Rose Conway Walsh (Sinn Fein)
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I thank the Minister of State, Deputy McGrath, for his presence in the House today. I wish to discuss the lack of physiotherapy services in County Mayo, which have reached a crisis point.

Patients throughout County Mayo are not getting the physiotherapy they need. This includes children, post-operative patients, people with disabilities and arthritis and elderly people. If a person can afford to access private physiotherapy and he or she is able to travel, that person can get as much treatment as he or she needs. If that person is a medical card patient living on a low income, it is becoming increasingly impossible to get physiotherapy in County Mayo.The long-term damage of not being able to access physiotherapy is well documented. The physical pain experienced by many patients who are denied treatment is truly awful and the mental trauma of knowing permanent damage is likely to arise from delayed treatment is not acceptable. The solution to this crisis is very simple. An adequate number of physiotherapists must be appointed to meet the needs of those waiting for physiotherapy in Mayo.

Why are physiotherapists from the panels not being appointed? Why are applicants to physiotherapy panels not given the choice of which areas they would like to work in on their applications, rather than just being asked to define one area? People applying in the west should at least be given the opportunity to list the counties in which they would like to work in order of preference. If people are forced to say that they will work in Mayo, they can only choose Mayo. Somebody on the Mayo-Galway border cannot have his or her application considered for both counties. This is absolute nonsense.

I am particularly concerned that when physiotherapists go on maternity leave or long-term illness leave or move to another location the replacement process seems to meet an absolute dead end. It is not as if the HSE does not know when someone is going on maternity leave or when someone is going to retire. It has several months' notice, yet it does not respond by employing a replacement. Why is this? I know that three members of staff have left in the last three weeks alone, in addition to others who left in recent months.

It is not a surprise that physiotherapists are leaving. The pressure they are under to provide a service without having sufficient hours is unsustainable. When they are only able to see a child who needs weekly physiotherapy for one session every four to six weeks, it reflects on the integrity of the whole discipline and causes huge distress to the children, parents and the physiotherapists themselves.

It is also having a knock-on effect in other medical disciplines. People who should be fully recovered and active are having to be admitted to acute hospitals and having to go back to their GPs. This is all taking up valuable scarce resources. Patients from community and district hospitals are unable to be discharged because they cannot get the physiotherapy that would allow them to go home. These beds cannot then be used as step-down beds for acute hospitals, which backs up the accident and emergency departments and adds to the trolley crisis. In the meantime dozens of fully-qualified physiotherapists are forced to emigrate because they cannot find work in their own areas. I know one physiotherapist who has waited on a panel for months and who has now been offered €5,000 to relocate to Canada to work in the Canadian health service. Who is accountable for this debacle? What immediate actions will the Minister of State and the Government put in place to sort this out?

I will give the Minister of State an example of what is happening. Up to last September, physiotherapy for the Belmullet District Hospital and its community nursing unit was provided through primary care. A change was then made whereby this could no longer happen. Why did this happen? This is a crazy situation. There was already a backlog, which was being dealt with by a physiotherapist who was there. Will the Minister of State explain to me who, in their wisdom, decided that physiotherapy could no longer be provided to both of these facilities through primary care, but rather that it had to be provided through social care? There is absolute mayhem in the area of physiotherapy, in Mayo at least. I ask the Minister of State those questions specifically. What can be done to sort it out?

Finian McGrath (Dublin Bay North, Independent)
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I thank the Senator for raising this very important issue. I am very interested in some of the points she has raised in this regard, particularly the last point because, in theory, we have a strong emphasis on services being provided within primary care settings. The Programme for a Partnership Government commits to a decisive shift within the health service towards primary care in order to deliver better care close to home in communities right across the country. That is the first thing. The aim of primary care policy is to provide services in local communities so that people can be maintained in their own homes and communities for as long as possible. Effective delivery of primary care services will enable people to have direct access to integrated, multi-disciplinary teams of GPs, nurses, physiotherapists, occupational therapists and others. It has been estimated that up to 95% of people's health and social service needs can be met within a primary care setting and primary care teams contribute greatly to enhancing community-based services in these areas. In regard to the issues raised by Senator Conway-Walsh, physiotherapy services form part of the services provided by many primary care teams. In particular, physiotherapists play a key role in chronic disease management, especially in instructing and guiding patients through safe and appropriate exercise regimes. Physiotherapy services for adults and children are also delivered through specialist disability providers or early intervention and children's teams from birth to 18 years of age.

