Vol. 1055 No. 5
4. Deputy David Stanton asked the Minister for Health if he has given any consideration to funding continuous glucose-monitoring sensors for people with type 2 diabetes under the community drug scheme; and if he will make a statement on the matter. [25754/24]
I wish to ask the Minister about the position regarding the funding of continuous glucose-monitoring sensors for people with type 2 diabetes. My reading of the situation is that this technology is amazing and makes a huge difference to the quality of people's lives. They feel better and can perform better. It is really effective. I understand that a change was made to the scheme last Christmas whereby people with type 2 diabetes who had been involved previously are not now. I would like the Minister's comments on this.
I thank the Deputy for the question and for his advocacy in this area. I have discussed this issue with him. Deputy Devlin is Chair of the all-party Oireachtas committee. We met with Diabetes Ireland before last year's budget. I assure the Deputy that this is a matter of great priority for the Government. There are various things we have done in the past few years. One is, in line with a request from Diabetes Ireland, that we are setting up the national diabetes register. We have not had one before. We began rolling out screening for gestational diabetes last year, which has been received very well.
One of the most important advances is diabetes is included in chronic disease management, CDM. We have got these CDM hubs around the country. I have met diabetes patients in my own constituency at the CDM hub in Bray and they said it has been life-changing for them to be able to get the specialist care they need in the community rather than having to go into the hospitals.
Another great advance, as the Deputy said, has been these continuous glucose-monitoring products. There is good news for those with type 1 diabetes in that there has been a significant increase in the numbers using them. In fact, there has been nearly a threefold increase in the past few years, up from 6,000 to nearly 17,000 now. It is not cheap in terms of the additional cost to the State. The €20 million in funding in 2021 has now gone up to €56 million just for type 1 diabetes. The estimated cost we have, were we to roll out the same to people with type 2 diabetes - and it is something the Deputy would like to do and Government would most certainly like to do - would be about €200 million to €400 million extra per year. To put that in context, it would be about the size of the entire additional healthcare budget for last year. At this point, we are keeping it under advisement. We want to set up the national diabetes register, and we are setting up that so we can accurately ascertain the numbers with type 2 diabetes. Then we will move from there.
I thank the Minister for his response and congratulate him on the work he and the Government are doing in this area. I wonder what the cost will be of not making these sensors available to people, particularly if they get ill, end up in hospital or whatever and their quality of life disimproves.
One of my constituents informed me that the sensor changed the quality of his life when he started using it. His readings were kept at a manageable level and he feels much better when going out and about. He also said that prior to Christmas, the sensors were free to type 1 and 2 diabetes patients but that this has changed since then. I hope the Minister will clarify whether that is the case. My constituent applied to the HSE to have his sensor added to his long-term illness card but his application was rejected due to what he tells me was a change in the rules. He has had diabetes for over ten years. His consultant has indicated that the man also requires insulin. Since he obtained the self-funded technology, he has transformed his diabetes care with excellent control of the disease and improved safety. This is extremely important. It could be subsidised, and the Minister might consider that.
I thank the Deputy. The technology is not cheap. The cost of one sensor is about €1,500 to €3,000 per year. They are expensive and, hence, the additional cost to the State would be €200 million to €400 million. If the Deputy is comfortable with sending me on details of the case or if his constituent is happy to send them on, I will take a look specifically at what he is saying he had access to and now does not have access to. I would be concerned if there are patients who were eligible and who, for some bureaucratic reason, are now being told they are not eligible. I will certainly take a look at that. Then, as the Deputy said, once we have the diabetes register in place, we can start doing the assessments now with respect to the money saved by preventing people having to go into hospital, particularly combined with the diabetes management services we now have in general practice with the chronic disease management hubs. At that point, we can look to see if there is a way of phasing this in, perhaps on a means-tested basis or on the basis of clinical need.
I thank the Minister for his very positive response. To support him in moving forward with this, my constituent tells me that the sensor has to be replaced every ten days at a cost of €92.50, or €75 plus VAT. This is, as the Minister stated, very expensive. However, the improvement in quality of life for these people is massive. They do not require hospital treatment to the same extent or anything near it, so there are huge savings there with respect to not having to be hospitalised, not being unwell and being able to actively work and perform in society as they would like to do. I will certainly send on the details with the constituent's permission, and I would encourage the Minister to have a look at this. Even if there was some assistance given to these people, it would help in a big way. I thank the Minister for that.
Bogaimid ar aghaidh anois go dtí an chéad ceist eile, Ceist Uimh. 5 in ainm an Teachta Gino Kenny.
I have mixed up my notes. Does Deputy Smith want to go ahead?
If Deputy Duncan Smith is agreeable, we will move to Question No. 6 in his name.
6. Deputy Duncan Smith asked the Minister for Health what actions his Department is taking to lower car parking charges at hospitals in circumstances where car parking charges are currently at unacceptable levels and waiting times in hospitals can mean that undertaking a CT scan can cost a patient €15; and if he will make a statement on the matter. [25065/24]
We are bringing up again - this has been brought up a great deal - car park charges for patients. It remains a major cost and burden on sick people accessing our hospitals to obtain acute care. We need to see a strategy from Government that will bring these costs down. I thank the Minister.
I thank the Deputy. I took another look into the current state of play when I received the question in preparation for this morning. The figures are as follows. There are 36 public or voluntary hospitals, 33 of which now charge €10 or less for parking. The Deputy quite rightly points to the figure of €15, which certainly can be a lot for parking, particularly for someone who is already dealing with the pressures and difficulties of having to be in a hospital in the first place. The good news is that only three hospitals of the 36 charge up to €15, which is good. They are St. Vincent's University Hospital, the Mater and St. James's Hospital. I have asked my Department to engage with those hospitals. What we are being told is that in many cases, the hospitals do have schemes for patients. For example, where there is somebody coming in to visit a relative on a daily basis, they can give them free access or a big discount on the access.
Speaking to the Deputy's point, someone who is coming in for a CT scan may just be coming in once so they will not have any agreement in place. They may have to pay the €15. We have taken many steps in recent years to reduce hospital costs. We abolished inpatient charges entirely. That was costing up to €800 per year for an individual. We have included CT scans and made them free for a patient directly referred by their GP. This has two benefits. Previously, somebody might have had to wait for months to go into a hospital for the CT scan, or they could have chosen to pay privately, which could be very expensive. It is now completely funded by the State, so you can go into one of the private providers or one of the State hospitals.
I acknowledge that even though we have reduced healthcare costs for people pretty radically, this €15 charge is real and it can be difficult for people. We are going to engage with these three hospitals to see what more can be done.
I thank the Minister. That is good to hear. There are different costs in the various hospitals. As the Minister knows, there will be sick people who might have treatments in different hospitals. There is no uniformity to it. I acknowledge progress has been made and costs have come down and I want to acknowledge the work of the Irish Cancer Society and others with respect to their advocacy on car park charges. However, there are still anomalies and costs for people such as those I have outlined in my question with regard to CT scans.
