Dáil debates

Thursday, 16 April 2015

Ceisteanna - Questions - Priority Questions

Drug Treatment Programmes

9:30 am

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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2. To ask the Minister for Health if it is the case that the Health Service Executive recruitment embargo has resulted in a crisis in the executive's counselling services and dangerously high caseloads; that certain individual addiction counsellors in the executive working in the Dublin region are tasked with over 200 client cases; that no new counsellors have been appointed in the past year; that this is the first Government in 21 years not to have a Minister with responsibility for dealing with the issue of drug abuse; that the Government has presided over a 37% cut in drug rehabilitation services in the past five years; that there has been a failure to fill the 1,000 ring-fenced places for drug rehabilitation participants; and if he will make a statement on the matter. [14806/15]

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I again point to the fact that there is no designated Minister with responsibility for dealing with the issue of drug abuse and seek to highlight the level of cutbacks in drug addiction services in the past five years, the HSE recruitment and replacement embargo, the reduction in the number of women accessing addiction services, the embargo on the recruitment of addiction counsellors in the HSE, the restrictions and difficulties experienced by support workers and the restrictions on access to rehabilitation schemes.

Photo of Leo VaradkarLeo Varadkar (Minister, Department of Transport, Tourism and Sport; Dublin West, Fine Gael)
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I am advised by the HSE that there are three addiction counsellor posts vacant in the Dublin region. Recently, these positions were offered to candidates on the relevant HSE national recruitment service panel. As no candidate accepted the offer of work in the Dublin area, a recruitment competition specifically to fill these vacancies is under consideration by the HSE. The ending of the moratorium on recruitment announced by the Minister for Public Expenditure and Reform in budget 2015 will give the HSE greater autonomy to manage its staffing levels within the overall pay framework.

Average current counselling caseloads within the addiction service are dependent on where a clinic is situated. The HSE has indicated that the average caseload ranges from 25 to 50 individuals and that there are no addiction counsellors with caseloads in excess of 200 clients.

Drug-specific community employment schemes make a significant contribution to the rehabilitation of recovering drug users. At the end of December 2014 there were 936 referred clients in drug rehabilitation places, which is close to full capacity. In any given year participants may exit for a variety of reasons, but there is a cycle of places becoming vacant and being filled on an ongoing basis.

Despite the economic downturn, cross-departmental provision for drugs programmes continues at a significant level, with over €240 million allocated for drugs initiatives last year. An extra €2.1 million has been provided in the HSE national budget for measures to target vulnerable drug users in 2015, in line with the Government's ongoing commitment to the national drugs strategy. This additional funding will support the expansion of residential detoxification and rehabilitation services, the continued provision of needle exchange services outside Dublin and a demonstration study for the use of naloxone in the prevention of opioid overdose. This initiative forms part of a major effort to reduce drug-related deaths by increasing access to naloxone for non-medical staff, such as the families or friends of a drug user.

I am fully committed to the drugs brief, and am eager to tackle the issues in the area in as comprehensive a way as possible. My Department is beginning work on the development of a new national drugs strategy for the period after 2016, and as Minister with lead responsibility I will play an active role in the development of the strategy. I look forward to engaging with all interested parties on the matter.

9:40 am

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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This is an area of major concern, yet it is the first Government in, I understand, 21 years where we have not had a designated Minister with specific responsibility for drugs. There has been a 37% cut to drugs services over the past five years, and this is showing itself in the strain experienced by people entrusted with the delivery of drug addiction services. They have to cope with significant caseloads, in particular in Dublin city where addiction counsellors are trying to cope with more than 200 individual cases each.

The challenge in any one of these is significant and that any one counsellor would be asked to cope with 200 client cases presents difficulties. It is very important that the real breaking points are noted in the current service, not only in the Dublin region but across the country. I ask the Minister, apart from the response he has given, to outline the measures he now intends to take to address this most serious area which is currently seriously under-resourced.

Photo of Leo VaradkarLeo Varadkar (Minister, Department of Transport, Tourism and Sport; Dublin West, Fine Gael)
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It is important to point out that the total cross-departmental budget for the drugs programme was reduced consistently throughout the period of the recession. It was reduced in 2009, 2010, 2011, 2012 and again in 2013. In 2014 in was increased from €237.5 million to €240 million and this year it is being increased again. When we had a dedicated Minister of State with responsibility for this area the budget was cut every year. Now that we have a dedicated Minister who is a senior Minister in the Department the budget is being increased. That may be lost on people, but when one controls the entire budget it is much easier to move small amounts of money into priority areas, which is what I have done.

Some 97% of those who are waiting on treatment will receive it within weeks, which is a very short waiting list compared to some of the waiting times that people may face in other areas. If people require treatment they can get it within weeks in almost all cases.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister is correct when he refers to small amounts of money. What we need, given the crisis we face with drug addiction, is not the proposition that we add to the already chaotic situation additional areas of responsibility, such as alcohol or cannabis. We need to properly resource the area, if we are to take on board these other critical areas and not add to the impossible situation with which the current cohort of counsellors and those working with the services have to cope.

Before the Ceann Comhairle clips me once again with the clock, I would like to highlight the situation of women, in particular, and the fact that there has been a 13% drop in the number of women on special community employment schemes following the adoption of measures in a number of social protection Bills. These are being highlighted as responsible for the withdrawal of a significant number of women from drug rehabilitation services. I ask the Minister to comment on that, as well as the fact that the Government has failed to fill the 1,000 ring-fenced places for drug rehabilitation participants.

My final point is that despite three additional posts being offered we cannot get away from the fact that the Minister also confirmed that they have not been filled. No positions have been filled in this area over the past 12 months, something which needs to be addressed. It is not good enough to report that posts have not been filled. We need to proactively seek to recruit the additional supports that are absolutely necessary.

Photo of Leo VaradkarLeo Varadkar (Minister, Department of Transport, Tourism and Sport; Dublin West, Fine Gael)
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It is true that positions have not been filled in a number of areas across health, but this is not because of a lack of finance or effort by the front-line managers involved. We have moved from a situation where for years, all of the effort involved paring down staff, so when one then tells managers to start hiring a lot of people it creates difficulties. We are finding it difficult to recruit in some areas and in some parts of the country, but we are not giving up on that by any means.

Under the dormant accounts scheme, local drugs task forces did not have their budgets cut for the first time in seven years which was in recognition of the fact that they now have responsibility for alcohol. I can confirm that their budgets will be increased slightly this year because some of the money from the dormant accounts fund will be given to each local drugs and alcohol task force to do a specific project on alcohol in the area. The sums involved are modest but we are getting to the point where we will have an increase in funding this year.

Community employment schemes are the responsibility of the Department of Social Protection, as the Deputy will know, but I have been informed that considerable progress has been made on increasing the number of participants on community employment drug rehabilitation schemes. In December 2014, there were 936 referred clients, which is almost the full capacity of 1,000, of whom 644 were male and 292 female. Of the support workers, 103 were male and 117 were female. In total, 1,156 places were taken up, compared to only 655 when the Government came into office. I am also advised that there has been no change in the entry requirements for community employment schemes. Places are available only to service users who are in drug rehabilitation and are referred to a place by an addiction service practitioner, referral practitioners, key workers, case managers or counsellors, GPs, treatment centre practitioners or other health service practitioners.