in the last few weeks. That application is now undergoing a rapid review at the National Centre for Pharmacoeconomics. The NCPE target for that is four weeks but it does not always meet it because it assesses many new medicines. Yet, typically, the target for a rapid review is approximately four weeks. Following the rapid review, it may recommend a full health technology assessment, HTA, which takes a bit longer. The National Centre for Pharmacoeconomics may not - but I hope it will - recommend that this goes to a full HTA. Then, it would go to the corporate pharmaceutical unit, CPU, in the HSE. As part of the budget for this year, we were asked to sanction additional staff for the CPU for exactly this reason, namely, to speed up the process so we could assess more new medicines at the same time.
I will continue my reply in my next response to the Deputy.
It is widely expected that by approximately April, this drug will become available to market and people will be able to access it. The timing on this is therefore highly sensitive. It would be great to have it available on the DPS right from the start.
There is another very significant aspect to which I wish to draw the Minister’s attention. Aside from the shock of receiving a cancer diagnosis, the difficulty in dealing with the treatment, etc., there is also a financial shock to the person. They will have lost income. Once they have put the cancer treatment behind them, they may face the possibility of having an expensive drug at menopause. It will be even more difficult for them at that stage and, therefore, the cost is hugely significant. Can a factor such as that be taken into account when the Minister is setting the price at the DPS? Let us bear in mind that people who will be using this drug will have already had this difficult, expensive time, on top of their difficult treatment.
These are exactly the issues that will be looked at in the rapid review and the health technology assessment. How much would it cost the State if it is on the drug payment scheme? What amount of good would the medicine do, given the amount of money that would be spent? That is how we must look at all medicines. It may be the case that it will be recommended for the drug payment scheme. The figure of €6,000 was mentioned; I am not familiar with the figure, but let us say that it is €6,000. The State would pay nearly all of that and the patient would be left with just €80 per month, or much less if they have a medical card. Certainly, if it is recommended through the process of reimbursement, the vast majority of the €6,000 would be paid for by the taxpayer. Then, the individual would pay €80 per month for the amount of time they are accessing the medicine.
Mental Health Services
Darren O'Rourke
Ceist:9. Deputy Darren O'Rourke asked the Minister for Health the number of psychologists employed by CAMHS in the Meath area; the number of psychologists working in CAMHS in the Meath area; the size of the waiting list for access to CAMHS services in the Meath area; the average time waiting to secure an appointment with a psychologist in the Meath area; the average waiting time to access CAMHS services in the Meath area in 2020 to 2024, inclusive, in tabular form; and if he will make a statement on the matter. [9553/24]
I want to ask the Minister about the number of psychologists employed by CAMHS in the Meath area; the number of psychologists working in CAMHS in the Meath area; the length of the waiting list to access CAMHS services in the Meath area; the average time waiting to secure an appointment with a psychologist in the Meath area; and the average waiting time in recent years.
I thank the Deputy for tabling this question. Officials in my Department sought an update from the HSE in relation to the specifics of the question that has been raised. The HSE has advised that four CAMHS teams are shared across the Meath and Louth area to address the population demands of County Meath, as well as the catchment area served by the team in Drogheda. These teams are based in Navan, Ashbourne, south Louth, east Meath and Trim.
As part of the multidisciplinary make-up of each CAMHS team, each of the four teams is funded for and holds a senior psychology post. I often speak of the CAMHS multidisciplinary teams, which include consultant psychiatrists, clinical psychologists and the whole way down to occupational therapists, OTs, clinical nurse specialists, social workers, etc.
To respond to the specific question, of these four posts, a senior psychologist is currently in place and working in the Navan team. Of the two further teams, two posts are vacant but I need to say again that they are funded. One post-holder is currently on sick leave so it does leave a situation where instead of having four psychologists working across four teams, there is currently only one person in post due to two vacancies and one person on sick leave. Data made available to my Department indicates that within the Navan team from 2021 to date in 2024, there have been fewer than ten children who have had to wait to be seen by a psychologist at any given time. That is the importance of the multidisciplinary team. In addition, there have been fewer than five children waiting more than one month from receipt of an internal CAMHS psychology referral to be seen in Meath.
