Eoghan Kenny (Cork North-Central, Labour)
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I wish to address the provision of incontinence products by the HSE. Although the Minister of State is not the line Minister, I wish to raise this serious issue for families across the country. Incontinence products are essential. They are used daily. I wish to speak specifically about incontinence products for children. I refer to a specific case raised by a parent with me in relation to her son. I will read out some of her correspondence to me, with her permission:

My son was born prematurely before 26 weeks in May 2021. In his first few weeks, he suffered a lung haemorrhage, two brain haemorrhages and a bowel rupture that led to a stoma for a year. He also experienced significant eye issues and has since been discoursed with cerebral palsy. Every step of the way has been a fight, and I have had to pay privately for nearly every service he is entitled to under the CDNT system. I have remained quiet until now, but the latest development has left me utterly shocked and disgusted. Now that my son is four, he qualifies for HSE-provided incontinence pads. However, he has yet to receive any. He currently weights 21 kg and still wear Pampers size 8 - the largest I can find - despite them no longer fitting properly. Pull-ups in size 9 are available, but they're unsuitable as he wears and AFO. The most infuriating part of this situation is that I have been told he will only be allocated four pads per day. He routinely goes through at least eight nappies a day - and that's while I'm still paying for them myself. To be told by a district nurse not to change him if he is only wet - with the implication that he must sit in it to conserve supplies - is not only medically unsound but dehumanising. After all he has been through, particularly with his bowel and stoma history, I will not stand by while his dignity, comfort, and skin integrity are compromised to meet a quote. Only last week, a doctor speaking on a documentary about nursing home care highlighted how unacceptable it is to leave people sitting in wet nappies. Why should it be any different for a four-year-old child with complex medical needs?

The Minister of State will appreciate the distress, anger and disappointment felt by this mother.

Her word "dehumanising" puts it lightly.

I tried to resolve this issue through a parliamentary question but the HSE response to me was quite unclear. It stated that, based on a clinical nursing assessment, a public health nurse may prescribe containment products to assist with the management of incontinence and that the provision of containment products is subject to parent-client engagement in a toileting programme. It added that the clinical nurse specialist for continence in north Lee is currently working with the child and his family. Furthermore, it stated the prescription of containment products is in line with the child's assessed requirements and that these will be monitored or adjusted as necessary by the clinical nurse specialist. I am sure that is probably in the response the Minister of State has.

Does the Minister of State know what the policy on incontinence product provision is? How many products may be allocated to children with complex needs? This mother has been told four is the limit; however, it has increased to six. The mother told a nurse she was lobbying local TDs. Will the Minister of State provide clarity on the number for me?

The nurse the parent is engaging with in her community has met her only once and has never met her child. That does not align with the clinical nursing assessment and the policy on the prescribing of incontinence products as outlined in the parliamentary question. In the response, the HSE highlighted engagement with a toileting programme. Of course, the mother wants her son to be toilet trained at some stage, but that will not happen overnight. I ask the Minister of State to engage on this specific case or ask his colleagues in government to do so to ensure the child will be provided with the number of incontinence pads required per day.

Charlie McConalogue (Donegal, Fianna Fail)
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I thank Deputy Kenny for raising this matter. I am answering on behalf of the Minister for Health.

I have the details and response on the guidelines and policy around incontinence pads. I will give the Deputy these as part of my response but I assure him that I will be following this case up further, on the back of his contribution, with the Department of Health and the HSE. The guidelines and policy are focused on the fact that the approach has to be person centred. It has to take into account the needs of the individual person, be it a child or adult, and has to be appropriate. I will certainly be taking this up following on from the Deputy's engagement on the floor of the Dáil this morning.

The HSE provides a wide range of medical products and services under the community-funded schemes to eligible persons in accordance with the Health Act 1970, as amended. These are provided following assessment by a relevant health professional. The HSE oversees the provision and supply of incontinence wear products for eligible persons across the country. Provision is based on an appropriate clinical assessment and the determination of the most appropriate products that will meet the individual's needs.

