Written Answers Nos. 319-329
319. Deputy Willie O'Dea asked the Minister for Health his plans to increase the capacity of the department of clinical genetics of Our Lady's Children's Hospital Crumlin, as at present people living with a rare disease wait over two years for a diagnosis after a referral for genetic testing; and if he will make a statement on the matter. [7108/24]
Amharc ar fhreagraThe Government and I are fully committed to improving genetics services in Ireland. One of the key ambitions of the National Strategy for Accelerating Genetic and Genomic Medicine in Ireland is to build a strong patient and family-centred national genetics service that can be accessed equitably across the country and lifespan of patients. In 2023, the Government allocated €2.7 million to the implementation of this Strategy which included the establishment of a National Office of Genetics and Genomics and the allocation of front-line staff across the HSE Health Regions in areas of immediate need.
Last year, the following genetics/genomics posts were allocated to deliver services in CHI, Crumlin:
• 2 genomic resource associates
• 1 genetic counsellor
In addition to these CHI Crumlin allocations, the following posts were allocated to build an equitable service at a national level:
• 1 genetic counsellor to each of the following locations:
• HSE Dublin and North-East - Beaumont Hospital
• HSE West and North-West - Galway University Hospital
• HSE Dublin and Midlands and HSE Dublin and South-East - St. James Hospital/St. Vincent’s University Hospital
• HSE South-West – via post allocated to CHI to deliver clinical services in Cork
• HSE Mid-West – via post allocated to CHI to deliver clinical services in Limerick
• 1 Consultant Clinical Geneticist to each of the following locations:
• HSE West and North-West - Galway University Hospital
• HSE Mid-West – via post allocated to CHI
Recruitment through the strategy will be ongoing during its implementation phase, and beyond. Some of the posts approved in 2023 were affected by the extension of the temporary pause on the application process for new and replacement posts at all grades of Management and Administration, effective from 4th October 2023, as directed by the HSE Chief Executive Officer.
A priority for 2024 is the development of a robust National Genetics and Genomics Workforce Plan to support the recruitment, retention, education and career development of specialised roles. As part of this, a workforce planning analysis will take place. This will include genetic counsellors and the development of the Genomic Resource Associate (GRA) roles to support patients to navigate the genetic and genomic care pathway and improve coordination of care.
The development of a National Genomic Test Directory for Rare and Inherited Diseases is another priority deliverable for 2024. This Directory will support the delivery of equitable national genetics and genomics services, including clinical genetics services, genomics laboratory capabilities and associated bioinformatics. The Directory will map the current genetic tests conducted across Ireland and provide a more transparent process for referrals. This will be a key development in improving national genetic testing and ultimately helping to reduce wait time.
320. Deputy Mark Ward asked the Minister for Health about the capital plan working group tasked with the development of a ten-year plan to address the existing and future capital requirements within mental health; who is on this working group; how often they will meet; when such a plan will be published; and if he will make a statement on the matter. [7109/24]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
321. Deputy Steven Matthews asked the Minister for Health the position regarding the community neurorehabilitation team that was committed to by the HSE in 2019 for CHO7; a timeline for this to come into operation; and if he will make a statement on the matter. [7127/24]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
322. Deputy Niamh Smyth asked the Minister for Health if an appointment can be expedited (details supplied); and if he will make a statement on the matter. [7165/24]
Amharc ar fhreagraUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
In relation to the particular query raised, as this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
323. Deputy Denis Naughten asked the Minister for Health for an update on implementation of each of the recommendations of the Sláintecare report of the Oireachtas Committee on the Future of Healthcare; and if he will make a statement on the matter. [7170/24]
Amharc ar fhreagraIn 2017, the Oireachtas Committee on the Future of Healthcare in Ireland published the Sláintecare Report which set out a new vision for the future of healthcare in Ireland. Sláintecare is the most significant reform programme in Ireland’s Health Sector. The shared vision of Sláintecare is to introduce a universal health and social care system where everyone has equitable access to services based on need, and not ability to pay.