The HSE have confirmed that there are currently 305 children and young people on the waiting list to access CAMHS in the Meath area, across all four teams. In the Meath area, since 2020 to date in 2024, routine appointments for CAMHS have been seen within four to 13 weeks. I will come back in the next slot.
I thank the Minister of State for the reply. It is very concerning that we have a 75% vacancy for one reason or another. Can I have an update on filling those posts? I appreciate that the funding is in place but I would push back and say it is not enough for the Department or the HSE to provide the funding. We need to secure and fill those posts. Are enough psychologists being trained? Is the HSE recruiting to a significant degree? What is being done to fill those posts? It is recognised that they are required; they are absolutely needed to address the demand that exists. There are 305 children waiting. They serve a geographical area but a population area as well. What is being done to fill those vacancies, including in terms of training?
As I put on the record of the House on Tuesday, we have made progress on the CAMHS waiting list. At the end of 2023, there were 3,759 children on the list. This was a decrease of 480 children through the end of the year. It is still a very high number. I have a dedicated focus on it week on week, month on month. I welcome that reduction. It has to be noted in this context that CAMHS provides a multidisciplinary service, composed of psychiatry, psychology, nurse specialists and health and social care professionals. The Deputy asked a specific question and I was delighted last year, with the support of the Minister, Deputy Donnelly, to be the first Minister of State ever to support counselling psychologists, which we use across a lot of our teams. We allocated €750,000 in recurring funding year on year because it is a very costly role to take on. People are in college, qualifying and training for a very long time. This is a step forward to support more psychologists to work in Ireland.
There is an urgent need to address those vacancies and I encourage the Minister of State at the earliest opportunity to meet the demand that exists. I encourage her to review the workforce plan in respect of the overall demand for the services and ensure those teams are filled as full as possible and that there are not vacancies. We are talking about psychology here. I expect it might not be to the same extent but there might be a similar picture in other grades as well. Is social prescribing being explored as a priority for the Department, the Minister or the HSE as an option as a matter of priority for our mental health services?
We currently have 820 people working in CAMHS, with 225,000 appointments issued last year. There were 12% more referrals last year and in 2021, there was 33% more referrals. By the end of 2024, there will be more than 900 people working in CAMHS. I have received that funding in the budget. As late as yesterday evening, I had a meeting about these posts being put in place. One of the issues we are examining is geographical spread. It is really important in respect of this postcode lottery that when we are recruiting, the geographical spread is really important for children wherever they live in the country. I had that meeting yesterday with the Department and the HSE.
I am a big supporter of social prescribing. It is a really great initiative. We mostly work with adults in social prescribing but it has been a game-changer for many people who might have felt disadvantaged or who might have felt outside their community.
Health Services
Violet-Anne Wynne
Ceist:10. Deputy Violet-Anne Wynne asked the Minister for Health if he will grant funding for a satellite haemodialysis unit at Ennis hospital; and if he will make a statement on the matter. [9592/24]
Can the Minister provide an update on the establishment of a haemodialysis unit in Ennis hospital and when he expects works to begin?
I am afraid this will be a very short interaction on my side; I apologise. I looked into this in detail and asked the HSE to come back with more but at the moment all I can tell the Deputy is that there is a proposal, as of course she will be aware, for an externally contracted satellite haemodialysis unit for Ennis. It is under review and that is really all I have. I am sorry; I am not trying to avoid the question at all. The answer at this point is short. It is under review, it is being looked at. There is no new development funding in the budget for it. It would be a new project. It is not something that was flagged back in September.
It would be of great benefit to patients. We have talked about the trip from Clare to Limerick, particularly for those in north Clare. It is quite the trip for anyone who is undergoing dialysis. We are looking at it. It is the kind of measure that fits very well with our push for universal healthcare, Sláintecare, and making sure people can get the treatment that they need either at home, with home dialysis becoming an increasingly common service, or in their local hospital. In this case it is in the model 4 hospital and I fully accept that, particularly for north Clare, it really is quite the trip into University Hospital Limerick, UHL. I cannot say anymore on the review other than that I think it is a good idea. It would be good for the people of Clare to have this and it would be good for Ennis hospital. Ideally we would not contract the services in. We would have them within the HSE as publicly provided services but, even as temporary measures, these services can sometimes provide a lot of benefit for patients.
