Dáil Éireann debate -
Thursday, 9 Nov 2023

Last year, the HSE published the national stroke strategy from 2022 to 2027, which I fully supported. It received €4.9 million in funding for 2023. I understand that approximately €1 million worth of posts are unfilled and there are concerns over their funding. For 2024, the national stroke programme requires millions of euro for 75 essential additional posts to safely staff our stroke units. In the budget just gone, how much additional core expenditure was provided to fund the national stroke strategy?

I thank the Deputy very much for his support for the stroke strategy. I think we can agree that our healthcare professionals are making important progress on behalf of patients and families. As a result of the work over the last ten years, deaths from the most common form of stroke have fallen by nearly 30%, which is very welcome. The average length of stay for patients has fallen a lot as well, from 11 days in hospital to eight. The proportion of patients being seen by a medical team within ten minutes of arriving at a hospital has more than doubled. I know the Deputy will join me in acknowledging the huge efforts of our healthcare professionals to put these responses in place.

The stroke strategy the Deputy referenced is from 2022 to 2027. It is a five-year strategy with aims around prevention, better outcomes and more after-stroke care. The predicted outcome of the new strategy is a reduction of about 1,000 strokes a year, so it is clearly very important. As the Deputy said, I approved the national stroke strategy last year and allocated in the budget for this year a significant amount of money, nearly €5 million, to support the implementation of the strategy. This included the recruitment of two consultant stroke physicians, a consultant neuroradiologist and senior speech and language therapists, with additional recruitment ongoing as well. Two new early supported discharge teams were established this year and six existing teams received increased staffing. A major FAST - face, arms, speech and time - awareness campaign has also been undertaken and I am sure we have all seen that.

Through next year, the amount of money being allocated will increase from €4.9 million to €7.3 million. To answer the Deputy's question directly, that is for the existing level of service. I expect the national stroke strategy will fully use up all that money. The next phase has a particular emphasis on the extension of the GP chronic disease management programme to include those with hypertension. There is funding in the budget for that as well.

This shows again that it was quite dangerous not to properly fund the health service for next year but also not provide any additional funding for new measures. As I suspected, any additional funding that will come to the national stroke strategy is simply to stand still and is funding for existing levels of service. Some 6,000 people have a stroke every year and 2,000 of them do not get to a stroke unit in the first instance. A further 2,000 are discharged early. We know we have lots of problems. The aim of the stroke strategy is to address the deficits we have. There are about 70 posts that need to be funded and put into the stroke units right across the State. There are posts that are still not funded even from last year. The concern I have is that we have again put a national strategy in place, which everybody welcomed. I welcomed it. Obviously we want the strategy to work and be properly invested in to support stroke patients and provide the funding for prevention but also for treatment. If it is the case that we have not provided enough funding or any new funding for next year, that will have consequences for patients.

I think we are going to be having different versions of this conversation throughout the next hour and a half, based on the questions the Deputy has tabled, which I fully appreciate. As to whether there is a level of funding for new development next year at the scale there is for this year, there is not. We will not be expanding these services next year at the pace we expanded them this year. However, is there funding to expand services, which can include stroke services? The answer is "Yes". The Deputy will be aware that there is additional funding in new developments through the Department of Children, Equality, Disability, Integration and Youth for more neurorehabilitation nurses. They are directly related to post-hospital supports. There will be an expansion there. We are hiring more consultants next year. The clinical strategies, including the stroke strategy, will undoubtedly benefit from that. We are fully staffing all the hospitals to safe staffing levels and all patients, including stroke patients, will benefit from that increased level of service.

