Dáil debates

Wednesday, 2 February 2022

Healthcare (Transparent Payments) Bill 2022: First Stage

Cabinet Committees

1:12 pm

Photo of Mary Lou McDonaldMary Lou McDonald (Leader of the Opposition; Dublin Central, Sinn Fein)
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1. To ask the Taoiseach when the Cabinet committee on health will next meet. [2175/22]

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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2. To ask the Taoiseach when the Cabinet committee on health will next meet. [3614/22]

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
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3. To ask the Taoiseach when the Cabinet committee on health will next meet. [4370/22]

Photo of Dara CallearyDara Calleary (Mayo, Fianna Fail)
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4. To ask the Taoiseach when the Cabinet committee on health will next meet. [4633/22]

Photo of Richard Boyd BarrettRichard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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5. To ask the Taoiseach when the Cabinet committee on health last met. [4700/22]

Photo of Paul MurphyPaul Murphy (Dublin South West, RISE)
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6. To ask the Taoiseach when the Cabinet committee on health last met. [4703/22]

Photo of Aindrias MoynihanAindrias Moynihan (Cork North West, Fianna Fail)
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7. To ask the Taoiseach when the Cabinet committee on health will next meet. [4902/22]

Photo of Mick BarryMick Barry (Cork North Central, Solidarity)
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8. To ask the Taoiseach when the Cabinet committee on health will next meet. [5135/22]

Photo of Micheál MartinMicheál Martin (Taoiseach, Department of An Taoiseach; Cork South Central, Fianna Fail)
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I propose to take Questions No. 1 to 8, inclusive, together.

The Cabinet committee on health oversees implementation of programme for Government commitments in relation to health, receives detailed reports on identified policy areas and considers the implementation of health reforms, including Sláintecare. The Cabinet committee last met on Thursday, 9 December. It is currently scheduled to meet next on Monday, 28 February.

In addition to meetings of the full Cabinet and Cabinet committees, I meet with Ministers on an individual basis to focus on different issues. I meet regularly with the Minister for Health to discuss priorities in the area of health, including Sláintecare and, in particular, our management and response to Covid-19. The health sector faced significant challenges this winter with the surge of the Omicron variant we saw over the Christmas period. We will now refocus our efforts on the resumption of non-Covid health and social care and progress commitments to reform the health service.

The year 2022 will see the biggest ever investment in the health system to deliver Sláintecare, reduce waiting lists, increase capacity, protect the most vulnerable and address inequalities. Over the coming weeks and months, work will continue to advance a number of priority programmes of work identified in the Sláintecare Implementation Strategy and Action Plan 2021-2023, including progressing six new regional health areas, the multiannual waiting list reduction plan and taking steps towards the establishment of elective care centres in counties Dublin, Cork and Galway.

We will continue our investment in an expanded public health service and embed the lessons learned in the pandemic into community and primary care services. In this regard, the Minister for Health last week announced the establishment of a public health reform expert advisory group. The expert group will initially focus on identifying learnings from the public health components of the response to the Covid-19 pandemic in Ireland, with a view towards strengthening health protection generally and future public health pandemic preparedness specifically. The expert group will then examine the key components of the existing delivery models for public health in Ireland, with a view to recommending an appropriate operating model to develop and oversee the delivery of public health in Ireland into the future.

Photo of Mary Lou McDonaldMary Lou McDonald (Leader of the Opposition; Dublin Central, Sinn Fein)
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When the Taoiseach meets with Children's Health Ireland, CHI, it will confirm for him that 649 children are waiting for scheduled or elective orthopaedic surgery, 56 of whom have been waiting between one and four years. I invite the Taoiseach to confirm for the House that he will instruct the Minister for Health and the HSE to release the necessary funding as a matter of urgency to ensure that this list is cleared and these children have the care they need.

I also wish to raise the issue of St. Brigid's District Hospital in Carrick-on-Suir. It was closed in the midst of Covid-19 with the promise that it would be reopened. Locals have learned that this reopening is not now going to happen. I commend their campaigning efforts. In fact, the local campaigners will be before the Joint Committee on Public Petitions today. They have gathered 11,000 signatures in support of reopening the hospital and seek a meeting with the Taoiseach. Will he agree to meet with the campaigners and ensure that the commitments made to retain services at St. Brigid's District Hospital are honoured?

Photo of Dara CallearyDara Calleary (Mayo, Fianna Fail)
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In the context of the Cabinet committee on health, as we move into the next phase of Covid-19, has the Taoiseach discussed the future role of the National Public Health Emergency Team, NPHET, and what shape and size it will be going forward?

I know the Taoiseach in his previous ministerial role did a huge amount of work in the area of strokes and stroke care. He may have seen this morning the audit of strokes in Ireland, which is a really interesting piece of work highlighting the challenges facing stroke treatment. Will that be discussed at the Cabinet committee on health to ensure that we improve our responses?

