Tuesday, 16 May 2006
Dáil Eireann Debate
Mr. Kenny: The “Prime Time Investigates” programme exposed once again what is probably the greatest scandal of modern Ireland, that is, the growing numbers of people who have to brush with death rather than go into accident and emergency units. As one of the wealthiest countries in the world, we have failed to provide even basic health care for our people, especially the old and vulnerable. Eileen Reilly said she would sooner die than go back into an accident and emergency department. The late Jimmy Kerry asked his family why he was on a trolley when he would be better off at home where he had a bed. Marie Kilkenny said she wished she would never have to go near an accident and emergency department again and the late Robert Hamilton, as the Tánaiste will know, refused to go into an accident and emergency department. This time, this hard-working man kept his dignity and was staying at home.
The fact is these people worked all their lives to build up this economy but their experience, stories and, in some cases, deaths prove how the Government has failed to use the wealth they created and generated to deliver a proper accident and emergency service to look after them. Some €60 billion has been spent to deliver a lack of privacy, sensitive information discussed in overcrowded conditions, intimate procedures carried out in full view of patients and their visitors, and dangerously overcrowded conditions which have turned our hospitals from sources of healing to sources of infection.
The real scandal is that this is not a new crisis because four years ago the Government did an analysis on what was needed to fix the then crisis so. There can be no shock-horror now. After nine years in power and three different Ministers for Health and Children, a Tánaiste and €60 billion later, the Government has failed to deliver, look after our most vulnerable, invest in the beds we need and invest in developing proper primary care which is the key to a good health service. Last night’s “Prime Time Investigates” programme sums up the Government’s story so far: plenty of promises, no delivery, quick to blame and slow to shame. When the Taoiseach saw that programme, as Head of Government, Taoiseach of Ireland and Leader of the Government for nine years, was he not ashamed this could happen in this country in 2006?
The Taoiseach: As I said earlier on Question Time, last night’s programme showed the distress of patients and their families and the conditions and waiting times in some of our accident and emergency departments. That is an issue I have addressed in the House several times over the winter. We understand the distress. That is why the Health Service Executive is determined to reduce unacceptably long waiting times for patients and all the other issues to which I referred earlier. No stone is left unturned to address problems where they occur. All the necessary funding is being made available. Deputy Kenny is correct in that over a number of years we have put in the resources which effectively have been for extra staff. The HSE is bringing management attention to this as never before. The accident and emergency action group has been working since the HSE was formed early last year and will support the commitment of doctors, nurses and other staff to continually improve patient care. It ensures that in many of our hospitals those departments are working well. We have 53 acute hospitals, with 35 accident and emergency units, of which about 13 are recognised to have a problem. The other two thirds are working effectively and well. There are many such examples across the country. The task is to bring the remainder into line.
The “Prime Time Investigates” programme also carried an interview with Sir George Alberti about the accident and emergency area reforms in Britain, reforms which we have been carrying out for several years. He said it is important there is faster access to senior decision makers and consultants for extended periods of the day, a vital reform I have spelt out in the Dáil many times. It is not that individual consultants in accident and emergency and elsewhere do not work long hours, but the problem is they are not scheduled to be routinely available to patients at all times when needed. That is the issue that arises. The accident and emergency task force has identified practical actions being implemented to get faster access to patients by consultants. Such actions have been suggested by consultants themselves on the task force, and we are working with the individuals to move that forward.
Many other issues are involved. Some 3 million people use our 53 hospitals annually on an inpatient and outpatient basis. Some 1.3 million people — 3,000 per day — use the accident and emergency services annually. That figure has risen substantially, by 10% during the past year alone, so people are using the accident and emergency services in increasing numbers. That increase of 10% is the biggest for a number of years, so it is a myth that people are not using the services.
