First, I thank Deputy McDonald for raising the issue and for reading out Nikita's letter to her, which clearly illustrates the very debilitating impact endometriosis can have on women. It is extremely debilitating, painful and the span of impacts are very wide. Regarding a phased response, this can be at GP, gynaecology or indeed specialist centre level. There has been progress for endometriosis. Approximately €5 million in additional funding has been spent and €2.1 million has been allocated for this year. If it is allowable, I ask Deputy McDonald to forward the correspondence to us because Nikita mentioned it has been three and half years. We have two supra-regional hubs established in Tallaght and Cork, with the latter opened recently. The estimates are saying, and they are conservative estimates, that there are 350 severe cases - and Nikita is clearly in the severe category - per year that will require a referral to the specialist endometriosis clinics and services that are located in Tallaght and Cork. In addition to those, there are five other hubs across the country in the Rotunda, the Coombe, the National Maternity Hospital, University Hospital Limerick and University Hospital Galway. There were approximately 760 women on a specific waiting list for treatment at the end of last year and the agenda is to get through the backlog as quick as possible. There are discussions under way and hopefully the national framework in respect of endometriosis will be concluded but there is engagement with GPs and between GPs and the HSE regarding the precise role of primary care versus gynaecological care and then obviously the specialist hubs. As the Deputy said, one in ten women will have this condition. There is the development of a national endometriosis framework and the Minister is keen to bring this to a conclusion. This was discussed in the House previously and all questions have been asked in respect of that. The model of care has been outlined and there is a clear framework there. Investment is happening and will continue. This is on top of significant investment in women's health in recent years which has been quite transformative compared to what was there before. There has been specific investment into a whole range of areas pertaining to women's health. This is one area that needs further investment but it also needs the national framework to be concluded. The two supra-regional hubs are there for the specialist and severe cases and the referral should be sent there in the context of Nikita's letter, although I do not have the full background to it. We fully acknowledge it is a very real issue for women involving very severe pain that impacts on one's personal and working life. It is something Government is very committed to addressing.
Sentiment score: 0.10
There has been significant progress in this area. That has to be acknowledged. More than 200 new patients were seen in Cork's endometriosis service from May to December last year. About 94% of women on the waiting list in that region are now seen within six months. As I said, more generally we are seeing improvement in terms of the Tallaght centre also. The Government is listening. In terms of the State, the Government, the HSE and everybody involved in this area have been engaging to get the national framework concluded so that there will be a comprehensive range of services covering the entire span of symptoms or manifestation of the condition, in other words, from primary care to the hubs to the super-regional hubs. Specifically, specialist care is available. There is ongoing recruitment. Additional posts are being recruited as we speak, specifically for this area. Admhaím go bhfuil géarghá le níos mó infheistíochta. Tá sé sin á chur ar fáil againn faoi láthair. Is é sin an aidhm atá againn. When we look at all the other developments in women's health over the past two to three years, it is clear we can and will do this. There have been some very significant developments. I am not going to list them all but they are there. In terms of endometriosis, it will be manifest as well. It already is in that two super-regional hubs and the five other hubs are there.
Sentiment score: 0.12
It is important to get the framework.