The cost of care and the cost of being sick in this country are still very high. Much of this lies outside our care system in the context of people’s diet and everything we had previously. The cost of disability report highlighted a great deal in this regard. If we had uniformity in car parking charges, people accessing our hospitals would know the amount they are going to pay, whether they are in Castlebar, St. James's Hospital, Cork or wherever. That said, I acknowledge the progress which has been made.
I thank the Deputy. In nine hospitals, car parking is free. We have a bunch which charge up to €10 and then we have those three hospitals to which I referred. The latter will, understandably, tell us that this is all well and good but they need money to make it up. It is reasonable for them to state that there would be a funding shortfall in the context of the provision of healthcare services if the fees were lower. This is something we can certainly look at. We can run the numbers on what it would cost these three hospitals to reduce the charge from €15 to €10. Indeed, the hospitals will say that, much of the time, €15 is okay for many people when they are coming in. It costs us approximately €300 to provide a CT scan. These scans are provided because the State funds them. Some of the hospitals may say that many people who are coming to get State-provided healthcare are okay with paying €15. However, there are others who simply cannot afford it. Rather than just bringing the charge down, we must ask if there is a different way of doing it. Certainly, the guiding principle must be that healthcare must always be affordable. Cost cannot be a barrier. We will continue to look at this matter.
Okay.
Tá muid ag dul ar ais go dtí Ceist Uimh. 5 in ainm an Teachta Gino Kenny.
5. Deputy Gino Kenny asked the Minister for Health if he is aware that an organisation (details supplied) recently published the Irish national ICU audit annual report showing that an average 5.6 critical care beds per 100,000 population were open in 2022, which is less than half the mean value of 12 for Organisation for Economic Co-operation and Development, OECD, countries; and if he will make a statement on the matter. [25786/24]
I thank the Leas-Cheann Comhairle. My question relates to the Irish national ICU audit. There was a recent audit on intensive care beds in the State. It pointed out a number of an anomalies and, obviously, deficiencies. There were also positive things in that report on our healthcare system. I wish to hear the Minister’s views on the report.
I thought it was a very useful report. I have a lot of numbers here as I got into a lot of the numbers comparing our baseline with the OECD figures in preparation for this morning. The situation is better than the OECD comparison suggests. I will explain why. There is no question that we have had a shortage of intensive care beds. We know they are needed for very sick patients and for scheduled surgeries. Not having enough of them can have a serious knock-on effect, particularly for the sickest patients or for those most in need of complex surgery.
When Covid-19 arrived, we had 258 beds. We are adding 92 to that, which will bring us up to 352. That is nearly a 30% increase which is very useful. That is phase 1 and it will be finished at the end of this year. Phase 2 will bring us a lot further; there will be a further 106 beds, which will bring us up to 458 beds in total. That is a very big and much-needed increase. In fact, it goes beyond the 2018 capacity review. The Deputy will remember that a capacity review was completed following the Sláintecare report. The review stated that the correct number of beds for Ireland is 430. We are going beyond that to 458. We are going a good bit beyond what the capacity review said was required.
To answer the Deputy’s question as to how, if that is the case, Ireland is still well below the average in the OECD figures, the information I received is to treat the international comparison with care because some countries count neonatal intensive care units, paediatric beds and other types of beds that other countries do not count. It is, therefore, difficult to do a like-for-like comparison. I will comment further in my next response.
I acknowledge there has been significant progress in intensive care beds since Covid-19, which exposed crack lines in medical need. Obviously, there is more demand in our public healthcare system because of population growth and so forth. Obviously, not having ICU beds creates a knock-on effect and a trickle-down effect. If there is full capacity at ICU level, that will have a knock-on effect in terms of bringing people out from the ICU into hospital wards.
Another issue to which the audit referred was the staffing of ICU beds. For every ICU bed, six well-trained clinical staff are needed. The audit pointed out that, in order to keep and retain these staff – which is a big issue in our public health system - there must be incentives to keep them. I wish to hear the Minister’s views in that regard.
I have been looking at the ratios. The OECD average is 12 beds per 100,000. When neonatal units, paediatric beds and level 1 beds are included, we get to approximately 11 beds per 100,000. It actually goes way up. For whatever reason, however, we do not count all of them in our OECD submission. We are going on the baseline, that is, the 2018 baseline set out in the report which examined what was needed in Ireland, and we are exceeding it.
As to the Deputy’s point on highly skilled staff, I could not agree more. In fact, in opening the beds we have opened during the lifetime of this Government, we have recruited nearly 800 extra staff into critical care alone. These are incredible staff who are highly trained and who deal with very complex health situations which are, sometimes, very emotionally and personally difficult. They really are extraordinary staff and I take my hat off to them. I meet them around the country. They are incredible healthcare professionals. I fully agree with the Deputy. We have hired nearly 800 so far. The plan is to keep going in order that we can open more of these ICU beds.
I accept that. I said from the outset that there has been progress in respect of ICU beds. The report referred to the issue across our health system in retaining staff who are trained here and who may emigrate and so forth. There are mitigating circumstances in this regard such as the work-life balance and staff getting accommodation in built-up areas like Dublin, Cork, Limerick and Galway where many of these beds are located. That is having a knock-on effect. Other countries have incentivised staff, whether that is retaining staff or bringing staff from overseas. There has to be imaginative ways to keep staff in terms of the cost of living and accommodation. If that can be done, people will stay. Accommodation is one of the factors for people not staying. Although it is not a simple thing, if it can be addressed, a lot of staff will stay in the Irish healthcare system.
I wish it were simple.
Yes.
While this is an issue, it is not an issue in all of our hospitals. In the context of some hospitals, the cost of living in the local area is much lower and rents and house prices are much more affordable. However, as Deputy Kenny has said, in some parts of the country, it really is an issue for someone on, say, an ICU staff salary, whether that is an ICU nurse or ICU healthcare assistant. It can be difficult. There is no question about that. The good news is that we are significantly increasing our nursing graduate places. From the start of this Government's term of office to the end, we will have gone from approximately 1,800 first year entry places to approximately 2,500. That is approximately 700 extra places per year, and we are going to continue to grow. We need to double the number of nursing places. We must have a situation whereby people want to work in the HSE. Approximately nine out of ten graduating nurses either start work in Ireland or, after a few years abroad, come back here. However, I fully acknowledge the cost-of-living issue is one that the Government and everyone in the Oireachtas need to keep working on.
7. Deputy Gino Kenny asked the Minister for Health if he is aware that an organisation (details supplied) stated that over 604 patients were treated without beds in Irish hospitals on the Wednesday after the June bank holiday and that this level of overcrowding, which is now consistent and continuing into the summer, at a time when winter respiratory infections are not circulating, indicates that the system of hospital avoidance is not effective and that, at a minimum, the HSE must significantly increase the number of acute hospital beds before year-end; and if he will make a statement on the matter. [25789/24]
Is féidir linn bogadh ar aghaidh go Ceist Uimh. 7 in ainm an Teachta Gino Kenny, arís.
