Peadar Tóibín
Ceist:70. Deputy Peadar Tóibín asked the Minister for Health the number of persons diagnosed with cancer in the State in each of the past ten years; and the number of deaths from cancer in each of the past ten years. [9276/25]
Ceisteanna Eile - Other Questions
Question No. 69 taken with Written Answers.
Cancer Services
The former Minister for Health, Stephen Donnelly, previously furnished me with data that showed the number of people diagnosed with cancer was increasing every year until 2020 when the pandemic hit. Then it went significantly down. This suggests that people's cancers went undiagnosed when significant elements of the health services were closed down in 2020. To what extent did this happen?
In 2013, there were just over 21,000 invasive cancer cases diagnosed in Ireland. By 2022, that figure had risen to 26,000 annually. Of course, the population grew very considerably in that time as well. That increase is in line with projections made by the National Cancer Registry Ireland. With a growing and ageing population increases in cancer cases are to be expected, with cancer being more prevalent as one ages.
While we are seeing more people being diagnosed with cancer, those people are living longer with and beyond cancer. When the concurrent national cancer strategy was published in 2017, there were 150,000 people living following a diagnosis of invasive cancer. That figure has now increased to 220,000. In 2021, there were almost 9,600 deaths from cancer in Ireland. In 2013, that figure was 8,700. While still too high, cancer mortality rates in Ireland are falling faster than the EU average, having fallen by 17% between 2011 and 2021, compared with the EU average of 12%. More than €105 million has been invested in the implementation of the national cancer strategy since 2017. This includes €23 million for cancer services in 2025. That investment has allowed us to recruit more than 670 new staff to cancer services.
This Government is fully committed, as I know everyone in this House is, to developing and improving cancer services. Our investment in cancer services is delivering better outcomes for patients. I will arrange for a table outlining cancer cases and deaths to be provided to the Deputy. I have to say that when I first looked at the data, I was quite struck. I had not realised quite how high the proportion is of people who are dying from cancer. Nevertheless, I take some measure of comfort from our falling mortality rates relative to the rest of the EU and the return that we are getting on investment where more and more people are living with and beyond cancer.
I look forward to the Minister sending the figures to me. In those figures we know there was a fall of 4,000 in the number of cancer diagnoses in 2020. These are the figures that were given to us by the previous Minister for Health. That fall in cancer diagnoses happened because the Government shut down significant elements of the health service. It stopped the cancer screening processes during that time. This led to a number of people not having their cancers diagnosed in time, and those cancers developed into much more dangerous cancers. What is the Government doing to try to catch up and make sure those individuals get the necessary treatment? I myself had cancer of the skin at that time. I delayed going to the doctor at the time because I listened to the Government's narrative that, unless you were seriously ill, you should not go to the health service. Thank God I was one of the lucky ones to survive it. I am trying to find out how many people died as a result of the delayed diagnoses that happened as a result of the shutting down of the health services in large part in 2020?
It is really important to look at where we are versus the rest of Europe in terms of the impact of the investment we deliver. The most important impact is that people are living longer and recovering from cancer and living with and beyond cancer. When we talk about investment, that is what we are trying to achieve. Of course we want to use the resources we have in a way that will deliver the best return on our investment for all of our people. I have spent some time on this. Report after report, whether it is the OECD country cancer profile or the EU analysis, shows that Ireland is doing better beyond its European peers in its cancer performance and mortality rates.
The Deputy is right that there were measures of delayed diagnoses during a period where the health system was shut down for the benefit of the broader community with a highly transmissible lethal virus that was killing many people in this country. The Deputy is right that there was an impact in that respect, but notwithstanding that, our cancer strategy is trying not just to address that but is also trying to make sure we are delivering on the additional services brought by the previous two strategies.
The Minister is right that Covid killed many people, for sure. Cancer also killed many people, for sure. We have not had a Covid inquiry yet so we do not know the effectiveness or net benefit in terms of saving people's lives of shutting down hospital services and stopping cancer patients getting treatment. The Minister mentioned survival rates. The National Cancer Registry shows Ireland has a breast cancer survival rate of 82%. Sweden has a 7% higher rate and Britain a 5% higher rate. It is not just about geography; it is also whether you use the public or private system. If you go by the private system for breast cancer, you have a 12% better chance of surviving for five years.
There are a number of things I would like the Minister to address and I understand she will not be able to do them all in this question but I want the Government to tackle what happened in 2020 and the effect it had on cancer sufferers. Also, why are we not as good as the likes of Sweden and England in terms of survival rates for breast cancer? Why is it the case that if you are on a low income and use the private sector, you are 12% less likely to survive over five years?
I am a supporter of the public health system. That is what I am trying to drive investment into. I would like to see everybody treated in the public system. That is what this programme for Government and this House is about. It is about Sláintecare and delivering the best service in the public health system. My concern is making sure that happens.
The Deputy has cited Sweden and the UK and it is important we do that. We want to be the best and for the people of Ireland to have the best experience. The Deputy is quite right to highlight where other countries are doing better. I am always interested in why and how that is happening. I always want to have the conversation about how we do this better. However, I also recognise the progress we are making. Our cancer mortality rates are falling faster than the EU 27 average and than our economic peers. Our EU country cancer profile in 2025 comments favourably on the measures taken to reduce cancer risk and prevention-----
Thanks, Minister.