The reason we tabled the questions the way we did is to cut through all of the spin and essentially lay bare the consequences of a Government that does not properly fund our health services. As Minister for Health, the Minister knows a huge mistake was made in not properly funding the health services even to stand still but what is worse is that if we do not provide new funding each year, particularly for these strategies, we lose a year. We stand still. With the greatest of respect, funding coming from other Departments for other areas does not make up for the fact that we have lots of consultant posts and allied healthcare professional posts that are needed in stroke units right across the State, which will not be filled next year. To me, that is a mistake. This is only one part of the health service. I could have picked lots of different elements of the healthcare system that will suffer because of this. I am very concerned. The figures I have received from the Irish Heart Foundation show that 600 more patients will not be admitted to an adequate stroke unit next year as a direct consequence of no new funding coming into that stroke strategy. While the foundation welcomed the strategy and was happy and pleased that it was in place, it is a real disappointment to it and, I would imagine, to stroke survivors and patients, that there is no new funding for new measures. That will have consequences for patients.

We will probably be repeating ourselves a bit this morning. There is not the level of funding next year for the same pace of roll-out of the strategy that I and the Deputy would like to see. However, there is significant funding in there to enhance services. We are both agreed that safe staffing makes a difference. It makes a difference to patients and that includes stroke patients. That is expanding. We are both agreed that bringing down the inpatient day-case waiting lists is going to make a big difference to all patients. It is going to take pressure off the hospitals. The six new surgical hubs are fully funded, including one in the Deputy's constituency. We are all agreed that we need more beds and that those beds will make a difference to patients and 162 new beds are funded. I think the Deputy is in agreement with me on the benefits of the chronic disease management programme run by GPs. Hypertension is now being added to that as the fourth condition.

It is an important measure and it has been funded, which speaks directly to prevention of stroke.

I thank the Deputy for raising this issue. I agree that the waiting times for scoliosis and spina bifida surgeries are not acceptable. I am conscious of the pain, suffering and anguish that are caused to the children and young adults who are waiting and to their families. For this reason, I committed €19 million in 2022 and 2023 to tackling these lists. Our goal is clear; it is to reduce the wait time for anyone for whom surgery is clinically appropriate to no more than four months. There is broad agreement on that target. That is why we invested the €19 million.

To date this has meant posts for an additional 193 healthcare professionals being funded across Temple Street, Crumlin and Cappagh hospitals, including nurses, consultant doctors, anaesthesiologists, radiographers and others. As the Deputy is aware, we are in the middle of bringing much more capacity online. Children's Health Ireland, CHI, has hired many more people and more surgery is taking place. Another wave of capacity is coming online, which includes a fifth operating theatre in Temple Street hospital, a second MRI machine in Crumlin hospital and 24 additional beds, of which 20 are already open and four more will come on stream shortly.

Last year, 509 spinal procedures were carried out, compared with 380 in 2019 before the Covid-19 pandemic. We have seen an important increase in the number of spinal surgeries. However, we have not seen a corresponding fall in the number of children on waiting lists. The clinicians have given us various reasons for that. Our focus now is to ensure the additional capacity is being used for what it was dedicated to, namely, paediatric orthopaedics and spinal surgeries, and that the increase in activity will result in what we all want to happen, which is a significant reduction in the number of children on waiting lists to the agreed levels.

That is positive but there are families with children who have been waiting for well over four months. That is completely unacceptable. The Minister's predecessor said six years ago that no child would wait more than four months. That promise has been broken many times. The Minister will understand that it is frustrating for people who have a child waiting for surgery that could be revolutionary for the child when that surgery does not happen. What the Minister said was all positive but the litmus test for families is the intervention and waiting times before their children can get surgery. It is clearly not happening quickly enough. Will the Minister reassure the families in question that surgery will happen as soon as possible?

I assure the Deputy, the House and, more important, the people who are waiting for the surgery and their families that a lot of activity is taking place. The resources are in place. The Taoiseach and I met advocacy groups recently. They put many important issues on the table. There is better engagement now. We are looking through a list of actions they asked to be looked at. The Deputy will be aware that Mr. Nayagam is doing an important review looking at some of the issues that have been raised. I have also asked him to come back with any recommendations for improving the service. At the same time, my Department and I are engaging with the HSE and CHI to ensure the changes needed to the current service are made quickly in order that children can get the care they need when they need it, which is what we all want.