This is the Gino Kenny show at this stage. My next question is about the statement by the Irish Nurses and Midwives Organisation last week on bed capacity.
More than 604 patients were being treated without a bed in Irish hospitals last week. That is completely unacceptable and is a continuous thing. We cannot have people without proper provision in our hospitals because that will have a detrimental effect on their well-being.
On the day in question, the HSE figure was 401 patients between those in emergency departments and those in the wards. Regardless of whether we use the INMO figure or the HSE figure, both are still far too high. I met the emergency department task force earlier this week. There is a new approach we put in place last year. Many emergency departments, many patients and their families, and many of our staff are still under very significant pressure. However, I do want to acknowledge that our healthcare workers are getting on top of this. The Government has invested a lot of extra money. We have hired a lot of extra staff and added a lot of extra beds in the community and in the hospitals, but ultimately, any credit for the improvement must go to our healthcare workers.
Putting aside UHL for a minute because it is entirely on its own in the increase in numbers, for the rest of the country combined, in spite of thousands more people coming into the emergency departments - we have had a 10% increase in the number of patients coming into emergency departments and being admitted - there has been a 20% reduction in the number of patients on trolleys. That is still not enough but, in fairness, that is a 30% spread between 10% more people coming in and 20% fewer people on trolleys. One very experienced emergency department doctor said it was the best turnaround he had seen in his many years of practice. The credit for that goes to healthcare workers. UHL is in a completely different space and we are taking a range of actions with it that are way above what we are doing with any other hospital.
We will continue with this work. We need to continue adding beds and we need to continue building up not just the emergency department teams but the hospital teams and the acute teams. We will continue putting in discharge options, home care, led by the Minister of State, Deputy Butler, and community beds. We have to keep that number going down. It does take time but we are moving in the right direction.
I accept that there has been progress in this regard. However, especially at bank holiday weekends, there seems to be a spike in the number of people who cannot get a hospital bed. The figure of 404 or whatever the actual figure is, is too many. We have the situation of hospital beds in the Irish public health system, which is a legacy issue. We all agree there needs to be more bed capacity in Irish hospitals. Since the 1980s and 1990s, there has been a serious reduction in the number of hospital beds per head of population. The recruitment freeze is having an effect on morale because if people want to access the public health system, the capacity is not there at this time. I would like to hear the Minister's views on this
There are a few issues there which I will cover. First, there is an acknowledged deficit in the number of beds. The Deputy will be aware that, two weeks ago, we launched the new business plan, which includes 3,500 beds on top of the 1,200 that have already been opened. This Government will either have opened, have under construction, or now have fully committed to, on a site-by-site basis, almost 5,000 extra hospital beds. This is a transformative number of beds. As the Deputy quite rightly says, we have to staff them. The new development funding has been put in place. New posts are being created for the new beds, so the hiring embargo is not affecting our ability to open the new beds. It is putting our healthcare workers and services under pressure in other ways, but not when it comes to the beds.
The other thing we must keep the focus on when it comes to getting our emergency departments to where they need to be is reform. We are putting in place very significant extra capacity and have been doing so for a few years. The hospitals that are winning, those that are reporting no trolleys or a very small numbers of trolleys, are those that have embraced a different way of managing patient care. We need all hospitals to be doing that.
The INMO appeared before the health committee two weeks ago and painted a very stark picture regarding capacity. The organisation is calling for thousands of extra beds in the public health system. It laid out where the deficiencies exist in the health system. INMO members are the people on the front line. The representatives focused on the lack of beds in the Irish health system where there has been a reduction in the past three or four decades, and it can be seen that Ireland is playing catch-up all the time. I know progress has been made but there needs to be more in terms of hospital beds in the health system.
For years the INMO has been calling for an extra 5,000 beds, and we are adding nearly 5,000 beds. I did not see the glowing press release from the INMO welcoming all of this, but its members and doctors across the country whom I talk to are very happy with the new beds plan, partly because of the scale of it. It is beyond what people were expecting. People are expecting about 1,500 beds and it is 3,500. Also, we have done this on a regionally balanced basis. In the mid-west, for example, where UHL is, when this Government came to office, the region had the lowest number of beds per head of population of any region. With this plan, it will have the second highest number, so it is much more balanced. The regional inequalities we have seen around the country, particularly on the west coast, from Kerry to Cork and Limerick right up to Letterkenny in Donegal, are all being addressed through this plan. I repeat that we need beds and capacity but reform and increased productivity are also required.
9. Deputy Paul Murphy asked the Minister for Health if he is aware that an organisation (details supplied) states that many funded nursing vacancies arising from staff retiring, leaving or going on maternity leave are remaining unfilled due to the recruitment freeze and that this is happening when there is unprecedented demand on our health services, meaning that various departments and community services are short-staffed; and if he will make a statement on the matter. [25758/24]
I will be happy to get the Minister's answer on this question, so I will skip my 30-second introduction.
I want to make sure I am addressing the correct question.
It is Deputy Paul Murphy's question on nursing vacancies.
I am taking his question as well, just to make things more complicated.
The number of nurses in our health service has been increasing dramatically in the lifetime of this Government. Since January 2020, right across the health service we have increased the number by almost 29,000 whole-time equivalents. It really has been a huge increase. Deputy Murphy asked specifically about nurses and midwifery. In the lifetime of this Government, the nursing and midwifery workforce has grown by nearly 10,000. This has been much needed and they are doing huge work. A 10,000-person increase in nursing and midwifery staff is very significant.
When it comes to the embargo, it is so frustrating. We funded the HSE last year to increase the workforce by 6,000, a record number. The HSE did not stop at 6,000; it kept going to increase the number to 8,000. We now have more than 2,000 extra staff in the HSE for whom there is no funding for their salaries. Obviously, we are still paying their salaries, but there was no funding allocated for their salaries so action needed to be taken. It may come as a surprise to many that, in spite of the embargo which we want to resolve and move away from as quickly as we can, actually, the number of nurses in the HSE this year has increased by about 500. For certain posts where somebody might have retired or resigned, a hospital might be told a post cannot be filled for now, although we know they are using agency workers at a level they have never used them before either, so a lot of agency staff are being brought in for those posts.
In spite of that, there are 500 more nurses working in the HSE today then there were on 1 January. I will come back on this in my response.
I thank the Minister. In certain areas, there are pressures on staff. Probably one good example is public health nurses in CHO 7. In CHO 7 in Clondalkin and Lucan, there are no public health nurses whatsoever. This is very worrying. I got a response to a parliamentary question on why public health nurses could not be recruited and the reason was that new public health nurses just could not be recruited into that area. That is extremely worrying. If you do not have public health nurses looking after young children or elderly people, this will have a really bad effect on public health. I have spoken to the Minister of State, Deputy Butler, about this and it is one area that has to be addressed and that gap closed off for public health nurses, not only in CHO 7 but in other areas as well.