Excuse me.
General Practitioner Services
Conor D McGuinness
Ceist:71. Deputy Conor D. McGuinness asked the Minister for Health her views on the worry and deep frustration of families and individuals in County Waterford and across rural Ireland about the shortage of GPs and the consequent difficulties being experienced by many patients accessing timely GP care, especially in rural communities. [10113/25]
What are the Minister's views on the worry and deep frustration of families and individuals in County Waterford, and rural Ireland more generally, about the shortage of GPs, and the consequent difficulties experienced by many patients in accessing timely GP care, the distance they have to travel to access it, the delays in accessing it and the impact on their health and well-being?
I certainly understand the frustration and worry that comes with having difficulty in accessing GP services. That is not what we want. Timely and available access to GP services is critical to good healthcare. In rural and remote areas, in particular, general practice is often in a role of clinical leadership for patients for whom access to other services is farther away.
Being aware of this, and that the country as a whole needs more GPs, the Government has taken a series of measures in recent years - and is committed to continuing them - to increase the number of GPs. Significant investment in general practice has been made under the 2019 and 2023 GP agreements, which provide for increased fees and supports for GPs, including specific supports for rural practices, making general practice in Ireland as a career more attractive, I hope. The agreements also provide for new services for patients, including the GP chronic disease management programme, which is having a transformative effect on patient care. In addition, recruitment of GPs from abroad is ongoing under the international medical graduate, IMG, rural GP programme, with 114 IMG GPs in practice as of October last. Placement of GPs under that programme is targeted at underserved and, in particular, rural areas. Most important for the future, the number of GP training places available has been increased from 202 in 2019 to 350 last year, and that will feed through to an increased number of GPs graduating and entering practice.
I welcome the initiative of the University of Galway to develop medical and pharmacy education with a focus on the differences and additional challenges of delivering services in rural areas. It is appropriate and important that people are being attracted into that from an early stage.
The continued use of increased GP training places and GP recruitment under the international GP programme is committed to under the programme for Government, which also - I think we will come back to this - recognises the potential for using HSE-employed GPs in a variety of locations.
These measures are not being felt in the communities I represent in towns and villages from Tallow to Dunmore East, Portlaw, Dungarvan, Lismore, Cappoquin and Kilmacthomas. Capacity is not keeping pace with demand for GP services. Retirement, as I know the Minister is aware, creates difficulties and has created particular difficulties in west Waterford for people accessing GP services. The Irish College of General Practitioners said late last year that 25% of GPs currently working are aged 60 or over, so this problem will only get worse. There are significant barriers to young GPs entering practice, particularly in rural Ireland. They need to be faced down.
I put a parliamentary question to the Minister a number of weeks ago. The hands-off approach of the Department to, in particular, guaranteeing GP services to non-medical card holders, leaves an awful lot to be desired in rural communities including in my county, Waterford.
I echo the points made by my colleague. I visited with him a GP centre in Tallow, County Waterford. It has an application in for funding because the practice is too small and the space in the centre is not fit for purpose. We could see that ourselves when we visited. There is a need to progress funding for it. The same is true of the Cappoquin health centre. I got a phone call from the lead GP there last week. It was accepted as a GP training surgery. It has three young GPs. They have an application for funding in and they are telling me that application is not progressing as quickly as possible. These are two GP surgeries in rural towns with multiple GPs working from them contacting us as public representatives and asking us to intervene because they believe their funding applications are not progressing as quickly as possible. Will the Minister look at both of those and make sure they are expedited as much as possible?
I always thank Deputies for raising practical problems and barriers I can interrogate and investigate within the Department and HSE. I do not know the status of every application so I really appreciate it. I am informed by the Minister of State, Deputy Butler, who also serves the community in Waterford, that she met HSE Estates last week on the Tallow project, which is important. She will be keeping a close eye on the progression of that. She also informs me Tallow GP service now has four GPs operating. It is a small rural town and it needs the GP services but this is a welcome development and we will continue to work with HSE Estates.
The locum situation in Lismore has been resolved, with a permanent GP now in place, as is appropriate. The Department is working with several practices in west Waterford on their premises. There are plans for a new primary care centre in Lismore. We always want to hear about-----
Will the Minister have a look at the one in Cappoquin?
I will indeed.
It is over a year since we visited Lismore, so it is urgent.
To pick up on what my colleague, Deputy Cullinane, said about Cappoquin, this is a case in point. We are trying to get GPs into rural communities. This GP practice is seeking to become a training centre for GPs. Because of the delays with this, it is unable to do that. That is creating downstream issues.
Dungarvan lost a GP to retirement a number of years ago. I, the Minister of State, Deputy Butler, and others worked very hard to get appropriate care for many of that GP's patients. Many of them have been forced to travel significant distances, including people who are ill, older or infirm. We need to grapple with that. How can we ensure there are GPs not just in our small towns and villages but also in larger towns so people can access GP care where they live? Key to that will be elements of Deputy Cullinane's landmark policy proposal published last year. Directly employing GPs within the health service is an important aspect.
I have not seen that for some time. It is welcome to see it.
It has not gone away.
The Government was making the same case during the election and continues to make the case for employing GPs through the HSE. It does not matter where an idea comes from. Let us just do it.
Deputy McGuinness referenced barriers in his earlier intervention and I did not answer him.
