Hospital Waiting Lists
112. Deputy David Cullinane asked the Minister for Health her plans to reduce children's orthopaedic waiting lists; when the independent clinical review of spinal services at Temple Street is likely to be published; and if she will make a statement on the matter. [24428/25]
What are the Minister's plans to reduce children's orthopaedic waiting lists? When is the independent clinical review of spinal surgeries at Temple Street likely to be published? I have a number of other questions that I will get to when I respond to the Minister.
I thank the Deputy. I will update the House that I have now met all of the advocacy groups representing the children, young people and families affected by spinal conditions. I thank them sincerely for their time and their honesty. I have heard directly from them about the impact that gaps in communication and long waiting times can and do have on children and families and I have assured them of my commitment and the commitment of this Government to improving paediatric spinal services.
By way of background, the House will be aware that more than €30 million has been allocated to reduce waiting lists in this area over recent years. Targeted initiatives have been making some difference in how we deliver spinal services. It is important to point out that CHI has a ring-fenced theatre providing dedicated capacity. GPs can now access a clear referral pathway to prioritise urgent cases. Additional outpatient clinics have seen more than 600 new patients, which has reduced the waiting list for initial assessment by 40% year on year. We need to maximise capacity. Surgeons have been given the pathways to do so through national and international outsourcing.
These initiatives are driving some progress. In 2023, 513 spinal surgeries were completed, which represents a 35% increase on 2019. The initiatives are delivering results for many children and families, although I accept not for all. The number of children waiting longer than four months dropped by 37% last year. At the end of April, 68 children remained on active spinal waiting lists for longer than four months. This is an 18% reduction compared with last year. However, as I have told the House before, what matters is the Sláintecare targets.
We must not let the numbers distract from the reality. Progress on the part of CHI and the people in charge of delivering these surgeries has been too slow. Too many children are still waiting. The operational plan I received for spinal services did not propose a significant level of activity to meaningfully address the waiting lists or a level of activity that is commensurate with the level of investment that has been put in.
When I met the CHI board on 14 and 28 April, I made it clear that addressing these waiting lists is a top priority and that we need a new and much more ambitious plan. I have asked for a revised plan to be submitted without further delay that effectively addresses the waiting list, obviously with the focus on the longest waiters and recognising the various levers that have been provided to the Government.
As far back as 2017 the same families were told that this was a top priority. The Minister might recall that Simon Harris at the time gave a clear and unequivocal commitment to reduce waiting lists and that no child would wait longer than four months. That point was restated by the next Minister for Health, Stephen Donnelly. He said that by the end of the year just gone no more than 20 children would be waiting longer than four months. The figures, of course, tell a different story with 3,400 children on waiting lists for their first orthopaedic outpatient consultation, 230 children on spinal surgery waiting lists and 137 active waiters. There are now 48 children who are waiting six-plus months for their surgeries. As this has increased from 37, rather than going down the number of people waiting has gone up.
I asked the Minister also about the clinical review in Temple Street, which is being carried out by Mr. Nayagam. I have asked about this review time after time. When are we going to see it? There is no draft or interim report and no update. I know these things take time but it is really important to restore confidence in Children's Health Ireland, CHI, so that we get some sense as to when these reports will be concluded, and that we can see what is in them.
I will respond to the second part of the Deputy's question. In respect of both reports the Deputy and I await, which are very important reports that everybody is entitled to see, I am given to understand by CHI that it expects to receive them very shortly and in the next number of weeks. I feel as though I have said that before, however, and I really do expect to receive them. As I have said to the House previously, it is not directly within my control but I do expect to receive those very shortly.
On the broader question of addressing the lists and the times, as we discussed previously, the more referrals and more outpatient clinics there are, the more people will be added to the waiting list. That is okay. What is not okay is the duration of time they are waiting. To be clear, the Government has provided significant additional funding, which has resourced an uplift in staffing and provided additional infrastructure. If Deputies opposite were saying there was no theatre or there was no ring-fenced bed or there was no increased access to MRI or there was no additional surgeons or provision for it or if they were saying there was no investment enabling national and international outsourcing to three additional sites in Ireland, as well as two hospitals abroad in the UK and the US, I would accept all of those things but all of those things have been done and there is no excuse for not getting on with dealing with the cases that need to be dealt with.
