Martin Daly Demands Action on West-North-West Cancer Delays

Thank you, Minister, for coming here this morning, and to the urgency and the focus that you're bringing to your brief, and also to Minister Kiran O'Donnell, Minister Murnane O'Connor, and also to Minister Mary Butler, who has brought a lot of progress to the mental health area. I do want to start where you had finished, Minister. You talked about West-North-West. North-West-North-West seems to be doing very poorly by a number of metrics, not just in trolley weights, not just in ER weights, but also in cancer care, and also in the area of access to primary care therapies. When we ask parliamentary questions on these areas, we're finding that West-North-West is doing poorly compared to the rest of the country. Now, I just would like to ask you to make a comment around the cancer care in West-North-West. We've had numerous complaints that women, for example, with breast cancer, receive their diagnosis in a timely manner, but there's a significant interval between their diagnosis and their treatment starting. Could you make a comment on that, please? MS. Thank you. Yes, it's not acceptable, and what we want to achieve is that everybody gets their cancer treatment, their cancer diagnosis and treatment within the requisite period, particularly in those urgent symptomatic cases, and there has been a difficulty in relation to the West-North-West in different ways. That is one of the reasons that we are making the regional funding model different this year, that we are clearly tracking outcomes. So I expect the West-North-West to devote themselves to making sure that there is a quality of treatment and quick access. That is as much to do with how the hospitals are run and managed as anything else. MS. That's the question I would ask. Is this about simply resources? Because I've been told, for example, that CAR-T therapy has been funded for Galway, for cancer services, and has not yet been delivered by HSE West-North-West. So is this a management issue? Is this a resource issue? As it appears to me, Galway, Mayo, Roscommon, Sligo, the West is being left behind. And you talk about the inconsistency of service throughout the country. I want to know, can a focus be brought on the issues and the deficiencies in West-North-West. So for example, primary care, we have the longest waiting list for occupational therapy, the longest waiting list for speech therapy, the longest waiting list for physiotherapy, the longest wait for community ophthalmology. There's something really wrong. There is something wrong. And you also have, last weekend, one third of all of the hospital trolleys came from the West-North-West, despite it not being one of six regions and having nothing like the population that would justify that. And there being a significant weather event on the East, not the West. So I agree with you there is an issue. Can I say to you that tomorrow, Thursday, I am in Sligo with the managers of every single hospital from the West-North-West, with the regional executive leadership team, and I will bring directly your concerns on all of these issues to them. My conversation is specifically around what are you doing to roster people in the way that other regions have managed to roster? What are you doing to make sure that there is weekend discharging? Because the impact of urgent and emergency care impacts on everything else. If you are not getting that right, you are not getting the other things right either. If you are not rostering people for quick diagnostics to get people in and out of hospital, you are not doing it for cancer care either. And you are right, there has been significant additional investment in cancer services in Galway. Last year, there was over 14 additional posts fully funded across surgical oncology, breast cancer, family history, radiotherapy, survivorship, CAR-T services, the acute hematology oncology service received additional advanced nurse practitioners. There is this very significant investment, but how is it being organised? How is it being organised for the delivery of patients? And I have an issue with that and I appreciate you raising it with me because now I can take your commentary directly to that important meeting tomorrow with the West-North-West leadership. Well, I appreciate your honesty around it because I have the embarrassing, it is embarrassing for the state and for the health service of women and their families phoning my office in Roscombe and Galway asking for ways to get into the private system and pay cash to initiate their therapy for oncology after getting a diagnosis of breast cancer. And I would appreciate that you would bring a focus specifically on the interval between a breast cancer diagnosis and the delivery of treatment for those women because by and large these are young women with families and there is severe apprehension, anxiety around their issue. And also, I would like you to bring a focus on why has the CAR-T therapy programme not progressed in West-North-West? I know it is in St James' Hospital in Dublin. I understand the funding was made available to start that programme there, but there is no sign of it starting. But where is the urgency? You are right, it is due to open in quarter one of this year and that has to happen and I will do that. Again, you are absolutely right, GUH has faced challenges in meeting its performance targets for cancer services. That is not okay. There are, the SACT services are due to be expanded with six additional chairs as you know. I have also devoted two surgical hubs to the West-North-West region to ensure there is additional surgical capacity. But one of the difficulties I have is we can put all of the resources and all of the