To be fair, the Government has tried to place a particular focus on rural supports. The 2023 contract is an example. Practices in receipt of rural supports receive the maximum rate of practice staff subsidies in a significant effort to reduce staff costs for those who will establish their own practice. They also receive the maximum rate for locum supports for leave taking. On new GPs, the Deputy is right that when a retirement happens it is very disruptive. As I said, the GP training scheme increased by 80% from 2019 to 2024 with 350 new training places and 346 new entrants commencing training last year, an increase of 21% on the previous year's intake of 286. The very crude replacement rate is estimated at a rate of one to three GP graduates taken on board for every GP retirement and we have that particular focus on rural GP training.
Question No. 72 taken with Written Answers.
Ambulance Service
Mattie McGrath
Ceist:73. Deputy Mattie McGrath asked the Minister for Health to review the current situation within the National Ambulance Service where emergency response vehicles have been removed from off-duty paramedics as such vehicles are perceived to be a benefit-in-kind and the impact this decision will have on response times to an emergency; and if she will make a statement on the matter. [9144/25]
I ask the Minister for Health to review the current situation within the National Ambulance Service where emergency response vehicles have been removed from the off-duty paramedics. Such vehicles are now perceived to be a benefit-in-kind, which is a strange situation that will have a huge impact on response times. As they are bad enough at the moment, I ask the Minister to make a statement on the matter.
I thank the Deputy. I have been informed in recent weeks that a benefit-in-kind liability was identified by the HSE for staff using the NAS response vehicles when travelling from home to work. A review is under way in the National Ambulance Service, which it is hoped will be concluded in April. The National Ambulance Service took the prudent step of informing relevant staff members of a potential benefit-in-kind liability that may exist in 2025.
The Deputy will appreciate that the HSE must comply with Revenue Commissioner regulations, like everybody else, in relation to what may be considered a potential personal use of a publicly-owned vehicle. The National Ambulance Service is also preparing to seek a ruling from the Revenue Commissioners in the matter.
It is important to clarify that the response vehicles highlighted by the Deputy are not patient-carrying vehicles and that is a really important distinction. The vehicles in question are rapid response vehicles for authorised NAS staff to respond to an incident in support of an emergency ambulance while on duty but they are not patient-carrying ambulances or patient-carrying vehicles.
The decision taken by the National Ambulance Service, pending the ruling by the Revenue Commissioners that has been sought, does not impact on the National Ambulance Service emergency ambulance provision. I emphasise the Government's commitment to investing in our National Ambulance Service, with an allocation of €285 million in 2025. That includes €8 million new service development funding, with a full year investment of €16 million in 2026, to deliver up to 180 additional posts this year.
The National Ambulance Service is badly broken and the Government must intervene here to try to ameliorate this situation. It has been doing a wonderful job. The paramedics are not, as the Minister said, driving an ambulance or patient-carrying vehicle - we know that - but they are normally the first people to arrive to an accident or incident. In many cases now, when they are driving their cars, they have to pass the scene of the accident or emergency to pick up the ambulance and come back. That valuable time is lost. Often there are only minutes to spare - seconds, in some cases - to revive or stabilise a patient. This is a farcical situation.
We know there are huge issues with ambulances and burnout of the staff but this is something that came in a few years ago in a blaze of glory. It has been successful. How come it was not benefit-in-kind until now? In my own area and areas I know where they have them at home, they are not a huge benefit but they are there and they do not have to go to the hospital or ambulance base to pick them up, which could be 20 miles away. It makes no sense whatsoever. Surely, it can be dealt with in some other way so they have the fastest response time. That is what they are meant to be; a lead response before the other ambulances arrive.
I thank the Deputy and of course, I clarify for the benefit of others watching and not for him in respect of the patient-carrying vehicle. I know that he knows this but perhaps others have not been as involved in this issue as his good self.
This review was prompted by the National Ambulance Service itself. It undertook a review in September 2024 of the procedures governing the out of hours use of official response vehicles. It identified a potential benefit-in-kind liability. It is much better and more prudent to have taken that approach rather than to find out after the fact that it had been done wrongly and a liability had accrued. It is a precautionary measure and it has sought a ruling from the Revenue Commissioners.
We all have to comply with the rulings of the Revenue Commissioners. The NAS has sought such a ruling and the review of the scale of the use of response vehicles for out-of-hours incidents is being examined. The results of that review will be presented to the HSE in April 2025. I agree about the good work done but it has to comply with the rules as well.
I would accept this if it was about some other group of employees but these are dedicated, vital, fast responders. I salute the first responder groups - there is one in my own community - that do excellent work here. They do the work of the HSE and in some cases, they are supported by these particular paramedics who have these cars. They train with them and support them every which way. It is a reassurance that they are in an area. They have the blue lights so they can travel quickly to an incident or accident. If they go in their own car, they have to observe the rules of the road and they do not have blue lights which results in delays.
We are already crucified with delays and some people must wait three, four, five or six hours for ambulances, which come from Sligo to Clonmel and from Clonmel up to Roscommon. The whole thing is badly broken. This is the one area that was not broken; it was ag obair go hiontach, doing great work and working. Why change it? It was changed because Revenue may be an issue. Why do we not wait and see if it has an issue? We literally have taken these vital paramedics off the road. This is penny-pinching on a vital service. There are plenty of other areas to sort out the waste and issues in the HSE but not for these angels of mercy who can come so swiftly to an accident or incident.