Over the weekend, concerns were expressed by Irish Medical Organisation, IMO, representatives and other organisations about the need to attract specialists into our regional hospitals, in particular, specialist consultants. It is becoming increasingly challenging to get consultants to take up positions in regional hospitals. There is no sense in us piling into the city hospitals when we have really good regional hospitals and health infrastructure regionally. I ask that a focus be given in terms of enhancing packages to attract people.

Photo of Richard Boyd BarrettRichard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The north Kerry child and adolescent mental health services, CAMHS, scandal brought to light a much longer-term scandal of the over-medication of young people compensating for the chronic lack of staffing and resources in our mental health services.

I want to ask particularly about the utter lack of community psychology and primary care psychology. One aspect of this, and I have been trying to point this out for a long time, is that CAMHS gets overrun, and often with referrals that probably should not even go to it, because of the lack of community psychology and talk, occupational, speech and language therapy. This is not just for child and adolescent community psychology, or the lack of it, but also for others.

I am aware of a case at the moment of a man whose doctors referred him for psychology. He was told by community psychology in my area that he will have to wait six years for a psychologist. What happened to primary care? It does not exist in the area of psychology. As I have raised repeatedly with the Taoiseach, why do we make it difficult for young people who want to be psychologists to qualify because we do not fund educational and counselling psychology? We have massive fees of up to €15,000 and similar obstacles in the area of psychiatry for people being qualified.

Photo of Paul MurphyPaul Murphy (Dublin South West, RISE)
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I wish to raise again the heartbreaking case of Ava Cahill, an 11-year-old old from Tallaght. She has spina bifida, which results in her feet being turned inward making everyday tasks very difficult. Putting on her shoes on a daily basis is a challenge. She needs help to put on her trousers. She has been left waiting for more than a year and a half for corrective surgery with her condition worsening on a daily basis. Imagine what it is like for her and her family. They do not even have a date for surgery to look forward to. Worse still, if her condition continues to deteriorate, it could end up being inoperable. She is just one of 649 children waiting for surgery, including 56 children with spina bifida. It is a national scandal.

The Taoiseach's earlier response seemed to suggest it is not the Government's problem and that the hospitals have the funds so why do they not just do it? I put it to the Taoiseach that this does not make any sense. We need to provide the resources to clear the waiting lists rapidly and build a top-quality Irish national health service.

Photo of Mick BarryMick Barry (Cork North Central, Solidarity)
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There is a shortfall of 15 neurology nurses at Cork University Hospital, CUH, which is the State's number two neurology centre according to the neurology clinical programme. The programme made a request last year that the HSE would fund posts for at least two new neurology nurses at CUH this year. The HSE decided not do so.

This underfunding impacts negatively on the lives of people with multiple sclerosis, Parkinson's disease, motor neurone disease and others. It is happening on the watch of the Taoiseach and a Fianna Fáil Minister for Health. Will the Taoiseach agree with me that what is happening here falls short of what should be acceptable in a civilized society? Will he undertake to look very closely at this situation as we head towards the Estimates process this year?

Photo of Matt CarthyMatt Carthy (Cavan-Monaghan, Sinn Fein)
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Talking about our health services, it is impossible to ignore the fact that the pay for the Secretary General of the Department of Health went up yesterday by €3,000. That is on top of the increase last November of €3,000.

That is on top of the additional €81,000 on which the Taoiseach, the Minister, Deputy Ryan, and the Tánaiste collectively agreed, without any process, rationale or justification. There is no justification. His salary now stands at €297,869. Compare that to the head of the British NHS, whose salary is £199,000. Does the Taoiseach recognise just how disgusting this scenario is when he is looking for plaudits for giving front-line healthcare workers €1,000? He has done virtually nothing for all those workers and families who are struggling to make ends meet. Yet, he took €87,000 of their money and handed it to one of the highest paid civil servants in the world. Does the Taoiseach regret his role in this grubby affair? Will he now move to restore the salary to the Secretary General level at a rate that was based on some level of process?

1:22 pm

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
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The Taoiseach has just over five minutes to reply.

Photo of Micheál MartinMicheál Martin (Taoiseach, Department of An Taoiseach; Cork South Central, Fianna Fail)
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Deputy McDonald again raised the issue of Ava Cahill and the orthopaedic situation. Government is responsible overall for the delivery of healthcare. The point I was making earlier was that the funding has been allocated. A figure of €5 million is not an issue. I want to make that clear. Since 2018, which was before I came into office, to be fair, an extra €9 million had been allocated each year to the HSE specifically for the funding of orthopaedic services. This additional funding supported the recruitment of approximately 60 extra staff in 2018 and 2019 to enable the expansion of paediatric orthopaedic services.