I understand that the review by Mr. Nayagam is ongoing and that it is looking at the broad spectrum of ways to improve services. Is one of those - I am sure the Department has looked at this - for children to travel abroad for intervention or surgery? That can be slightly complicated given the nature of this surgery. Has it been actively looked at? It is good that we have more capacity but the test is whether children are waiting longer than they should for intervention, and they are. The Minister and his colleagues want to reduce the waiting time to as close as possible to the four-month target but that target is clearly being missed. As I said, 90 children have been waiting more than four months. This surgery is complicated. Has the possibility of children travelling abroad been looked at or have medical facilities where the surgery could take place been considered, other than the main hospitals in Temple Street, Crumlin and Cappagh?

The short answer is "Yes". Clinicians are cautious about that option. It happened before. Children went to Germany before the Covid-19 pandemic. Clinicians are not opposed to that but they urge caution because these surgeries tend not to be a single episode in a theatre. Ongoing care is required and multiple surgeries can be required. Nonetheless, we are looking at what is called outsourcing. A good relationship is being built between the Boston Children's Hospital and CHI. What they call insourcing is also being looked at, which means that rather than the children and their families having to go abroad, potentially several times, we would bring additional consultants and expertise to Ireland and use the capacity we have so they can get the service they need here.

The number of children on CAMHS waiting lists has doubled from 2,000 to 4,000 under this Government. More than 16,000 children are on waiting lists for psychology and more than 6,000 young people have presented to emergency departments due to a mental health illness since 2019 because they do not have alternative care pathways. CAMHS does not seem to be the solution for them. The service is dramatically underfunded and it has major problems in many areas. Despite lots of good work being done by people who work in CAMHS, there are problems. How much additional core expenditure was allocated to CAMHS in budget 2024 to improve services?

I thank the Deputy for the question. Year-on-year funding for mental health services increased by €74 million from €1.221 billion announced in budget 2023 to almost €1.3 billion in 2024, with a strong focus on investing in youth mental health. Improving access to mental health services remains a commitment for me and my Department. To this end, funding for mental health has increased by 25% during the lifetime of the Government.

As the Deputy will be aware, we have a new HSE office for youth mental health which will improve planning for and the delivery of CAMHS and wider services in 2024 in line with recent audits and reports, such as those by Dr. Maskey and the Mental Health Commission. I sought these reports because I thought it was important to have real-time data that were not available to us previously because they were not collated.

Examples of service initiatives for mental health that will be funded under budget 2024 include additional staffing of CAMHS teams to improve access to services and reduce waiting lists. I am on the record as stating that I was disappointed about the allocation for new developments next year. Working with the HSE and the Department, I decided to prioritise youth mental health so there will be 76 posts. We will also expand the multidisciplinary CAMHS hub teams to complement traditional service models and further develop specialist mental health teams providing early intervention in psychosis and eating disorders. A lot of recruitment is under way for 2023 and some of the posts funded in 2023 will only come on stream in 2024. In many instances, it takes up to 12 months to recruit someone. Those posts are safe and they will come in early next year. Initiatives also include a new youth mental health app to provide interactive supports and dynamic signposting and the development of a central referral mechanism, the no wrong door approach, which I know Sinn Féin welcomes. As the Deputy will be aware, the HSE service plan is currently being worked out so to give specific figures is difficult at the moment.

I appreciate that but it is certainly nowhere near enough for what is required. I have on many occasions, both in this Chamber and outside it, welcomed an awful lot of very good work done by both the Minister and the Minister of State, Deputy Butler, and I will always acknowledge where good work is done, good initiatives put in place and additional funding made available. Nevertheless, it is my job to call out, as is right to do, what I feel was a dreadful decision made by the Government and the Cabinet not to fund the health services properly and to starve them of any additional funding for new measures and new programmes.

We had a discussion earlier on the national stroke strategy and we are now talking about CAMHS. We all know CAMHS is not working. Far too many young people cannot get access to it. We have difficulty recruiting psychiatric consultants and allied healthcare professionals, and young people are going into emergency departments in the wrong places looking for care because they cannot get it in the service where they should get it, namely, CAMHS, and that is down to resources and capacity. Starving CAMHS of new funding to the extent we have done in this budget is wrong and will have consequences for people's mental health.