The Deputies are simply saying that eight years ago, promises were made and here we are with these issues still not resolved and waiting lists nowhere near where they should be. I want those waiting lists to come down. I want children to get the services they need. I was not the one that made the promise. I certainly was not in the room when commitments were given on what capacity would be needed to meet those promises. I can only hold the Government to account based on where we are at the moment.
The Minister raised the issue of hip dysplasia in that report as well, or a review she is waiting on. The Minister will know that I received a response to a parliamentary question this Friday gone, which was covered in the media today. It says that the letters that issued in recent weeks in relation to families and patients who had hip dysplasia procedures since 2010 were to provide reassurance and information about the audit and to ensure all potential cases were included. I do not know what that means and it has not been properly explained. We have been chasing CHI to give us this information time and again but we still do not know. Nobody has answered the question as to how many letters were given to parents. Surely to God CHI has that information, can give it to the Minister and then the Minister could tell parents and families. I do not know why that information is being concealed from us. In my view there is no good reason as to why that should be the case.
We are making the same case with regard to CHI and spinal surgeries. I am simply making the point that surgeons have to respond to the investment that this Government and this House has put into the services. I expect them to do that.
On CHI and the hip dysplasia, it is a matter for CHI to give that number and to be able to confirm that. I will use every power I have to make sure they do that. I will request they publish that number and there is no reason not to. By way of caveat, I do understand that the reason for the numbers going back to 2010, which I gave to the Deputy in reply to a parliamentary question, is that any follow-up requirement relates to skeletal maturity, which is typically around 15 years of age. This is a clinically based decision as opposed to any other set of criteria. It is really important that CHI confirms the number of letters it has sent. It is not just CHI, it is also Cappagh hospital. They are two different numbers. I expect CHI to provide that and that the HSE would have provided that by now. I expect this information to be clear but I do expect it will continue to evolve. The most important thing is that we get the report, which will stand us all in much better stead on the next steps we must appropriately take.
Medicinal Products
113. Deputy Marie Sherlock asked the Minister for Health the action she has taken to ensure that community pharmacists will administer the free hormone replacement therapy, HRT, scheme from 1 June 2025; and if she will make a statement on the matter. [24511/25]
I put it to the Minister that 1 June is 19 days away. The majority of pharmacists I have spoken to - and I have spoken to many - tell me they are not signing up to the free HRT scheme. I understand that no communication has been made to the pharmacists about the software. It is my understanding that the providers of the software have not been given any information by the Department about adding free HRT to the system. Most pharmacists are opposed and no IT system is in place. What actions has the Minister undertaken to ensure the women of this country can access free HRT from 1 June?
I thank the Deputy for the question; it is an important one. I thank colleagues for their support on the approach taken to date. I want to be absolutely clear in relation to the intention with regard to the HRT initiative. Budget 2025 aimed to continue the good work ongoing to improve women's healthcare, and in particular to support women on their menopause journey. It was originally intended the State would pay for the HRT product - for the medicine - and pharmacies would be free to continue to charge a professional service fee to women who are not eligible either for the GMS or the drug payment scheme, DPS, while recognising there are many women who are getting this for free already. The programme for Government then re-emphasised the scope of that commitment.
I have prioritised substantial engagement with the Irish Pharmacy Union to find a pathway forward on the issue. I listened to its position - and this is important - that its members did not want to see the cost of medicine and the dispensing fee decoupled under a State-funded arrangement. Nevertheless, the Deputy will be aware that I did of course give them that option to charge the fee they are currently charging. In the spirit of compromise I offered to invest healthcare funding on dispensing fees, which was not intended from a healthcare budget perspective and not intended as Government policy in this space. I offered every participating pharmacy a €5 dispensing fee for each and every HRT product. The €5 fee is the highest fee paid under the community drug scheme to date. It is essentially a 15% to 20% increase on the existing dispensing fee for those products under the GMS and DPS at present. I made that in order that it would be an uplift for all of the women who are on the GMS or DPS. It would be a 15% to 20% uplift on the average dispensing fee paid in that case. Of course it would be €5 for all of those private patients who are paying at the moment. I made that offer to every pharmacy by writing directly to them. I also spoke at the IPU conference last Saturday.
