Martin Daly: CAMHS failures and new models for rural GP care
Martin Daly criticised CAMHS referral practices and rural GP provision, arguing current systems create delays and distress for families. He described returned referrals, a specific ADHD case returned from the United States, and called for changes to GP staffing and funding models.
Martin Daly recounted a family who returned from a two-year work contract on the west coast of America with a child assessed and treated for ADHD. He said a local CAMHS referral was returned with a response that the child was "not suitable for our assessment" and a warning that, even if seen, the service would take the child off medication and reassess after six months because it could not be guided by US professionals.
He contrasted Deputy Ardahl's Dublin experience with problems in rural Roscommon and East Galway, saying referral-handling practices had been disrespectful to GPs and created resentment among parents and clinicians. He described the issue as historical but recurring and not limited to one area, with GPs elsewhere reporting similar experiences with the same service.
Martin Daly said he welcomed assurance on a "one-door" referral approach - that a child referred into the service would receive the most appropriate HSE-deemed care. He acknowledged the commitment that the system would change, while stressing the problems he and other GPs had observed.
He raised recruitment and retention challenges in rural and deprived inner-city areas, noting longer consultations and greater complexity since 1989 when 1,200 medical cards per GP became a benchmark. He urged fresh thinking on models - including salaried or other subsistence arrangements and targeted training - and gave the example of long home visits in Bantry, West Cork, to illustrate rural workload pressures.
CAMHS referrals and a family case
Martin Daly recounted a family who returned from a two-year work contract on the west coast of America with a child assessed and treated for ADHD. He said a local CAMHS referral was returned with a response that the child was "not suitable for our assessment" and a warning that, even if seen, the service would take the child off medication and reassess after six months because it could not be guided by US professionals.
Wider institutional pattern across regions
He contrasted Deputy Ardahl's Dublin experience with problems in rural Roscommon and East Galway, saying referral-handling practices had been disrespectful to GPs and created resentment among parents and clinicians. He described the issue as historical but recurring and not limited to one area, with GPs elsewhere reporting similar experiences with the same service.
Acceptance of one-door policy assurance
Martin Daly said he welcomed assurance on a "one-door" referral approach - that a child referred into the service would receive the most appropriate HSE-deemed care. He acknowledged the commitment that the system would change, while stressing the problems he and other GPs had observed.
GP numbers, recruitment and alternative models
He raised recruitment and retention challenges in rural and deprived inner-city areas, noting longer consultations and greater complexity since 1989 when 1,200 medical cards per GP became a benchmark. He urged fresh thinking on models - including salaried or other subsistence arrangements and targeted training - and gave the example of long home visits in Bantry, West Cork, to illustrate rural workload pressures.
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Transcript
Deputy Ardahl, because I was very impressed by her passion in relation to this subject on CAMHS, because what she says is true. And whilst I take Mr Gloucester's observance that if a clinician makes a decision, he doesn't feel in a position to second guess that. However, I would say that any branch of medicine or health services is open to review. We had a situation in the Rascommon East Galway area, where it was my impression that the person who was receiving the referrals, the professionals receiving the referrals, it's now historical but only recent, took particular, almost viewed it as some sort of a performance to push back as many referrals to GPs. It was a major issue for GPs in the area. So much so that the letters were full of disrespect for fellow professionals. And I think it has been resolved now. But you see, the same issue keeps coming up over and over again. So Deputy Ardahl is speaking about Dublin. I'm speaking about rural Rascommon and East Galway. But at the end of the line, we have parents who are dealing with very, very difficult situations who are striving to do their best for their children. So I'll give you an example. I had a family who, for work reasons worth, middle management, went to the west coast of America on a contract for two years with a child with ADHD. The child was assessed over there by a professional psychologist and a pediatrician specialising in the area and put on treatment. The child came back to this country because the contract was up. Parents wanted to continue the medication because it had changed their lives in terms of the child's ability to attend school and be in education. My referral to the CAMHS was received and sent back. And this was essentially what it said. First, we don't think this child is suitable for our assessment. Secondly, even if I did see this child, I would have to take them off the medication, reassess them at six months and decide because I couldn't be guided by professionals in the United States of America. I had reports from them. I couldn't be assessed. That's the level of dysfunction. That is not patient-centred. That's not parent-centred. That's not child-centred. That's not even productive in any. It creates resentment. It creates anger. It creates frustration. And I had this from loads of GPs in that area who were absolutely outraged, not just because of the waste of time for them, but also the absolute disservice to the