We have bucked the trend in recruitment when it comes to mental health services. In 2021, a total of 659 people were working in CAMHS, whereas at the moment, there are 820. It is an area in which we have done well to recruit where posts have been available. By the end of next year, 900 whole-time equivalents will be working across the 75 CAMHS teams. Notwithstanding that, there are difficulties, but I am delighted to say the waiting list fell to 3,900 during the course of the summer. The latest figures are for the end of August and it will be interesting to see how they continue to come down.

Turning to year-on-year funding for mental health services, the budget for CAMHS is €137 million, but we also support NGOs to the tune of €108 million. A lot of that relates to youth mental health organisations such as Jigsaw, SpunOut, Turn2me, Pieta, Barnardos and Shine.

Again, I am duty-bound to point out that a scathing Mental Health Commission report on CAMHS made a lot of recommendations, some of which, I understand, will be implemented, whereas in the case of others, the Government is pushing back against them. The Government might have its reasons to push back against them, but we cannot push back against the dire need to invest in CAMHS services to give young people better opportunities. I accept some of what the Minister of State said about additional posts that have come on stream, but it is still far from where we need to be and key specialist posts throughout the State are not in place, which is having an impact. We all saw what happened in CAMHS in the south west, and in other areas over recent years there has been scandal after scandal and crisis after crisis. A lot of that is down to poor workforce planning. The Government and the Minister for Health waited until very late in the day to put an emphasis on workforce planning, and that, in my view, is part of the problem.

I reiterate that not properly funding CAMHS and other mental health services next year will have consequences for young people and their mental health.

It is important to put some balance on the discussion. In 2020 and 2021, there were 33% more referrals to CAMHS. I have to build confidence in CAMHS and, as the Deputy conceded, a great deal of really good work is going on. Approximately 21% more children were seen during that period and that was at a very distressing time during Covid. Last year alone, CAMHS teams allocated 225,000 appointments to people under 18 throughout the country. A huge amount of very good work is going on. A new mental health office is being led by Dr. Donan Kelly, who took up the post on 1 September, and for the first time ever, there is a clinical lead doctor, Dr. Amanda Burke, who has 30 years' experience of working in CAMHS. With that dedicated focus in the HSE, we can now try to address the waiting list once and for all.

I thank the Deputy and acknowledge his own work. He is part of the seven-person team in the University College Dublin, UCD, trauma project, the initiative led by UCD professors Gerard Bury and Chris Fitzpatrick. Professor Fitzpatrick and I have been going back and forth on this project for some time. I know that the Deputy was involved in training for 100 personnel and that the visit focused on procedures to counteract haemorrhaging and deal with combat wounds, so I acknowledge his own role, which is greatly appreciated. It is fantastic to see an Oireachtas Member, one of our own doctors and an ex-member of our Defence Forces playing a leading role on the ground in Ukraine in this lifesaving way. I thank him for everything he has done, and his six colleagues who have gone out to Ukraine. I fully intend to keep supporting the UCD trauma project. It is fantastic.

Ireland's health service has strongly expressed its solidarity with our Ukrainian counterparts. The Ukrainian health minister asked me some time ago whether we could pair one of our hospitals with theirs. We have done that and it is bearing fruit. Humanitarian medical aid is provided by the Irish health service as part of a wider Government response to the outrageous and illegal invasion by Russia of Ukraine.

To date, the health service has donated nearly €9 million in medical supplies to Ukraine. This is being done through collaboration between the health service, the Government, Ukrainian nationals working in Ireland, private donors and civil society partners. The donations have included lifesaving medical equipment, medicines, ambulances and a generator. In addition, medical beds, aids and appliances and medical consumables have been supplied.