I thank the Minister for the reply. At the heart of this mess are women on HRT and the women who could be on it. For non-GMS patients, the cost is €35 to €70 per month. This is a serious amount of money for many women. I am hugely passionate about this scheme but this crack of announcing first and working out the details later is simply unacceptable. There are four key issues here, the first of which is the lack of HRT. We want to give out free HRT and yet we know there are enormous stock shortages in the system. Pharmacists now are having to seek out unlicensed medicines, which are not recognised with the primary care reimbursement service, PCRS, and costing on average €15.90 while the GMS is only paying €6.47. It is either the patient or the chemist who will have to absorb that greater cost. This is going on right across the country at this point in time. The second issue is the IT system. I do not know if the Minister has looked at this but there is a key issue about adding that into the software. There has been no information to date on that. The third issue is co-operation with the sector. With the greatest of respect to the Minister, the effective use of power means sitting down and talking. Going on to Joe Duffy to issue a diktat is not how to go about it. The Department has-----
I will give the Deputy another chance to come back in.
The first thing is that I issued a press release in relation to this and then went on a media outlet. I must check when the Deputy last went on a media outlet and whether she regards that as an effective way of communicating either her party's position or to her constituents in any way.
It is certainly a way for the Government to communicate, as we often do. The fact that we go on a different show means what, exactly, aside from being a way of communicating directly and taking questions, having issued a press release and having engaged? There is no question of power in this regard; it is a question of delivering for women. I suggest, very carefully, that the Deputy goes back and discusses the IT system issues with whoever has briefed her regarding it. I have correspondence that says there are no IT issues, and we should watch that progress over the coming days and weeks.
I acknowledge the lack of HRT. There is an issue of medicine shortages across Europe, as we have discussed before. That is precisely why I have tried to recognise the experience and expertise of pharmacists to make sure they are recognised for what they do. I am not exactly sure what the Deputy would have me do differently. I made them two offers: one was an uplift of 20% and the other was an offer to charge anything they liked. I am not sure what the Labour Party position would have me do on behalf of the women of Ireland in order to get this effected, but perhaps the Deputy might advise me.
The first thing was to have written to every pharmacist in the country-----
I did.
I wrote to pharmacies across-----
I did.
----- my constituency. The first they heard of it was on "Liveline". The key thing is that the Department-----
That is just not true.
----- has form on this. With regard to the Covid vaccination, the first pharmacists heard of it was through the airwaves. The prescription extension scheme was introduced last September, and no homework was done on it. GPs are writing "do not repeat" scripts. There was no fee agreed with the pharmacists. The scheme is not operating as intended. On the fee itself, there is a sense out there that the diktat of €5-----
A diktat.
----- is the straw that is breaking the camel's back. We are all clear that pharmacists are not on the breadline.
I cannot believe this.
It is extremely foolish to assume that the pharmacy sector is like what it was 20 years ago. This is about recognition and respect for what pharmacists are delivering. A figure of €6.50 was agreed for the contraception scheme. I get that a negotiation has to take place - I come from a trade union background - but to my mind, no negotiation took place here.
With regard to the IT system, I have looked at the software.
An additional line has to be put in. I have spoken to a number of pharmacists - not just one - and they have told me that there has been no communication with them about what will be added to the software to link them to the PCRS by 1 June.
