Tuesday, 28 September 2021
Ceisteanna - Questions
I propose to take Questions Nos. 21 to 28, inclusive, together.
The Cabinet committee on health oversees implementation of programme for Government commitments in regard to health, receives detailed reports on identified policy areas, and considers the implementation of health reforms, including Sláintecare. The committee last met on Monday, 14 December and is expected to meet again shortly. Since then, there have been 13 meetings of the Cabinet committee on Covid-19.
In addition to the meetings of the full Cabinet and of Cabinet committees, I meet with Ministers individually to focus on different issues. I meet regularly with the Minister for Health and his Secretary General to discuss priorities in the area of health, including Sláintecare and, in particular, our management of and response to Covid-19.
I am delighted to get an opportunity to ask about an issue that falls under the remit of the Taoiseach's Department. The programme for Government includes a commitment to a citizens' assembly on the issue of drugs. As he knows, many people are working on a campaign for the decriminalisation of the drug user. I do not want the word "decriminalisation" in this context to be confused with the idea of decriminalisation or legalisation of drugs. We are talking about the decriminalisation of drug users. The objective is that people who use drugs or have an addiction should not be pushed through the criminal justice system and should be helped, supported and empowered purely through the health system. When is the promised citizens' assembly on drugs, which falls under the Taoiseach's Department, going to happen?
Earlier this year, the Taoiseach confirmed with Carmona School in Glenageary that its dedicated on-site therapy supports would be retained. The school has 37 children with profound or severe intellectual disabilities.
In May, the Minister of State, Deputy Rabbitte, informed the HSE that services at Carmona were to remain at pre-Covid levels, provided by clinicians of the same grade and skill set specialisations, and, specifically, that the clinicians were to be based on site. That was confirmed in June during a meeting with parents at the school. It had been accepted by the Minister and the Taoiseach that the HSE's reconfiguration of children's disability services into children's disability network teams under the progressing disability services programme had to include the retention of on-site clinicians where needed but, despite these commitments and the specific instructions of the Minister of State to the HSE regarding Carmona, the HSE has now withdrawn all on-site therapists from the school. This decision has profound implications for the children in question. None of the children have been seen by a physiotherapist since June. The occupational therapist is no longer based on site and there is no speech and language therapist. The clinicians who attend are based out of the HSE office in Leopardstown.
I point out to the Deputy opposite that we are all desperate for answers. Nobody has a monopoly on desperation or the need for information.
Does the Taoiseach have any news for the House regarding extra hospital beds coming into the system, assessments of needs of teenagers and young children in particular under the Disability Act, or home help waiting lists, which are, obviously, very much always on our radar on this side of the House? If he has an update for the House on any of those issues, I would appreciate it.
This morning, we got the horrific news that Cork University Maternity Hospital sent organs and tissue of 18 deceased babies to Belgium for incineration without the knowledge or consent of the parents of the babies. The State has an ugly history on this issue but we thought that chapter had ended. Twelve years ago, the Willis report recommended and the State accepted that the incineration of babies' organs and tissue should cease but here we are again. We have learned that senior management apparently disagreed with senior medical staff and argued that this was not a serious matter. The backdrop to this decision was the spectre of the pandemic but that does not excuse the inexcusable. The pandemic loomed over every Irish hospital. The Taoiseach indicated earlier that all hospitals have been written to in order to ascertain whether something similar happened on those sites. When are replies to those queries expected? I hope the investigation is thorough and concludes reasonably quickly.
I hope the senior managers who let this happen are made to understand that it is a very serious matter. It might be necessary for some powerful people to pay a price in order to ensure this never happens again.
I wish to raise an urgent matter. This Friday, several hundred patients will lose their GP in the Monkstown Farm area of Dún Laoghaire because there is a rule, of which I was previously unaware, that GPs are compulsorily retired when they reach the age of 72, even if that retirement is against their will, as it is in this case. They wish to continue serving their patients but are no longer allowed to do so. Many of these patients who have mobility problems, chronic illnesses and so on will now have to travel long distances and most of them have not even been told what new GP service will be available. The doctor in question can continue in private practice but can no longer provide for his General Medical Service, GMS, medical card patients. I have appealed to the Department of Health to provide an extension for this doctor, which is what he wants. His patients want him to have an extension. The Department is just saying "No" because the rule is that GPs have to retire at 72 even though there is no rationale for it.
More than four years ago, Sláintecare promised "a universal single tier service where patients are treated on the basis of health need rather than on ability to pay". Where are we today? We have a further embedded and deeply unequal two-tier system, the weaknesses of which were badly exposed by the pandemic. There are almost 1 million people on hospital waiting lists. Hospital staff are overworked and underpaid and significant amounts of public money are ending up in the private healthcare system through, for example, the National Treatment Purchase Fund. There were the resignations of Laura Magahy and Tom Keane from the Sláintecare implementation advisory council and that of Professor Geraldine McCarthy, chair of the board of the South/Southwest Hospital Group. In her resignation letter, she wrote:
I have waited for a long time for developments led by successive ministers for health and government. However, recent information and my own experiences tell me we are no nearer to the required reform than we were six years ago.
