Seán Crowe (Dublin South West, Sinn Fein) | Oireachtas source

I have some questions. I welcome the Minister of State at the Department of Health, Deputy Hildegarde Naughton, to our meeting. I believe it is her first time attending our meeting and we look forward to it as a committee. We are meeting in the next couple of weeks on health awareness. We look forward to that session.

I will do some overviews of some of the challenges within the system. I will not get into the detail of how many millions of euro and so on. I genuinely believe it would be more constructive if we were to talk about some of the challenges we are facing in the system.

I welcome that the Minister is talking in terms of some of the challenges and the waiting lists going down in some areas and so on.

We touched on North-South co-operation at the start of the meeting. One of the issues in the system is capacity and the lack of key personnel in certain areas. Speech and language is one such area. I am conscious that if we do not have people trained up to come into the system, there will be challenges in future. The positive message we heard from Magee was there was capacity in its system. The pattern is, and all the information indicates, that if people are trained in the general area, they normally stay in that system. It is of benefit to both jurisdictions and both areas on the island of Ireland.

One of the areas we looked at in Magee was obesity. We have not touched on it this morning but I raised the matter previously. We met with Professor Alexander Miras, who talked about the co-operation between Magee and Galway at an academic level. He said there were huge challenges within the northern system, not necessarily involving just young people but those of all ages, concerning travelling abroad, for example, to Türkiye. We have heard the horror stories of these stomach bands and so on. People have actually died on these trips. The common agreement was that people were travelling because they could not access services and were waiting for years or whatever. I raised the issue of Loughlinstown and the system there. I talked to a constituent who was told in a letter that they would be waiting between five and seven years for access to the clinic there. I raised this matter with the Minister and the Taoiseach. The answer I am still getting for that patient is that it is still a five-year waiting list. It is something that needs to be looked at. I am conscious that it is not just about stomach bands. It involves appetite suppressants and the reluctance of GPs to go down that road.

There are things we could do within the system. I am just flagging obesity as one of the issues that clearly needs to be addressed as we move forward. We have a huge challenge. It is not just an Irish problem. It is a western-world problem. The figures on obesity are going the wrong way. It affects people from when they are children. We hope to address some of the issues when the Minister of State, Deputy Naughton, comes before us regarding the availability of processed foods, especially in disadvantaged communities, and the role of companies and the State in what we can do in that regard. Maybe that is something the Minister could address.

I realise section 39 workers are voluntary workers but they are doing the same work. The system would collapse without them. I am conscious the Minister of State with responsibility for the drugs strategy is present. Some of those who work in front-line initiatives and groups working at the coalface have talked about not getting an increase for ten years and the challenges that we face. Again, has the Minister any plans or proposals, not necessarily outlined in this Estimate, to address that issue any time soon?

The issue of capacity within the hospital system was touched on by members. One of the proposals is the need for an additional allocation for hospitals. Cork and Galway were two of the hospitals referenced. I am trying to address some of the issues that have come up at the committee over the past 12 months. We asked for a note or an update on what is happening with those hospitals. Is the Department of Public Expenditure, NDP Delivery and Reform involved in the process? When will we see developments in that regard? We all accept they are needed within the system. I accept the budgetary challenges the Department faces but it is a key component. I am talking about elective hospitals in Cork and Galway.

On oral health, the Minister mentioned additional dentists and GPs. This involves two areas. The fact is that it is almost impossible for people on medical cards to get treatment. The Minister will probably suggest that the figures indicate more people on medical cards are accessing services, and there are more people who can get access to a GP and medical services, but the challenge is that in many cases, particularly with young and older patients, it is about accessing a dentist or GP. The committee talked about possibly looking at the Scottish system in respect of the roll-out of rural GPs. Has the Department looked at other jurisdictions regarding how we can encourage GPs, or how the State can hopefully establish GP services in those areas of the country where there are clear gaps, and where people have to travel an excessive distance to try to get basic access to a GP or dentist? There is a crisis for young people within our health system, particularly those who are younger, with regard to the importance of oral health in the health of an individual. Again, the fact is people are waiting years for their child to be treated. In some cases, the child goes through school without getting access to a dentist. We all accept that is unacceptable.

The Minister mentioned 1 in 50 in respect of CAMHS. There are other challenges in the area of adult mental health services. One of the big challenges, particularly for young people who may have an intellectual disability, whether that disability is profound or not, is access to accommodation and supported care. That is a huge problem. The Minister will know that from his constituency but also through his ministerial role. Is there any positive message we can send to families regarding access? We are over-reliant on voluntary and charitable bodies in this area. I will give an example. The daughter of a woman in my constituency has been trying to access a service for a number of years now. This woman wants to go into a senior citizen facility but she cannot do that while her daughter is living with her. Her daughter wants to have some sort of independent life. The big worry for the mother is who will look after her daughter as she gets into increasingly bad health. There are no follow-up services and no way of moving on. Going around all the possible accommodation, it is all full. Even though money has been allocated for this individual, the beds are not there. What can be done about that? There is also a role for local authorities in accommodation for people with disabilities. It is about doing that. What conversations is the Minister having with the Minister for housing on that? All development plans should include something in relation to suitable accommodation for people with disabilities, regardless of whether they are profound or mild. If we are building an inclusive society, it should be about that.

I have outlined a number of issues. I could go on a lot longer but I will not. I touched on capacity, key personnel and speech and language in the context of the visit to Magee. People are waiting years with a child who may not be able to speak. The longer that child waits, the more difficult it is to get that child into a service. There is frustration for both child and parents about that. I acknowledge that positive things are happening but many of those families are under severe pressure.

In many families it is not just one child. It could be a number of children who are on a spectrum and who cannot speak or who need these supports. We need to do more about that. I accept that where key personnel are missing and there are broken teams, multidisciplinary teams can carry out only so much. The difficulty, which we have touched on as a committee, is that you are trying to recruit people into an area where the backlog of a thousand cases faces them when they come into that, so there are big challenges within the system. I would be interested in the Minister's views on that.

Going back to the all-Ireland stuff, specifically the all-Ireland breast milk bank in Enniskillen, there are really positive things there, but people have said there could be tweaks to the system that we could be doing with the roll-out of that.

Organ transplant is a big challenge for anyone in that situation. There is co-operation there, but it is a matter of increasing the number of organs available. I recognise there is legislation on that coming through but I think we all know friends who have been on those waiting lists and who have, unfortunately, passed because there are not enough operations going on.

One of the issues we have tried to address as regards services is the challenge concerning children with scoliosis. I realise the difficulties in that respect and that inquiries are ongoing and so on. We heard there was a field report on one of the metal bands. There were challenges with that in one of the hospitals. What message can the Minister send to those families? There are long waiting lists for scoliosis treatment. There are difficulties now within the system as regards other matters, but for those families who have a child in that system, their conditions are getting worse and they are waiting long times for access to life-changing operations. I have mentioned the metal bands. There are huge challenges as to what to use for children in that situation.

The common theme of the questions I have asked is that, while funding is one issue, they all probably need champions, such as the Minister and the Ministers of State, in moving these issues forward. I would like to think that, collectively, we as a health committee can work with the Minister and Ministers of State and their officials in trying to move many of these issues on.