Many other issues have been highlighted. The two programmes shown last night, “Prime Time” and “Questions and Answers” must be considered together. Nothing was said in them which I have not said several times before, such as how we avoid hospital admissions, enhanced out-of-hours GP services, greater GP access to diagnostics, rapid access to clinics, increased community intervention time, primary care teams, the chronic illness management programmes and home care packages.
The Taoiseach: We have tackled reducing hospital stays, appropriate use of capabilities, beds and facilities, proactive admission and discharge planning, the diagnostics available over extended working days, the consultants providing daily and routine rounds for all patients, the provision of more consultants and working teams and hospital out-reach services.
The Taoiseach: Nevertheless, that is how we will get on top of it. There are more than 2,000 consultants, 4,000 non-consultant hospital doctors, 7,000 extra nurses and 7,000 extra paramedics, all working to get on top of the one aspect of the health services which we must deal with.
Mr. Kenny: The problem is that we did hear it all before. When Professor Drumm addressed the Fine Gael parliamentary party in Portlaoise last year he said that of the 140,000 people who had worked in the health boards, at least 3,500 did not know what their jobs were or where they fitted into the service.
We have heard this all before and the Taoiseach has put the taxpayer to considerable expense producing another consultants’ report to identify problems which he knew existed for the past nine years. While the Taoiseach sits here beside the Tánaiste, he has done nothing about after-hours GP care, step-down facilities or getting value for money. The State and the system cannot cope with elderly and vulnerable people who need emergency care. They are not deemed to be a priority and that is the scandal.
When, on 12 October last, I asked the Tánaiste to identify her main target during her Ministry in 2004, her response was accident and emergency care because, as she rightly said, it is unacceptable that people have to spend up to 12 hours on a trolley. Before the report was published, hours before the “Prime Time Investigates” programme was shown, the Tánaiste said that the latest consultants’ report on accident and emergency services showed there was no crisis in that area. It seemed to be a case of lurching from a national crisis to a national emergency to no crisis at all, simply because the taxpayer was put to the expense of having another consultants’ report to show the same problems that have existed for the past nine years, with which the Government has not dealt.
There is no point blaming nurses, doctors and consultants. This is a problem of Government. The Taoiseach said the spend has gone from €4 billion to €12 billion, but while the extra money is being spent, patients are not seeing the value. The Government has failed to deal with step-down beds, GP out-of-hours care and the provision of acute emergency care as a priority for elderly people when they arrive in accident and emergency units. As we are told, the chaos in such units costs lives — someone’s husband, wife or child.
Tomorrow is the fourth anniversary of the last election. The Government has been in office for nine years, with three Ministers for Health and Children and a Tánaiste in charge of that Department and, while, as the Taoiseach rightly pointed out, the spend has been increased to €60 billion, the issues of out-of-hours GP services, step-down beds and medical priority for vulnerable, elderly people in particular who need emergency care are not being dealt with. The Taoiseach is responsible for that and, as head of Government, was he not ashamed to see the carry-on involving elderly and vulnerable people in some of our accident and emergency units around the country? The television programme showed that what happens in a number of our hospitals is disgusting. The Government has failed to deal with this problem, which it has known has existed for the past nine years.
The Taoiseach: As Deputy Kenny knows, the GP out-of-hours service is excellent in many parts of the country. Until recently, we were not able to resolve the service in a large part of Dublin, covering about half a million patients. Thankfully, those negotiating that issue have now concluded an agreement which will become operational from 1 September. That has been publicly announced. That coverage is very important because up to now, as I regularly pointed out, people without the out-of-hours service had no alternative but to attend accident and emergency units in three or four of the hospitals out of the 13 where there was a difficulty.
Deputy Kenny is not correct on the step-down facilities. Last year, more than 500 beds were used from private nursing homes for step-down beds and already this year over 300 have been provided. About 50 people per week finish their acute treatment in hospitals and they are the people who require step-down facilities.
