Public Accounts Committee: Dept. of Health

Full Transcript:

Deputy Marc Ó Cathasaigh: I thank the witnesses. I have a number of issues but I want
to pick up on something other Deputies raised, relating to the CDNTs and CAMHS. As a member of the autism committee, I know there is a huge issue whereby, when someone arrives with
an autism diagnosis, they are referred out of CAMHS and into the CDNT. CDNTs are a black
hole at the moment. I have to concur with Deputy Murphy. My experience of trying to make
contact with certain CDNTs to try to talk about individual constituents has not been a good one.
When someone speaks for a long time, sometimes some of the things they say will not stack
up, and I made a note of something Mr. Gloster said. He stated children cross over and back
between services, but that is not my experience at all. Children do not cross over and back
between services. I want the CDNTs to work. I want that multidisciplinary approach to work,
for children in particular. I could point Mr. Gloster to a school in the centre of Waterford city
that has children from three city CDNTs. When I look at the work we are trying to do to get
our RHAs to map more closely with our CHOs, I see the fragmentation that is happening with
the CDNTs whereby one school will refer children to three different teams and the teachers are
tearing their hair out trying to get services. I do not mean to be overly parochial, but my home
parish, Butlerstown, is about 5 miles from the city centre and parents have been told their child
is now being referred to Dungarvan because they are regarded as living in part of the county.
We have to intervene with Ministers to avoid children being put into that position.
Unfortunately, when Mr. Walsh was answering the question earlier, it sounded terribly like
civil servant speak. He referred to a “roadmap plan”. These are relatively new structures, and
I am hearing about a lot of people who work with the CDNTs leaving. They are leaving to go
to private practice and, contrary to some narratives, they are not going to private practice because they want to cash in. They are leaving because they are incredibly frustrated, and they
are frustrated because they are not getting to see children. They are engaging in huge amounts
of administration, they are not getting to see children and the whole structure is not working
for them. As I said, I really want this to work for children. I echo some of the points made by
Deputy Murphy about eating disorders and provision for eating disorders within the south east.
It is very difficult to get access to services. We do not really want children to be in acute beds,
if we are honest. That is not a good place for them or a good solution.
Where are we with this? The phrase “roadmap plan” just makes it sound more distant than
ever that we will have some sort of seamless way of referring children to services that are so
critically needed.
Mr. Bernard Gloster: First, to clarify, what I meant about “over and back” was not that
children go over and back but that the issues cut across both services and, indeed, more widely.
When children have many complex needs, there are often arguments between services as to
which service is the most appropriate for the child. I have a very clear expectation that all the
services of the State should work together to support the child and the family. Children rarely
live in one particular item of need. That is a huge problem for us, and—–
Deputy Marc Ó Cathasaigh: I am sorry to interrupt, but this is especially true of autism.
When there is an autism diagnosis—–
Mr. Bernard Gloster: Completely.
Deputy Marc Ó Cathasaigh: —–you think to yourself, “My God”. We know there is a
strong link between mental health and autism, yet they get locked out of the mental health services and it is awful on parents.
Mr. Bernard Gloster: Yes. In respect of the case of the school in Waterford that the Deputy
cited, I am the first to admit, and I will put my hands up in saying, that the south east is particularly challenged with the model, more so than other parts of the country are. I am very anxious
to get behind that and I have met people there myself. I am anxious to try to improve it. I have
met people who left teams, in a very safe way, to allow them to tell me exactly why they left. I
really am trying to get under the bonnet of this but the solutions are not simple. We struggle to
a huge degree to provide responses to children with autism and to families as a result.
I accept the point about the terminology and language we use. To be fair, the roadmap is the
roadmap – it is officially called that – because it sets out the milestones by which we are accountable, the first of which was that new, accelerated recruitment campaign two weeks ago, which I
talked about earlier. I am not proud of where we are in our response, but I am in no doubt that
we are making improvements.
Deputy Marc Ó Cathasaigh: I think we would all like that to come to pass. I will stay on
the south east, given Mr. Gloster mentioned it. The reconfiguration of the new RHAs is welcome. The more quickly we can get them to coherently shadow the CHOs in order that we will
get that linkage of services, the better. Under the reconfiguration, however, Limerick hospital
anchors the mid-west, which has the smallest population by far among the regions, Galway
hospital anchors the north west, Cork hospital anchors the south west but in the south east, we
have to refer all the way to St. Vincent’s hospital in Dublin. I know the decision was made in
2019 but we have a model for a hospital in Waterford. We have a population of 600,000 who
live within an hour of that hospital, which is in excess of the population that relates to the midwest. Who made the decision in 2019, and why was it made, not to build the south-eastern
regional health area around Waterford and adequately resource UHW to be able to answer the
health needs of the region?