I do not disagree with the Deputy one bit about the value of the service they are providing. The National Ambulance Service prudently is seeking a ruling on whether there is a benefit-in-kind liability and has informed people there may be a liability to put them on notice of that. We await a determination.
The review is useful more broadly because it will look at the scale of use of response vehicles for out-of-hours, as I said, but it will also determine the benefit and balance of the use of those vehicles out of hours compared to others existing out-of-hours or voluntary responses including, as we all know, the community first responder schemes. We have 300 of those schemes and 4,000 community first responder volunteers nationwide, which is extraordinary. We also have the NAS off-duty responder scheme, where we have 682 National Ambulance Service staff involved.
Pending the results of the review, the National Ambulance Service took it upon itself to inform people there may be a benefit-in-kind liability. Had it not done that, it would have been rightly criticised for being aware there may be a liability that would accrue to people and not having informed them. We await a ruling of the Revenue Commissioners on it.
Question No. 74 taken with Written Answers.
Health Strategies
Frankie Feighan
Ceist:75. Deputy Frankie Feighan asked the Minister for Health her plans to advance the women’s health action plan; and if consideration has been given to improvements in treatment for endometriosis in view of the fact that women have to travel abroad for surgery.. [9742/25]
I ask the Minister, in respect of the women's health action plan, what are her intentions and what are the plans, particularly when it comes to endometriosis, as it affects nearly 155,000 women in this country.
I thank the Deputy for raising this important issue, which has been a hidden difficulty for many women for many years. It is great to see it mentioned so freely in the Seanad yesterday and in the Dáil today. I thank her for raising it. It is estimated that one in ten women will be affected by endometriosis and although not all women will be symptomatic and not all women will experience it in the same way, it can be really debilitating for some women and our health service should support those women in every way possible.
Treatment for endometriosis ranges from everyday pain medication and hormone treatments to surgical interventions. Budget 2024 provided an allocation with a full year cost of €2.175 million for 2025, which brings the total investment for endometriosis care to more than €5 million since 2021. The development of a national endometriosis framework was announced in 2023 and the HSE has advised that framework is nearing completion. I know that women with endometriosis have a keep interest in seeing that framework, as they rightly should. The HSE is engaging with all stakeholders in its attempt to finalise the framework.
The clinical pathway for endometriosis care spans primary, local and specialist hospital care. Not everybody needs specialist hospital care but for those who do, they absolutely need it. The model of care ensures treatment through supraregional specialist centres with a support network of five regional endometriosis hubs. The HSE has advised these sites are currently taking referrals and providing treatment pathways. The supraregional sites offer specialised care to more complex cases. It is a good thing to note that 1,150 new patients were seen across those sites in 2024, though I imagine there are more in need.
Personally, I am committed, as I know this House is, to fully implementing the Women's Health Action Plan 2024-2025 to continue to improve women's health outcomes and experiences.
I thank the Minister for the recognition of this very important issue. As she said, it has wide-ranging effects on women. Some can live with it day to day; others live in chronic pain. We have to highlight as well that many women have to go abroad in order to get some of the surgical treatment, so I welcome the fact that we will focus on this and get the surgical treatments for these women closer to where they live, because every mile they do is a mile in pain for them.
It is always important as well to recognise the debilitating impact that endometriosis can have on somebody's life, their ability to be at work or their ability to care for children. It is a serious condition that needs intervention. It is important to set out where the specialist centres are. There are supraregional ones in Dublin, in Tallaght and in Cork University Maternity Hospital. The five regional hubs are in the Rotunda, the Coombe, the National Maternity Hospital, University Hospital Limerick and University Hospital Galway. The idea is to try to provide interdisciplinary care to women experiencing endometriosis up to a moderate stage - for example, the cohort of women whose symptoms cannot be adequately managed in their primary care setting. All of those five regional hub sites are now taking referrals and providing treatment pathways for those women.
Medical Cards
Brian Stanley
Ceist:76. Deputy Brian Stanley asked the Minister for Health if she will examine the threshold for full medical card entitlement for those over 66 years; and if she will make a statement on the matter. [8791/25]
I welcome the opportunity to put this question. I congratulate the Minister and the Minister of State beside her, Deputy Murnane O'Connor, on their appointments. It is the first time I have had an opportunity to raise an issue with the Minister in the Dáil, so I wish her the best of luck in her position. She has a big job ahead of her.
I want to raise with her the income threshold for medical card entitlements. We have not moved on this for years. It is causing problems. There are a great many people caught there without it who are in desperate need of it. We have the aim of getting to a universal health system but we are caught in this situation now and we need movement on it.
I thank the Deputy, and I look forward to working with him as we worked together on the public accounts committee.
Eligibility for a medical card is primarily based on a financial assessment, as the Deputy is aware, which is conducted by the HSE in accordance with the Health Act 1970. The HSE assesses each medical card application on a qualifying financial threshold. That is the amount of money that an individual can earn per week and still qualify for a card. It is specific to one's individual financial circumstances.
People under 70 are assessed under the general means-tested medical card thresholds which are based on an applicant's household income after deduction of tax, PRSI and universal social charge. Certain expenses are also taken into account. People aged 70 or older are assessed under medical card income thresholds which are based on gross income. However, those aged over 70 can also be assessed under the general means-tested scheme where there are particularly high costs.