I thank the Deputy. I fully agree, and we had a debate with his colleague Deputy Smith recently on exactly this. There are parts of the country where they have found it very difficult to recruit or replace public health nurses. It is not something that can be allowed to stand. Public health nurses are doing essential work with infants and with older people. We cannot have babies for whom the developmental checks are being missed. We cannot have mums and dads who cannot avail of the supports for their babies that the public health nursing teams provide. I do not disagree with the Deputy that there are parts of the country and of Dublin where it has been very difficult. The point we made last time was that this was the inverse care law at play. Parts of the population who need the most help are actually getting less than other parts of the population. It is something I have asked the HSE to look at as a matter of urgency and to look to redeploy or bring in cover if necessary. We simply cannot have a situation where developmental checks, for example, are being missed.
8. Deputy Catherine Connolly asked the Minister for Health further to Question No. 33 of 2 May 2024, to provide an update on the recruitment of the required staffing resources to ensure Clifden District Hospital can remain open on a permanent basis; and if he will make a statement on the matter. [25537/24]
I am glad the Ministers are here. Táimid ar ais arís go dtí an ospidéal sa Chlochán. I am asking for an update for the recruitment of the required staffing resources to ensure Clifden District Hospital will remain open on a permanent basis. Will the Ministers zone in on that in their contributions?
I put on record the Deputy's constant advocacy regarding Clifden hospital which I was delighted to visit last year. We know there has been challenges in staffing so I will focus on that. Following a derogation I secured, I am pleased to inform the Deputy that HSE community healthcare west has now successfully recruited the required staff to safely reopen Clifden District Hospital. The hospital currently has seven beds available, of which five are occupied, and two are available to support University Hospital Galway for discharges. Staff have been recruited through the use of agency staff as a temporary measure as the HSE completes the recruitment process for staff identified through local panels for nursing and healthcare assistants. The recruitment process is expected to be completed by September 2024. They are currently dependent on agency staff again but the recruitment process is under way. To maintain those seven beds, which is hugely important, the five respite and the two step-down beds from University Hospital Galway, having permanent staff in place is the way forward.
Management in the HSE community healthcare have liaised with the local management in Clifden District Hospital to ensure the reopening of the beds in Clifden is on a stable basis and that the rosters in both St. Anne's community nursing unit and in Clifden District Hospital can be maintained at safe levels to provide both short- and long-term care in Clifden. This is an area on which I have engaged consistently with the lead for older people in the HSE, Mr. Des Mulligan. They know in no uncertain terms that I will not accept these beds not being open. They are so relevant for supporting older people to be able to live well in their own communities and having that vital respite. We have been challenged in the Galway area getting respite beds open, as the Deputy knows, but I am pleased to say the recruitment will be finished by September.
I thank the Minister of State. It is not a mutual admiration club but I want to pay tribute to her own hands-on approach. Having said that, this hospital has been limping from week to week. Back in October 2022, which is almost four years ago, it was announced that Clifden hospital would be closing. It was a terrible blow and all of the local representatives, those from Fine Gael, Fianna Fáil and everyone, were in. I pay tribute to them all. There were public meetings and the sense of frustration at those meetings was just palpable. It has limped on from October. It is not a good position to be in that it is limping on. It closed in February of this year and it reopened in May with a few beds and a small number of staff. The Minister of State herself has referred, as has the senior Minister, to the number of agency staff that are now being used. We have gone full circle again. We tried to stop agency staff and we are now back. We in the Opposition find ourselves saying we should take any staff, which is not a good way to run any system. I will not go over time. I will come back in.
As the Deputy knows, the HSE community healthcare west is committed to the new 40-bed community nursing unit in Clifden. The new CNU build will amalgamate the residential services currently in Clifden hospital and in St. Anne's. The new build will allow long-term care currently provided in St. Anne's and convalescent step-down care currently provided in Clifden hospital on the one site. The project is currently going through the planning process. Later on today, I am travelling to Roscommon to turn the sod on another CNU we are developing at the former Sacred Heart Hospital. It is really important for these CNUs that we have the whole continuum of care. We have the long-term beds, the short-stay beds, the respite, the convalescence, palliative supports and dementia supports. That is the complete focus on this. I am getting fortnightly updates from them regarding the planning. I want this to start sooner rather than later, especially on my watch while I am in this role, because that area of the country deserves a community nursing unit as much as anywhere else, whether it is Ballyshannon, Roscommon or Waterford.
Yesterday, there were 57 people on trolleys in Galway. I will be coming to this later during Leaders' Questions. I give forewarning to the Minister there and to the Taoiseach that I will be coming back to Galway later. There were 57 people on trolleys. Have any of us spent time on trolleys? If we did, I think it would be sorted out very quickly. We go back again. There are beds empty in Merlin Park University Hospital and in the heart of the Gaeltacht, sa Cheathrú Rua. There are empty beds and no staff. Then we have Clifden. In the middle of this, I welcome the progress but I am not sure what the decision is regarding Clifden District Hospital and that is the kernel of this. There seems to be a conflation of the two things. There is a new nursing home, which I welcome, although I am upset that it is going from 50 to 40. Initially, it was 50 beds; now it is 40. It seems to me the different answers being given are saying that the district hospital would close then. I am very concerned about that and so are the representatives on the ground. The local GP, Dr. Casey, is also very concerned, and he made a very strong case the night of the public meeting to keep Clifden open as a district hospital. It does - or did - a whole range of activities. I would really appreciate clarification on that and on when the complement of staff will be in place.
To go back again to the complement of staff, when the beds closed, I sought a derogation in person to make sure, because of the moratorium, that we could have permanent whole-time equivalents there. It is very important for older people especially that they have continuity in the staff they are seeing. My understanding, and what I want to achieve, is that 48 of 90 community nursing units are being reconfigured and rebuilt to a very high standard. This investment is approximately €35 million. As I said, and I cannot state it clearly enough, this will encompass what was the district hospital and what was respite rehabilitation in the St. Anne's section. It will be a whole continuum of care.
It will not be just long-stay beds like people under the fair deal. We have to be able to provide all the support, including respite, rehab and palliative care. A dementia offering is also very important and is something I am focusing on.
What will happen to the district hospital?
It will be amalgamated into the new community nursing unit. The new facility will include the long-stay beds currently in the district hospital, but my understanding is there will be no loss of service that is currently available in the district hospital.
10. Deputy Violet-Anne Wynne asked the Minister for Health his views on the increase in attendances at University Hospital Limerick, especially those who are in need of mental health support; and if he will make a statement on the matter. [25771/24]
What are the Minister's views on the increase in attendances at University Hospital Limerick, especially those who are in need of mental health support, and will he make a statement on the matter?
I thank the Deputy for her question. The Government has invested significantly in University Hospital Limerick, UHL. Since the start of 2020, staffing at the hospital has grown by more than 1,200, an increase greater than 40%, and more than 100 beds have been opened on the site. The Minister, Deputy Donnelly, is also keenly aware of the increasing demands nationally on our emergency departments and UHL has not escaped this trend, with a 10% increase in attendances from January to May 2024 compared with the same period last year. While a breakdown of data on reasons for attendance is not available, a proportion of those attendances will be for mental health.
