Chairman: I welcome our witnesses to this meeting. They will provide us with an update on the implementation of Sláintecare. I should also mention that the Sláintecare Implementation Strategy and Action Plan 2021-2023 was published last month and makes for interesting reading. I welcome, from the Sláintecare programme implementation office in the Department of Health, Ms Laura Magahy, deputy secretary; Ms Caroline Pigott, principal officer; Ms Rosaleen Harlin, principal officer; Ms Sarah Treleaven, principal officer; and Mr. Bob Patterson, principal officer. I also welcome, from the Healthy Ireland division of the Department of Health, Mr. Tom James, head of the unit; Ms Fiona Mansergh, assistant principal officer; Mr. Greg Straton, assistant principal officer; and Ms Ursula O'Dwyer, assistant principal officer. From the e-health and health information systems division of the Department of Health, I welcome Mr. Niall Sinnott, principal officer…. 

Senator Frances Black: …The witnesses are doing phenomenal work so I thank them for that. I am particularly interested in the treatment of alcohol harm. I worked closely with others on the Public Health (Alcohol) Act 2018 and alcohol has had major public health implications in Ireland. The harmful use of alcohol is a causal factor in more than 200 disease and injury conditions. These include diseases like liver cirrhosis, heart disease and cancers. Three people per day die from alcohol-related issues, amounting to 88 deaths per month or 1,000 per year. There are 900 people in Ireland diagnosed with alcohol-related cancers each year, which is quite shocking, and 500 people die from these diseases each year. One in eight breast cancers is alcohol-related. That may only be the tip of the iceberg. One in every two pedestrians killed on the road dies as a result of an incident involving drink-driving. 

There is a major cost to health arising from alcohol. Alcohol-related discharges from hospitals cost the Exchequer €1.5 billion in 2012, which is quite shocking. 

I have another question after my next one and it, too, will be on alcohol. From Sláintecare's point of view, what will be put in place? There is a lot of focus on obesity, which is fantastic. The question of eating disorders also needs to be examined. What can be put in place to deal with the major impact of alcohol harm on public health? I am concerned that alcohol harm done to family members of alcohol abusers is not often visible. It can have very serious consequences for the safety and well-being of family members. Children in particular are very vulnerable. Alcohol is a significant contributor to child neglect, for example. Parental drinking has been identified as a key child welfare issue. It contributes to many assaults, including sexual assaults, and rape, domestic violence and manslaughter. It can go on and on. One thousand five hundred beds are taken up every day because of alcohol-related harm. I did not hear anything about this. Does it fall under mental health services? Where does it fit in? 

Ms Laura Magahy: I thank the Senator. It crosses several areas. One of the biggest opportunities is within the healthy communities context. We are working at local level with community groups and across agencies. For example, we are working with Tusla and social welfare colleagues, especially in respect of children and vulnerable families. Within the healthy communities context, we have an opportunity because we will have co-ordinators at local level who will link with the relevant agencies to focus on prevention. It has to be done really carefully, however, working with communities and families and through agencies and local bodies. That is where the opportunity lies. We can certainly consider specific initiatives in that regard. 

Mr. Greg Straton: Ms Magahy said most of what needs to be said. The key is working with the alcohol and drugs task forces locally but also creating multi-agency responses. We are aware that alcohol contributes to adverse childhood experiences that can have a significant health impact across the life course. It is definitely about finding the preventive focus before alcohol becomes an issue in the family and home. 

Senator Frances Black: I am talking not so much about addiction as alcohol harm and the unhealthy relationship we have with alcohol. It is a matter of keeping that in mind. One thousand five hundred hospital beds are taken up every day because of alcohol harm, not addiction. That is a very high number. It is shocking. 

The main aim of Sláintecare is to provide universal access to timely, quality integrated care for everyone in Ireland. The lack of investment in and funding for our Sharing the Vision policy has been heavily criticised. How do the delegates believe we should strategise for the increased need for timely and early interventional mental health services after Covid? We are aware of the mental health impact of Covid and the restrictions. We are heading for a tsunami in the future. What has been put in place in this regard? 

Ms Laura Magahy: I thank the Senator. Ms Pigott might refer to the oversight work. Investment is one aspect. I will not be popular for saying the siloed nature of funding in some of the mental health services is also contributing to some of the issues. We fund mental health services in primary care. We fund through prevention and secondary care. I am told by those in general practice that the path between general practice and where a patient is directed is not always clear. Therefore, we have some work to do on pathways of care for people with mental health issues, from the early talk therapies right through to psychological interventions in the community and psychiatry, etc. A body of work has to be done on the pathways so it will not simply be about investment, although investment is needed also. 

Sharing the Vision is committed to. It is in the programme for Government. Ms Pigott, who is on my team, is on the oversight group. Does she want to add anything to that? 

Ms Caroline Pigott: Yes. The oversight group was set up at the end of 2020. Of the recommendations in Sharing the Vision, 83 are HSE-led. The HSE is drafting an implementation plan for the period 2021 to 2023 and wants to hold workshops in June. The focus of the implementation committee is on monitoring and making sure we see the impacts of the investment made in implementing the recommendations in Sharing the Vision. The other recommendations in Sharing the Vision are linked to either Healthy Ireland or other areas and voluntary sectors. They are all being progressed. That work is going well. We meet monthly to consider progress and to steer in respect of what else needs to be set up, including specialist subgroups, to progress various actions. 

Senator Frances Black: Does Ms Magahy believe that progress in community-based mental health services is needed? How does she see it all playing out? Community-based mental health services will be vital. What is Ms Magahy's view on this in light of the current crisis? 

Ms Laura Magahy: They are absolutely needed. Through the enhanced community care fund, allied funds and the community care networks, there is funding for community services. There has been a bit of a lack of focus on the earlier stages, such as the talk therapies, which we would like to see scaled up. We invested in the likes of Jigsaw and other talk therapies, especially for young people, LGBTQ people, etc. I would like to see them scaled up. We are determining how they might be mainstreamed through the next phase. They showed very good results. Young people absolutely appreciate and need an instant response rather than being told to wait for a week or whatever for a more in-depth service. These approaches have been shown to work. We have embarked on scaling them up right across the country. 

Senator Frances Black: The Rise Foundation, for which I do work, is an organisation that supports family members who have somebody they love with an alcohol, drug or gambling problem. It does not get any Government support whatsoever. It has six to eight therapists but it also has a waiting list. There is something not right about that picture at this time. This needs to be addressed. The organisation does phenomenal work. It is more of an intervention organisation. It stops the intergenerational trauma caused by addiction. I will leave it at that. 

[For the full debate, click here for the Oireachtas website]