I assure the Deputy that my Department keeps medical card issues under review in order to ensure the medical card system is responsive and sensitive to people's needs. Over the course of 2025, we will review the existing eligibility framework to clearly assess what is working well and to inform future policy proposals regarding the eligibility framework based on robust evidence. That is an important step towards delivering universal healthcare in Ireland.
I thank the Minister for her reply. I have another question about people of working age, or people under 66, as they are referred to in the question. This question refers to people over 66 years of age. I have deliberately phrased the questions that way because for people who are under 66, the income thresholds are €184 for a person who is single and €201.50 if you are over 66. The basic rate of social welfare is €50 ahead of that at the moment. For a couple, the figure is €266.50, and for a couple over 66, it is €298. I ask the Minister to picture this. For a couple with two children, €342 is the limit, the income threshold. I checked yesterday. I checked the HSE website and I double-checked on the Citizens Information website to make sure I had not got this wrong. It is a real problem for workers and families. The Minister indicated that she might review it. I ask her to go for it in the next budget.
Of course, every extension of eligibility means that we cannot do something else, and we have to try to get the balance right. In 2023, GP visit card eligibility was extended enormously. While that does not meet everything, if you have a GP visit card plus the drugs payment scheme plus, potentially, the long-term illness scheme, there are a lot of measures that the State is taking towards reducing your costs in different ways, and the combined effect is very significant. What I really struggle with is that while 430,000 people were estimated to be eligible under that expansion, as of 13 January this year only 38,517 GP visit cards have been awarded under that median income expansion. It is not as though we do not want people to take them up. As a result of that initially slow update, a media campaign was rolled out to encourage uptake in 2024, including radio ads, out-of-home ads and in-office screens. The other 400,000 people who are eligible for a free GP card might look at the income limits and see if they are eligible.
I thank the Minister for the reply. That is helpful because the GP visit card is welcome. We acknowledge that it is there. The figures she gave mean that, I think, about one in 12 people who are entitled to it have applied for it and got it, or one in 11 or something like that. Obviously, there is a big piece of work there for the Government and all of us to try to get the word out there on that. It is important that we get people into primary care and that we are able to treat them in primary care because many people neglect their own health due to health costs and they finish up with a more chronic condition in some accident and emergency unit. Obviously, that is not the place we want them to be. It is bad not only for their health and for outcomes but also for financial management within the HSE. We are supposed to be moving towards a universal health system under Sláintecare. As I understand it, we have less than two years left to do that. This is one thing we can do, but I wholeheartedly welcome the GP visit card. We need to go the whole way and we need to start moving up the income limits. I think the Minister will agree that a €184 income threshold in 2025 is just off the Richter scale. She mentioned the balance. The seesaw is tipped too much against those on lower incomes.
Again, yes, it is about getting a balance, and we want to extend eligibility and reduce costs as much as possible. The very last thing that I or anybody else in this House wants is somebody not getting medical care because of a question of cost. The Government has taken a range of different ways to spread the benefit it is giving to people in the broadest possible way in addition to medical cards. The GP visit card is one. I would love to see 430,000 people taking it up and using it when they need to use it, supplemented by the drugs payment scheme, supplemented by the long-term illness scheme, which I think needs review as well, supplemented by removing the public inpatient charges for children and adults, and supplemented by our extension of contraception. We are trying to reach different groups in the broadest possible way and reduce the cost of medicine and access to medicine. In addition, all children under the age of eight years and all people aged 70 and over are now automatically eligible for a GP visit card. On the basis that most of our primary care is attempted to be delivered through the GP and primary care network closest to home and getting the original access, it is a really important step. I encourage every Deputy to encourage their constituents to check if they are eligible.
Healthcare Policy
Paula Butterly
Ceist:77. Deputy Paula Butterly asked the Minister for Health her plans to advance the women's health action plan, specifically in respect of County Louth; and if she will make a statement on the matter. [9741/25]
I wish to return to the women's health action plan, in particular when it comes to young women, specifically young women in County Louth. For far too long in decades gone by, women's health in this country was neglected and ignored, partly because women tend to take care of others ahead of themselves and also because men in general and the State in decades gone by have simply ignored women's issues and women's health and have tended not to ask us how we are.
Not only that, but when women do express symptoms, they have often not been listened to. That was particularly evident to me in the new funding we have given from the women's health fund to cardiovascular care in particular yesterday, where there was an acknowledgment of bias in understanding symptoms and the way in which women describe them. The implementation is ongoing for the second women's health action plan for 2024-25. Our goal is to improve health outcomes and experiences for women and girls nationwide, and that has been supported by additional investment of over €180 million.
Specifically, as regards County Louth, significant investment has been provided to Our Lady of Lourdes, Drogheda, for its maternity and gynaecology services, including the midwifery-led unit operational, with services extending to the community. Water birth services commenced in late 2023. Postnatal services are to be further developed in 2025.
Of course, it was one of the first hospitals to implement termination of pregnancy services. It has also had an ambulatory gynaecology clinic operational since late 2022. Within the Louth-Meath CAMHS service, two new advanced nurse practitioner posts have been approved specifically for eating disorders. This is a particular problem for young girls especially, as the Deputy has identified. Funding has supported the provision of free period products in buildings and facilities managed by Louth County Council. BreastCheck is also currently operating a mobile breast screening unit in Drogheda. There are 56 cervical screening contract holders in primary care in County Louth. I am committed to women's health action right across the country, but these are some specific examples. This is additional to women and girls in County Louth being the beneficiaries of the broader supports in relation to HRT yet to come and the cost of contraception supports.