additional theatre capacity in. If you don't manage it properly, if you don't run it properly, if you don't roster it properly, all of the additional capacity in the world isn't going to change outcomes. It is how people turn up. For example, Tipperary Hospital has not had significant additional resources last year. It had an 88% reduction in its trolleys. There are more people being discharged from small hospitals that weekend than Galway University Hospital. Again, sorry to focus on that, but it speaks to the way in which resources are deployed. But you are right to focus on it, Minister, because the state is investing a huge amount of money in our health services, and we need to ensure that there is the proper return on that investment for the citizens of this state. And there should not be an inconsistency in access to service in a small country like ours. It shouldn't be beyond. I come back then to – and thank you for your answer in relation to that. We have seen the RT Investigates programme, and I have spoken to Minister Butler about this, and this is no reflection on anyone and the focus that has been brought on mental health service and the increased funding that has been brought to bear in that service. But there is no doubt in our rush to deinstitutionalise mental health care from a time where we were putting people with additional special needs into congregated mental health settings like our psychiatric hospitals. We have forgotten a group of citizens. They are the citizens who have enduring mental health issues, who have challenging behaviour that are a danger to themselves and to others. But there is another group of patients, our citizens, and they are the ones with enduring mental health issues, who need supervision and care in the community setting, probably in a residential setting, because they simply cannot look after themselves. Now, I know in County Ruscommon since 2016, 140 of these community beds were closed down. There were issues, and the CEO of the HSE said that, around some of those homes, but that wasn't a reason to close them down. Many of those of our citizens who are not able to look after themselves, the most vulnerable in our society ended up in local authority housing and are going around the streets, for example, in Castle Rhee, where kindly supermarket owners feed them their breakfast because they cannot manage their own resources. And the promised wraparound services weren't there and aren't there for those patients. We have the Mental Health Commission coming to Ruscommon University Hospital and publishing a report that shows that the psychiatric unit in Ruscommon University Hospital is deteriorating from two years ago, and that they had to issue an immediate action notice. Because they didn't get adequate assurances, they had to have a regulatory compliance meeting. I would like you to make a comment on that. We feel very strongly, and we have had a lot of messages in on the issue of the ORT Investigates, and notwithstanding some of the inaccuracies that might be in it, there is no doubt there is a sense that we have criminalised mental health, enduring mental health issues for people who should be receiving their treatment in appropriate centres, either in secure units or in the community in residential care. I would like to ask Minister Butler to speak to that, please. Thank you very much. Deputy, I have to push back on some of your commentary there, because I think it is very unfair. We came from a situation where we had people institutionalised in asylums, and we had to move back from that. Minister, I have no problem deinstitutionalising. My mother described in 1967 people with Down syndrome, unmarried mothers being put into St Bridget's Hospital in Banisloe, I have no problem with that. But in the rush to deinstitutionalise, we have forgotten a cohort of patients. And that is a reality in my world, Minister, I do not want to have a row with you, because I recognise your focus on mental health, I recognise the increased budgets, but I have to say there is a reality on the ground in relation to this cohort of patients. So, I am just going to speak to a couple of points that you made. So, in relation to your saying there is a person there who has been fed by the local shop. There is not a community in Ireland that do not have people living in the community with enduring mental health conditions. But I know, for example, out in Port Law, where I have one of those people, that he is a social worker that visits every single day, that he has meals and wheels delivered to the house. There is something happening here that that person is not referred on, to have a social worker to protect them, and also being supported by the community mental health teams on the ground, because they are doing a phenomenal amount of work with 285 community teams across the country in relation to CAMHS, in relation to general adult mental health, in relation to psychiatry and later life. Sixty-five of those teams have been put in place since I took up office in 2020. I accept that. Two hundred and eighty-five teams. I accept that. We also have twelve hundred people living in the communities, in houses all over the country, with wraparound supports. I accept that. And five hundred people, no, it's very important, I'm sorry, just two seconds. Five hundred people with enduring mental health conditions have been rehoused in the last 18 months, working with the Department of Housing. I accept that. So there are always going to be people that fall between the cracks, but if you know of somebody that's going to a shop being fed, the onus is on you to have them referred to a social worker so that they can get the correct wrapping of this report. Thanks very much logo! You