families and the parents who are trying to do their best and making their lives even more difficult than they already are. So what Deputy Arda says is true. And, you know, and so I am delighted and I take your assurance that this one-door policy of a referral into the service where a child in the family will receive a service which is deemed most appropriate by the HSE. I am happy with that and I am happy with your assurance on that. But what Deputy Arda describes is true. It's not just her experience or a few people in her area. It's true. And it seemed to be an institutional issue throughout the country. Because you talk to GPs in other parts of the country and they're telling you the same stories about the same service. But I accept your assurances on that and that things will change. Moving on, and I'm glad to get the second point. Our Senator Boyle spoke about GP numbers in rural areas. An easier topic maybe to discuss. But nonetheless, the service that's required, and I do agree with you, Mr Gloucester, that the modelling has to change. And part of that is a reluctance. And it's not just in general practice. I see it in specialties in smaller hospitals, that reluctance and a difficulty to recruit and retain medical professions, but also allied health professions as well in those areas. But we probably do need to look. I know I accept that there's been an extension of training. We also need to be careful and we cast a net so wide that we make sure that we get high quality graduates into those training programmes. And that's also a challenge. But I think in some remote areas and rural areas where there's specific need, and I would also put in to that deprived inner city areas where there's a difficulty recruiting and retaining GPs, that we need to look at a different model. Like somewhere along the line, someone decided that 1,200 medical cards was enough work for one GP in 1989 with one nurse and one secretary. But no one ever did a work and time study on it. And we've changed considerably in the last 35 years to a point where there's much more complexity in the work we do. The consultations are longer. And, you know, in those areas, the state does have a responsibility to provide a service. And it may be that there's a less number of patients, but it takes two GPs to provide that service, maybe on a salaried model, maybe on some other subsistence model. But we do need to think outside the box. And that's not just in rural areas. It's also in deprived inner city areas, I would say also. So I'd probably ask just for your own observation on that. Yeah, look, I don't disagree. I don't think a uniform or an homogenous type model for Ireland works anymore. That's the truth. We have always had, and I think to the greatest value of our health service, our GPs have always been independent practitioners. And I actually think that model has, in the main, served us very well. And I don't think we should go and break the whole thing. In areas of huge disadvantage, like Summerhill in Dublin, where the GP care for all construct came, and despite challenges around the revenue rules and so on, they still, we've managed to sustain that. And that works for people who'd never have a chance of getting a doctor. I think we have to think as creatively as we can as to how we support the model of general practice and the funding of general practice for rural isolation. I was down in Bantry in West Cork two weeks ago, and, you know, if you were to do a home visit there, you'd nearly want a day to go out and back to do it. So, and I think in fairness, in terms of the strategic review of general practice, the Minister is very attuned to not simply saying one size fits all. And I think the ICGP, and I've no doubt the IMO and others will all contribute to that. But I don't disagree with you. I think we just probably need more support as well in terms of nursing and research. But again, I just don't want to run down the clock. A couple of just other questions, and thank you for being so open on this. The St. Bridget's Psychiatric Hospital campus, maybe it's Brian dealing with that, but I know that's to be disposed. I have to say, as a representative of people in Banneslaw and that area, that people are deeply frustrated that this site has been left in such a derelict state. It's an eyesore for the town. I know there's a protected building at the front, but the protected building has a tree growing up through its floor. So there's not much protection for that anymore. It's going to be sold off as one piece. And I'm wondering, has there been any discussion between the HSE and the local authority to consider a more rounded view than simply disposing of this estate? Okay, so just in relation to Banneslaw, firstly, the delay to date has been, we're trying to rectify the title issues. So first registration, so that just takes a period of time. So it has been identified as surplus to requirements, and we are engaging with all the local stakeholders in relation to any interest. I would say that there would be challenges to get other interested public bodies involved in the historical buildings, to be perfectly honest. But it is a big campus. I mean, there would be opportunity to have some form of a community campus where you could have education, social, health campus. It would be an ideal... So there's a varying range of different plots in the town and around the town that was within the HSE ownership. We will look at a strategy at disposal to see what best suits that sort of model. Again, it's on the property register, surplus to our requirements. So it's there for the County Council to express an interest at the moment. We're absolutely open to engage. We want to get this reused and repurposed. It's just not conducive to modern health care provision. And it is a town that has huge need, social and health need. Basin, have I... You're on time. Totally can't? You're on time, yeah. Okay, great. He's smiling. Thank you. Thank you.