The Taoiseach: The step-down facilities provide continuing care. With regard to the report mentioned by Deputy Kenny, no report like that was done before. This was a detailed report on ten individual hospitals. Until now they were always classified in statistics that were grouped together and did not look at the individual requirements. This is the first time a report has examined the individual difficulties on the ground by talking to the staff who deal with the problems. The report shows that there are different problems and issues. The issues are not all the same in different areas.
The HSE has looked at the recommendations. They deal with the issues of beds, step-down beds, general practitioner out-of-hours service and the ability of general practitioners to access diagnostic services, whether those services are in public hospitals or private operations. It is a huge benefit for general practitioners to be able to get quick diagnostic turnaround. It means patients do not have to go to accident and emergency departments and those departments can be used for their real purpose. Community intervention teams have been established by the HSE which are hugely helpful in dealing with people in their homes and communities. Primary care teams have been set up and the HSE has worked on the chronic illness management programmes.
Many of these programmes are not new. In the past few years, we have examined the best practice we have seen in hospitals such as St. Luke’s Hospital in Kilkenny, where there is very good community access. I spoke about this previously. We are trying to take that best practice into other hospitals.
Mr. Rabbitte: Last week I asked the Taoiseach if it was not the case that the decentralisation programme announced by the then Minister, former Deputy McCreevy, had run aground and the Taoiseach denied it. Three days later he contrived an interview in which he announced the climb-down. This programme was to be the major plank of this Government’s term of office and involved the biggest relocation of civil and public servants in the history of the State, and the Taoiseach contrived one of his interviews to say that it will not go ahead as planned.
In any of the number of chat show interviews the Taoiseach gave over the weekend he did not deal with any of the questions that are uppermost in the minds of the civil and public servants concerned and in the 53 venues to which the Government pledged to transfer sections of the civil and public service. As a result of the Taoiseach’s climb-down, which venues will not get the Departments, agencies or the civil or public servants that were promised? What is the new deadline for any decentralisation that will proceed? How many of the 10,300 personnel pledged by Mr. McCreevy will still be relocated? How many of the agencies will be relocated? Will any of the specialist staff be relocated?
Is it still the Taoiseach’s intention to proceed with the relocation of the policy functions and the heads of policy making in Departments? How much of the 200,000 sq. m. of office space which the Office of Public Works was instructed to procure has been procured? Has the Taoiseach told the Office of Public Works to stop acquiring such space since he announced his climb-down? With regard to the instructions to the OPW to dispose of a similar amount of office space in this city, how is it proposed that will happen given that the people occupying it are not transferring? Does the Taoiseach agree with the Tánaiste who said: “The target will be reached within a very short timeframe and I believe that if we don’t reach it quickly the uncertainty that is hanging over the public service will be damaging to the public service and damaging for this Government”?
Is it not time to go back to the drawing board and review a plan that was ill thought out and off the top of the head? It was designed to disperse civil and public servants throughout the country but had little to do with genuine decentralisation or devolution of power. It was never intended to correct regional imbalance and it has now run aground. The Taoiseach has had to climb down on it, which is a major humiliation for the Government. He ought to tell people whose lives have been put on hold precisely who will be transferred and when.
The Taoiseach: A total of 10,600 civil servants have applied to the central applications facility to relocate. The central applications facility continues to receive new applications every week. It is anticipated interest will increase further as buildings are built and timetables firm up. With regard to property, site acquisition negotiations have been completed in 13 locations, contracts have been received for an additional ten locations and suitable sites have been identified in a further 15 locations. Negotiations to acquire have either commenced or are close to commencement in these locations.
Agreement has been reached on most of the human resource and industrial relations issues and has enabled progress on transfer to staff promotions. Discussions are ongoing in other areas. Movement of staff between Departments and offices is well under way and 1,500 people have already signed up for Departments. All the Departments and offices have produced implementation plans setting out the detailed arrangements they are putting in place for the relocation. The various negotiations with the unions are progressing. In the Civil Service they are far more advanced but there have been difficulties in the agencies. There are some difficulties on the professional side as well.
