David Stanton (Cork East, Fine Gael)
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I thank the Ceann Comhairle's office for selecting this Topical Issue and the Minister of State for being present. The integrated care programmes for older people, ICPOP, hub is probably one of the most exciting and positive developments I have seen in health in quite a while. It looks after people with chronic diseases through an ambulance centre. People can go there, be looked after, travel and so on.

On 10 February 2022, which is more than a year ago, we had a presentation from HSE south on this very exciting and positive development. The HSE proposed the establishment of three hubs, one of which was to be in Mallow. I understand from a parliamentary question I tabled that quite a number of staff have been recruited and appointed to the hub. Unfortunately, however, up to recently, there was no hub so there was no place for them to work. I understand that in the past couple of days since my parliamentary question was tabled there has been some movement, which I welcome. I want to see more of that movement and the hub established. The HSE said at the time that it was a work in progress but it is quite a bit of time since February 2022. The HSE is now establishing a hub in the primary care centre in Mallow, in addition to some other places.

This initiative will be of huge benefit to people. I ask the Department and the Minister of State to support the further roll-out of this project, to ensure that an adequate premises is identified, located and made available for people who are working there, and that the staff, who have been recruited and are very excited about this, can actually begin their work. I understand some of them may have been doing very little for the past while. For instance, I received a report from the HSE indicating that the total number of patients in north Cork reviewed in May by the respiratory team was 11. From what I can see in the report, three people are working on that team but just 11 patients were seen in a month by those three professionals. The Minister of State is good at maths; she can work that out. There were 66 people seen by the diabetes team, again, in a month. People on those teams could probably be doing an awful lot more and want to do more. It is just a matter of getting it done.

I will raise another issue. The Minister of State will know the geography and that Mallow is in the centre of north Cork, but it covers a big area. It is covering community healthcare organisation, CHO, areas 4, 5 and 6, as far as Youghal, which is more than an hour's drive away. We need to start planning ahead to get these hubs spread out a little more. Cork is a big county. If somebody has to drive 74 km and take more than an hour and ten minutes to get to Mallow, they probably will not do it. We either have to move staff to where those people are or, ideally, plan ahead to open another hub, possibly in Youghal or somewhere in east Cork to care for those people.

It is a very positive development. I am not here to criticise, attack or give out but I encourage the Minister of State, the Department and the fantastic people in the HSE who put this together to drive it on, make it happen, get the staff working and get the service out to the people who need, want and deserve it. As I said, it will make a huge difference to people. It is a home support.

People can live at home, get the support they need without having to go into a hospital and manage chronic diseases such as respiratory diseases, diabetes and cardiac issues. I look forward to the Minister of State's response.

Anne Rabbitte (Galway East, Fianna Fail)
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I am taking this on behalf of the Minister, Deputy Donnelly, and the Minister of State, Deputy Butler, both of whom are actively involved in this. I thank Deputy Stanton for raising this issue and providing me with the opportunity to update the Dáil thereon.

This Government is committed to the delivery of Sláintecare and to providing increased levels of service in primary care and community settings. Significant funding in recent years, including provision of annual funding of €195 million in 2023, is enabling implementation of the enhanced community care, ECC, programme, which represents a programmatic and integrated approach to the development of the primary and community care sector. The programme aims to expand capacity in primary care and enable the reorientation of service delivery towards general practice and community-based services, thereby providing health services closer to a person’s home and reducing pressure on acute hospitals. It also enables a population-needs approach, enabling better local decision-making and involving citizens in determining the health needs of their local community.

The ECC has made excellent progress to date in establishing community healthcare networks, CHNs, and community specialist teams, CSTs, to provide care to older people and those with chronic disease in primary and community settings, with 94 of the 96 planned CHNs and 47 of the planned 60 CSTs already operational and providing services to patients nationally.

CSTs are consultant-led, multidisciplinary teams who provide integrated specialist healthcare to patients, with the teams for older persons and those for chronic disease management colocated in ambulatory care hubs in the community, conveniently located closer to home, thereby preventing unnecessary hospital attendances for those requiring access to these services. The hubs are usually adjacent to a primary care centre, with clinical governance being provided through the local model 3 or model 4 hospitals.