I thank the Minister. That was an impressive list of supports, which is good and which I welcome. I want to single out UCD’s Ukraine trauma project for two reasons. First, I thank the Minister for his €170,000 support and his personal intervention, without which it would not have happened. Second, I highlight the six people involved. They are very humble people who have never asked for any recognition and it is important the House acknowledge their contribution. It was the brainchild of Professor Gerard Bury, Professor Chris Fitzpatrick, Dr. Niall Conroy and two excellent advanced paramedics from the National Ambulance Service, namely, Mr. Ben Heron and Mr. Niall Carty, as well as a doctor called Roxana, who is a Ukrainian living in Portarlington. What is unique about the course, as the Minister pointed out, is that the 100 students have got about €1,500 worth of medical kit, in the form of tourniquets, field dressings and advanced drugs. I have no doubt the course has saved a considerable number of lives.

I thank the Minister for his support. The country can rightly be proud of the project's contribution.

I thank the Deputy. I had the easy job; he had to go to Ukraine and work on the ground, so I thank him. As I said to Professor Fitzpatrick, if the UCD team is looking to go out again and needs that support, the State and the Department of Health will certainly not be found wanting. We have an allocation this year, and a similar one next year, of €50 million to provide services. It is a combination of providing services to Ukrainians coming here, mainly women and children fleeing the atrocities of the war, and we will continue to provide those supports. I acknowledge the work of healthcare professionals, both our own and Ukrainian ones, who have come here. It does not get much comment or notice, but a very substantial healthcare service has been put in place to make sure those who are fleeing war get the supports they need. I take the opportunity to acknowledge that. In every part of the country, our healthcare professionals are stepping up once again to meet the need.

I acknowledge also the role of the Irish Embassy in Kiev, which has been very hospitable and generous when we are out there. Likewise, I acknowledge Mr. Peter Ott, a Kildare man working for an NGO out there, Caritas, which is very supportive, as well as retired Lieutenant Colonel Ray Lane, who is working with the UN from a mines-clearance point of view. I am reassured by the Minister's comments. Knowing Professor Gerard Bury, I am sure he is already planning the next course for 2024. Of course, we will be very grateful for the Minister's continuing support in that regard.

That is very clear; they will have my full support to keep going with this. As for some of the other supports that have been provided so far, 23 decommissioned ambulances are fully kitted out, loaded with additional medical supplies and ready to use. There are more than 7,000 blood bags and reagents from the Irish Blood Transfusion Service and nearly 6,000 items of medical equipment and consumables, including critical care equipment, diagnostics, therapeutics and infant care equipment, which was fantastic to see out there.

I recall seeing some of the photographs of it being unwrapped and deployed in Ukraine. As the Deputy will be aware, we have also sent non-lethal military aid from different parts of Government.

As we are talking about Ukraine, I cannot but comment on Gaza, where operations are being carried out without anaesthetic. We might balance the conversation and look at our policy. My specific question concerns plans for an audit of the long-term residential care for older persons in Galway city and county. I ask this because I am keeping a close eye on the imbalance between public and private beds.

On foot of a conversation we had in the House last year about an audit, I requested one. In 2022, the HSE carried out an audit on publicly-funded bed capacity across all nine community healthcare organisations, CHOs. We have 128 HSE public residential care centres for older people, many of which are classed as community hospitals. Subsequently, the HSE completed an in-depth bed reconciliation exercise that validated its publicly-managed residential bed stock. The purpose of this exercise was to reconcile variances derived from the audit and agree particular bed data going forward, with a view to providing accurate information that would identify challenges and support future planning. I agree with the Deputy; this was important post Covid to see exactly how many beds we have. A community bed management system is being developed for the provision of real-time bed data. This will be progressed for roll-out across the HSE in the coming months. In the meantime, the HSE compiles a monthly bed register report of public residential care centres for older persons. As of 31 August, the bed register recorded a total of 256 designated nursing home support scheme beds in Galway, inclusive of all open and temporarily-closed beds. Some 238 of these beds were open, of which 206 were occupied. Data on waiting lists are not collected nationally. This information is held at a local level and is affected by ongoing industrial action. It is extremely frustrating for me, as a Minister of State, that this information is available but is not being passed on at the moment.