The point I made in the House last week that we had extended the timescale was made last year at the launch of the implementation report and was written about in many newspapers. What I said a few days ago was that we will not get all this done. It will not be possible to build all the buildings and get everything finished by Christmas. That was my great announcement and I thought it was stating the obvious——
The Taoiseach: ——but I am sorry if I upset Deputy Rabbitte’s weekend and that he thought I would get it finished by Christmas when I replied to him last week. That was not my intention when I replied to him.
The original timescale set for the programme when it was announced was very ambitious. It was to be done within three years, requiring the full and active co-operation of all the parties involved. It has become clear that some issues which surfaced will take a considerable period to resolve. However, setting ambitious targets was the best way to drive the programme forward. If we did not do that, we would not have made so much progress.
All the civil servants in the various areas are moving. We have made some changes along the way. The implementation group has produced a number of reports. Last week it announced that the probation officers would not be decentralised to Navan but that other sections of the Department will be decentralised. There has been a number of such instances. The Department of Justice, Equality and Law Reform has proposed that in addition to the headquarters of the probation and welfare service, a number of other organisations will move to Navan, such as the national property service regulatory authority, the coroners agency and a new human resources unit. We have made a number of such announcements where the original staff units have been switched to other units.
There is huge interest in the programme and we will continue to implement it as stated. There is no lack of interest on the part of civil servants but there is on the part of public servants. That is a difficulty we will have to deal with. We will, however, do it in conjunction with the Civil Service unions. I thank them for their patience and diligent work in which they have engaged with us on the programme. It will continue with the Minister for Finance, Deputy Cowen, the Minister of State at the Department of Finance, Deputy Parlon, and the rest of the Government.
Mr. Rabbitte: At the weekend, I saw the Taoiseach paying tribute to his predecessor, Mr. Haughey. If Mr. Haughey had uttered the misleading statements to the House that the Taoiseach habitually utters, people would have been marching on the streets. I wrote down what the Taoiseach just said. He said, “All the civil servants in the various areas are moving”. In what kind of parallel universe is the Taoiseach living? The point is they are not moving. The only items dispersed around the country are electronic voting machines that do not work.
Mr. Rabbitte: It turned out that no one from ADM Limited moved to Clifden but that they were new staff there. ADM Limited then issued a statement on the same radio programme, stating it is neither a public service nor Civil Service organisation but an independent board and it is none of the Government’s business from where it functions.
I ask again, what is the timescale for the decentralisation that will go ahead? Will there be negotiations to ensure whatever transfers take place are voluntary? Last week the Taoiseach said that in an organisation with 100 staff and where 99 were moving, the fellow remaining could not expect to get promotion. Apart from the fact that it is the other way around, what does he mean by the fellow remaining behind cannot get promotion?
Has the Taoiseach put any halt to the gallop of the Minister of State at the Department of Finance, Deputy Parlon, who, no more than himself, would say anything? Is the Minister of State still going around the country, acquiring property in the uncertain climate that the Taoiseach has created for the programme? Will the Taoiseach agree the people who work in the service of the Government deserve to know what the future holds for them? Does he have any regard to the damage done to the coherence of Government by the unique difference in this package of decentralisation that proposes to transfer the policy-making functions of Departments from Dublin city? Has any cost benefit analysis been conducted on the programme? Will we ever see any of the figures involved?
Mr. Rabbitte: We will have a situation that has happened to those units already transferred where the specialist staff refuse to move and have to be retained in Dublin city while staff have to be employed. The Government has made commitments to so many towns and villages where there is a definite need to address regional imbalance. These towns do not know whether they will be the beneficiaries of the pledged relocations.