The first three-year Sláintecare Implementation Strategy was approved by Government and published in 2018. It set out an ambitious programme of reform commencing with implementing an initial set of key actions in the Sláintecare Initiation Phase. Key progress in this period included the establishment of an independent HSE Board, of The National Safety Office, Community Healthcare Networks and of the Integrated Care Hubs for Older People with Chronic Diseases. The establishment of the six new HSE Health Regions was approved and increased eligibility for GP access was achieved. Significant investment in workforce and in various Healthy Ireland projects increased health system capacity and improved health awareness and disease prevention.
The 2018 Implementation Strategy was succeeded by the Sláintecare Implementation Strategy & Action Plan 2021–2023. It built on the reform progress made in the first three years, as well as on COVID-19 learnings and commitments made under the Programme for Government. This Sláintecare foundational phase has continued to deliver significant progress during the implementation of concurrent key reform projects in multiple areas, such as Enhanced Community Care (ECC), HSE Health Regions, Elective Care, Eligibility Expansion, Digital Health and Healthy Ireland. During this period the Public-Only Consultant Contract was also introduced, and 3 major Trauma Centres were established. A Final Progress Report on the implementation of the 2021-23 Strategy and Action Plan is in preparation.
Work on the next phase of implementation of Sláintecare from 2024 onwards is also at an advanced stage of development. The Government remains fully committed to the continued delivery of Sláintecare reform. The 2024 Health Budget provided €22.5 billion to build on the significant reform progress made to date, to continue the delivery and expansion of quality, affordable healthcare services.
Key Sláintecare progress to date has included:
• Health Regions (formerly Regional Health Areas). The Government approved the creation of 6 new strategic Health Regions on 31 July 2023. They will become operational this year. Each region will align community and hospital services based on defined populations and their local needs. This will increase efficiency and will maximise the use of resources. The recruitment of Regional Executive Officers (REOs) is now complete.
• The new Sláintecare Public Only Consultant Contract was implemented in March 2023 and is the only contract available to new consultants. This will increase the number of senior decision-makers in our hospitals, including out of hours and at weekends. The new contract will benefit public patients by allowing for the incremental removal of private care from public hospitals. As of end of January 2024, there are more than 1,821 consultants on the new POCC. More than 40% of the total number of consultants working across our health service are now on the new contract.
• Eligibility Expansion. In 2023, additional measures which also facilitate better access to affordable, high-quality healthcare have been introduced. These include:
- Public inpatient hospital charges were abolished in April 2023.
- All children under 8 years of age are eligible for a Free GP Card since August 2023.
- Expansion of free GP care to people earning no more than the median household income,
- Free contraception is now available for women aged 17 to 30 (extending to 31 in 2024 following Budget 2024).
• Enhanced Community Care. A patient-centred population-based approach is integrating community care with the acute hospital sector, providing health services closer to people’s homes, and reducing pressure on acute hospitals. A total of 96 Community Health Networks (CHNs), 24 Community Specialist Teams (CSTs) for Older Persons, 24 CSTs for Chronic Disease, and 21 Community Intervention Teams (CITs) are now operational.
• Workforce Planning. Since 2020 we have 22,655 more staff (a 19% increase). This includes 6,683 nurses and midwives, 3,132 health and social care professionals (HSCPPs) and 2,501 doctors and dentists. With €4.6m in 2023 funding, we now have 59 new postgraduate places, and a total of 879 intern posts of which are 24 new. GP training increased by over 80% since 2015. In 2023, 287 GPs entered training and 350 places are planned for this year. The HSCPP Projection Model will provide demand and supply projections of numbers required in medicine, nursing and HSCPs spanning short- (3-5 years), medium- (5-10 years) and long-term (18-20 year) time horizons.
• Digital Health. There are 43 programmes funded under the eHealth Capital Plan, such as:
- The Digital Healthcare Framework (2024-2027) will set out our roadmap towards digital health.