The provision of clinically appropriate incontinence wear products to eligible persons is administered within each health region under a national tender arrangement. The HSE advises that this is a person-centred delivery system which allows the individual or their carer to vary both the time of delivery and the amount of product delivered according to their specific needs. It is also possible to alter the location for a particular delivery should the need arise.

The HSE also utilises the service provided by public health nurses and continence nurse advisers to assess individual patient needs to ensure the supply of incontinence wear products is appropriate.

As part of the national service improvement programme for the community-funded schemes, the HSE has completed and implemented national guidelines in respect of incontinence wear products. These are published and are available on the HSE website.

Governance arrangements have been strengthened through the implementation of an integrated electronic management system to support the ordering, supply and distribution of incontinence wear products across all healthcare settings, including the home delivery service.

The HSE advises that in circumstances where a person does not hold full eligibility, such as through a medical card or a long-term illness scheme card, reimbursement support for incontinence wear products is provided under the drugs payment scheme, DPS. This scheme provides for the refund of the amount by which expenditure on approved prescribed medicines or medical and surgical appliances, including incontinence wear, exceeds a named threshold in any calendar month. The DPS is not means tested and is available to anyone ordinarily resident in Ireland. The scheme threshold is €80 per month. While there are no set limits on the quantity, the DPS claim must be supported by a valid prescription for the products.

That outlines the policy, oversight and guidance. At the core should be appropriate care and supply for the individual. I will certainly take up the case with the Department and the Minister for Health following the Deputy's contribution.

Eoghan Kenny (Cork North-Central, Labour)
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I thank the Minister of State. I appreciate that.

When I offered my sympathy to the family, including the parent, the parent told me directly she did not want it. I appreciated that because, from a public representative's point of view, it was quite difficult for me that a parliamentary question did not outline specifically whether the child would be provided with the necessary incontinence products he so needs. At four years old, the child, along with his mother, has gone through so much, as outlined in the mother's email that I read in my opening statement. The Minister of State knows himself that when an email like that comes into your inbox, you directly engage on it because it is the on-the-ground issues that are directly affecting people. Often they go unnoticed because parents are afraid to speak up about them. They try to buy the incontinence products themselves. The Minister will have noted from the email that the mother has paid for all CDNT provision from her own pocket. This points to a systemic failure in our CDNT system.

What the Minister said about person-centred policy and further engagement is very welcome but, as he will have noted from my opening statement, the clinical nurse has never even met the four-year-old child. That is the disappointing thing here. Perhaps there are several boys and girls of the same age under the nurse's remit but the fact that the nurse has not even met the child is an issue. This is why I do not understand how a clinical assessment could have taken place. It cannot just be a conversation between a parent and a nurse.

I cannot see on the HSE website the policy that the nurse has outlined to the parent, namely, that four incontinence products is the maximum number that can be provided. The number increased to six after the parent told the nurse that she had been lobbying local TDs. I ask the Minister of State to ask the Minister, Deputy Carroll MacNeill, to engage with the parent on a one-to-one basis.

Charlie McConalogue (Donegal, Fianna Fail)
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Certainly, I will. Obviously, the parents have been through several challenges and the child has had a very difficult and challenging start to life. It is really important from the point of view of the State that the health service we provide be appropriate to the child's needs. It is important that incontinence pads be appropriate to and sufficient in number for the child to meet all his needs. I will certainly engage with the Minister for Health and her Department on this case and ask that it be fully considered and responded to.

The Deputy raised the child development network therapies and teams. I am aware that there have been recruitment challenges in various parts of the country, including my county and the Deputy's. The challenge has primarily been the availability of therapists. The Department of Health, the Department of education and the Department of further education have been working to ensure additional staff are trained to meet the needs. They have been seeking to recruit and there have been improvements over the past year to two years in regard to increasing the size of the team. There is significant demand that is not being met but the objective is to have more people coming through who can take up the positions and meet the needs. This is essential to affected children, and supports are essential to families.

I thank the Deputy for raising this. I will ask the HSE to engage further.