Mr. Bernard Gloster: I do not think it is a case of it being built around St. Vincent’s. The
hospital groups have been split in the new geographical areas, and St. Vincent’s is one part of
that, but all the other services in the south east remain. There has been investment in Waterford
hospital and there is no intention of not investing it in the future in deference to St. Vincent’s or
anywhere else. That is not the purpose of the regional construct at all.
Deputy Marc Ó Cathasaigh: Historically, we have suffered through the link with Cork,
and there is concern in the region, which is well founded, that we are going to suffer—–
Deputy Marc Ó Cathasaigh: Historically, we have suffered with the liunk with Cork, and
there ius concenr in the region
Mr. Bernard Gloster: But you will be separate from Cork now.
Deputy Marc Ó Cathasaigh: We are going to be separate from Cork now.
Mr. Bernard Gloster: Yes. I have already spoken to the new executive regional officer,
Martina Queally. I expedited her appointment in the south east last Monday. She herself will
not even have one base to either prejudice one part of the region or the other, as it were. I think
you will see a lot of very good engagement and progress there. I am very confident it is a region
that can work and it needs to work.
Deputy Marc Ó Cathasaigh: It absolutely does for the people of the region. There are
600,000 people, as I said, within an hour of that hospital.
I will stay on that particular area before I go to more generalised questions. The 8 a.m. to 8
p.m. cardiac service across seven days of the week, as we know, is an extremely important topic
in Waterford. I had reason to be glad of the 8 a.m. to 8 p.m. service over Christmas rather than
the 6 p.m. cut-off that was there previously. Deputy McAuliffe spoke a lot about funded and
unfunded posts. Is the recruitment we need to move to an 8 a.m. to 8 p.m., seven day a week
service, funded? Will that happen?
Mr. Bernard Gloster: I am not sure if the chief clinical officer knows exactly the plan on
the percutaneous coronary intervention, PCI, service there. It is not a question of unfunded
posts, I do not think. I am not exactly sure on the detail of that now.
Dr. Colm Henry: There is no question that those posts are embargoed at all. They are important clinical posts to provide the 8 a.m to 8 p.m. service.
Deputy Marc Ó Cathasaigh: Are they in place?
Mr. David Walsh: I am not sure. I will have to come back on that.
Deputy Marc Ó Cathasaigh: When in Waterford, you hear about recruitment embargoes.
I think Deputy McAuliffe did a very good job of myth busting that a little bit. When people in
the south east hear about recruitment embargoes in the context of a service we fought so hard
for, people worry. Are we content that we are moving to that 8 a.m. to 8 p.m., seven day service?
Mr. David Walsh: I will come back with the report but that is our plan.
Mr. Bernard Gloster: The predominant requirement for 8 a.m. to 8 p.m. is both cardiac
nursing and consultant cardiologists. The embargo does not impact on those.
Deputy Marc Ó Cathasaigh: That is very good. It is the clarity that I need.
I want to raise a couple of issues across two heads. In B.1, there are two items jumping out
at me where we did not hit the spend we would like. Women’s health research and mother and
baby homes research. Under E.1 developmental, consultative, supervisory, regulatory and advisory bodies, there was an underspend or postponement to supports for Thalidomide survivors,
women’s health taskforce initiatives and Nursing and Midwifery Board of Ireland developmental projects. You can see the common theme in them.
Mr. Bernard Gloster: Dr. Henry or Mr. Mulvany can speak about some of the specific
issues on women’s areas. In general, in 2022, hitting all the spending targets in certain programmes was slowed and delayed because we were still on the outdrift of Covid and the reprioritisation of services.
Deputy Marc Ó Cathasaigh: You can see, though, in the specific ones that I picked that
there is a trend there. It is all around women’s health.
Mr. Bernard Gloster: Yes but maybe I can assist the Deputy. The research on the mother
and baby homes is something I am very familiar with from my previous life as CEO of Tusla. I
think events overtook that in terms of the response to the Mother and Baby Home Commission
reports.
On women’s health, is there a specific reason on the research side for underspend, Dr. Henry?
Dr. Colm Henry: No, not for progressing with establishing the six maternity networks or
sustainable consultant funding. There has been considerable investment in midwife appoint-
ments and expansion of gynaecology ambulatory clinics. There has been substantial investment and expansion of both obstetric and gynaecology services in recent years to make them
more sustainable and safer.