The Taoiseach: Civil servants are well-informed through staff negotiations. I appreciate the work that has gone on for the last two and a half years on these issues. The Civil Service unions have been deeply involved in the discussions. Agreement has been reached on a large number of issues, including human resources. It has enabled progress to be made on a range of issues, including mobility, promotions and discussions of transfers to other areas. As I have already stated, building and site acquisition negotiations have been completed in 13 locations. Contracts have been received for another ten locations. Suitable sites have been identified in a further 15 locations and negotiations to acquire sites have either commenced or are close to commencement.
The Taoiseach: Those civil servants who wish to transfer have made their applications on the central applications facility. Some difficulties have arisen about professional grades, as there were during the last decentralisation round. We will not duplicate the positions but we must negotiate a way through this. It was done before and will have to be done again.
It is not a charge to get civil servants out of Dublin and into caravans. When the sites are available, they will move. It will not be finished by Christmas, but some hundreds of civil servants will have moved by then to the 13 locations.
Difficulties have arisen with the State agencies which have no history of decentralisation and where small numbers of people are involved. I referred to the argument put forward by some outside the House that if some State workers opt to stay in Dublin, they should be automatically promoted. That cannot happen as they must be treated equally. That is the understood position with the Civil Service unions. Where there are difficulties, we will negotiate through them.
I see no difficulty with policy-making units being here, there or anywhere. Some of the largest multinational companies in the world operate in Ireland. With their bases in different parts of the world, they have policy and business meetings through televised conferences. I have addressed some of these meetings. Personnel in these companies can deal with policy in Latin America and the US. To say that because someone is in Nenagh or Sligo, the whole Civil Service system will stop functioning is a statement from the 1930s.
The Taoiseach: There are no difficulties with this issue. Thankfully, Ireland is one of the world’s largest exporters of information and communications technology. To believe that in a small island we cannot communicate on policy issues is nonsense.
Mr. J. Higgins: Over the last few days, we have the tragic and unsettling event of a group of Afghan refugees, in desperation at the uncertainty of their situation, mounting a hunger and thirst strike in St. Patrick’s Cathedral. Deputy Cowley and I, along with other Opposition Deputies, visited them today. Happily, they are now taking liquids, a great relief to them and to all who wish them well. Dehydration was having a dramatic and extremely rapid deteriorating effect on their health. This afternoon, there was a meeting with the Department of Justice, Equality and Law Reform, the outcome of which we do not know yet.
Only two months ago the Taoiseach was in the US. He pleaded with the President of the US to allow, on grounds of compassion, 40,000 to 60,000 — we are not sure of the exact figure — Irish citizens in the US without official permission to remain and make their lives there. Every Member, be they on the right or the left, strongly supports that view.
Mr. J. Higgins: By implication, that means supporting the view that up to 12,000 migrant workers and their families without official sanction should also be given permission to remain and make their lives in the US. We do not single out the Irish as being special and that they alone must receive compassion.
Will the Government extend this to a few dozen people seeking the compassion of the Irish people for refuge and a new life? Seven of the group are under 18 years of age, studying for their leaving certificate examinations. Their classmates are concerned and supportive. Six have been taken to hospital, one described as being in a serious condition. Will the same humanitarian concerns for immigrants in the US, particularly for our fellow countrymen and women, be applied by the Government in the case of those coming from a tragic, troubled and dangerous country?
The Taoiseach: On Sunday last, 14 May, some 34 Afghan nationals entered St. Patrick’s Cathedral and commenced a hunger strike which they stated would not end until they were granted asylum in Ireland or leave to remain. At present, approximately 40 Afghans remain in the cathedral. The exact number is still imprecise as some additional people were admitted to the cathedral on Monday morning and some have been admitted to hospital today.
According to the information available to me, which is based on the individual names available to the Department at present, all the individuals concerned are in either the asylum or the leave to remain processes. At present, none of the individuals concerned has been issued with a deportation order as the process has not yet concluded in any case.
