Tuesday, 16 May 2006
Dáil Eireann Debate
Progress on the implementation of the Government programme is kept constantly under review. Deputies will be aware that for every full year Fianna Fáil and the Progressive Democrats have been in Government, we have published an annual progress report. The third annual progress report of the current Administration was published on 25 July 2005. Work has commenced on the fourth annual progress report and it is intended to publish this later this summer.
The progress reports set out the progress to date in implementing every single commitment contained within the programme for Government. It is the responsibility of each Minister to ensure that the commitments in the programme that fall within his or her portfolio are fully implemented.
The Department of the Taoiseach derives its mandate from my role as Head of Government. As such, it is involved to some degree in virtually all aspects of the work of Government. It provides support to me as Taoiseach and to the Government through the Government secretariat and the Cabinet committee system and through its involvement in key policy areas and initiatives.
The current key strategic priorities of the Department are set out in its strategy statement. They include Northern Ireland, EU and international affairs, economic and social policy, social partnership, public service modernisation, the information society and e-Government. I and the Ministers of State in my Department answer questions in the House on these issues. In all its work, my Department works closely with other Departments and offices. Individual Ministers are answerable to the House in respect of their specific areas of responsibility.
The key areas for which my Department is responsible in terms of An Agreed Programme for Government can be broadly summarised as follows: supporting the development and implementation of social partnership, working with the British Government and the parties in Northern Ireland to achieve the implementation of the Good Friday Agreement in all its aspects, co-ordinating the e-Government initiative to bring about an expansion in the range and quality of on-line Government services and ensuring that Ireland’s key objectives in the European Union are carried forward in the context of my role as a member of the European Council.
Mr. J. Higgins: Does the Taoiseach accept that as he moves towards the fifth year of a second term in Government the vast bulk of An Agreed Programme for Government should have been implemented at this stage? How does he explain to the people who watched the RTE “Prime Time” special last night that a senior doctor in the British health service would compare with the Third World some of the conditions in a world-class health service the Taoiseach promised to deliver in An Agreed Programme for Government? Elderly people were slumped on chairs in accident and emergency departments——
Mr. J. Higgins: I am anxious to establish with the Taoiseach, in view of what the people witnessed last night, what timescale he is setting for the achievement of the health section of An Agreed Programme for Government and to put to an end the disgraceful position of elderly people begging that they would not be sent to hospital——
The Taoiseach: I am sure Deputies would agree with that. On the issues pointed out in the “Prime Time” programme which showed the distress of patients and their families about the conditions and the waiting times in some accident and emergency departments in some acute hospitals, I understand the distress. That is why, with the Health Service Executive, we are determined to reduce the unacceptably long waiting times for patients. No stone is being left unturned to address these problems when they occur. All the necessary funding is being made available and this has been acknowledged by the Health Service Executive. The HSE has drawn the attention of management to this as never before. We will support the commitment of the doctors, nurses and staff to improve patient care continually and ensure that the accident and emergency departments of many hospitals work well. We are confident that the improvements we seek will be achieved. It is for all of us — the Government, the Department and the HSE — to work to achieve that.
Mr. Kenny: Does the Taoiseach regard as disgraceful what has occurred in recent days where hundreds of thousands of commuters have been discommoded? They cannot meet appointments, attend for interviews or attend college because of the disruption to the transport system.
Mr. Kenny: This matter has to do with the programme for Government and obviously there are complex, well-tested mechanisms in place to deal with such issues. Because this is a wildcat strike, does the Taoiseach have a view on how it can be settled?
Mr. Kenny: In case the Ceann Comhairle has not read Question No. 2, it asks if the Taoiseach will report on progress to date on implementing An Agreed Programme for Government, and if he will make a statement on the matter.
Mr. Kenny: I am asking a question about An Agreed Programme for Government, which was signed by the Taoiseach and the Tánaiste. Will the Taoiseach give an update in terms of implementing the Government’s programme for the development of the marine industry, in view of the fact that trawlers valued at €400 million are tied up in Killybegs for the past three months?