It definitely would, for north Clare and west Clare specifically because of the geography and the distance patients have to travel. Most often, the treatment requires three trips per week so it is a significant stress on my constituents. For those who cannot drive or do not have access to their own transport, it is a significant distress that they face on a weekly basis. That is something they do not want to face when they are already dealing with a healthcare issue. I know the Minister appreciates that. He has stated that the funding was not made available in the budget and it was not flagged last September. I would be interested if he could provide a little bit more detail as to what may have occurred. People being forced to work out how they are going to travel is an undue distress. Huge amounts are also being spent on transporting patients throughout the mid-west. For example, in 2021, €1.6 million spent.
I can certainly look into the timing of when this was initially flagged locally. All I can tell the Deputy is that it was not part of the considerations for new development funding for this year. However, it is a good idea. It would make a big difference for west Clare as well as north Clare, as she quite rightly said. I have witnessed the impact of home dialysis.
We all know people, as the Deputy said, who are going for dialysis three times a week and it is a significant burden on them. If we can provide more local services, we should do so and we should fund them. Should they be funded, it would typically form part of the Estimates process and part of the conversations coming into July and August this year.
I take this opportunity to commend the great work of the Clare branch of the Irish Kidney Association in supporting thousands of patients and their families since its foundation in 1989. Its work on campaigning and advocacy is owed a lion's share of gratitude for the development of the unit, which will be a terrific asset to Ennis hospital as we look to build capacity and increase services provided in the county. The Minister mentioned the funding issue, but a recent response to a parliamentary question by the acting CEO of the UL Hospitals Group mentioned that HSE board approval is required. Can the Minister shed some light on that, including how long such approval usually takes?
I have mentioned those who do not have access to their own transport. Currently, given the public transport system in west and north Clare I spoke about earlier, it is not possible to get to an appointment at UHL and back home within a reasonable timeframe.
I am not aware of the HSE board approval requirement. It is a clinical service and the HSE board agrees the national service plan. Any capital investment above €10,000 has to go to the board, but that is not what this is, so I am not sure what approval is being referred to.
I join the Deputy's acknowledgement of the Irish Kidney Association and many other organisations such as the Irish Heart Foundation.
We had a lovely milestone yesterday. The President signed the Human Tissue (Transplantation, Post-Mortem, Anatomical Examination and Public Display) Act 2022 into law, which was lovely to see. It will make a huge difference. We will have a country where people will have a default opt-out of organ donation. Hundreds of families and individuals, including a friend of mine, are waiting for organ donation. We are investing further in the area, which I announced last week. The human tissue Act will make a big difference and I hope we can bring this matter from strength to strength so the people we are talking about who are on dialysis can get what they ultimately need, which is a healthy kidney.
Nursing Homes
Rose Conway-Walsh
Ceist:11. Deputy Rose Conway-Walsh asked the Minister for Health what assistance can be given to a person who is living in full-time care in a nursing home, registered disabled, non-verbal, and has no family assistance and requires transport for various treatment at different hospitals; who is responsible for transport costs to and from medical appointments; and if he will make a statement on the matter. [9701/24]
Where does the responsibility lie for people who are in long-term nursing care and have to access vital hospital services or orthodontic services. I have a case of a person who has been given a bill of almost €2,500 to get the necessary services. The person does not have an income, is on the fair deal scheme, topped up by his disability payment and his family does not have any means either. Who is responsible in that case?
It is an important question. I will not comment on the individual case, but it is important to state that nursing home residents, whether younger people or older adults with disabilities, should enjoy the same level of support and access to services for which they are eligible as when they lived in their own homes. It is acknowledged that the reason they require 24-hour support is their level of dependency, which, in turn, may cause them to require access to clinical services, including hospital and other healthcare appointments in the community.