Applications for asylum are assessed as part of an independent process under the Refugee Act 1996. Case assessments are made on the basis of information provided by the applicant, as well as the detailed country of origin. An applicant who is found to have no grounds for refugee status is invited to make representations to the Minister under section 3 of the Immigration Act 1999 stating why he or she should not be deported from the State. In addition, the safety of a returning person, or refoulement, is fully considered in all cases.
As Deputy Joe Higgins is aware, the asylum process in this State is comprehensive and compares well with those of any of our EU partners. This was recently acknowledged by the former UNHCR representative in Ireland who was quoted as stating that Ireland is now a model for the new member states of the European Union and that it has a system which in many respects is one of the best in Europe.
I understand the present position to be that the individuals concerned have asked to meet officials of the Department of Justice, Equality and Law Reform to discuss their situation. The Department has agreed to meet a small representative group in its offices at Burgh Quay. The purpose of the meeting is to hear the exact reasons for their protests, as well as to explain the nature of the asylum and leave to remain processes and that the Minister is bound by law to deal with their cases within the present framework. No negotiations will take place at the meeting. It is a question of explaining the position to the protestors. As Deputy Joe Higgins has noted, there are eight minors among the group.
To be clear, people of more than 100 nationalities participate in the asylum process at present and conceding to any demands from the protestors would have major negative consequences for the asylum system which has been built up in the past decade. Undoubtedly, concessions would lead to similar protests and a major inflow of additional applicants in the hope of benefitting from similar actions. At present, 20 churches in Belgium contain asylum seekers. I wish to be straight in this respect. We will not go down that road. We have a system which people may follow if they wish. However, we will not give way to threats.
Mr. J. Higgins: The Taoiseach should not consider this to be a threat when people are so desperate and insecure for their future that they put their health and lives at risk. People come here seeking refuge and compassion because they are under threat in the places from which they have come. Many Members who deal and have dealt with individual cases of people in grave difficulties and human situations have reacted compassionately.
Interference by the major powers for more than two decades has plunged Afghanistan into being one of the most violent and disturbed countries on Earth. First the Russians and then the CIA and Saudi Arabia and the rest intervened with their national interests in mind. Latterly, the CIA and Saudi Arabia called both the jihad and the horrific Taliban, which has been a major source of the instability and violence, into existence.
Does the Taoiseach not agree it is a gross misrepresentation of the truth to portray or attempt to portray Afghanistan as a peaceful and democratic society? Does he not agree it is one of the most disturbed and violent places on Earth? Some of the Afghans who seek refuge here carry healed wounds from that conflict, unlike our Irish compatriots in the United States.
I noticed the Taoiseach did not refer to my equation of their seeking humanity and compassion in Ireland with the position of the tens of thousands of our fellow countrymen and women. Can he not see that in many ways, it is a similar situation? Irish representatives, both here and in the United States, who call for compassion on the part of the United States Government do no more than do Members in respect of these people and others who seek refuge. Will the Taoiseach to speak to the Minister for Justice, Equality and Law Reform? On the grounds of compassion, humanity and the humanity of the people, as well as the respect for human rights cherished by the people, I ask that these people be allowed the refuge they need to have some future in society.
The Taoiseach: I will not argue with any of Deputy Joe Higgins’s observations regarding Afghanistan or its difficulties. However, people of more than 100 nationalities have lodged applications in our present system.
The Taoiseach: ——and by the UNHCR. While 1% of the population was non-Irish a decade ago, that figure reached 9% before the recent census was taken. We have been very fair and tolerant. None of the individuals concerned has completed the process or been served with a deportation order.
Neither St. Patrick’s Cathedral nor any church is an office in which to deal with our legislation. We will be unable to have a process if we give into this action and I will not countenance that prospect. The individuals concerned should talk to the officials and follow the process. While I do not wish to be hard in this respect, there is no other way to deal with the process. They would be best advised to listen to the officials and to understand the system. This also applies to everyone else.
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