The Taoiseach: On the first matter, without going into detail, the Government’s programme on rail transport shows that €177 million has been invested in the supply of new rail cars this year. Most of these are now coming on stream and various discussions have been taking place since 2000 to make provision for them. Those discussions were concluded last January and I understood everything was resolved, but clearly there is a small group of people who do not agree. Before the action was taken yesterday, there were scheduled meetings to take place between the official union representatives and the Department of Transport. From the point of view of the programme for Government, I hope the implementation of a large capital expenditure programme to improve public transport, with mainline rail, the national work on the safety of the lines and the work on a number of rail routes such as the Kildare route will be allowed to proceed speedily without unnecessary disruption. Such improvements are for the benefit of the customers.
Regarding marine matters, Deputy Kenny is aware of the difficulties in Killybegs. During the lifetime of this Government and the last one we invested major capital expenditure to finish work on the pier and the infrastructure in the Killybegs area. There are some difficulties with which the Minister for Communications, Marine and Natural Resources will deal, but from a Government perspective we put in much needed facilities that were sought for 20 years in terms of marine capital infrastructure. I do not know for how long the current problems will continue. Some serious matters are involved, but they are not related to the programme for Government because, to the best of my knowledge, the capital expenditure programme for Killybegs is concluded.
Caoimhghín Ó Caoláin: Can the Taoiseach confirm that the programme for Government, which came about following the general election in 2002, was agreed between the Taoiseach and the Tánaiste, Deputy Harney, and that both of you signed off on it? If that is so, can the Taoiseach confirm that the programme commits the Government to the core objective of developing, among other things, a world-class public health service? Is that one of the stated core objectives? Can he confirm that the programme commits the Government to provide 3,000 additional public health beds? That was set out in the Government’s health strategy of 2001, which predated the programme for Government. Can the Taoiseach confirm that the programme states the Government “will implement” a full range of measures to provide accident and emergency services——
An Ceann Comhairle: Yes, Deputy, but the Chair has ruled, as have several incumbents of the Chair in the past, that questions for line Ministers should be submitted to line Ministers. Deputy Joe Higgins and Deputy Kenny have accepted that and you must also accept it.
Caoimhghín Ó Caoláin: On the implementation of the programme for Government, how is the Cabinet currently addressing the issues I have raised, which were committed to in the programme for Government? What role does the Cabinet health committee have, if any?
The Taoiseach: Obviously, the commitments have been laid down so I need not refer back to them. The Cabinet committee on health operates with the relevant Ministers, the HSE and the Department of Health and Children, reviewing current issues such as accident and emergency services, the capital programme, negotiations with doctors, nurses and general practitioners, out-of-hours services and so forth. That is how the system works.
With regard to our commitments, we are providing our health service with resources. We are working for a better service across the board. There are large numbers of additional staff. Most of the resources have gone towards providing the additional staff required to provide an improved service. There are an additional approximately 7,000 nurses, several hundred extra consultants and a large number of paramedical staff in the health service. The capital programme each year is approximately €500 million. All this is improving the service.
Total health expenditure has increased. Ireland has the fastest rate of growth among OECD countries in spending per capita on health. There are approximately 32,000 extra staff in the health service. There are more than 2,000 medical staff and 7,000 other professionals. There are various initiatives with regard to public and private beds and day care beds. There has been an enormous increase in the number of day care cases, up to approximately 500,000, which is a much better utilisation of the acute hospitals than the old system. Some 1,000 new beds have been put into the system. This year, we have a large capital programme——
The Taoiseach: The medical card system has been extended. We have worked to get the out-of-hours doctor system resolved. We have used the National Treatment Purchase Fund to lower acute waiting lists. The waiting lists are lower than they have ever been, as seen in recently published figures. A programme of more than €900 million has been provided to improve services for people with disabilities.