I spoke to the Minister of State, Deputy Rabbitte, about this question last night because there is a crossover of responsibility. She said that, generally, people who live in nursing homes because of a disability and because they are not able to look after themselves would normally have had access to supports in a day centre run by the Brothers of Charity, St. John of God or whoever is delivering that support. Transport would always have been provided in such cases and those pathways should be utilised. That is what she tells people. He or she would be known to services and that is where her or she should go.
In my constituency, Waterford, we have also used LocalLink, which is all over the country. Once LocalLink services are given appropriate notice, they have a small discretionary budget that can be used to support people who have no other means of transport to attend appointments. I have used the service, but notice must be given. It is not possible to ring them up and ask for something the next day, so an emergency appointment would be different. The HSE provides a number of intermediate care vehicles, which are used predominantly for non-emergency transport, but they are not everywhere. They are reserved for those who need specific support in transport.
Much more clarity needs to be brought as to where the responsibility lies so that we can avoid a situation where invoices are being sent to the home of someone who is non-verbal, aged in their 40s and does not have the means. Parents become distraught in thinking they have to somehow find this money they do not have.
I commend LocalLink because it is a key to this issue but it does not have the resources. The Minister of State said it has a small amount of resources. Much greater resources must be given by the HSE to LocalLink to take up the possibility, because its staff know a lot of the people involved. That is one option. This is also relevant to ambulance services. Ambulances come from Galway to north Mayo to bring a patient to Castlebar. That is a waste of people's money. I ask the Minister of State to sit down and work this out with the other Ministers so that something like this does not happen again and people in rural areas have transport to get to services.
If the Deputy sends me the details of that case, I will have it looked into because it is not appropriate for the family of someone who is non-verbal, living in a nursing home and dependent on disability allowance and the fair deal scheme to be sent a bill of €2,500. As she said, we need to bring more clarity to this area. I deal with it myself.
LocalLink has been helpful, especially for people who need wheelchair accessible vehicles to transfer them. It is not always possible for people with disabilities to sit into an ordinary taxi to be brought to an appointment or for their families to bring them. I agree that we need clarity on this issue, as it does pop up.
If the Deputy sends me the details of that case, I will work with the Minister of State, Deputy Rabbitte, to see how we can resolve it.
I appreciate that because this is a good example of how we can change things for others. We are not talking about people who can hop on a bus and get to where they need to go. Transport is such an integral part of people being able to keep appointments and get the services they need, and there are not any funds to help people. I am happy to work with the Minister of State to try to solve the problems, not only in this case, but in many other cases. What has happened is that services have been centralised. In some cases, that has been good, such as in cancer care, but without transport, more and more are being disadvantaged. A good service is available, but without transport, people cannot access them. Denying people access to vital dental care and vital healthcare is not acceptable in this day and age. Solutions are available, some of which we have discussed and we will continue to develop them.
The response, which the Deputy will get a copy of, states that under the Social Welfare Consolidation Act 2005, an exceptional needs payment can be made, but that is not always appropriate for a person who may not have family backup and may not be able to communicate. It can be used in some instances, but we need a stronger solution to support people. The CEO of the HSE, Bernard Gloster, has been clear about this, as have the Minister, Deputy Donnelly, and I. Those living in nursing home care should be afforded the same rights as they would be afforded if they were living in the community. I will work with Deputy on this. We get these individual cases every so often, but the Minister of State, Deputy Rabbitte, was very clear that there should always be a previous pathway that can support people and we can also work with her on that.
Health Strategies
Richard Bruton
Ceist:12. Deputy Richard Bruton asked the Minister for Health whether his Department has mapped out a pathway for the role technology can play in keeping patients healthy and in the planned statutory homecare scheme; and the status of the roll-out of the planned actions. [9731/24]
Will the Minister outline whether the Department has mapped out a pathway for the role technology can play in keeping patients healthy and in the planned statutory homecare scheme and the status of the roll-out of the planned actions?
I thank the Deputy for the question. Our overall ambition in government is to use technology to the fullest extent possible to keep everybody well and provide them with support in their homes where they need healthcare support. Our ambition is also to utilise it fully in community and hospital care. Several really good programmes are in place, the chronic disease management, CDM, programme being one of the best examples. Technology is playing a role in supporting people with chronic diseases at home through the CDM programme.