I thank the Minister and welcome those updates. I turn my attention now to women in mid-life and older women in general. I have realised myself since I entered this Chamber and come down those very steep steps that my bones are tending to creak a little bit more than they were two months ago. There are programmes in the plan for bone health. This is a vital issue, especially for women in mid-life and older age. The term "older age" does not sit right with me as I advance towards it perhaps, but I would like to hear a little more about those plans, particularly for the women of County Louth.
In terms of my role as the Minister of State with special responsibility for older people, and the specific aspect in terms of women in the context of the issue raised by the Deputy, I am going to work with the Minister on the matter. More specifically, I am going to work on the issue raised by the Deputy regarding women moving into their older years. It is something I am very strong on and I will work with the Minister on the specific matter raised by the Deputy.
I also acknowledge the work being done on the cardiovascular health of women. As the Minister pointed out, the symptoms for women are not the same as those that present in men. Very often, we tend to ignore it. Through marketing, communication and just general acknowledgement these symptoms are different, we can definitely change the lives of many women across the country.
I launched three such research programmes identifying exactly that aspect, as well as identifying women who may experience particular risk factors through gestational diabetes or experiences during pregnancy or maternity generally that may be markers for cardiovascular difficulty in future. I also wish to highlight to everybody quite how easy it is to have an early marker check. Yesterday, I went through the horrid situation of having my blood taken and checked, which I despise. Nevertheless, it is a very useful process. I got the results 20 minutes later, which, notwithstanding some stress, were absolutely fine. The point is that they could just as easily have shown an early marker. Would we not much rather find out about an early marker for risk for the future? These are readily available to be done and I encourage everybody to try to spread this word, especially when it is women's health week. I thank the Deputy for her focus on women's health during this week.
Question No. 78 taken with Written Answers
Eating Disorders
Marie Sherlock
Ceist:79. Deputy Marie Sherlock asked the Minister for Health her plans to deliver on the previous Government commitment from 2018 to increase the number of specialist public eating disorder adult in-patient beds to 23; and if she will make a statement on the matter. [10127/25]
My question relates to the 2018 commitment regarding inpatient beds for those with an eating disorder. It is important to say there was a significant amount of hurt at some of the previous comments made by the Minister of State about the need for these beds. We met some of those suffering from eating disorders last week. The reality is that while we very much welcome an expansion of community care, there is a desperate need for an increased number of inpatient, specialist beds for those suffering from an eating disorder.
As the Deputy will be aware, eating disorders are complex, individualised and are and can be one of the most serious mental health illnesses anybody can go through. As Minister of State, I am firmly committed to improving services for eating disorders in Ireland. The national clinical programme was set up in 2018, and when it was set up it was envisaged there would be approximately 60 people who would require the supports of clinical eating disorder teams. The figure now stands at approximately 600 in the space of seven years. The programme has progressed very well. Some 90% of all people with an eating disorder are treated in the community. Quite rightly, therefore, a decision was made to focus the supports as much as possible in the community. We now have 14 of the 16 teams envisaged by the model of care funded. Eleven of them are in place and one of them actually moved into a new premises last Friday, while three of them are currently in the process of recruitment. Most teams, as I said, are fully operational and seeing people with eating disorders every day. It is also extremely important to point out that there are 100 dedicated clinicians working across all the eating disorder teams in the country, with ten psychiatric consultants. The progress being made is not being acknowledged at all. There was recurring funding of €9 million this year alone for eating disorder teams under this clinical programme. We have two more teams to fund and I hope to do that in next year's budget, with the support of the Minister. Under-18s can access 20 eating disorder beds across the four CAMHS inpatient units. This is very clear. I say this because this has been lost in translation as well. There are 20 dedicated eating disorder beds across four CAMHS inpatient units. Coupled with this, the majority of people presenting with eating disorders are, unfortunately, aged 14, 15, 16 and 17. I will respond during my next contribution concerning the adult beds.
I look forward to that response from the Minister of State concerning the adult beds. What I am hearing from the initial contribution of the Minister of State is that there is no intention to make good that commitment from 2018 regarding the 20 adult beds. The reality is that it is a very complex psychiatric condition. When we look at the data from the Health Research Board, it can be seen that eating disorders require the longest inpatient stays of all psychiatric illnesses. The reality in this country is that we have outsourced care for some of the most severe eating disorder conditions to the private sector and charities. Some 76% of inpatient admissions for eating disorders are to private facilities and private charity providers. Quite a number of people have to go to England. Now, that is shameful in this day and age. We also know the number of those concerned, especially for the under-18s, has increased by about 43% in a short period between 2019 and 2023 in respect of those requiring inpatient stays. I welcome the 20 CAMHS beds, but there need to be an awful lot more. We do not have sufficient provision for people with eating disorders in this country now.