Key service enhancements under way in mental health services in the mid-west will reduce the need for ED presentations for mental health reasons. These include an additional CAMHS team for the region, and a CAMHS hub, which is a consultant-led multidisciplinary support that is an alternative model to providing inpatient care, with treatment at home or in a day hospital. One of these is already operational in the west and it works very well. Supporting people with enduring mental health conditions in a day hospital means they can go home every evening, sleep in their own bed and have the support of their community and family. For those experiencing addiction or homelessness, key new services include a dual diagnosis team, commencing next month, to treat people who have a mental health diagnosis and experience addiction.
The Minister visited UHL again in early April and met with senior management, doctors and nurses. He announced a package of actions to alleviate the pressures at UHL and to support staff in implementing reforms to work practices to better suit patients.
In that region we will also shortly open a solace café or a kind of crisis café, which we have done in Cork and in Galway. We know from figures received that it reduces the number of people who need an intervention and they do not have to attend the emergency department.
I really appreciate all the information. It is welcome to hear about this solace café, the CAMHS hub and the additional team. I queried how many under-18s presented at the UHL emergency department with mental health issues and the data shows that the numbers have increased, which is a huge concern to me. In 2023, for example, 173 under-18s presented with mental health issues or as being at risk of suicide or self-harm. I believe they are presenting in crises and the emergency department is not the best environment for those cases. I appreciate the information the Minister of State supplied, which is very welcome. I have data showing there has been an increase of 14% in the people presenting at the emergency department in UHL versus the same period last year. Among the over-75s, trends show the presentations have increased by 15% and the number of patients on trolleys has increased by 49%. This is in stark contrast to the reduction in all other emergency departments. I know the Department is developing a national reform framework and I ask the Minister of State to speak to that in her contribution.
I will give a bit more information on mental health supports in the region. Since 2022, a total of 16.6 whole-time equivalents have been recruited across CAMHS in the mid-west. The number of CAMHS-registered consultant psychiatrists in the mid-west has increased to 6.2, up from 3.6. As the Deputy knows, we had challenges in that area due to retirements. I am glad to say we are back up to six there again. As I said, an additional CAMHS team is in development for the mid-west. We spoke previously about the challenges in the Clare area and the amount of travel. This will bring the total number of CAMHS teams to seven across the whole mid-west.
As I said, a CAMHS hub is in development. This is a consultant-led multidisciplinary support that is an alternative model to providing inpatient care, with treatment at home or in a day hospital. We have seen a spike in the number of presentations, with young people being referred to CAMHS teams. Having this type of alternative to an admission to hospital is very welcome.
We discussed this previously. After that team has been set up, we could possibly look at a further team for the west of Clare, just because of the geography and how far they are from other kinds of supports. The full-capacity protocol was triggered every single day of 2023 in UHL, again pointing to the emergency department not being the best place for those patients. I also queried how many people leave the emergency department each month of the year and the numbers were stark, with in excess of 500 people month on month. July showed the highest number at 656. It was significantly higher for UHL than any other hospital bar the three main Dublin hospitals. That again points to UHL being a major anomaly, as the Minister has indicated. In 2009, HIQA recommended the closure of Ennis Hospital as insufficient numbers of patients were presenting to maintain healthcare staff's clinical skills and expertise. However, we also know from the regional health forum that 25% of presentations to UHL, nearly 8,000 people, are from Clare.
I want to touch on the dual diagnosis service which is due to commence in July 2024. Last year I announced the new model of care for dual diagnosis, something Deputy Gino Kenny has raised with me on several occasions. This is the treatment of people with a mental health diagnosis who also experience addiction. We have also been working with the Department of Justice on this. It is important that people with dual diagnosis whom we divert away from prison get the appropriate support. The dual diagnosis service is due to commence in July 2024. This is the second one in the country, which is very welcome.
I want to speak briefly about the Pathfinder. When someone dials 999 for an ambulance and the paramedics come to their home, the Pathfinder is available in Limerick. It avoids the hospital emergency department. They come to the home and they are able to provide all the tests. They are able to provide IV drugs. They are able to do the blood test, urine dip and everything that is needed. The Minister, Deputy Donnelly, and I are anxious to continue to roll that out across the country. It really supports people's mental health when they can stay in their own homes in their own beds.
11. Deputy Gino Kenny asked the Minister for Health if the review planned by his Department of the medical cannabis access programme, MCAP, has begun; if so, when he expects it to be completed; and if he will make a statement on the matter. [25788/24]
My question is about the ongoing review of the medical cannabis access programme. As the Minister knows, the Health Research Board, HRB, did a very extensive review which was published in January. It recommended a number of progressive changes to the medical cannabis access programme, which at the moment is stagnant in terms of patients who can access medical cannabis treatment. I would like to hear the Minister's views of the review by the Department of Health.
I acknowledge the Deputy's ongoing advocacy and work in the Oireachtas on this issue. From a policy perspective, I want to take a very open approach to medicinal cannabis-based products. We want to make sure it is safe for patients, obviously, and we will always follow the clinical advice. Within that, I have told the Department and the HSE that there should be no idea of shutting these products down because they are cannabis-based. Let us follow the evidence and let us do what is best for patients.
On the initiation of the medicinal cannabis access programme pilot in 2021, the intention was to commence this review after five years, which would not be for another two years. However, I decided to bring the review forward. I do not think we need to wait for five years. My Department commissioned the Health Research Board to undertake an international evidence review as an important input to the process. Earlier this year, the HRB published its review, entitled The Efficacy and Safety of Medicinal Cannabis in Adult Populations. The next step in the review process is to establish a clinical review group. We have the report and it is a very good piece of work from the HRB. The clinical review group will be there to review the evidence the HRB has found.
My Department is now in the process of making the necessary arrangements to establish this group. The good news is that I anticipate the group will be set up in the coming weeks.
I had my head in my hands there because the level of despair about the lack of progress on this issue is palpable. Those who have been campaigning on this issue have been frustrated, to say the least. Since the legislation was introduced in 2019 and the MCAP was set up, only 50 people have received access to the programme. It is too restrictive. The HRB stipulated that it should expand to other conditions, particularly neurodegenerative conditions. The Danish medical cannabis access programme is much more extensive and includes conditions other than the three conditions that are stipulated under our programme. At the moment, some people have to go abroad to get access to medical cannabis products-----
-----and some people have to go to the black market, which is bizarre. Some people have to do without. That is just not acceptable when we have a programme that is up and running, but is largely stagnant in getting people access to these particular products.
I thank the Deputy. I apologise, I was just chasing up one or two bits for him there. I hear what he is saying about the campaigners and their demands for the process to move more quickly, and that is exactly what we have done. The process that was set out in 2021 was for the review to start in 2026. We were going to wait for five years to gather sufficient evidence. The review would then take a year, let us say. That means we would be into 2027. I have compressed all of that. We are now at a point in 2024 that we can do it, but the initial original timeline was for three years from now. We have accelerated it by three years. Having that working group in place in the coming weeks will be of assistance.