- The Health Information Bill will ensure a fit for purpose health information system.
- The New Children’s Hospital Electronic Health Records (EHR) Systems is underway.
• Waiting Lists. €443 million of funding was allocated in 2023 to reduce hospital waiting lists by 10% and to move towards the Sláintecare waiting targets of 10 weeks for outpatient appointments and 12 weeks for procedures. There has been an 11% reduction in the numbers waiting longer than the Sláintecare targets of 10/12 weeks and a one-third reduction in those waiting over 12 months. The average waiting time for outpatients reduced from 9.7 months to 7.5 months in 2023. Last year was the second consecutive year that national hospital waiting lists fell.
• The Sláintecare Integration Innovation Fund Programme identifies and promotes innovative and integrated models of care and new ways of working, leveraging technology where possible, by funding projects that serve as a ‘proof of concept’, from ring fenced funding in the health budget, with a view to mainstreaming/scaling successful projects. To date over 100 projects have been successfully tested and are receiving recurring funding annually.
The above-mentioned reports can all be found at the following link: www.gov.ie/en/publication/0d2d60-slaintecare-publications/#slaintecare-report.
324. Deputy Marian Harkin asked the Minister for Health when a child (details supplied) will receive a rheumatology appointment; and if he will make a statement on the matter. [7175/24]
Amharc ar fhreagraUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
In relation to the particular query raised, as this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
325. Deputy John McGuinness asked the Minister for Health if nursing home charges will be refunded to a person (details supplied). [7176/24]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly.
326. Deputy Alan Dillon asked the Minister for Health if the HSE will clarify a matter concerning sensors (details supplied) used by type 1 diabetes pump users. [7177/24]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
327. Deputy Paul Murphy asked the Minister for Health what methods his Department will employ to select a chairperson for the inquiry into sodium valproate; and if he will make a statement on the matter. [7184/24]
Amharc ar fhreagraWork is actively ongoing in my Department in relation to sourcing an appropriate person to Chair the inquiry, and the Deputy will appreciate that this is a sensitive matter. The Chair is an essential role that needs careful consideration. The role requires an experienced person who will run a fair and independent process, and who can give the inquiry the time and attention it deserves.
Over recent months, my Department has worked to identify and to approach candidates deemed suitable, on the basis of criteria discussed with OACS and Epilepsy Ireland, but this has not succeeded to date. The next step in progressing this is the publication of an expression of interest communication which is scheduled to be advertised via the www.publicjobs.ie portal in the immediate weeks ahead. This campaign aims to attract interested and suitably qualified candidates; from which cohort an interview process is planned to determine the most appropriate candidate from any applications received.
I will be glad to provide an update on this matter once this work is finalised.
328. Deputy Catherine Connolly asked the Minister for Health his plans to review the health services currently covered by medical cards and GP visit cards, with a view to ensuring the inclusion of blood tests; the details of any recent engagement he or his Department has had with GP representative bodies with a view to reaching an agreement that no charges for blood tests would be applied in any circumstances; and if he will make a statement on the matter. [7185/24]
Amharc ar fhreagraGP services are provided without charge to people who hold a medical card or GP visit card under the GMS scheme. Under the terms of the current GMS contract, GPs are required to provide eligible patients with ''all proper and necessary treatment of a kind usually undertaken by a general practitioner and not requiring special skill or experience of a degree or kind which general practitioners cannot reasonably be expected to possess.".
The issue of GPs charging GMS patients for phlebotomy services (blood tests) is complex given the numerous reasons and circumstances under which blood tests are taken. Clinical determinations as to whether a blood test should taken to either assist in the diagnosis of illness or the treatment of a condition are made by the GP concerned. There is no provision under the GMS GP contract for persons who hold a medical card or GP visit card to be charged for such blood tests.
In addition, blood tests undertaken in the context of services provided under the GP Chronic Disease Management Programme are covered by the fees paid to GPs by the HSE for this care.