Sentiment score: 0.20
There are a number of issues there and I thank the Deputy for raising them. I fully understand the trauma that the family of Daniel Collins is going through in respect of the delay in getting surgery carried out. I do not want to go into the background of every individual case in terms of complexity of the case and so forth. My understanding is that there has been engagement. The assistant director of nursing lead for the spinal surgery management unit spoke with Daniel's family on 2 April and discussed his plan of care. There was a further engagement on 7 April. I hope that his case can be progressed. As I said yesterday, it is now in the hands of the clinical team managing his case. A multidisciplinary team meeting will be held in respect of Daniel's case in terms of assessing and dealing with the issue. It is a matter for the multidisciplinary team to come forward with that and engage with the family in respect of timings and so forth. In terms of the broader issue, there has been far greater activity in spinal surgery within CHI. That has to be said. There has been a reduction in waiting times and in the lists. Others have come forward. It is not where it should be. We are going to continue to press ahead. The Minister is very focused on the issue, to further reduce waiting times for scoliosis surgery and spinal surgeries more generally and also to increase activity levels there. We are awaiting further reports to be presented to the Minister. HIQA is the external independent body to ensure quality within healthcare settings in Ireland. It has produced a report in respect of the specific issue of the use of springs, which is absolutely unacceptable. We are all agreed on that. Then there are issues regarding the independent review being led by Mr. Nayagam. There are two parts to that, namely, the review in terms of the individual risk and then the independent review in terms of assessing the governance of paediatric orthopaedic surgery service to make findings on improvement in governance, quality, safety outcomes and performance metrics. Meanwhile, the work has to continue in CHI. A new CEO has been appointed to CHI. The chairperson has resigned. A new chairperson needs to be appointed. The board needs to do that. Some have called for the board to be disbanded. That would not help the situation right now in any shape or form. It would weaken governance even further and could lead to further difficulties and challenges.
Sentiment score: 0.13
Nobody is happy with this. I am certainly not happy with it and I know the Minister is not happy with it. The Minister is meeting with the board and the HSE regarding these issues. The two further reports, one of which is about dysplasia, need to come in. The three reports will be assessed in totality. We need - over time because we do not want to create any further disruption - to get to the bottom of this, and we will with these reports. The report about spinal surgery has been very clear and transparent about what happened and has outlined what happened. We now need to keep the focus on getting more activity within in the hospital. A lot of good work has been done within the hospital. That needs to be said. Many of the consultants have done very good work and have co-operated. We have significantly improved the level of activity in this area in terms of scoliosis in particular and spinal surgery more generally. In the medium to longer term, we need to look at the overall structures governing paediatric care. That is a point I would make and we need to reflect on and consider that.
Sentiment score: 0.13
A lot of progress has been made and that does not get acknowledged. The HIQA report is a good report insofar as it clearly lays out what happened. What happened was wrong. It was incomprehensible. I said that yesterday. It is beyond belief that one would insert devices into a child that are not CE approved. It is very hard to comprehend that. That is unacceptable. In terms of spinal procedures more generally, we are increasing activity year on year. There has been a 35% increase in activity compared to 2019 but we need to do more and that means recruiting more qualified surgeons and entire teams to enable that level of activity to increase. There has been a decrease of close to 20% in the number of those waiting over four months and a 59% reduction, as it should be, in the number of those waiting over 12 months but it is not enough in itself. We set up the dedicated paediatric spinal surgery management unit in 2024. There is a ring-fenced theatre in Crumlin. A lot of things have happened to enable a greater throughput and more consistency in terms of getting surgery done. I spoke about public inquiries during Questions to the Taoiseach yesterday. Up to five public inquiries are being sought on different matters. I told the entire Dáil that we need to reflect on that. Is it the best model to investigate issues of this kind? Public inquiries are costing millions. Since 1998, €500 million has been spent on inquiries. There is an ethical question as to whether resources should be targeted at existing services for children living today across social, healthcare and education services. Inevitably, victims who seek inquiries do not get closure from them and are not happy with the outcome of inquiries. Many of these inquiries are taking years and costing millions. This is a serious issue. I have been in opposition so I am not casting aspersions on anybody but the easiest thing to do is to call for a public inquiry. It is a case of "that's done, we've called for it, so let's have it". Judges are taken from courts, reluctantly now because very few judges are coming forward. As an Oireachtas, we need to examine this. My view is that we have agencies we have statutorily established to investigate issues. That is what HIQA is for in terms of healthcare. That is why it was set up. The Health and Safety Authority was set up for accidents while Fiosrú, which was GSOC, was set up for An Garda Síochána. These agencies need to do their jobs effectively and properly. I am not sure whether having public inquiries or calling for public inquiries or commissions of investigation that go on forever, cost millions and where people are not happy at the end of them is a sustainable model.