Is the Government actually committed to what is in Sláintecare or is it just politically expedient to say it agrees with it?
The University of Limerick offers a fabulous paramedic degree course and has done so for several years. The course has many positive attributes but one of the negatives is that the students need to go to Liverpool to complete part of their training. In many cases, that leads to brain drain, with people qualifying from the University of Limerick and remaining in Britain to work out their professional lives. Covid has taught us that we need to increase our capacity in all forms of front-line healthcare. I ask the Taoiseach to consider the brand new Civil Defence facility in Ennis which has fabulous lecture halls and the capacity to deliver this form of training in Ireland. I ask him to push for a partnership between the University of Limerick and Ennis. Limerick Institute of Technology will gain technological university status on Friday. Ennis could have a very positive link with the University of Limerick and solve the brain drain problem of paramedics leaving the country.
On the final point, I do not know what the circumstances are that necessitate the travel from Limerick. It must be regulatory or relate to a particular aspect of the education programme. We are open to any submissions from the University of Limerick in respect of having that completed here or a liaison with the technological university. That is something we are open to having pursued.
Deputy Paul Murphy raised the issue of health needs and Sláintecare. I will simply say that a lot of progress has been made. Deputy Lahart raised the issue of extra hospital beds, for example. In the context of the generality of debate that has ensued, there are approximately 800 additional hospital beds this year. That is the largest number of new hospital beds opened in a single year for many decades. That is the level of State investment in the State system that is now occurring.
On the issue of home helps, approximately 5 million additional hours were provided for in the budget. The waiting list last year was approximately 7,250 people. Now there are approximately 1,307 people waiting for home helps. The next stage has to be to try to get more people into that workforce. We have to look at work permits and facilitating people coming into the country to work in our health sector, as well as training up and skilling up people in the home care health sector, which is growing and will continue to grow. We do not want waiting lists in that area because it is very connected to the acute hospital system. The Minister will be establishing a task force shortly and announcing a waiting list initiative which will again concentrate on a further level of expansion of acute hospital beds, including intensive care beds, but also the whole area of elective care facilities and ambulatory care facilities. The Minister is close to bringing proposals to the Government in respect of ambulatory care in Cork, Galway and Dublin and additional electives that will be required as part of the Sláintecare programme. That is more medium term in terms of obviously giving us the capacity to do the electives. That relates to the waiting lists.
I met with Tom Keane and Laura Magahy yesterday. Deputy Murphy raised that issue. Their issues relate more to structural factors. In fact, they would acknowledge that a significant amount of progress has been made on many fronts in terms of activity levels, but there is a fundamental structural issue from their perspective in terms of the role of the office within the Department of Health vis-à-visthe HSE. That is something the Government and I will reflect on in terms of the structural approach to implementing Sláintecare but the Government remains very committed to the implementation of the principles of Sláintecare right across the board and in all aspects.
Deputy Barry raised the issue of the Willis report.
I dealt with that earlier in terms of organ retention. With regard to reviews on the way within the hospital that are required, the practice was not in accordance with the guidelines, rules and regulations laid out by the HSE itself in respect of the retention of organs, and particularly in respect of post mortems and the need to have the full consent of the parents in terms of what happens after the post mortem and the return of the organs to the parents for burial or cremation. That did not happen on this occasion. As I said earlier, the Minister is seeking assurances that this was not a practice across other hospital sites during the pandemic. He has not received a response yet, but is hoping to receive one.
Deputy Boyd Barrett raised the issue of the Monkstown situation. I will talk to the Minister for Health in relation to that. It could be a medical council issue or a regulatory issue. That would be my own observation.
My view is that if there is no alternative and the 72-year-old is hale and hearty, then common sense should prevail and provision should be made for it.
In terms of a citizens' assembly on drugs, I will come back to the Deputy on that, because now that we are coming out of Covid, we might be in a position to accelerate that. We said we would identify three areas for citizens' assemblies. One was the mayoral situation in Dublin and another was drugs. I take the Deputy's point about the decriminalisation of drug users. It is well made. The point that this is fundamentally a health issue as opposed to a justice issue is also well made.
I will come back to the Deputy on the timelines around that.
On Deputy McDonald's point about the progressing disability services programme, I will talk to the Minister of State, Deputy Rabbitte, about what is essentially a real difficulty in the context of the programme. Resources are being taken out of existing special schools and then they are told that they should access those resources through a central provision. That is causing undue stresses and strains. It is not something I agree with.