In regard to the specific issue raised by the Senator, I am advised by the HSE that physiotherapists in County Mayo have in the region of 37,000 face-to-face contacts in a year, which is a significant figure. The HSE has informed me that there are staffing related matters affecting the delivery of physiotherapy services in County Mayo. These staff issues relate to a number of factors in paediatric services across the county, including maternity leave, sick leave and a recent resignation, as mentioned by Senator Conway-Walsh. I am further advised that, in regard to adult services, a physiotherapy post in the Erris primary care area is now vacant as a result of maternity leave. The HSE is exploring the use of agencies to deal with priority one trauma clients in the area. These are the most urgent cases and require physiotherapy services after orthopaedic surgery and hospital discharge.

Delays in access to physiotherapy services can be very difficult for those affected. The need for additional therapy posts is highlighted in A Programme for a Partnership Government. At the end of February 2017, there were 529.38 whole-time equivalent physiotherapists employed by the HSE in primary care, of which 59.48 whole-time equivalents were employed in the community health organisation area two, which includes County Mayo.

To follow up the concerns of Senator Conway-Walsh, the HSE has established a service improvement group to develop a new model to improve waiting times for physiotherapy services. The terms of reference of the group include devising and implementing short-term measures to address current waiting lists and agreeing a revised national model of physiotherapy provision that will be standardised across all community health organisations. This group will examine standardisation of recruitment, which is very important, to include an agreed process and approach to vacancy management. That issue must be addressed. The work of the group is ongoing and a report on the issue is expected later in the year.

Rose Conway Walsh (Sinn Fein)
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I thank the Minister of State for his reply. However, there is an absolute disconnect between what he has said and the reality on the ground. It bears no resemblance to what is being experienced by those waiting for and working in physiotherapy. It is very simple. The panels contain fully qualified, ready, willing and able physiotherapists. What is stopping them from being appointed?

The agency solution cited by the Minister of State worries me. Until he confirmed it, I could not believe it that private agencies are being engaged from Galway and brought into Mayo. Does the Minister of State know how long it takes to get from Galway to Belmullet in Mayo? It is a six-hour round trip. If that is the most economic way to deliver physiotherapy in Erris, God help us. It is not a solution.

Who is on the group and what advice is it being given? It is obviously disconnected from what is happening on the ground. The Minister of State's answer has given me no more confidence in the approach being taken. I appreciate that he has been given the answer by the HSE, but the situation needs far more urgent attention to solve the problems in the area. People are coming out of hospital after hip and other very serious operations without any physiotherapy follow-up. There is no realisation of the damage that is being done right across the board.

Finian McGrath (Dublin Bay North, Independent)
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I thank Senator Conway-Walsh for her contribution.I will definitely follow up the point the Senator raised regarding the service improvement group whose purpose is to improve waiting times for physiotherapy services. I will also follow up the Senator's point on the need to address issues such as the management of maternity leave and sick leave.

Another important issue and one which I regularly raise with the Health Service Executive is the outsourcing of services. When I hear about outsourcing, it sets off a red light in my head.

Senator Conway-Walsh also referred to the logistics involved in travelling from Galway to Belmullet. I have seen a similar example in the disability sector where we had a service which cost €80,000 per person. When a crisis arose in the health service, bills suddenly issued for twice this price. We will have to address that issue.

The Senator also raised the important issue of physiotherapist recruitment panels in the various counties. Those who have been placed on panels are ready to roll, as it were. I will raise this matter with the Minister. The message I will take to the Minister and the Health Service Executive is that we must ensure services are in place.