The €5 is the top fee that is paid under the current structure. The €6.50 is the once-off fee for contraception. I gave pharmacists the option to charge above €6.50 - €7, €8, €9 or €10, whatever they wanted - and they refused that. It is a very interesting position for the Deputy to have adopted this evening. I am trying to give every option possible to deliver for the women of Ireland, but I am hearing IPU speaking notes back, which is an interesting position for the Labour Party to take. What is the cost of setting the fee at €6.50 for the rest of the schemes that we have? We can tease this through over the coming days, but I strongly suggest and hope that pharmacists will sign up. The best option for the women of Ireland is a €5 dispensing fee to be paid to pharmacists because it makes it completely free for women. I would have thought that everybody in this House on the side of the women of Ireland would be behind that and working through the other issues that are also there. I engaged strongly with the IPU at its conference and since its conference. I thanked it for its continued engagement. I hope we will find a way through on all of these issues, but I have learned a lot about the Labour Party's position this evening.
Legislative Measures
114. Deputy David Cullinane asked the Minister for Health when she will introduce comprehensive adult safeguarding legislation; and if she will make a statement on the matter. [24429/25]
This question is on the need to introduce and implement adult safeguarding legislation. I have been raising this issue for a long number of years. I know there is a commitment in the programme for Government to review policy in this area, but we need a strong legislative framework. I want to see an independent safeguarding authority in place, a legal right of entry for social care teams and mandatory reporting. I will outline why I want to see all of those things in my supplementary question, but I am interested to hear the Minister's response on whether she is able to give a timetable or a commitment for when we might see legislation in this area.
I thank the Deputy for his ongoing work on this.
Safeguarding adults who may be at risk of abuse is a very important objective for me, my Department and all health and social care services. A framework of standards, policies and procedures for safeguarding adults in the health and social care sector is already in place. This includes a national safeguarding office in the HSE, specialist safeguarding and protection teams in each health region, designated safeguarding officers within services and specific regulatory requirements for residential care services which are inspected by HIQA and the Mental Health Commission. Further measures are now being developed to strengthen that framework.
My Department is at an advanced stage of finalising a national policy on adult safeguarding for the sector, in liaison with the Department of Children, Disability and Equality. This will be the first national policy in this area and is a significant development. Considerable work has already been undertaken to inform this policy, including an international evidence review, stakeholder engagement and a public consultation last year, which received more than 250 responses. I hope to bring this policy to the Government in the coming months.
Second, the Government has included a health (adult safeguarding) Bill in its current legislation programme. This will facilitate underpinning legislation for this sectoral policy. Drafting of this legislation will commence once the policy is finalised. There is a pressing need for robust safeguarding frameworks. That was thrown into sharp focus for all of us again with the recent publication of the Farrelly commission’s report on the Grace case. I am mindful too of other safeguarding failures that we must work hard to ensure never happen again, including the recent Brandon and Emily cases. I assure the Deputy that this is a priority for me. I expect to see progress within my Department and on a cross-departmental basis this year. I expect to be able to update the Deputy in that way.
We are reflecting on the Grace case. We had very lengthy debates in this House over a number of days last week, as the Minister knows. Grace was an adult for 12 years of her time in that home. As we know, she suffered very serious neglect and abuse in that home for a long number of years. As the Minister mentioned, it is not just about the Grace case; we also had the Brandon and Emily cases. We have had far too many cases and reports which have made the same recommendations that we need a much stronger and more robust legal framework with regard to the protection of adults in disability centres, nursing homes and care homes. In fact, whenever the Government gets around to its statutory home care scheme - I do not know when that will ever see the light of day - social care teams will say that there will be a need for safeguarding legislation in that area as well. Policy is all well and fine. I am not in any way dismissing the importance of what is being done by the Minister. Legal frameworks, legal rights of entry and mandatory reporting are very important because in their absence, we have more failures and issues, and we then have tea and sympathy afterwards and reports where we say are sorry and we will look into it and apologise. It is our job to get the legislation right and to ensure we have the most robust legal protections for adults in all care settings. All I am asking for is legislation that will enable that to happen.
Hear, hear.
I agree with the Deputy. I also want to reflect the work of the Law Reform Commission report in this regard. I hear what the Deputy is saying with regard to policy. Of course, the policy analysis is to bring us to the legislative path, because that has to be agreed across the different Departments with regard to that. It is also important to note, though I know the Deputy is already aware, that while legislation is important, it is everybody's business to do this correctly in the meantime. It is everybody's responsibility.