Already this year, the 23 operational specialist teams for older persons, which are part of the integrated care programme for older persons, which the Minister of State, Deputy Butler, would call the ICPOP, have delivered more than 22,000 patient contacts, with 12% of referrals being seen on the same day or the next day of referral. Some 64% of the patients treated by these ICPOP teams were discharged home, avoiding admission to hospital, where clinically appropriate to do so, and facilitating the home-first approach to care which is a key objective of the ECC programme.

The 24 operational CSTs for chronic disease management, CDM, have increased access to specialist care to those with COPD, asthma, cardiovascular disease and diabetes in the community setting, are aligned to the GP chronic disease management programme and have provided more than 28,000 patient contacts already this year, with almost 168,000 patients having been reviewed by their GP as part of the CDM programme.

The north Cork CDM hub will be located in Mallow, as the Deputy said, and will deliver services to the catchment area serviced by the CHN, namely, north-east Cork, east central Cork, Mallow, Charleville, Newmarket, Kanturk and Millstreet, a population of around 150,000. Recruitment of the required integrated care programme for chronic disease management, ICPCDM, consultant and health and social care professionals to staff the CST in the hub is ongoing and the HSE endeavours to have the hub operational as soon as possible.

I take on board what the Deputy said on the catchment area, population base and geography challenges.

David Stanton (Cork East, Fine Gael)
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I thank the Minister of State for her response. This is a positive development but we need more of it. The fact this was announced in February 2022 and staff were recruited later that year without a hub being available is a concern. I also understand we have not had consultants. It is supposed to be consultant-led, according to the Minister of State’s response, but I do not think any consultants have been appointed in that time. This is hugely important.

Quite a number of people are referred to in the response I got from the HSE: operational leads; project officers; administrative officers; clinical nurse specialists – there are four of those; staff nurses; rehab co-ordinator; senior physiotherapists; staff in cardiology and respiratory; and dieticians and podiatrists. All are in position but do not have a place to carry out their work. We need movement on this. We need to see it established and to get these people working and then broaden out this programme to different parts of the country.

The Minister of State said the north Cork CDM hub, which will be located in Mallow, will serve a population of 150,000 people. Mallow is the centre, which is great, but Youghal is at one end of it and Millstreet at the other. The distances are fairly large so if we expect people who are chronically ill to travel those distances, it will take quite a while every day and involve cost. We need to broaden our thinking and look at ambulance centres in places like east Cork, Youghal, Newmarket and Kanturk so people will not have to travel such distances but can go to the specialisms in their areas. Ambulant walk-in centres are the future. It is a fantastic programme. I encourage the Department, the HSE and the Minister to drive this forward and make it happen.

Anne Rabbitte (Galway East, Fianna Fail)
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I am very conscious of sticking to the script on this one or the Minister of State, Deputy Butler, would have words with me but I agree with what the Deputy said on capital. Capital investment is once-off investment and is the solid foundation required for the teams to work out. I could be so bold as to say I hear what the Deputy is saying on the outreach model and satellite piece that needs to be put in place, but I will stick to the script.

We have a growing and ageing population and through ambitious reforms, such as the ECC programme, we are responding to the changing needs of those who use our services by changing how and where we deliver healthcare. The programme is already delivering increased levels of healthcare in the primary care and community setting, with the CSTs delivering consultant-led integrated specialist services in locations closer to home for those who most need it, namely, older persons and those with chronic disease.

As previously highlighted, an important element of this programme is the provision of 30 CSTs for chronic disease nationwide, with 24 of the 30 already operational and providing the community with access to specialist services close to home for people living with respiratory, cardiac and endocrine chronic disease. We have already achieved significant recruitment to these multidisciplinary teams, including consultants, clinical nurse specialists, advanced nurse practitioners, physiotherapists and dieticians.

With recruitment ongoing, full implementation of the programme will be achieved by the end of this year and, when fully embedded, we will have fully developed integrated care pathways between acute and community services, thereby improving access to, egress from and integration with acute hospital services, on one hand, and delivering more care closer to home, on the other.

Recruitment of the required consultants and health and social care professionals to the north Cork CDM hub is in progress, and the HSE aims to have the hub operational as soon as possible.