Seán Crowe (Dublin South West, Sinn Fein)
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I thank the Minister of State for taking this matter. Ideally, it would be helpful if a Minister from the Department of Health were present, but there is a certain urgency about this case. I would appreciate it if the Minister of State could feed what I am about to say to his colleagues in that Department.

I am concerned about the lack of a dietician in CHO 7 and what this means for people who require the services offered by such an individual. Modern medicine relies on multidisciplinary teams, medical nurses and other professionals to provide the best possible patient care. When we fail to recruit and allow gaps to appear in various specialties, the model does not work and the disciplines are just not there.

A constituent approached me recently. She is the mother of a baby boy who needs to see a dietician. Her child, who is called Frankie, started to show a severe allergy to his food. He is aged about a year and a half. His reaction was so acute that the mother brought him to the doctor immediately. She was advised her to keep a food diary and the child was referred to the community dietician for urgent intervention. However, there is no community dietician. The mother naturally expected to be told how long the waiting list was for CHO 7 and hoped that a baby would be prioritised, given how serious this can be and how the situation can deteriorate so quickly for children so young. She was told in May that there was no waiting list because there was no dietician for the entire CHO 7 area, which takes in Kildare, west Wicklow, Dublin west, Dublin south city and Dublin south west. For all those hundreds of thousands of people, there is not one dietician. The child cannot see a consultant in Tallaght University Hospital until the allergy is proven, but an allergy skin-prick test cannot be performed unless a consultant or dietician requests it. This is a catch-22 situation. The only way out of this limbo is to have the test done privately. Since the private system is being forced to cover the gaps in the public system, the family is being forced to wait. It costs about €180 for the test. Not every family has that. All the while, the GP advises that the child might face development issues with his digestive system as a result of the untreated allergy. To have any hope of getting the diagnosis and treatment for her child the mother was going to be forced to go private. What sort of message does that send to new parents with all the stress and worry they already have? All those people in CHO 7 cannot receive nutritional assessments or tailored care plans to meet nutritional requirements or correct a poor nutritional status.

Dieticians are vital in the context of improving the lives of people suffering not only from gastrointestinal disorders but also diabetes, cancer, kidney failure and a host of other conditions. As a specialism in the health service, it is not an optional extra. We talk about preventative healthcare but we are failing to cover even the most basic provision in so many areas. What options do parents and families like this in the public system? What way can the find their way out of the limbo where they need tests to see specialists that only specialists can provide? The matter is compounded by the lack of community nursing in the system. The community nurse would normally monitor the development of the child, both in this case and generally in the community, but because of the shortage in the system at the moment, that is not happening. There is a bit of a crisis in the area. I do not know if the Minister of State has something positive to tell this family. It is a cry for help from this family and I am sure there are many others who are in the same boat and looking for some sort of support on this.

Malcolm Noonan (Carlow-Kilkenny, Green Party)
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I thank Deputy Crowe for raising this matter. I am taking it on behalf of the Minister for Health. The Minister recognises the central role that primary care therapy services, including dieticians, play in providing care and treatment to both children and adults in the community. He is also aware that the demand for a dietetic service in the CHO 7 area has grown over recent years, and that this increase in demand has been coupled with an increasing complexity of service-user needs.

Additionally, the recruitment of dieticians in this area has been an ongoing challenge due to the lack of availability of suitably qualified candidates, along with the current pause on recruitment in the HSE. For example, the HSE has advised that, at this time in CHO 7, the enhanced community care, ECC, chronic disease programme has 12 whole time equivalent, WTEs, in post which is 46% of the 26 WTE posts approved. At the community healthcare network and hub level, the dietetic community service has 15.73 WTEs in post, 47% of an approved 33.4 WTEs. Unfortunately, the number of vacant dietitian posts coupled with the increased complexity of service user needs in the community has resulted in the provision of dietetic services being restricted in many areas in CHO 7. These restrictions include a reduced home enteral nutrition, HEN, service or the absence of paediatric dietetic service.

The Minister acknowledges that the restrictions on the provision of dietetic services in CHO 7 and the increasing waiting lists for those waiting for a long time to access these services is a source of real concern for clients and their families. The Deputy highlighted this in the context of the case he outlined.

The HSE has advised that is working to address the challenges in the dietetics service in CHO 7, with the service prioritising referrals based on clinical need, staff availability and appropriate clinical governance to provide the best service possible. The HSE has further advised that there is a focus on increasing the numbers of service users seen across primary care therapy services, including dietetics, to drive improvements in waiting lists.

In 2023, waiting list action plan funding of €3.5 million was allocated to primary care therapy services which saw over 5,000 long-waiters removed from waiting lists nationwide. Ongoing initiatives include a validation of waiting lists to drive increased productivity and ensure effective management of therapists’ time and a focus on reducing the numbers of long waiters.

I also wish to advise the Deputy that the Minister for Health has, in recent weeks, approved the allocation of the 2024 new development posts relevant to the health budget and plans to recruit these 2,269 additional staff are in progress. This is welcome news. This will enable the HSE to set out its recruitment targets in each area for 2024 and will inform decisions at local level on the filling of available posts.

Seán Crowe (Dublin South West, Sinn Fein)
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The Minister of State indicated that progress has been made, but this family will want to know when that happened. It is all part of a much wider issue of failing to fill key posts across the health system which is creating massive gaps in service provision. This is just one case of a baby who cannot get access to a dietician at this stage of their development but the lack of public nurses is also a problem. Back in April, I received a response from the HSE on the waiting list for children’s audiology services had more than doubled in two years.

In Tallaght alone, 5,856 children are waiting on audiology services, which is again down to a lack of staff in that service. The HSE itself identified the problem there as high demand levels and a number of staff vacancies which could not proceed due to the recruitment pause within its organisation. Again, it is ordinary families who are suffering. The big question is when we are going to fill these vacant posts in the health service and get patients like this baby the care and treatment they need. I raised this already with the Tánaiste regarding the audiology services. I never even got an answer on that. He said he would pass it on to the Minister. If there is anything the Minister of State can do within the service itself, it would be appreciated. I am particularly focused on this child but I am aware there are many children in the system at the moment and whose families are crying out for help. They do not know who to turn to. They are coming to us. We are not medical experts but they are looking for us to try to find a pathway through this mess that is currently there. I welcome, as the Minister of State mentioned, that plans to recruit 2,269 additional staff are in progress but people want to know when.

Malcolm Noonan (Carlow-Kilkenny, Green Party)
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I thank the Deputy for his response. Certainly, the Minister fully acknowledges the frustration of those who are impacted by the restrictions in diatetic services in CHO, 7, and that of their families. He agrees that much more needs to be done to address the gaps in staffing and the waiting list for dieticians, in addition to other key primary care services. As the Deputy said, the new development posts are welcome news but the translation of that into those posts being filled, in a country of full employment where there are challenges filling posts, does not offer much comfort to that family. Certainly, if there is anything the Government can do to help in that specific case, the Deputy should bring it to the direct attention of the Minister as a possible way forward for this specific case. Again, as the Deputy said, there are other cases in audiology where there are other families as well and it is critically important that the HSE moves to try to get those posts filled as quickly as possible.

The Department of Health has also engaged with the HSE in advancing a programme of work to both develop short-term and longer-term strategies to address the need for more consistent management and a reduction in waiting lists for primary care therapies, with a national oversight group charged with progressing this work due to meet in July. Ultimately, it is expected that this work will ensure consistency of access to primary care therapies irrespective of location and in a much timelier manner than is currently the case. I hope that offers some comfort to the Deputy and to the family of the case he raised with me.