Some of the Deputy's information is inaccurate. I have put a major focus on eating disorders. Just to be clear, no child under 18 has had to have treatment abroad since 2019. This is because we now have-----
We now have the-----
Please let me answer. We now have the nasogastric tube feeding, which is available in the Eist Linn centre in Cork, in the Linn Dara unit and in Merlin Park. Unfortunately, this is a feature associated with an eating disorder, but we do have this provision. For the past six years, we have spent €1 million annually treating some very complex cases abroad. We also spend money every year on supporting adults with eating disorders in private facilities in Ireland. This is a fact. In relation to the beds issue, I had a review undertaken of all mental health bed capacity. It has taken place and is currently under consideration by the HSE. This includes a review of data on eating disorder bed use in the HSE, in the approved centres, and in private placements and treatment abroad.
When are we going to see that review? We have been waiting for these beds. They were promised quite a number of years ago now, but we have not seen them. It is good that there is a review, but we need urgency on it. The reality is there are too many people in this situation. It is simply unacceptable that the State is spending money on sending people suffering with this condition abroad. We need to be providing for these individuals here. This is particularly the case given the length of inpatient stay required for many of these individuals.
Many people choose to use the treatment abroad scheme themselves. They actually choose to use it. We have to be fair. People do choose to use the treatment abroad scheme.
No, they do not.
I am expecting-----
All the people I have spoken to did not choose to-----
Does the Deputy want me to answer her question or does she want to heckle me? It is up to her.
The Minister of State without interruption.
I expect to receive a plan from the HSE regarding future eating disorder bed provision very shortly. Yesterday, I met Dr. Michelle Clifford, clinical lead, and Dr. Amir Niazi, national clinical adviser and, on Monday, I met Bernard Gloster, the CEO of the HSE, to discuss this specific issue. I have had four priorities since I was reappointed. I thank the Minister for my delegated functions this week. These priorities include the CAMHS waiting list, the adult beds and the Mental Health Bill 2024, which I hope to bring to Committee Stage in the Dáil next month.
In relation to the eating disorder beds and the Deputy's earlier comments, what I said was that the review was specifically looking at the fact that 90% of all eating disorders are treated in the community and we may not need the 20 beds.
That is the whole purpose of the review and the report on it, which I await. The spread of the beds will be geographical; they will not just be located in Dublin.
Question No. 80 taken with Written Answers.
Primary Care Centres
Naoise Ó Cearúil
Ceist:81. Deputy Naoise Ó Cearúil asked the Minister for Health for an update regarding the proposed primary care centre in Maynooth; and if she will make a statement on the matter. [10050/25]
Ar dtús báire, guím gach rath ar an Aire. I wish the Minister well with her new brief. We have seen the success of primary care. I look to my home town of Maynooth, which is yet to have a primary care centre. I have been calling for this for a long time. The population of Maynooth is 17,000, on top of which there are 14,000 students, as I mentioned previously, and a projected population increase of 10,000. We are looking at a town of around 31,000 without a primary care centre. Will the Minister update us regarding the proposed primary care centre in Maynooth?
I thank the Deputy for allowing me to update the House on this matter. Significant consideration has been given to developing primary care centres for both Maynooth and Leixlip. Since 2015, while several site locations for a primary care centre in Maynooth were explored, no suitable option has come about. As a result, a larger primary care centre will be built in Leixlip to serve both the Maynooth and Leixlip populations and their surrounding areas. However, and importantly, as part of that plan, the HSE will continue to deliver health services locally from the Maynooth health centre which will serve as a satellite and complementary unit to the larger north-east Kildare primary care centre in Leixlip. The development of the larger primary care centre in Leixlip has some advantages for service users which include access to a larger multidisciplinary team and the co-location of both core services and the enhanced community care programme community specialist teams in a larger and improved clinical space. It is welcome news that we are moving forward with more services in that region generally. A schedule of accommodation is being finalised with a view to the HSE tendering in the second quarter of 2025. I recognise that the population is growing in Leixlip and Maynooth. I welcome the HSE's commitment to continuously review infrastructure in those areas in conjunction with Kildare County Council. I examined the location, distance and public transport routes between Maynooth and Leixlip to best understand how people would access the more significant service that will be available in Leixlip. I am aware that Maynooth continues to grow. It was the original intention to have that facility there. A number of issues have been thrown up in that infrastructure process that give me pause as Minister for Health as to how we will deliver better infrastructure around the country.
I welcome the news about the primary care centre in Leixlip. As the Minister mentioned, it will be a significant investment by the State and a significant primary care centre in Leixlip but bear in mind that the whole idea of primary care is accessibility, that older people, young families and mums with children can walk down to a primary care centre and receive care in the community. I ask the Minister, as she stated, to continue the review. This goes back as far as 2015. It is now ten years on and no real progress has been made for a primary care centre for north-east Kildare. While it is positive that there will be a primary care centre in Leixlip, for a town the size of Maynooth - it is the same in south County Dublin, Dún Laoghaire-Rathdown, Louth and Meath - there need to be primary care centres. It is not good enough that towns are combined for primary care.
I could not agree with the Deputy more. The intention was to do this in Maynooth. Several site locations for the Maynooth area have been explored since 2015 within HSE and State capital, but with no success. The important point is that the HSE applied for planning permission to develop a primary care centre on the site of the current health centre in Maynooth and it was not approved. The HSE had to seek planning permission to turn a health centre into a health centre, and it was not approved. I have a serious commitment to developing health infrastructure in this country. I want to deliver the services that I believe Maynooth and everywhere else needs. I am serious about the infrastructure guidelines and how we have to go about doing things. It will hamper the delivery. I am not trying criticise planners or their decisions - I appreciate that every application is different - but there was a need for a site in Maynooth, planning permission was applied for to turn a health centre into a health centre and now we have to do it in Leixlip.
