Bernard Durkan (Kildare North, Fine Gael)
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75. To ask the Minister for Health the extent to which he can ensure access to services such as elective procedures, mental health services, endoscopy and oncology treatments that have been affected by the Covid-19 crisis, including access to services for persons with special needs; if he has in place or in mind a specific action plan to deal with the issues; and if he will make a statement on the matter. [23663/20]

Stephen Donnelly (Wicklow, Fianna Fail)
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The COVID-19 pandemic led to an unprecedented interruption to normal health services, both in the community and acute hospitals. While some services were suspended or delivered on a reduced basis, it is important to recognise that many vital services have continued throughout the pandemic, ensuring that priority care needs were addressed and the most vulnerable protected even at the height of this crisis.

Resuming health and social care services and building the health sector capacity and capability for the pressures of Winter 2020 and into 2021 is a priority for the Government.

To ensure that services were restored in a prioritised manner with investments targeted at rebuilding services guided by Sláintecare - shifting service provision from Hospital to community-based care, the HSE published in June 2020, a Strategic Framework for Delivery of Service Continuity in a COVID Environment. This ensures a safer environment for patients and service users.

Over the summer period we have seen a gradual resumption of many of those services that were curtailed, although unfortunately there are still areas where the level of service falls below that which was being delivered up to mid-March. The immediate priority for the HSE is the finalisation of a Winter Plan that would incorporate the enhancement of services to cope with Winter pressures into early 2021 to ensure the capacity and capability of health system is prepared for this challenging period.

Additionally, a more strategic approach to Service resumption is being undertaken, with the development of a longer-term plan to include augmented levels of service to regain a level of provision across community and acute hospitals that had capacity adversely impacted by COVID 19.  This would include establishing key community services envisioned in Sláintecare and the 2018 Capacity Review, while building toward the appropriate level of capacity in our acute hospital services.

As part of the Winter and Service Planning process,  a range of initiatives have also been developed, and as these are rolled out in the coming weeks and months, we will see further service resumption and increased capacity across the community (primary care, mental health, older persons and disability services) and Acute Hospital system.

This will include implementing new initiatives, new ways of working and eHealth solutions to keep people safe and keep people out of the acute hospital system e.g. ePharmacy, ePrescribing and virtual clinics.

For Mental Health Services, this year has been exceptional with the outbreak of Covid-19. The pandemic has been a source of significant stress, anxiety, worry and fear for many people throughout the world. This arises from the disease itself, as well as from impacts such as increased social isolation, disruption to daily life and uncertainty about employment and financial security.

The HSE has continued to provide all community services, in so far as possible, while following Covid-19 guidelines to ensure the protection of patients and staff. To note, acute inpatient and community residential facilities have remained open and patients have been provided with services throughout the pandemic, although numbers have been reduced in some settings.

The advent of Covid-19 has led to a rapid acceleration in the delivery of online mental health services, with the Department of Health launching numerous initiatives to promote mental health and wellbeing. Among these was the launch of the national Crisis Text-Line in June. An additional €2.2m has been provided for a mental health promotion and well-being campaign, through enhanced online supports, and to support the HSE psychosocial strategy. This will enable the Irish healthcare system to implement integrated telehealth solutions and to augment existing online interventions funded to date. An example of this is the free counselling sessions offered by HSE NGO partner MyMind and Turn2me created online peer support groups for frontline workers.

Tele-psychiatry pilot projects have been tested to enable planning for the delivery of this service nationally to support those with complex mental health needs. This service will alignment and augment existing mental health services.

To plan for the ongoing and increasing need for mental health services nationally and the demand for more holistic person-centred responses across the whole community, the refreshed national mental health policy, Sharing the Vision – A Mental Health Policy for Everyone, was published in June 2020. Service users and their families, carers and supporters will have timely access to evidence-informed mental health services. Tailored measures will be put in place to ensure that individuals with complex mental health difficulties can avail of services across the state without discrimination. This builds on the intent of A Vision for Change and Sláintecare and is expected to be implemented as part of a ten year plan.

Regarding access to services for persons with special needs, adult day services as well as children’s disability services were stepped down in March 2020 in line with government recommendations to minimise the spread of COVID 19.

Adult day services have since been reopening over the last month and this will continue throughout September, and information on reopening dates for all 966 services has been available on the HSE’s website since August 4th.

When day services resume, capacity in day service locations will be reduced, however, the HSE and service providers will keep this measure under review and as public health guidance evolves, capacity to provide supports will adapt accordingly. The HSE is committed to maximising the support that can be provided within these restrictions and providers are exploring options such as the use of other community facilities to augment capacity.

For the foreseeable future, remote supports and supports provided from service user homes will become a key feature of day service provision.

Throughout the pandemic, children’s disability services continued to be provided on the phone/online and also, face to face for some children and families with high prioritised needs, taking all of the required IPC precautions into account, and in line with HSE’s Alternative Models of Support. 

On July 31st, the HSE issued “Guidance to Support Resumption of Children’s Disability Services” documentation to their individual Community Healthcare Organizations. These guidance documents are intended to support clinicians in decision making regarding disability assessments in the context of Covid-19 and secondly to support the return to more normal levels of service provision for children with disabilities and their families, who have been significantly impacted by measures taken to prevent the spread of Covid-19.

Having received these guidance documents, all Community Healthcare Organizations should be putting appropriate arrangements in place to resume assessment of need and intervention therapy services in line with public health guidance.