Driving a proactive and open culture of safeguarding is also a key focus of the policy, though I accept what the Deputy has said with regard to legislation. It is important to consider and acknowledge the role of the newly appointed chief social worker in the HSE. It is a newly created position and a person was appointed last year. It is a significant appointment. Similar to the chief nursing officer, these are important cultural signs about the importance of those roles and the functions they carry out. However, I agree with the Deputy in respect of legislation.
I agree that the Law Reform Commission report was very important and allows for the foundations for legislation to be put in place as quickly as possible. I raised this with the incoming chair of the health committee, Deputy Rice, as an issue on which the committee should focus. I am sure we would be prepared to work with the Minister in having the Law Reform Commission appear before the committee and talk through its proposals. Ultimately, however, I am sure that if it were before the committee, it would say it has made recommendations. I know the Farrelly commission report made recommendations on safeguarding, an independent authority and right of access - all of the same issues that would have to be in any legislation.
Everyone is saying the same thing but there is still no commitment to legislation. If the Minister were to commit to that in principle - I am not saying it needs to be done this week, next week or next month - I am sure the Oireachtas Joint Committee on Health would be more than happy to work with her to progress it as soon as possible. I am genuinely only interested in getting this legislation through to make sure people are properly protected and safeguarded.
I agree and accept that. The health (adult safeguarding) Bill is in the current legislative programme, but the policy must be considerably settled and developed on a cross-departmental basis. This is as much a question for the committees on disability and children as for the Joint Committee on Health-----
I agree
-----because the roles of the Departments are equally important in how we take this forward and they must be clearly working together on it. This would be an important piece of work for the committee and I look forward to working with it on it.
Healthcare Policy
115. Deputy Pádraig Rice asked the Minister for Health if her attention has been drawn to a series of investigative reports into transgender healthcare in Ireland (details supplied); if she will commit to reclassifying trans healthcare as part of sexual health rather than mental health, in line with the World Health Organization; to provide an update on the new model of care currently being developed; and if she will make a statement on the matter. [24053/25]
I am deeply concerned about the state of transgender healthcare services. In 2022, Ireland was found to have the worst transgender healthcare services in all of the EU by Transgender Europe, TGEU. The only dedicated gender clinic has approximately 2,000 people on the waiting list. Only 162 were removed last year. Waiting times are between three years and ten years, which is not acceptable. The journal.ie recently published a harrowing report on those services. One patient described feeling traumatised after going to the services. Another said it felt like an interrogation. People are being forced to go online to access hormone replacement therapy, HRT. Has the Minister seen these reports? Will she commit to reclassifying transgender healthcare under sexual health instead of mental health, following the model of the WHO? Will she provide an update to the Dáil on the model of care?
The programme for Government commits to ensuring a transgender healthcare service that is based on clinical evidence, respect, inclusiveness and compassion. A new model of care is currently under development to strengthen and standardise care, ensuring safety and best practice. My Department provided €770,000 in budget 2025 to support this. The clinical lead has been appointed, a cross speciality clinical advisory group has been established and a review of the evidence base is under way. A community pilot project to identify the needs of children and young people who are gender questioning will also commence in the coming months. The model of care will be developed in a consultative way, engaging with healthcare professionals in gender healthcare, stakeholders, including people with lived and living experience and the families of people who use and receive support from services.
It is important that the HSE is given time to develop a model of care that is based on the best clinical evidence and that will deliver the best outcomes for people with gender dysphoria based on respect, compassion and understanding. As the Deputy may be aware, the WHO’s international classification was updated to its current version, ICD-11, in 2019 and gender identity-related health diagnoses were moved from the chapter on mental and behavioural disorders into the new chapter on conditions related to sexual health.
It is important to note that the ICD-11 is not clinical guidance for gender healthcare. It is a system of classification where criteria for various diagnoses are described. From our perspective, we want a holistic, compassionate, respectful service at every stage of a young person's or adult's journey, at every point of contact. That is the approach I will take as will everyone in the Department of Health, including all the Ministers of State, to this issue and I know it is the approach of this House.