The issue of certain GPs charging GMS patients for necessary blood tests has been raised with the relevant GP representative body on a number of occasions. However, it has not yet proven possible to achieve agreement that no charges for blood tests would be applied in any circumstances.
Where a patient who holds a medical card or GP visit card believes they have been incorrectly charged for routine phlebotomy services or for a different service by their GP, then that patient should report the matter to their HSE Local Health Office. The local management, upon being notified of potential inappropriate charging of a GMS patient, will contact the GP concerned and carry out an investigation into each complaint and, where appropriate, will arrange for a refund of charges incorrectly applied by the GP.
329. Deputy James Lawless asked the Minister for Health to review the urgent need for regulations and reform of CAMHS; what plans are currently in place to achieve this; and if he will make a statement on the matter. [7193/24]
Amharc ar fhreagraI firmly support the regulation of all mental health services, including community CAMHS, and I have been progressing priority legislation to underpin this regulation.
The Government recognises the importance of ensuring all mental health services, both inpatient and community, and both adult and child and adolescent, are fully registered, regulated, and inspected by the Mental Health Commission in its role as the independent regulator of mental health services.
Under the Mental Health Act 2001, the Mental Health Commission registers, inspects, and regulates all inpatient mental health services, including inpatient CAMHS. The current Mental Health Act 2001 does not include any provisions for the registration or regulation of community mental health services and therefore, it is not considered that the Act provides the necessary legal basis to expand the Commission’s regulatory remit.
The expansion of the Mental Health Commission’s role into regulating all community mental health services, including community CAMHS, is being addressed in the forthcoming Mental Health Bill. This new Bill is a complex and lengthy piece of legislation. It will provide the necessary legal underpinning to ensure that the Mental Health Commission can regulate all community services. Additionally, the Bill will overhaul the involuntary admission and detention process, modernise provisions related to consent to treatment, provide enhanced safeguards for people accessing inpatient treatment, and provide a new, discrete Part that relates exclusively to the care and treatment of children and young people.
Drafting of this Bill has been prioritised and it is now in its final months of drafting. It will be introduced to the Oireachtas in the summer legislative session, which begins in April.
Work also continues to improve CAMHS at service level. Year-on-year funding for mental health services increased by €74 million from €1.221 billion in Budget 2023 to nearly €1.3 billion in 2024, and with a strong focus on investing in child and youth mental health. This is the fourth consecutive year of an increase for mental health services, and highlights in real terms the importance this Government places on the mental health of those living in Ireland.
CAMHS receives €146.5 million in dedicated funding annually. In addition to this, approximately €110 million in funding is provided by the Government to community-based mental health organisations/NGOs each year to deliver supports and services. A significant proportion of this is dedicated to supporting young people. I recently announced a further €10 million in funding for mental health to support the delivery of clinical programmes and youth mental health. This again highlights the Government’s recognition of mental health as a central component to overall health, in line with our policies Sharing the Vision and Connecting for Life.
There continues to be growing demand for CAMHS across the country with over 22,000 referrals last year. Between 2020 and 2021, referral rates into CAMHS increased by 33%, while the number of new cases seen increased by 21%.
It is a priority for Government, and for the HSE ,to improve access to CAMHS and to address CAMHS waiting lists. The new dedicated HSE National Office for Child and Youth Mental Health will focus on improved service delivery. This includes taking account of the recent Maskey and Mental Health Commission reports on CAMHS. The National Office is currently finalising the Youth Mental Health Service Improvement Plan which will set out agreed actions for focused service improvement through identified, timely, and measurable actions.
There are now 75 CAMHS teams and 4 in-patient units nationally. Staffing in community CAMHS has increased in recent years, with an increase of 500 full time equivalent posts between 2011 and 2024. I secured funding for additional new posts under Budget 2024, with a focus on child and youth mental health posts.
The Deputy can rest assured that I, and the Government, remain fully committed to the development of all aspects of mental health services nationally.