Sentiment score: 0.07
First, we will implement the recommendations of the HIQA report. Second, there is a task force on the broader issue of paediatric spinal surgery headed by Mark Connaughton with which the Minister will meet tomorrow. In terms of governance issues, we will engage with those from now on. Instead of waiting for further investigations we will proactively look at the structures and governance framework there and respond to that. We all know that the big issue in paediatric medicine more generally is the transition from the existing hospitals to the new children's hospital. This will be the big issue. Whatever we do, and we have to implement all the recommendations, absolute focus must be on that transition to ensure it is as optimal as possible in terms of resourcing and staffing the hospital. It will be transformative, even in terms of the physical conditions at Crumlin and Temple Street hospitals compared to those at the new hospital.
Sentiment score: 0.12
We will meet and the Minister is open to meeting and engaging with the advocacy group. We would like to work through these issues with the advocacy groups and give our perspective as to what would lead to more immediate and quicker results that everybody wants in relation to all the issues the Deputy outlined in the question.
Sentiment score: 0.35
I thank the Deputy for raising this issue which is very serious. I would make the overall point, and I do not want to go into the history of provision, that there has been dramatic exponential growth in the level of investment and provision both on the education side, in terms of special needs, and on the health side. On the education side, it is much more clearly to be seen in the transformative impacts over 20-odd years with investment in special education. Back in the late nineties and early 2000s we had no special classes or special needs assistants. That only started in the late nineties. Over the past five years alone the number of pupils attending special classes has gone from 9,000 to 19,000. Those attending special schools have gone from 7,800 to 9,000. The number of special classes has doubled and there will be further increases in that. That is on the education side. I accept fully the CDNT situation is not at all satisfactory and the absence of fully staffed multidisciplinary teams is a huge issue for CDNTs more generally. In the 2022 census, about 13% of children were identified as having a disability. Huge money has been allocated on both sides but people are not interested and rightly so because people are interested in a service for their child and they are not getting access to therapists in particular. Recruitment is under way. There is an issue with the assessment of need which the Government is examining. That is drawing down a lot of resources following that High Court decision which means an awful lot more is going into the assessment and not the delivery of services. Our Government will bring forward legislation on that. It will be challenging - I have no doubt it will be debated in this House – but that nettle has to be grasped because it has to be dealt with in order to have a more efficient and effective assessment of need and to make sure that from day one, children get the services they require. Second, recruitment continues. There had been issues in the HSE around the recruitment of therapists. Those were not funding issues but recruitment and retention issues. The vacancy rate was as high as 29% in 2023. That has come down to 21%. The posts are approved and funded but the recruitment issue has been a factor. The CDNT workforce has grown by about 17%, with an additional 272 posts having been filled, but it is still nowhere near optimal. That is why we have decided as a Government to pursue a therapy in education approach, particularly for special schools - we want them to be in a position to have multidisciplinary teams separate from the health service itself for the children with the most profound special needs.
Sentiment score: 0.16
I do not disagree with the Deputy at all. I agree with him that there is an issue with the budget going in and the services coming out. That needs to be constantly interrogated. There is no question about that. I am chairing a Cabinet subcommittee meeting on disability and we are establishing a disability unit in the Department of An Taoiseach to work hands-on with all the various Departments and get a co-ordinated approach in every single Department towards the disability issue. On therapists, in July 2024 funding was provided to boost training places in speech and language therapy, occupational therapy and physiotherapy. This will lead to a 35% increase in student places this September. New student places were launched in September in Galway in speech and language therapy, occupational therapy and podiatry. We have instructed the Minister for higher education to go back to the universities for the next academic year to have a substantial increase in the number of places for therapists but that must be followed and paralleled with an increase in clinical training places for them. We are also engaging with CORU about registering qualified people from overseas much more quickly than is currently the case.
Sentiment score: 0.18