Wednesday, 30 November 2022
Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions
I propose to take Questions Nos. 19 to 29, inclusive, together.
The Covid-19 and health unit of my Department supports me and the Government in developing and implementing health policy and related matters and co-ordinating the Government's response to Covid-19. This includes supporting the work of the Cabinet committee on health, the Cabinet committee on Covid-19 and the associated supporting senior officials groups and structures. In addition, the unit provides me with speech and briefing material on health matters and Covid-19 for Government meetings, Cabinet committee meetings, Oireachtas business, attendance at events and engagements with a wide range of stakeholders, including representative bodies and members of the public.
The Cabinet committee on health oversees the implementation of programme for Government commitments in regard to healthcare, receives detailed reports on identified policy areas and considers the implementation of health reforms, including Sláintecare. The committee last met on 14 November. The date of the next meeting has not yet been set but the meetings are regular.
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 to discuss priorities in the area of health, including Sláintecare.
Budget 2023 provides the highest allocation of funding to the health and social sector in the history of the State. It is designed to facilitate better access to affordable, high-quality healthcare and to advance further our ambition for universal healthcare for all. The budget delivers on our commitment to continue to expand the core capacity of our acute hospitals by providing more health professionals and more acute hospital beds. It includes a €443 million funding package to treat tens of thousands of people on waiting lists and reduce the waiting times faced by all.
Among other eligibility measures introduced this year, we removed inpatient charges for under-16s and we will remove them for all patients in 2023. Next year, we will widen the eligibility for the GP card, which will allow many thousands more people to be covered. Additional eligibility measures include the provision of €10 million for access to IVF treatments, the expansion of the entitlement to free contraception to women aged 26 to 30 and, subject to legal advice and consultation, to 16-year-olds, and an allocation of €5 million to introduce free oral healthcare for children up to seven years of age.
Major increases in mental health services will be implemented, support for older people with a range of needs will be extended, and nearly €30 million in new funding has been allocated for expanded disability services. Coupled with these service improvements, we are also reforming how and where we deliver services. The enhanced community care programme continues to develop healthcare at a more local level, closer to where people live, thereby reducing pressure on hospital services. We will continue to advance these reforms in 2023, with work progressing on the establishment of six new regional health areas and on the elective care centres in Dublin, Cork and Galway. While it faces very serious challenges, our health system has expanded dramatically and is treating far more people and with better outcomes than ever before.
I have two questions. Will the Taoiseach give an explanation as to why the long Covid clinic at the Mater hospital in Dublin is to close? What is the basis for that decision, which seems deeply unwise?
Second, I refer to community disability services, which have been caught in a debacle around the transfer of functions from the Department of Health to the Department of Children, Equality, Disability, Integration and Youth. The reality is that unless matters are resolved speedily, we will have a real crisis in the delivery of services. As the Taoiseach knows, €65 million in one-off funding has been agreed but, so far, the Ministers, Deputies Donnelly and O'Gorman, have not allocated those moneys. This has left the Taoiseach's colleague, the Minister of State, Deputy Rabbitte, between a rock and a hard place. Community disability services will haemorrhage staff by year's end if this funding is not released. I spoke to one service provider that is looking at losing six staff members by the end of next month. That is how critical this issue is. Will the Taoiseach intervene on the matter?
There remains a chronic shortage of speech and language therapy and physiotherapy services in special schools, with the waiting time for assessment by community disability network teams now being counted in years rather than weeks or months. Will the Taoiseach confirm whether the funds allocated in the HSE budget under the progressing disability services, PDS, programme will be used to reinstate services in special schools? I continue to be contacted by parents about this. Are there emergency measures that can be taken to speed up assessments?
There remain serious problems with obtaining a primary medical certificate from the HSE to confirm severe or permanent disability. Many cases are coming to my office in which applicants have been declined without medical assessment.