I referred previously to the work done in the one area that continues to create many difficulties in 13 to 15 acute hospitals. Several initiatives are being taken simultaneously to get on top of that problem.
The Taoiseach: It is accepted that a range of issues must be dealt with and interaction must take place between a large number of different groups to resolve this problem. I appreciate the commitment from the various medical and nursing professions to work to resolve this problem.
Mr. Sargent: Has the Taoiseach ensured there are no typographical errors in the programme for Government? When one reads the line “a world class health system”, one wonders whether the word “third” should be before “world”. Is that what the Government meant to say, given the evidence? Last night’s television programme was more clear evidence of the problems in the health service.
I must take my hat off to the Taoiseach. In the late 1980s, the then Fianna Fáil Government cut bed numbers from 18,000 to 12,000. The Taoiseach now makes a virtue of trying to put back in some beds. That takes the biscuit.
Mr. Sargent: Will the programme for Government deliver any of the measures to which it is committed? Given time is so short, is any mechanism in place to ensure action from the programme for Government is based on meeting the areas of greatest need? Is a mechanism in place to prioritise commitments made? Alternatively is it just a matter of business as usual and ensuring every issue gets the same attention?
Energy resources have become a key issue. People now pay more for fuel than in 2002 when the Government took office, yet the Government has taken no action to respond to it sufficiently. Farmers continue to have the legs cut from under them owing to mislabelling. The programme for Government contains a commitment for the introduction of a distinctive green label for Irish food produce. Will this ever happen? Teagasc claims only 10,000 people will be employed in agriculture by 2025, yet the Government has not put in place the review of small rural enterprises. Will it be delivered? Agencies identify the problem areas. They scream out for action but do not get it. Is there any mechanism for prioritising the raft of measures in the programme for Government? Although all will not be met, will the urgent ones be addressed?
The Taoiseach: Priority has been given to providing resources for the health service. The lion’s share of the increasing annual budget is given to health services. Resources have been given for additional staff, which last year increased again.
The Taoiseach: There are problems in some areas. I have pointed out many times on Leaders’ Questions that 3 million people a year use inpatient and outpatient facilities. The operations performed in Ireland are probably as sophisticated as in any other country. To state that it is Third World is totally——
Some 3 million people use the service and the inpatient services in our hospitals work effectively. Problems exist in approximately 13 of the 53 acute hospitals and we must try to get on top of them. However, there is greater understanding as to how we must do so. There must be more home care and palliative care packages, as well as more people working in the community to prevent the necessity for patients to go to hospital in the first place.
In addition, we must try to provide better services for the elderly and for those who cannot return home on completion of their acute treatment. While there are pressures involved in trying to do so, we are working on them and are putting major efforts into this issue. Many people in the accident and emergency task force are working to do that. This matter is complex, not easy. I have attended meetings in this regard and it is a difficult issue. If the problem were simply a matter of resources, this would be an easy matter to resolve.
Every week, there are approximately 50 new cases in acute hospitals of patients who could leave but cannot go home owing to various circumstances. While such people may not have a medical condition, they might have difficulties in managing on their own or whatever or may be too elderly. We must provide step-down facilities for such people.
The Taoiseach: Perhaps a different type of bed is needed. I have accepted that before. This is why we must try to take up more beds. There have been many initiatives which have worked very well in many hospitals. For example, Kilkenny, Waterford, Limerick and other hospitals have a superb record of dealing with such issues.
As for out of hours general practitioner services, I hope the discussions, which are now making good progress, will facilitate them in the regions. In particular, I refer to the northern part of west Dublin, where an out of hours GP service for 500,000 people will be opened up. The negotiations aimed to achieve this goal by the end of last week. Hence, these are important issues.