On homecare specifically, we have deployed the interRAI system, in respect of which the Minister of State, Deputy Butler, has had a leading role. Its purpose is to ensure, for the first time, consistency and transparency in the assessment of needs right across the country. Currently, there can be variations from place to place.
We are also running two programmes to trial the use of digital supportive technologies to enable increased service user independence and enhance homecare. This is a bit of a mouthful but essentially it means helping people to stay healthy at home. It includes increased independence and enhanced homecare for older people. It is particularly important during the development of the statutory homecare scheme, on which the Minister of State is leading, so people have the choice to ensure the service is designed and optimised for them by adopting enabling technologies.
In addition, as the Deputy will be aware, we are procuring an IT system for home support. It will facilitate and manage the application process from receipt of an application to a decision on service entitlement and make it easier for people to apply online. It is to make it increasingly easy for people to interact with the services.
I very much appreciate that work is being done in this area but I am just wondering about the timeframe for roll-out. In a discussion on an earlier question, I mentioned the growth of the older population and the need to fast-track new ways of managing both homecare and long-term care in nursing homes. I am not sure whether there has been any co-ordination between the HSE and public and private nursing homes regarding computerisation. Computerisation means that if somebody ends up in hospital, a clear file setting out the level of care he or she is receiving and the medication he or she is on can be easily accessed.
This week, I was talking to a general doctor who works in a Dublin hospital. Bearing in mind that we have been talking about additional hospital staff, including nurses and doctors, he spends 50% of his time trying to track down notes and scans. If they were all computerised, that would not happen.
I wish to comment on computerisation, especially regarding home supports. There is currently a split in that the 22 million home support hours last year were delivered between private, public and voluntary services. Approximately 55% of all the home support last year was delivered by private sector services, which all use IT to deliver their supports. Unfortunately, the HSE is lagging but we are trying to address this.
I also want to talk to the Deputy about a pilot project we are now running in CHO 5 with HaloCare. We are running it with more than 200 recipients of homecare. We are trying to support these people, especially those with dementia, to live in their own homes for as long as possible. For example, where a person with dementia opens the door on hearing the doorbell but does not know the person who rang it, the call is answered by a call centre. We will never replace one-on-one support but there is certainly no reason we cannot enhance what we are doing to support people to live and age well at home.
With regard to this subject, we need to fast-track. The private sector can deliver computerisation far faster. We seem to have a great difficulty in the HSE. Even in maternity care, a totally different area, while four or five maternity hospitals were computerised four or five years ago, the other 14 still have not been. I do not understand why, if we have a system in place in some units, we cannot have it in all of them.
We did actually pilot an IT system for homecare in former CHO area 3, which I think it is now called the Limerick–midwest region. It is hard to keep up with the changes in names. The staff are continuing to use the system. It makes a significant difference because, where a person in receipt of homecare has a fall, has been moved to hospital or has gone on holidays, there can be challenges for those delivering the care. Issues can arise over whether the carer who turns up should be recompensed for doing so and, therefore, there is a considerable challenge, and change cannot happen soon enough. The Minister and I are clear on this and the roll-out of interRAI system. We are currently recruiting interRAI assessors but what we are doing has to be backed up with legislation, which I will bring to the Dáil shortly. It also has to be backed up with a very comprehensive IT system.
Questions Nos. 13 and 14 taken with Written Answers.