I thank the Minister. The pace of change is far too slow. This issue has been going on for many years. We need an acceleration and the delivery of high-quality services for people across the country. The current system is operating on an outdated model. As the Minister said, in 2019 the WHO reclassified transgender healthcare as a sexual health issue. Despite this, the services are still being treated here under mental health. Being transgender is not a mental health condition but not having access to these services has an impact on people's mental health. Transgender healthcare services are lifesaving services. In 2013, a Transgender Equality Network Ireland study found that 78% of transgender people had considered suicide, but after they accessed services, that dropped to 4%. These are crucial and lifesaving services.
The Minister spoke recently about a framework to think about services with some that are operating well, some that need to be improved and some that are causing harm. I genuinely believe these services are causing harm to people and need to be improved.
I fully hear what the Deputy is saying. His feedback is important to me, as is everyone's. I did not congratulate him on his new position as Chair of the Oireachtas Committee on Health. I look forward to working with him on this and many other issues. We have a similar approach to these issues.
It is important to recognise that demand for transgender healthcare services has increased and I acknowledge that the current public services are not meeting people's full range of needs. For that reason, the HSE is developing the new model of care for gender healthcare services. The Deputy is right to identify that it is not a mental health condition. Of course, it is not. What absolutely is the case is that a multidisciplinary approach, including endocrinology, psychology, appropriate counselling, psychiatry if and as needed and the support of social workers if required, offers the best pathway of support and that is certainly the approach I hope the model of care will lead towards.
I fundamentally believe that the new model of care must be in line with the WHO guidelines. It must use an informed consent model and be delivered in the community, which is crucial. There are models in place in other countries that we can look to, including in Australia, New Zealand, Iceland, Malta, Canada and parts of the United States. They are already operating this model of care. That is where we need to be looking for best practice. The development of this model of care must be accelerated and crucially, it must be done with engagement with the community, people who are directly affected and their families. To date, that has not happened and relationships between the national gender service and the community are poor and need to be improved. People need to have a say in these services and the voice of the people must be crucial in that. It also needs to align with the core principles of Sláintecare, which are community-based and patient-centred because ultimately we are dealing with people's human rights and the right to healthcare because trans rights are human rights.
I agree with the Deputy and the person-centred approach is what we want to get to. Everyone is entitled to healthcare. I agree completely with him on the points he raised and I hear his important perspective on the national gender service. It is important that it be articulated here this evening and I hear him clearly on it.
I do not want to get distracted by the WHO definition, which is slightly more technical and does not sit against what we are speaking about in any way. It is not a clinical guideline. It is a classification system. I can give the Deputy more information on that by way of background if it is of assistance. It will not cross over the sort of model of care I want to get to, which sounds like what he is describing. There is no reason to be at cross-purposes on it. Perhaps we can speak about it in more detail. The model of care we are talking about is intended to be based on a consultation - putting people at the centre - with stakeholders, healthcare professionals and crucially those who use and receive support from the services and their families.
Hospital Waiting Lists
116. Deputy Sorca Clarke asked the Minister for Health the current waiting times for inpatient admission for eating disorder services; her plan to increase the number of inpatient eating disorder beds and to fully resource the model of care; and if she will make a statement on the matter. [24476/25]
This question relates to the waiting times for inpatient admission for eating disorders and plans that are in place, or not in place as the case may be, to increase the number of inpatient eating disorder beds and to properly resource the model of care. We know from the HSE's estimates that there are 1,700 new presentations of people with eating disorders every year. Between 2018 and 2022, those figures show us that of 700 people who presented to the HSE with an eating disorder, only 46 received inpatient treatment. Something is not tallying. What is the plan?
I thank the Deputy for the question. I was expecting Deputy Clarke.
Eating disorders are complex and individual and can be one of the most serious mental health issues. The national clinical programme on eating disorders is progressing well with 14 of the 16 teams envisaged by the model of care now funded and approximately 100 dedicated eating disorder clinicians working in teams across the country. Approximately 90% of people with eating disorders are treated in the community. Enhancement of eating disorder services is a key priority for me and I have stated my intention to secure funding for the remaining teams in the next budget.