Since the entire Disabled Drivers Medical Board of Appeal resigned in November 2021, no new board has yet been appointed. I ask that this be addressed without delay and a guarantee given that applications for a primary medical certificate from the HSE will be properly assessed.
I wish to raise the issue of the resignation of a GP in Blarney with the Taoiseach, which Deputy Gould brought up with him earlier. I raised this issue this morning with the Minister of State, Deputy Feighan, as a Topical Issue matter. My constituency colleagues and I have all been written to and told that an interim arrangement for cover has been provided for public patients. I know this and Deputy Gould knows this but he continues to politicise this issue. That is wrong and I need to call it out for what it is. Many people are concerned, elderly people in particular, and they are worried about their service. The HSE has responded to us and I got the response again this morning in my Topical Issue matter that interim arrangements will be in place. The issue I want to raise is related to a programme that the Irish College of General Practitioners, ICGP, is hoping to establish. It has doctors from non-EU countries, including South Africa, Sri Lanka and India, ready and available to come to Ireland. Can I get a commitment from the Taoiseach and the Government that they will support this pilot initiative in community healthcare organisation, CHO, 4 to bring those much-needed GPs to our shores?
There remains a particular focus in the Cabinet subcommittee on health on the recruitment of people into the health and disability services. Cope Foundation in Macroom was to have a seven day per week service to support clients and their families. While that was approved, it is still not possible to deliver it because Cope Foundation has not recruited people. Similarly, there is a serious situation with care assistants and home help workers, in that up to 20% of posts in the Cork and Kerry region remain vacant. These are vital services to support people who want to live at home and in their communities in order that they can avoid hospital. It is also an issue of backing up carers. It is an issue that is constantly raised with me in my office by people who are approved services but who cannot find people to deliver the service. The HSE has confirmed that there is a particular issue locally in Ballincollig, Dunmanway, Macroom and Millstreet, where it is struggling to recruit home help workers. Can the Cabinet subcommittee bring a particular focus or plan to ensure that community services continue to be provided?
When the then Minister for Health, Deputy Harris, offered free CervicalCheck screening, after the CervicalCheck scandal broke, 4,088 women received inaccurate test results or experienced delays in the issuing of letters as the result of an IT glitch at Quest Diagnostics. This week, three years and three months after the recommendation was made by the MacCraith report, the HSE has confirmed to RTÉ that conversations are ongoing with a small number of women as part of this continuing care. What does this mean? I have asked the Tánaiste and he said the Minister will come back to me but the Minister has never come back to me on this. What does "a small number" mean? Does this small number of women have cancer? Do any of these patients have a terminal illness? Has there been open disclosure in each of these cases? Have any of the delays in speaking to them affected their ability to treat their cancer or their survival chances? It is extraordinary that three and a half years after that recommendation of the MacCraith report, none of this information was forthcoming until we in Aontú raised it last week. Can we have the details today?
The following is a message from a student nurse:
I myself am a student nurse working 39hours on placement for free and having to work 2 days on top of this to earn money and i am honestly burnt out. Most student are doing over 60hors a week. It is costing 9euro a day in parking alone without including petrol and lunches. To add even more to this disappointment, I am yet to receive the thousand-euro nurses' bonus promised to us in June. something needs to change to help our health system and it is not for the lack of nurses training, it is the treatment we receive that people leave Ireland seeking better conditions.
She particularly asked, as do her colleagues, what has happened to the recommendations for an enhanced reimbursement scheme for student nurses arising out of the McHugh report and other recommendations, including the provision of uniforms and a payment for the cost of laundering uniforms and so on. It must be remembered that we have record numbers on trolleys. We have the highest number of patients on trolleys on record for this month of November. When we treat our student nurses in this way, is it any wonder we cannot get the staff we need in the health service?