As with any advocacy in healthcare, there is an urgency on behalf of those who are campaigning. I want to say to them very clearly that we have heard them and that is why we have accelerated the process by several years. We have a good report, and we will have this expert working group in place in the coming weeks.
I think the Minister, personally, is a good supporter of this issue and that he wants to see progress. Who will be on that working group? Is there a timeline for when it will finish its work? In the past, we have seen groups being set up, and it takes forever for them to come back with recommendations. The HRB report does recommend that the programme needs to expand. If it does not, I do not think the programme will last. I do not think it will go anywhere-----
-----and that would be a huge shame. Whatever your doubts about medical cannabis may be, it can be a hugely beneficial medical intervention for some people and particularly for some conditions, although not all. Some people will use it for all conditions and that is their business, but there is really good evidence to show that we should expand this programme. If it does not expand, I do not think there will be a future for the medical cannabis access programme going forward.
I thank the Deputy. It is very clear that there are beneficial effects. We currently have four authorised cannabis products, namely Epidiolex, which 184 patients have now been prescribed, Sativex, nabilone and dronabinol. There are 184 patients on Epidiolex and, while I do not have the figures for the others, I know that is the biggest group.
We are taking it very seriously and we have accelerated the process. I cannot provide the names yet as that is still being worked through, but we are getting a chair and we are putting the group together. The Deputy can take it from me that we are progressing this at pace.
12. Deputy Violet-Anne Wynne asked the Minister for Health to provide an update on the newly announced additional beds he plans to deliver for Ennis Hospital and the mid-west region; and if he will make a statement on the matter. [25770/24]
I ask the Minister to provide an update on the newly announced additional beds he plans to deliver for Ennis Hospital and the mid-west region.
I would be delighted to do so, and I thank the Deputy for asking the question and giving me the opportunity. The new beds plan, as the Deputy will be aware, is for 3,500 beds, which is on top of the 1,200 that have already been delivered. It is a game-changer. Between those that have been delivered and those that are coming, there are nearly 5,000 beds. Critically, to the core of Deputy Wynne’s question, not only is it a really important increase in the bed capacity, it is also regionally balanced for the first time in a very long time. It was something I insisted on as part of this plan. As we all know, of all the various regions, the mid-west had the lowest number of hospital beds per head of population. This plan will bring it up to having the second-highest number of beds. I am genuinely happy to be able to say that there will be a nearly 80% increase in the number of hospital beds in the mid-west under this plan. I do not know the last time anything like that happened but I imagine we would have to go back a very long time. I hope the people of the mid-west see very clearly that this is the strongest statement of intent you could have from a Government regarding the future of healthcare, proper services, community-based services, hospital services, emergency departments that work for people and all the things we need in our service.
Specifically regarding Ennis Hospital, the increase is even bigger. We are nearly doubling the number of beds in Ennis Hospital. We are adding 48 new beds. There are 50 beds there now, so it is a 96% increase. We are basically doubling it. In terms of the experience for the patient, it is way beyond that. There are 50 beds there now, some of which are in the nightingale shared wards. The 48 beds being provided are state-of-the-art single-room en suite beds. We are therefore essentially doubling the bed capacity in Ennis Hospital on top of the investment we put in over the past few years.
This is a very welcome announcement for the region and it has been received very well locally. I agree it is a strong statement of intent and I want to acknowledge the commitment to increase capacity at Ennis Hospital. As we know, the population increase is in line with national statistics of 8%. That is a reality that needs to be planned for and delivered on. I know that a theatre upgrade was also approved and is due to be delivered in quarter 1 of 2026 and that planning permission is already in place. Will either project have an impact on the other? Will they be delivered side by side? Does one of them have to be prioritised over the other?
Procurement delays have been an issue in Limerick in particular and I do not want to see that happening in Ennis Hospital. It is often the case that until planning permission is granted the process is paused, which just seems like an unnecessary hold-up. October of last year saw all surgeries being cancelled in Ennis Hospital, St. John’s Hospital, Limerick, and Nenagh Hospital due to overcrowding in UHL. How can we guarantee that this unit will not suffer the same fate?
I thank the Deputy. I can be very clear that the beds plan will have no negative impact on the projects that are currently planned. We are doing both. It is part of an ongoing investment in Ennis Hospital, which really is going from strength to strength. As the Deputy will be aware, a new outpatient department was opened in 2021. Importantly, a new injury unit was opened in 2022. It is doing incredible work. As the Deputy will know, as part of the UHL response, we are moving to 24-7 medical assessment units, MAUs. We have already extended and are further extending the injury unit opening hours and standardising those. As the Deputy has said, we have the new theatre block. I am not aware of any blockages to that. The information I have from the HSE is that it is at detail design stage. It is in the capital plan, which has been published. We are simply getting on with it and we are doubling the bed capacity as well.
I want to acknowledge the good work that has been done, particularly in respect of geriatric emergency medicine, the unit at UHL, the expansion of nine treatment bays and 24-hour operations.
I believe that is very significant, especially because our region has a far greater number of those over 75 than any other region. The data shows that in the first quarter of this year, 617 patients were seen and only 36 required admission to the UHL emergency department. I acknowledge that the Minister secured step-down community beds, but more planning needs to be done on carers for over-75s and on keeping them out of the emergency department unless absolutely necessary.
The Minister has spoken about the phased expansion, which I had intended to asked about. He outlined that care has been extended until 10 o'clock or midnight, after which it moves to the 24-7 provision at the MAU. The number of presentations at the MAU has increased by 32% since the expansion in our region, which is significant.
Finally, I wish to point to the housing issue. Given the number of additional staff we are going to need, is the Minister considering any policy regarding key-worker housing?
We are keeping a very open mind to anything local hospitals want to bring forward in terms of proposals, with one important caveat, namely, the capital budget is what it is. The Government has expanded it very significantly in recent years, but in respect of any proposal relating to bed capacity, we would have to ask whether it would have a knock-on effect on any opportunities to increase services, whatever they may be, such as diagnostics, a new outpatient centre or a new ED. We need to keep a very open mind to it. I am conscious that healthcare workers throughout the country really are struggling either to buy a home or to rent. There is a separate conversation, obviously, about the work being done to resolve that, but when it comes to healthcare, we will certainly keep an open mind to any proposals coming from hospitals throughout the country.
13. Deputy Pádraig O'Sullivan asked the Minister for Health to provide an update on the status of the primary care centre in Glanmire, Cork; and if he will make a statement on the matter. [25702/24]
Will the Minister provide an update on the status of the primary care centre in Glanmire?
I thank the Deputy and acknowledge his ongoing work, advocacy and interaction with me to ensure this essential primary care service in Glanmire will remain a Government priority and be opened.
The provision of the new primary care centre in Glanmire is an absolute priority for the Government and the HSE. The centres, as the Deputy will be aware, play an essential role in providing integrated care and, critically, providing it to people in their own communities rather than making them travel to a hospital. The primary care centre in Glanmire is to be delivered via an operational lease mechanism and, following a selection process, a preferred solution was identified. A letter of intent issued to the developer in April of last year. There has been positive engagement between the HSE and the developer to move towards an agreement for lease.