General Practitioner Services
Brendan Smith
Ceist:15. Deputy Brendan Smith asked the Minister for Health if he will outline the measures being implemented to increase the number of GPs practising in rural Ireland; and if he will make a statement on the matter. [9717/24]
Ruairí Ó Murchú
Ceist:17. Deputy Ruairí Ó Murchú asked the Minister for Health his plans to deal with the shortage of GPs in the State; and if he will make a statement on the matter. [9369/24]
Brendan Smith
Ceist:20. Deputy Brendan Smith asked the Minister for Health the measures being implemented to recruit and retain more GPs in rural practices; and if he will make a statement on the matter. [9716/24]
I welcome the measures the Minister has been introducing to strengthen the recruitment and retention of GPs. As he knows, there are particular challenges in rural practices. Recently, I have been engaging with him very strongly and continuously regarding the need for a permanent GP appointment for Swanlinbar, County Cavan. The permanent GP there retired some time ago and a locum has been in place in the meantime. As the Minister will be aware, having heard from me and other local public representatives, the local community is demanding very strongly that the HSE advertise for the post of a permanent GP. I am aware that he has engaged with the HSE on our behalf, which I very much appreciate, but I appeal to him to send on my very strong message. Over the years, the people of the very wide rural Border area of west Cavan have been served by permanent medical practices in Ballyconnell, Blacklion and Swanlinbar. That configuration needs to remain.
There will be an opportunity for only one minute each. We are going to run out of time. I call the Minister.
The question was on general rural GPs but I had a sneaky suspicion we would end up talking about Swanlinbar. I acknowledge the engagement and advocacy of Deputy Smith, other Deputies and Senators on this. The matter has been much ventilated.
As the Deputy will be aware, the GP who provided the service has retired. I believe it was in 2020. The HSE advertised to fill the position on five separate occasions but, unfortunately, it received no application in each case. It then initiated a new measure, under the GP agreement from last year, to work with a larger GP practice in a neighbouring vicinity to supply the services, with a view to having a GP on site in Swanlinbar for several days per week, which is very important, and to providing the wider services, such as nurse-led services, that are available in a larger practice. No final decisions have been made. I have engaged with the HSE on this at length. Ultimately, I want to ensure the people in the area have the best possible access, not just to traditional GP care but also to the growing number of additional services GPs now provide.
On the Deputy’s wider point, we are investing very heavily in growing our GP numbers, particularly in parts of rural Ireland and inner-city areas where it is difficult to get a GP. I am very happy to report that, thanks to a very significant increase in the number of training posts for GPs, we now have approximately two GPs entering practice for every one retiring. In addition, I am working with the Irish College of General Practitioners to bring several hundred more GPs on board. In fairness to the college, it is doing-----
I am really sorry but I have to cut across the Minister to call Deputy Smith.
I thank the Minister. I understand there will be applicants for the permanent GP vacancy in Swanlinbar if the position is readvertised. I sincerely hope it can be. The HSE makes the clinical decision on a suitable applicant. I sincerely hope this can be made in the best interest of the local community. Over the years, the permanent GP service in the area served the community very well. That is what the people of the area want to see continued. I strongly endorse their request in this respect. I thank the Minister for his help to date. I sincerely hope he can reinforce the message to the HSE today again.
I welcome the news in relation to the training of GPs but we need to accept that the GP system has changed somewhat. GP practices were generally private. When we were children growing up, GPs were probably available to people 24-7. They ran their own business, did their own administration and knew everything that was wrong with people and all their family members and everyone else. We are in a different world now.
A number of GPs cannot retire at this point because they cannot find replacements. People are not willing to step in and do not want to run a business or do the administration work. Some of them do not want to work full weeks given their family circumstances. That needs to be addressed and the State will need to step in because the private practice model in place since before the State was established will not work from now in. We need to ensure not only that training is provided but that we have a practice system that will work.
I agree that the State needs to step in and I suggest it has done so in a significant way. We have increased the number of training places from 120 to 350 and we are supporting the ICGP in what it is doing.
I am open to having directly employed GPs. In fact, in Swanlinbar, which has been referenced, there is a locum GP who is paid by the HSE to provide those services. In areas that are struggling to find GPs, I am open to having directly employed GPs.
With the significant increase in the numbers of GPs we are now beginning to see, many of these pressures are beginning to ease and will ease further, although not everywhere all at once. Some areas are under real pressure.
Ireland currently has approximately 65 GPs per 100,000 people. In Scotland, the figure is more than 90 per 100,000 people. Our aim is to get to that level. At the current rate of increasing GPs, we are on track to reach that target in the next five years. It will take time but hopefully people in more parts of the country are seeing better access.