Jillian van Turnhout (Independent) | Oireachtas source

The witnesses are very welcome. I fully endorse everything the Minister said about a tobacco-free Ireland and the Healthy Ireland initiative. I welcome the update from the Minister of State, Deputy Lynch, on mental health but regarding the child and adolescent mental health services, social workers have repeatedly told me about their difficulty of engaging and I am fearful that because they will now be in separate bodies under the new agency we may exacerbate that problem in some way. I would like to see a protocol in place at the earliest opportunity to ensure that does not happen. A situation that arises frequently is that once the child goes into care, child and adolescent mental health services, CAMHS, back off and say the child can now get private mental health services. We need to consider having a joined-up system because that is unacceptable. We must ensure that engagement is taking place. We have seen too many reports. I highlight that issue for the Minister, which I will follow up.

My question No. 9 on nurse prescribers came up during the end of life care hearings in this committee. The reply refers to the Department supporting that in principle and putting in place governance and accountability structures but the reality is that those structures are already in place. Nurse prescribers carry out regular audits of the medication they prescribe. They only prescribe from a list of medications approved by the general practitioner who has mentored the prescriber. There is a collaborative practice agreement in place, which was developed collectively, and when I read the answer I felt it reflected the policy versus practice dichotomy we often face in health care. The policy is in place. Could whoever is responsible be nudged to put that into practice?

The reply to question No. 10 on cardiac services is disappointing. It gives the impression that the services being supplied are adequate. The fact is that the number of patients has significantly increased but I believe that is down to the dedication of the staff and not a reflection of the shape of the services. It is likely that the staff would see the response I have been given here as using their dedication against them and it might increase their frustration and undermine their morale. We have to be very careful about that because they have given above and beyond.

The survey that listed a number of significant service deficits does not overcome the inadequacies. It is like having a builder make a virtue of the fact that one's house has two walls but not address the fact that the house is falling down. That is how I felt when I read the answer. We must ensure that we record appropriately. We must record that a service has access to a discipline, even if that access is as low as an hour per month. We must be careful about overstating the case. When I read the answer I felt it did not reflect the reality. It refers to staff vacancies and to maternity and sick leave but the reality is that there has been a constant diminution in staffing levels since 2005 despite the priority for this life-saving service.

Question No. 11 is on the neuro-rehabilitation strategy. It is not my first time to address that issue. It was due to be rolled out from 2011 to 2012. We are now half way through its lifetime and the implementation plan is still not finalised. How long will it take to finalise the implementation plan and is there any intention to speed up this painfully slow process, which will have a huge impact on people's lives?