We have a very good system here in respect of food labelling and traceability. While I am not familiar with the status of all commitments, our traceability is good and food product standards are very high. They match European and international food standards. This is why——
Mr. Rabbitte: Has An Agreed Programme for Government been renegotiated at any stage since it was promulgated? Can the Taoiseach be satisfied with the progress of implementation of the programme for Government given the spectacle on view last night in an excellent “Prime Time Investigates” television programme? Is he satisfied to be the Head of a Government which has stood idly by for nine years while the degradation and humiliation of older citizens, who have paid taxes all their lives, was presented in such circumstances as were on view last night?
A core commitment in An Agreed Programme for Government states clearly that: “We will expand public hospital beds in line with a programme to increase ... capacity by 3,000 during the period of the Strategy”. Has that commitment been renegotiated? Is that no longer part of An Agreed Programme for Government? Is that no longer Government policy? Has the commitment to put 3,000 beds back into the system been dropped? Is it not true that the only conclusion one can draw from last night’s “Prime Time Investigates” programme and the following programme is that we are now talking in a purely managerial context and that any reforms introduced will be purely concerned with management, deployment of resources and operation of the process?
The Taoiseach: The agreed programme has not been renegotiated. It is still the programme to which the Government is working. Every year, we produce a report on the updated position and Ministers answer questions every day. The individual cases reported in last night’s “Prime Time Investigates” programme on the accident and emergency services were very distressing for the individuals concerned, their families and the public. I understand we have provided approximately 1,000 additional public beds.
The Taoiseach: A considerable number of beds are being brought into operation in a number of hospitals under the capital programme and this year’s capital programme continues this work. We have introduced step-down beds and beds for the elderly hired from the private sector.
The Taoiseach: An initiative by the Tánaiste and Minister for Health and Children takes private beds out of public hospitals to designate them as private hospital beds. There is a debate within the HSE, which is the reason it is carrying out this re-examination. Senior figures in the HSE and the Department of Health and Children would argue that it relates more to the operation and use of acute beds and ensuring that discharge and admission policies are improved because 500,000 day care cases arise every year. When the last bed capacity review was carried out, the number of day care cases was very small.
I do not know how many acute beds are needed and I will not be drawn into guessing. I accept that our procedures and processes for admissions and discharges, where discharges sometimes do not take place for several days, are light years behind those of other countries. Resources could be better utilised. I do not know how many additional beds could result from better admissions and discharges procedures. In last night’s programme, the HSE argued that the amount of lost capacity is approximately 150,000 bed days per year. The HSE will carry out this study but in the meantime, the Government will continue with its sizeable capital programme for health. More than €508 million will be provided in capital funding this year. We will continue our work in respect of the step-down beds that we have negotiated with the private hospital sector, the work carried out with the diagnostic services and private hospitals and the national treatment purchase fund.
A considerable degree of State funding will go towards procuring beds in all of these areas. The question of what is the cheapest way to carry out measures if all these beds were brought into operation is academic because the most important matter is to procure these beds. We will need more beds for elderly people because it has been predicted that this country will have 1 million people over 65 within the next 30 years. This is not the position at the moment. The HSE calculates that we probably do not need any more acute beds but an analysis of this issue is being carried out. I have doubts about this argument but I am not the expert charged with carrying out this statistical analysis. Others are carrying out this analysis and the figures will be produced soon.
Mr. Rabbitte: Is the Taoiseach not the head of Government? After five years in Government, did he not decide with great fanfare that 3,000 additional beds would be put into the system? Was this not the cornerstone of the health programme? He now states he is not an expert and does not know the answers and that people are carrying out studies. The previous Minister for Health and Children, Deputy Martin, carried out 113 consultancy studies and there is now another study taking place.
Mr. Rabbitte: Yes. The question all Deputies sought to ask today is whether the core commitment to provide additional bed capacity is still Government policy. To anyone listening to the Tánaiste last night and various public statements on behalf of the HSE, it would seem perfectly clear that it is no longer Government policy to provide those beds. While there was a commitment to provide community care or step-down beds, it has not been done commensurate to demand. It remains a commitment only.