In response to the Deputy's question on inpatient admissions, eating disorders affect a relatively young section of the population and younger people can access 20 dedicated eating disorder beds across the four CAMHS inpatient units.
As of the most recent update available, the waiting list nationally to access beds in CAMHS units, for those aged 18 and under, due to eating disorders was two as of 6 May. For adults, the HSE currently works to meet people’s needs through the provision of general adult mental health beds, by procuring private capacity on a case-by-case basis and through the three specialist eating disorder beds at St. Vincent’s Hospital. As of yesterday evening, no one was waiting to access the beds at St. Vincent's.
A review of adult bed capacity for specialist eating disorder beds is currently under way and the national clinical programme is developing a plan with a geographic spread based on this review. I met with the HSE about eight weeks ago regarding a plan to increase bed numbers organically. We are keen to have a geographical spread of these beds. I expect to receive this plan from the HSE next month. It was promised that I would have it by the end of June.
I thank the Minister of State for the reply. As she outlined, the fact is that there are only three specialist beds and they are in St. Vincent's Hospital. When the current Tánaiste was the Minister for Health, he promised to deliver 20 beds by 2023. He did not promise to deliver them for no good reason. It was understood at that time that there was an urgent need for additional capacity in the system. We must also be realistic here. There might not have been anybody waiting as of yesterday precisely because the HSE is spending €12.5 million annually to send people abroad for treatment. Something we have done far too often in this country is to send women and girls, in particular, abroad for treatment. The statistics bear this out and show it is predominantly an issue affecting women and girls. The question remains as to what the plan is to increase this capacity. While it is appropriate and positive that many people are treated in the community, this is not suitable for everybody. What is the plan to increase capacity?
To be clear, since this model of care came in, no child under 18 has had to go abroad for treatment. Since 2019, 14 people have gone abroad for treatment under the auspices of the HSE. Other people may have gone under the cover of private healthcare, but we know that 14 people went abroad for very specialised treatment.
Turning back to the Deputy's initial question, there were two phases to the clinical model of care when it was launched in 2019. I suppose the plan was centred on the fact that the HSE and best practice showed the majority of people with an eating disorder are best served in the community. The emphasis was put on the teams being displaced all over the country. As I said, 14 of the 16 teams are funded, with 11 now operational. We will have the 14 teams up and running by the end of the year. Phase 2 concerns the eating disorder beds for adults. We have 20 for children and this capacity is sufficient. We monitor it weekly. I will speak to this aspect in my next contribution.
The other issue, and the Minister of State touched on it, is the number of people opting to go private. Often, parents are putting their hands in their pockets or borrowing money to access care for their children or young adults. It is important for the HSE to do work on this aspect. I understand the Minister of State does not have these figures and that they are not readily available. Whatever means are available and at the HSE's disposal in terms of surveying must be used to find out what percentage of these 1,700 new cases emerging every year are being forced to make the decision to go private because of the lack of capacity in the public system. This is an element that really needs to be looked at. Not only is it perhaps delaying and impacting treatment and creating divisions between the private treatment they are paying for and the other community supports they could return to, it is also putting families under real hardship at a time when people need to get access to urgent care.
Hear, hear.
I thank the Deputy for his question. We saw eating disorders grow exponentially during Covid, for example. This was especially the case among younger girls aged 14, 15 and 16. Last year, for example, the eating disorder clinical team worked with approximately 520 young people. Many of those were transferred back to a GP for further support. It is possible to recover from an eating disorder but it is a very difficult process and happens on a case-by-case basis. For some people, it can take up to seven years to recover. One of the challenges we encounter a lot is the transition of a young person who has been receiving the support of a dedicated team while aged under 18 to the adult services. This is an area we are really putting a focus on. It is the reason I am waiting on the plan from the HSE to develop eating disorder beds for adults across the country and to try to increase them organically. We have 64 approved centres round the country and there is absolutely no reason why there cannot be one or two beds with the correct wraparound supports. The support of a dietician here is extremely important.