The Minister has hit the nail on the head. There was a site where a health centre was to be changed into a health centre, which is ludicrous. There is a wider argument around planning, particularly how one arm of the State speaks to another. That is a wider question. I welcome that there will be a primary care centre in Leixlip. I will continue to work with the Minister to try to find an alternative site in Maynooth. I appreciate all the work she has been doing in increasing primary care throughout the country.
I am well aware of how much the town of Maynooth has grown in population and in its need. The best we can do is make sure that the Leixlip site is delivered and services are available there, that services in Maynooth are also delivered to the extent possible and that the broader community has access to both centres. I thank the Deputy for his question. There is no lack of commitment in relation to Maynooth, just this direct problem which I hope we do not continue to have. We will have to figure out a way around it, otherwise we will not get anything built.
Questions Nos. 82 to 86, inclusive, taken with Written Answers.
Mental Health Services
Martin Kenny
Ceist:87. Deputy Martin Kenny asked the Minister for Health if a mental health information database CAMHS consultant has been recruited to the children's disability network team for Sligo, Leitrim, south Donegal and west Cavan; if there are adequate supports for this role; and if she will make a statement on the matter. [9505/25]
I submitted a question on the issue of the MHID CAMHS consultant, but it was wrongly interpreted as referring to a "mental health information database" consultant rather than a "mental health intellectual disability" consultant. The intellectual disability service is required. We raised the issue in the Chamber several times of a child called Maggie in Drumshanbo, County Leitrim, who was referred to the intellectual disability team, which has not existed. The first person recruited - the consultant - to that team was recruited last November and only stayed a week because there were no services other than herself. Now, they are trying to recruit somebody else. This question is about intellectual disability teams and services.
I thank the Deputy for his question and for his clarification. Can I clarify the question number?
It is Question No. 87.
The question relates to the mental health intellectual disability teams, which are different from other teams because they are very small. There may be nine or ten people on an eating disorder or CAMHS multidisciplinary team, for example, but mental health intellectual disability teams can normally, believe it or not, be made up of just one person and some staff to support them. I am disappointed to hear that the person referred to by the Deputy left after a week. This is part of the clinical programmes under CAMHS. There are several clinical programmes. CAMHS received approximately €160 million in dedicated funding in 2024, an increase on €137 million in 2023. We also provided funding of €110 million to various NGOs, with a significant proportion dedicated to supporting young people. Due to how the question was posed - we understood it referred to an "information database" - the prepared answer is not sufficient for what the Deputy is actually asking about. There is investment across all clinical programmes this year, including eating disorders and mental health with intellectual disability. Is the Deputy's question about when that position will be filled again?
The CAMHS issue is an issue across the country. The Minister of State mentioned that it is one of her priorities. I will provide a second example in respect of CAMHS. A family's GP sent a letter to CAMHS to refer a child who needed to get into CAMHS. They received correspondence stating that there was no clinical lead for the CAMHS post in CHO 1, which covers Leitrim, east Sligo and west Cavan. The GP received a letter back saying that the child could not get a place in CAMHS and could not even be put on the waiting list to go into CAMHS. This is the situation across the country, but it is particularly acute in the Sligo-Leitrim region. There is no CAMHS service for any child. The principal in the local school in Ballinamore wrote to me regarding this. They had a child who also needed a referral but was informed that there is no access for the child to go to CAMHS. The letter, which came back to the family, said that if the child's mental health situation deteriorated, they had to go to the accident and emergency services. That is totally inappropriate. The Minister of State has said that this is her priority, but nobody sees that priority on the ground.
Did that child have an intellectual disability as well?
He said "There is no CAMHS service", but that is factually incorrect. There were 223,000 appointments last year for children-----
I will get the letter for the Minister of State.
No, no. To be fair, there were 223,000 appointments for young people with CAMHS last year.
Some people who are receiving the support of CAMHS can be in CAMHS for up to four years, for example, and can be seen on a two-weekly basis. I cannot comment on that individual case but we are investing €160 million this year in CAMHS. There are over 80 consultant psychiatrists working across CAMHS. I am not saying there are not challenges because there certainly are but we are investing in CAMHS. If the Deputy wants to give me the specifics, I will look at the case because his question did not lend to a proper answer being provided, as I am sure he will appreciate.
I will come back to the Minister of State with the specifics in respect of the case but the truth is that there are thousands of children across the country who cannot get access to CAMHS. I appreciate that there are more people being recruited but it does not meet the demand or come anywhere near meeting the demand. In team one in the Sligo, Leitrim region, the CAMHS team has no clinical lead. Having no clinical lead means that when a GP refers a child who needs a service, he or she gets a letter back saying "Sorry, there is no service. Go to accident and emergency." If the Minister of State thinks that is a good service being provided by the Government, then she needs to cop herself on.
The Deputy should realise that the clinical lead position is funded and the HSE is currently trying to recruit into it. It is not the case that it is not being funded. The Deputy should not give the impression that we are just leaving one particular area of the country without any support because we are not.
The reality is that it is without support.
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