In the same vein, I want to say this is the worst November on record for the trolley crisis. It is the last day of November today and it is the worst November on record. It has also been the warmest November on record so God knows what we will face when the weather gets really cold. We need to look at the health service in a very serious light. Figures tell us that in comparison with the EU, we have 2.7 beds available per 1,000 of the population, while the average in the EU is 5.7 per 1,000. Yet, our expenditure per capitais many times higher than most EU countries. There needs to be an entire review of what is going on in the HSE and the health service. In particular, according to the Irish Nurses and Midwives Organisation, INMO, which we all agree with, it is vital that the HSE focuses on recruitment, retention, accommodation and capacity for nurses and doctors as a matter of urgency. This applies to the mental health services as much as it does to children's health and general hospital care.
The Taoiseach previously told me the Government has a health-led approach to tackling drug addiction. There will be a test of whether the Government means that. Deputy Gino Kenny has brought forward a Bill to decriminalise the possession of small amounts of cannabis. All personal drug use should be treated as a harm reduction matter and not a criminal one. This Bill is a necessary step, it will begin a conversation and it will provide a stepping stone for a more progressive drugs policy in Ireland. The truth is the war on drugs simply does not work. If the Government is serious about reducing drug addiction, then the answer is to launch emergency interventions to combat poverty and deprivation to tackle the housing crisis and the crises of service provision. Will the Government support our Bill to decriminalise the personal possession of small amounts of cannabis? Can the Taoiseach confirm when the citizens' assembly on drugs will be taking place?
Families across the country who lost loved ones in nursing homes in the course of the Covid pandemic are calling for a human rights-led public inquiry. Among them are constituents of mine who lost loved ones at the Ballynoe nursing home. These families are calling and campaigning for the introduction of safeguarding legislation that would cover all care settings. They are calling for staffing-patient ratios in nursing home to be mandatory and set at a mandatory minimum rate. They are also calling for all records to be made available to families without delay. I support the calls and campaign of these residents and I would like the Taoiseach to comment on the issues they are raising.
Deputy McDonald raised the issue of the long Covid clinic at the Mater. I do not have the reasons here but the Deputy is suggesting it is closing. I will make inquiries with the HSE on what is happening there and what the background to the situation is. In the notes I received earlier, the indication was that this clinic is still operating. On the transfer, I have spoken to the relevant Ministers and Ministers of State and my understanding is we can bring that to conclusion relatively quickly with the transfer of disability service functions from the Department of Health to the Department of Children, Equality, Disability, Integration and Youth because substantial additional funding has been made available for disability services for 2023. We want that funding and the additional services provided as quickly as possible and I will revert to the House on that issue when it is brought to a conclusion.
Deputy Bacik raised the issue of special schools and the provision of therapy services within them. We will convene a meeting of the Ministers responsible for education, health and children in respect of disability services. I have said to the HSE that we want therapists restored to special schools. The progressing disability services programme is a different philosophical approach and model of care. It might be more accurate in dealing with disability services but one of the consequences of that was taking therapists out of special schools. We need a multidisciplinary approach within special schools. That has been agreed and that is being worked on by the HSE in terms the restoration of therapists to special schools. There is a broader recruitment process under way in disability services more generally.
I will come back to the Deputy on the medical board of appeal. The appointments should have been made by now. My understanding is that there would be moves on that front.
I note what Deputy Pádraig O'Sullivan says. It does not augur well if people are coming in knowing the solution to the problem they raise. What he is saying is that he clearly has it in writing that the HSE has already organised interim GP arrangements for the catchment area. Deputy Gould raised it earlier. I thought the implication was that it had not but it is clear now that it has. All Deputies have been informed of that. That is progress. I appreciate Deputy O'Sullivan alerting me to that.
I will examine the issue of doctors from Zimbabwe, South Africa and other locations with the ICGP. I would be supportive of being able to facilitate that in terms of the general shortage. I will talk to the Minister for Health in respect of it. I have not seen the proposal yet. I will follow that up with the Minister for Health. In the healthcare area generally, work permits are provided to allow people to come into the country. This is an Irish College of General Practitioners initiative, which means that the college is supporting it also, and that would give an added credibility to it and would be an important endorsement.