Improving capacity to allow for additional activity is the key enabler to improve waiting times. Proposals by the HSE under the waiting list action plan are for funding to extend theatre capacity in Crumlin and in Temple Street. There has been additional theatre capacity at the National Orthopaedic Hospital Cappagh since April 2021 for day case surgery. CHI has advised that this should result in a positive impact in reducing long waiting time for general orthopaedics, in addition to consequential capacity gains for scoliosis patients.

In 2022, CHI was planning to undertake a range of inpatient day case and outpatient orthopaedic appointments in Cappagh. There is also planning for additional orthopaedic scoliosis theatre sessions using private facilities that were supported to HSE procurement agreements. Huge funding has been provided to the health service, both in 2020 during Covid-19 and in 2021, and I mean non-Covid-19 health expenditures. There was a €600 million allocation given very early in the winter of last year with a view to ensuring that capacity would be increased right along the line.

We have said repeatedly to the health service operators that where they can get capacity quickly, whether this is theatre capacity or bed capacity, please go and do so. We said the same for recruiting staff. A record number of staff was recruited last year because of that extra funding. This figure was less than they said they were hoping to recruit. The health service had resources to recruit more last year. However, because there is obviously a huge demand on key positions and so on, they were not in the position to recruit as many as they would have liked to. Yet, they still managed to recruit a record number in any one year. Likewise, the same happened in 2020.

That said, as far as I am concerned, anything that can be done to make sure that Ava Cahill gets her operation and that other children are not waiting in an inordinate length of time has to be the priority. It is not about funding. They need to get the capacity in place so that they can do whatever can be done in the shortest possible term to get it done.

Photo of Mary Lou McDonaldMary Lou McDonald (Leader of the Opposition; Dublin Central, Sinn Fein)
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Tell the HSE that.

Photo of Micheál MartinMicheál Martin (Taoiseach, Department of An Taoiseach; Cork South Central, Fianna Fail)
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I have.

On Deputy Calleary's point, the work on the stroke units was an important piece of work. Since stroke units came in well over a decade ago, they have been transformative in terms of the impact on survival from strokes, improvements and prevention. I heard the consultant on “Morning Ireland” this morning in relation to this. We will examine that audit. Those clinical strategies are the most effective in health. While they do not get the same headlines, they have proven to be the most effective way to improve health, prevent injury and prevent disease through cardiovascular strategies, cancer strategies and stroke strategies. They have been the most effective in improving healthcare and survival rates in this country. The Deputy is absolutely correct about the challenges facing all of us in attracting specialists to the regions. That is a both an academic and an advanced medicine problem. Many consultants and clinicians want to be in centres of tertiary care so that they can get experience, as well as for their career development and so on. That is where the magnet is.

The hospital groups are now developing strategies, including a bespoke model, if you like, to enable those at the centre to provide services to hospitals within the group. I believe that is the way forward. We need to engage with the colleges, such as various colleges of anaesthesia, surgery or whatever, to tell them that we need new models to ensure that we can maintain and retain capacity in the regional hospitals. That is an ongoing challenge to health here and all over the world, but particularly in Ireland in our rural and regional areas.

I agree with Deputy Boyd Barrett on community. There has been a 19% reduction in waiting times in primary care for psychology for under 18-year-olds. There has been additional investment put into the primary care psychological services. That is a 19% reduction among under 18-year-olds years who have been waiting more than 12 months to access primary care psychology. We need to do more in relation to that.

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
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The Taoiseach is over time.

Photo of Micheál MartinMicheál Martin (Taoiseach, Department of An Taoiseach; Cork South Central, Fianna Fail)
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I and many of the NGOs support intervening much earlier.

I have dealt with Deputy Paul Murphy’s point in my response to Deputy McDonald. On Deputy Barry’s point, again the investment has been provided. Very often, this depends on how local management and regional management prioritise key services, as well as how they allocate the large funding that has been allocated to them.

On Deputy Carthy’s point, the health service needs radical reform. The Department itself needs to be developed strongly. It needs to be the place to go to, if I am frank about it.

Photo of Matt CarthyMatt Carthy (Cavan-Monaghan, Sinn Fein)
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It needs to be transparent-----

Photo of Micheál MartinMicheál Martin (Taoiseach, Department of An Taoiseach; Cork South Central, Fianna Fail)
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I have a lot of experience in health. I have been a Minister for Health. Regularly, in various Oireachtais down through the years, people raise health issues-----

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
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I thank the Taoiseach. We are eating into the next slot. I am sorry but-----

Photo of Matt CarthyMatt Carthy (Cavan-Monaghan, Sinn Fein)
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I asked if the Taoiseach regrets his part in this grubby affair. It is a grubby affair.

Photo of Micheál MartinMicheál Martin (Taoiseach, Department of An Taoiseach; Cork South Central, Fianna Fail)
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This goes on all the time.

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
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Everyone is going to lose out as there are 15 minutes per slot.We are moving into the next slot now. We were already two minutes into it. I am sorry.