To give the Deputy the breakdown, Áras Mhic Dara community nursing unit has 32 beds, Áras Mhuire community nursing unit has 19, Áras Ronáin community nursing unit, with which I am not familiar, has ten, St. Anne's community nursing unit has 21, St Brendan's community nursing unit has 87, Merlin Park community nursing unit 5 and 6 has 25 and Ballinasloe community nursing unit has 44. That comes to 238, of which 206 are currently occupied under the nursing home support scheme, fair deal.

I thank the Minister of State for following up on the audit. I have the advantage of having the answer before me but the specific figures for the homes are not in the answer. Will the Minister give us those figures? Concerning the audit carried out in 2022 following the Minister of State's intervention, is a copy available? Is it public? I am in Galway city; I am a firm believer in the public health system and beds but I watch with despair at how five beds officially remain empty in the heart of the Gaeltacht in Áras Mhic Dara. The one the Minister of State did not know is Áras Ronáin on the Aran Islands. Then there is Merlin Park. I took the trouble of checking the HIQA report for Merlin Park community nursing unit 5 and 6 - it was a glowing report, compliant on every level. By comparison - it touches on the Minister of State's area - the Aperee Living home closed. It owns eight or nine homes throughout the country, one of which is in County Galway. I looked at the HIQA report for that; it is absolutely damning. My concern is what happens when the health board takes over. What is the risk? What is the cost?

I, as a Minister of State, have been on the record, working with the Minister for Health, saying that I do not want to see any more public capacity close at any level. Upcoming projects in Galway include a new 60-bed unit in Merlin Park, an increase in capacity on the 25 already there, and a 40-bed unit in St. Anne's in Clifden. It was announced previously but progress is being made. The Deputy will know that recently the Helen and Joe O'Toole community nursing unit in Tuam was opened with 50 beds. It is a fantastic facility and residents will be moving into it shortly. We must also note that there were 12 short-stay beds at Clifden District Hospital. Even though older people need long-stay beds under the fair deal, step-down, transitional and respite beds are also important. I will come back to the Deputy's question about Aperee in my next response.

A subject like this is very difficult to deal with in a minute. If we look at the new one that will be built in Clifden, it was supposed to be 50 beds but has gone back to 40, inexplicably, when there is great demand. Look at the inexplicable vacancies in Áras Mhic Dara in Carraroe. I am trying to find out the waiting lists for Carraroe and Merlin Park. I do not expect the Minister of State to have this information at her fingertips but I expect to be able to get it at my fingertips quickly from the source. Going back to Aperee, I am extremely concerned that we have promoted a private system. More than 81% of nursing homes are owned privately, most for profit. Here we are with Aperee and the HIQA report for the home in Galway. One has to look at it. It was non-compliant with fire regulations, staffing and other matters. The energy of the Health Service Executive is going into taking back private nursing homes that have failed on governance and other issues. We are not going ahead to roll out a public system; it is down at 13%.

On Mulranny, which is outside my area, I know the man there. The nursing home wrote to the Minister in October. It is a not-for-profit nursing home. It is struggling and it is a most wonderful example of a nursing home and care.

I have been deeply distressed and worried and have intervened and worked with HIQA, the Department and the HSE on Aperee nursing homes. Some 15 companies own 10,700 beds in the private sector. That is the reality of the situation with which we are dealing. On 6 September, I think, HIQA published 50 reports; 17 were compliant and 33 had non-compliance. I read each and every one. Six Aperee Living homes were listed. There were very deep concerns. HIQA have mine and the Minister's full support to go into these homes and make the necessary changes. It tries to work with every nursing home to put in place a compliance plan; that did not happen. One of the Aperee Living homes in Kinsale has closed, as has one in my area, only 20 minutes down the road from me - Aperee Living Ballygunner. Last Friday week, the HSE took over Aperee Living in Callan. HIQA is keeping a special eye and focus on Aperee Living homes at the moment.