The developer has confirmed to the HSE it is intended to lodge a planning application in the third quarter of this year, in the coming months. It is very welcome news that progress is being made on the development of the Glanmire primary care centre and it is expected to move soon to a planning application stage, which is very positive. I assure the Deputy my Department is very actively engaged with the HSE to progress the further development of the primary care centre in Glanmire and, indeed, of others throughout the country.
I thank the Minister and appreciate the update. As he will be aware, Glanmire is a fairly large community on the eastern side of Cork city, whose population, depending on how widely the area is measured, comprises 30,000-plus people, so it is critical we get that primary care centre delivered as soon as possible. The Minister of State, Deputy Colm Burke, and I visited the one in Ballincollig, on the western side of the city, last year, when the Tánaiste was cutting the ribbon on it. The services it provides for people there, such as eye care and outreach through Cork University Maternity Hospital, CUMH, are critical and have reduced the pressure on the nearby acute hospitals.
It is welcome we are still on track to be in a position to submit a planning application soon, and I urge the Minister to stay on top of it. The planning application was initially to be submitted in quarter 2, and while that has gone back to quarter 3, I would rather we got it right because, as we learned in the case of Blarney, not too far away, it is better to get it right than rush it. I urge the Minister to keep on top of it.
I have no doubt the Deputy will make sure I stay on top of this. I fully agree that these centres make a huge difference to the local community and we do need to get it right. In order that people are aware, when it has opened, the services we are going to have at the primary care centre in Glanmire will include public health nursing services, primary care physiotherapy, occupational therapy and speech and language therapy, dietetics, podiatry and home support services, so this really is going to be important for the constituency and the community. It is now full steam ahead to get in this planning application. We are ready and there has been very constructive and positive engagement with the developer. The centres that have been built are fantastic. I know that the Deputy has visited many of them, and he referred to the Ballincollig one. It is full steam ahead for Glanmire.
I thank the Minister. As he outlined, the comprehensive services that will be provided at the centre will be most welcome. I understand that a number of GPs are waiting patiently to see whether they can locate themselves there. It will be a fantastic facility when it is eventually built.
Separately, while the Minister might not have a response to hand, we are also awaiting a primary care centre in Mayfield, which is only a few miles up the road from Glanmire. It is not at as advanced a stage as the centre there, but the Minister might follow up with an update on it in writing if he does not have a response to hand.
I will certainly ask the Department to revert to the Deputy on the Mayfield primary care centre as a matter of urgency. I echo his positive comments about the new ophthalmology services out of Ballincollig. For many years in Cork, circumstances simply have not been acceptable, whereby people could not get access to cataract appointments in a timely manner, but we are making that a thing of the past and the investment in Ballincollig is one really important part of that. Further investment in ophthalmology is going on in the elective hospital in the city as well. Our intention, and we are now on the way, is that everyone in Cork who needs to be able to access cataract procedures or other eye care will be able to get that in a timely manner in their own county.
14. Deputy Duncan Smith asked the Minister for Health if he has plans to provide State funding to an organisation (details supplied) that is currently fully reliant on donations; and if he will make a statement on the matter. [25063/24]
Does the Minister have any plans to provide State funding to the Irish Lung Fibrosis Association to help it carry out its ongoing work?
I thank the Deputy for the question, and the Irish Lung Fibrosis Association for the work it does in supporting and advocating for patients. Lung fibrosis, as he will be aware, refers to a group of diseases in which scar tissue develops in the lungs. I have been advised by the HSE that the national clinical director for integrated care has requested that a scoping exercise be undertaken to review the evidence and assess the needs of people living with pulmonary fibrosis and to determine how and where their pulmonary rehabilitation should take place.
Once the needs of this cohort have been determined, the next step will be to identify the resources required to put this programme of work together. We want to identify the resources needed to implement a proper pathway of care for this patient cohort. There is an opportunity to do more for these patients than has been done. I encourage the Irish Lung Fibrosis Association to engage with the HSE during this process, and I have no doubt it will do so, to make sure the members and patients it represents have their voices heard loud and clear. The model of care should be built around them and around what they are looking for.
I have asked my officials to contact the Irish Lung Fibrosis Association directly and to support it in identifying various avenues for accessing existing funding. We had a good conversation about this and one of the points made to me by the Department was that of course the Government can look at this issue but the Department believes there are already pots of funding available from which the association may be able to benefit. For example, reference was made to the HSE lottery-run scheme. I have asked my officials to contact the association directly to support it and walk it through any applications that might go in.
That is encouraging. The support to access existing funding pots while the scoping exercise is under way is welcome. The ILFA appeared at the health committee in April and has made a request to meet the Minister. Its asks include: additional financial supports for patients; consideration of tax rebates and grants - I welcome the Minister mentioning the latter; State funding for ILFA programmes, which I am sure will be included in the scoping exercise; and the streamlining of the oxygen provision system. If the ILFA engages with the HSE, it can look at achieving efficiencies in the oxygen provision system and getting it to patients. It is also seeking the establishment of a dedicated interstitial lung disease clinical care programme to improve diagnosis and access to healthcare supports. This is a very good organisation and I acknowledge Matt Cullen, a friend of mine, who is one of its patient advocates and has advocated very strongly on their behalf. I welcome the Minister's response and hope the ILFA will see progress in those areas.
15. Deputy Pearse Doherty asked the Minister for Health what plans, if any, are in place to deal with the crisis in neurology services at Letterkenny University Hospital; and if he will make a statement on the matter. [25767/24]
My office has been inundated with demands for a dedicated outpatient neurology service provided by a consultant neurologist at Letterkenny University Hospital. The community neurorehabilitation team in the north west is seriously understaffed and operating with only one third of the required number of staff. This will not change until the HSE's recruitment embargo is lifted. That recruitment embargo was brought about by Government underfunding of the health service. Is it not time for better neurology services to be delivered for the people of Donegal and the north west? If so, what will the Minister do about it?
I thank the Deputy. With regard to the recruitment embargo, there is definitely a debate to be had about funding of the health service, but the recruitment embargo had nothing to do with this issue. In fact, the HSE was funded to a record level last year for an additional 6,000 staff but hired in excess of 8,000 staff. I do not want the recruitment embargo to be in place but this particular issue is not a funding issue, though other matters which we have discussed previously are related to funding.
I asked my Department to contact Letterkenny University Hospital to understand exactly from the hospital's perspective what it is that it is looking at. At the moment there is an outreach service for neurology into Sligo. The service is operated by three neurology consultants. There is a wider team of clinical and social care staff. The diagnostic work-ups and treatment are delivered from Sligo at the moment but, as the Deputy stated, there is a demand locally in Donegal for neurology services to be provided not in Sligo, but in Letterkenny.