In the broadest terms, is the Government still in charge of health service policy or has it been ceded to an agency that has diagnosed the problems as being purely managerial? The programme announced with such fanfare by the then Minister, Deputy Martin, and the Ballymascanlon House Hotel brouhaha in advance of it——
The Taoiseach: I would like to believe that if we had every one of the beds today, it would sort out all of the problems in accident and emergency units, but that is not so and Deputy Rabbitte would not believe that either. The Government has provided and built new high-cost acute beds and will continue to do so in the capital programme for this year in respect of a number of new units.
I was making a point on day care beds. I am not confusing the issue with accident and emergency units. When one has more day care cases, with which our medical profession is doing well — we have 500,000 day cases whereas we used to have 10,000 or fewer not that many years ago — it takes away the need to have as many acute beds. We have provided——
The Taoiseach: Those people do not need to hold acute beds on a weekly basis. That is the argument. The HSE argues that we need to get a far better utilisation of our current number of beds. This is one issue. We need more step-down beds for the elderly and for people who have finished their acute care and are required to be discharged to a suitable setting. We do not have enough of those beds and that is why——
The Taoiseach: Those step-down beds are crucial and we have hired them from the private sector because they are not available in the public system. Last year the Tánaiste announced that 1,000 beds in acute hospitals that are designated private will be redesignated as public beds to improve the flow of public patients in our hospitals.
These are just some of the issues concerning beds but there is a whole range of other issues that will help the flow of patients through our accident and emergency departments, who number 1.3 million every year, or 3,300 per day, and ensure they have better services. A small proportion of patients, although it is still too many, wait for long periods for a bed. The idea is that nobody will wait, initially, for over 24 hours in accident and emergency units or over six hours once it has been declared that he or she should be admitted. That is the policy set down by the HSE and the requirement is to get on top of the problem. In the meantime, to give more dignity to patients, we provided additional resources last year and again this year to provide reception wards for people who will be admitted but for whom a bed is not immediately available, to improve the services for them.
These are good initiatives. We require the co-operation of everyone in the health service to improve matters. I welcome comments made in recent days and weeks at various health conferences about people working together to do that. It is not a question of resources. The Government has shown, by increasing resources by over €1 billion per year, that it is prepared to invest in health and will continue to do so.
Let us remember that there are 53 acute hospitals in this country, 35 of which are involved with accident and emergency services in a major way and 13 of which are experiencing difficulties. We must work to overcome those difficulties but that should not take away from the extraordinary work, of a world-class nature, that is being done in our hospitals on a daily basis by the skilled people who are employed in our health services. I accept there is an accident and emergency service problem. We must do our utmost to resolve it as quickly as possible and with the resources, staff and policies, we can do that.
Mr. Naughten: One of the key objectives in the programme for Government is ensuring balanced regional development. In light of the fact that there is not 50% of greenfield foreign direct investment in the BMW region, there are serious energy and infrastructural deficits in the west, the tourism sector is on its knees and decentralisation is being abandoned by Government, what is the Government doing to ensure that its target is met and that we reduce, rather than widen, the gap between the east and west coasts?
The Taoiseach: Deputy Naughten will acknowledge that the Government was right to fight for balanced regional development. He will recall it was not a popular issue when I fought for the division of the country into two regions to obtain greater resources for the Border, midland and western regions.
The Taoiseach: There is now, but there was not at that time. Deputy Naughten will be glad that those regions have done better than the eastern and southern regions, according to all analyses, in terms of employment, investment and other areas. Hopefully, in the period of the next national development plan, we can maintain those improvements by giving positive incentives through grant aid and greater expenditure on infrastructure. There are difficulties, as the Deputy said, with energy but we will try to address all the infrastructural issues, including rail, road and local airports to achieve balanced regional development. Decentralisation will also improve matters in many of the regions. The Government will continue to implement these proposals even if, as I said the other day, we will be a bit slower in achieving it.
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