Deputy Aindrias Moynihan raised recruitment to disability services. I do not know whether the Cope Foundation has advertised for the position in Macroom, but there is an issue generally. More people have been recruited to the health service in the past two years than in previous years. It has been quite dramatic. Never before have so many people been recruited, but there remains a specific issue for recruitment of therapists to services for children with disabilities. Other services across the full spectrum of services within the HSE and within the health service more generally tend to have more success in getting therapists. The disability sector for children is problematic and it needs a specific focus, which we have said to the HSE. That covers Ballincollig as well as Macroom.
I came across a home help the other night who is not working her full hours. We have expanded the home help hours dramatically and existing home helps should be availed of to the fullest extent possible by the HSE if they are available. That point was made to me.
I will follow up on Deputy Tóibín's point but I did not quite catch it. Did he say there is an ongoing conversation between the HSE and some women in respect of the IT glitch highlighted by the MacCraith report?
Yes, the MacCraith report recommended that there would be communication with the 4,088 women who were affected by the glitch, but many were not contacted and we do not know what is happening there, three and a half years later. The Tánaiste did say the Minister for Health would come back to me but he never came back to me.
I will follow that up with the Minister for Health and come back to Deputy Tóibín on it.
Deputy Boyd Barrett raised the issue of student nurses. Again, the €1,000 has been paid to healthcare staff.
My understanding is that it has been allocated by the HSE, which stated that all healthcare staff have been paid. I do not know the specifics of the case. If the person was working in the service in the past two years, albeit as a student, my understanding is that the payment would have applied to her. Again, the degree programme-----
-----involves placement. That is part of the programme, which I launched in 2003 when we moved from an apprenticeship model to a degree programme. It has been transformative in terms of the nursing profession more generally.
For the information of Deputies, we have nine minutes left for the next round of questions and we still have three Deputies waiting for responses. I draw that to their attention. The clock is running on the next lot of questions.
I do not think we will be able to give the full time to the next set of questions.
Deputy Bríd Smith raised the trolley crisis and bed capacity. We have improved bed capacity by close to 1,000 beds in the past two years, which is quite significant in itself, but we need to expand more. Post Covid, we have increased ICU beds and critical care beds significantly. Recruitment is the big issue within the HSE.
Deputy Paul Murphy raised a health-led approach to drug addiction, which I do support. I have not examined Deputy Gino Kenny's Bill in detail, but the relevant Minister will, and the Minister will then come back to the Government in respect of a recommendation on it. The broader point is that from a healthcare perspective, treatment and treating addiction is a core issue for those who are addicted to drugs more generally. We must acknowledge that drugs do cause harm. We cannot resile from that either. We must examine the provisions of the Bill and what they are designed to do. More broadly speaking, we favour a healthcare-led approach. I hope we can get the citizens' assembly on drugs established early in the new year, following completion of the one on biodiversity, which has sought a couple of weeks' extension. The Citizens' Assembly on a Directly Elected Mayor for Dublin is more or less completed. We are in a good position to proceed with the citizens' assemblies on drugs and education early in 2023.
Deputy Barry raised the public inquiry in respect of nursing homes. Again, at this stage I would not be minded towards a statutory public inquiry, but I know the Minister for Health has established a public health reform expert advisory group on the lessons that can be learned, an evaluation of how we performed in the pandemic, incorporating the lessons learned into a continued response to Covid but also potentially future pandemics and general preparedness in terms of the public health front. We do need a wider evaluation from the country's perspective in terms of how we manage Covid-19, covering all aspects of it, because that again would enable us to gain from the experiences of the Covid period.
We have very little time left. I continue and ask for the co-operation of Deputies on whether we can complete the next round of questions. I am conscious that there are no Taoiseach's Questions next week.