To that end, there is an ongoing review of neurology services in the north west that is scheduled for completion in the coming months, in quarter 3 of 2024. I have asked my Department and the HSE to be very cognisant of what people in Donegal are saying and what the neurology teams in Letterkenny University Hospital are saying. We need to let that review run its course and see what recommendations come from it. If there are recommendations to increase the neurology capabilities in Letterkenny as well as in Sligo, we will look at them very seriously.
I accept that Letterkenny University Hospital currently provides clinics for patients with neurological conditions but it urgently requires a dedicated outpatient neurology service provided by a consultant neurologist. This is not the first time I have raised this issue with the Minister. He previously informed me the review of the neurology services in the north west was under way. The difference is that the review was supposed to have been completed by now. The last time the Minister told me about the review, it was supposed to be completed in quarter 2 of 2024 but now it is to be completed in quarter 3. All of this time, people in my county are being denied this service. According to the information the Minister gave me previously, the review should have been completed by now. He has just told me it will now be another three months, possibly four months, and maybe it will slip a little further.
The Department was informed of the issues with neurology services a long time ago. I believe the Minister sat on his hands. People have to travel to Sligo for treatment and, for many people, that is a significant distance. It is a 300 km journey for people who should have services provided more locally to them. Why has the review slipped? Why is there new information now that puts this review back further? Has the Minister asked why the review has not been completed at this stage?
I will ask the Department to revert to the Deputy directly on the delays and the date for completion of the review moving from quarter 2 to quarter 3. Let us see whether that delay can be managed down to just a matter of weeks.
This is not about the denial of any service. The service is being provided but, as the Deputy reasonably pointed out, it is a long way to Sligo University Hospital for many people living in Donegal.
The review is nearly complete. Let us get the review and see what it recommends. It may recommend a neurology post or two in Letterkenny University Hospital or a team that moves between Sligo and Letterkenny. Let us see what the review comes back with. We will take that recommendation very seriously and can look at doing it through new development funding.
It is not acceptable to make neurology patients travel so far. The campaign group Patients Deserve Better has outlined the impact of this, including the increased costs and waiting lists, as well as unnecessary hospital admissions when services are not provided locally. It is not just the campaign group, however. The HSE model of care report suggests there is a need for a consultant neurologist to provide neurology services at Letterkenny University Hospital.
This is just another example of Letterkenny University Hospital being in a perpetual state of crisis. Waiting lists for diabetes care have gone through the roof, with a range of unfilled vacant posts. In an unprecedented move last year, 100 GPs signed a public letter to the Minister and to consultants, saying that the hospital's emergency department was unsafe. There are huge waiting lists in dermatology services due to unfilled posts. Letterkenny University Hospital cannot go on like this. It is leaping from crisis to crisis. It needs further investment but, crucially, it needs to be upgraded as a hospital. That is abundantly clear and it is one of the main reasons we cannot recruit people into positions. It seems as if I could raise another crisis at Letterkenny University Hospital with the Minister every week. This issue needs to be dealt with in its entirety. The upgrading of the hospital is probably one of the steps that need to be taken without delay.
The reality is that although there are ongoing pressures on certain services at Letterkenny University Hospital - I fully accept that and have visited the hospital many times - there has been a very significant increase in capacity in the hospital and in services delivered by the hospital in the lifetime of this Government. The budget has increased by a quarter. The number of staff has increased by a quarter, growing by 437. There are 437 more healthcare workers working in that hospital compared with when the Government came into office. That is a very serious statement of intent of investment and growth for the people of Donegal and Letterkenny. Probably most important, the Deputy will have seen the new beds plan. Between the beds we have delivered and the extra beds we have now committed to, we are looking at an extra 122 beds at Letterkenny University Hospital. Do we need to continue to focus on the ED? We do. Do we need to continue to focus on the neurology, oncology and diabetes services the Deputy and I have spoken about? We do. I want the people of Donegal to be very clear that there is much-deserved, much-needed and very important ongoing investment and growth in Letterkenny University Hospital
16. Deputy Duncan Smith asked the Minister for Health if he has plans to introduce a consultant-led helicopter emergency service that would bring lifesaving expertise to the scene of crashes rather than waiting for the injured to arrive at a hospital; and if he will make a statement on the matter. [25062/24]
What are the Minister's plans to develop a consultant-led helicopter emergency service that would bring lifesaving expertise to the scene of crashes and accidents? It was news to me that Ireland is an outlier among our European counterparts as regards this service. It is something we need to provide. I think the Taoiseach or the Minister has made positive comments on this matter. I would welcome an update.
I acknowledge the excellent contribution our National Ambulance Service, NAS, teams make in delivering emergency care right across the country.
Helicopter emergency medical services, HEMS, are consultant led and paramedic-delivered in Ireland. The NAS provides two dedicated HEMS aircraft, including one aircraft operated in conjunction with the Irish Air Corps. Also, the Irish Coast Guard provides aeromedical support to the HSE in addition to the services already mentioned. HEMS provide fast-access, lifesaving pre-hospital emergency care interventions. Currently, HEMS services are crewed by highly trained and qualified advanced paramedics. The HSE is aware that a variety of crewing models are used around the world depending on geography, distance travelled and other factors. The NAS is proceeding with a previously planned feasibility study to look at the suitability of physician crewing on NAS HEMS aircraft.
A number of emergency department consultants, some of whom have returned from the UK and are working in Ireland, are talking to many politicians - I know this because they are all talking to me - and trying to bring about a change to how this is done. We are not committing to any changes at this point because we are committing to a review. Maybe they are right and maybe they are not. Maybe they are partly right in that there is an augmented model we need to use. We are aware of it. I have had conversations with quite a number of members. These consultants are very politically active and are making a strong case. It is a model they have seen work very successfully in the UK and maybe further afield and they believe we should bring it in here. We are taking their expertise and submissions very seriously and are reviewing the model to see if it is one we should move towards.
I agree with what the Minister said in terms of how highly skilled our advanced paramedic teams are and the level of care they provide at the scene of accidents and crashes. However, having examined this consultant-led model, I think it is one we need to look at because there are things consultants can provide that cannot be provided by advanced paramedics such as anaesthesia to protect the brain, blood transfusions and accessing major blood vessels to stop haemorrhaging, so it is something we should explore. It is in the space of road safety as well. As we have spoken about in many debates at committees and in this Chamber, the numbers of road deaths and serious injuries are going in the wrong direction again. It is incumbent on the State to do everything it can to provide the best possible health service and if that means consultant-led services at the scene of a crash or accident, I hope this State would be able to provide that.
It is something we are taking seriously. We are looking at it. Essentially, the question is whether it is consultant-led or consultant-delivered. Is there a consultant in the background or is there a consultant on the helicopter? The argument is that if we have an emergency medicine consultant on the helicopter, there will inevitably be cases where the patient will get a higher level of care. In some cases, that might make all the difference. We must ask a balancing question about what the position would be if that consultant was in the local emergency department. In those circumstances, would other patients get the increased level of care on offer from emergency department nurse to non-consultant hospital doctor to consultant? There are about 150 emergency medicine consultants in the country. The question is where they are best deployed in order to do the most amount of good for patients. We are actively looking at this proposal.
