Thursday, 2 April 2009
Dáil Eireann Debate
The Health (Miscellaneous Provisions) Bill 2009 has several purposes. First, it gives effect to the Government’s policy on the establishment of the office for older people within the Department of Health and Children, and it develops the integration of other health service agencies in line with the objectives of the health service reform programme and the Government’s policy on agency rationalisation. Second, it provides for ministerial responsibility for the local government superannuation scheme for the health sector to transfer from the Minister for the Environment, Heritage and Local Government to the Minister for Health and Children. It also gives legal effect to amendments made to this scheme by the Minister. The third element of the Bill is the amendment of the Hepatitis C Compensation Tribunal Act 1997, as amended, to remove age limits for the travel insurance benefit provided in accordance with that Act. Fourth, the Bill makes certain technical amendments to the Health Act 2007. Finally, the Bill amends article 5 of the National Cancer Registry Board (Establishment) Order 1991, which deals with the composition of that board. This is in fact linked to policy on agency integration in the health service. I propose to give an overview of the different policy areas of the Bill and then to set out the provisions of the Bill in more detail.
One of the objectives of the health service reform programme was the rationalisation of health sector agencies, as recommended in the 2003 prospectus report on the audit of structure and functions in the health system. Successive Governments had established a range of health agencies, with over 55 such agencies established by 2003. These individual agencies each played a valuable role in the development of our health services. However, the multiplicity of agencies led to an overly complex and fragmented system that was ultimately unsustainable. Steps were therefore taken to rectify this situation with the integration of a number of agencies within the Health Service Executive and other bodies.
In light of the efficiency review announced in 2007 and the publication of the OECD review of the Irish public service, the Government agreed a process of rationalisation of State agencies. There are certain principles underpinning and guiding these policies of rationalisation. One principle is that the function of assisting Ministers in the formulation of policy is usually best located in Departments and should not be devolved unnecessarily to outside agencies. A further principle is that streamlining roles and operations should be maximised by eliminating the duplication and the overlap of functions between agencies, and by amalgamating bodies with similar roles. The Bill develops this programme of streamlining by paving the way for the integration of the National Council on Ageing and Older People and the Women’s Health Council with the Department of Health and Children, and for the integration of the National Cancer Screening Service Board, the Drug Treatment Centre Board and the Crisis Pregnancy Agency with the Health Service Executive.
The Minister is very conscious that these are agencies which enjoy great respect. The National Council on Ageing and Older People has made a significant contribution to policy development regarding older people. The Women’s Health Council has played a major role since its establishment. The National Cancer Screening Service Board has played a pivotal role in the provision of cancer prevention services to women through the BreastCheck and CervicalCheck programmes. The Drug Treatment Centre Board has made a highly valued contribution to the delivery of treatment services for drug misusers. The work of the Crisis Pregnancy Agency has been crucial in the implementation of strategies to reduce the number of crisis pregnancies.
We are at a point, however, where we need to bring together these agencies with others to achieve all the benefits that are gained from co-ordination, consolidation and integration. While there is a clear need to secure efficiencies from the rationalisation programme, the primary aim is to streamline service delivery and policy making in these areas. Efficiencies will be gained over time from economies of scale and the elimination of duplication in areas such as recruitment procurement, payroll and ICT systems. While change can be challenging, the Minister believes that the integration of policy formulation and services is the best way forward.
In the case of the National Council on Ageing and Older People,the Government approved the creation of an office for older people on 23 January 2008 to support me as Minister of State with responsibility for older people within the Department of Health and Children, the Department of Social and Family Affairs and the Department of Environment, Heritage and Local Government. As part of the creation of the office, the Government decided to subsume the existing staff of the national council into the Department of Health and Children. The staff of the national council have built up a range of expertise and experience on older people’s issues that they can bring to the work of the office for older people, and in particular to the development of the national positive ageing strategy. It is the intention to establish a national advisory council on older people on an administrative basis.
The Women’s Health Council advises the Minister for Health and Children on women’s health and on the implementation of recommendations on women’s health contained in policy reports commissioned by her. The integration of the role of the council within the Department of Health and Children was recommended in the 2003 report on the audit of structure and functions in the health system. This integration was also part of the rationalisation of State agencies announced last October.
Cancer screening is an intrinsic component of the national cancer control programme and the integration of screening services within the programme is the best way to ensure the full co-ordination of services and resources in the fight against cancer. The Drug Treatment Centre has been funded directly by the HSE for some time. The integration of the Crisis Pregnancy Agency within the HSE will facilitate co-ordinated planning in the area of crisis pregnancy as part of the HSE’s overall planning for and provision of health and social services, including contraception and sexual health strategies, family support, support for immigrant communities and teen parent support programmes. The integration of the functions and staff of all the bodies will be carefully managed to ensure a seamless continuation of the important services they provide.
The Minister does not in any way underestimate the complexities of the health service rationalisation programme. I said earlier that change is challenging, but it is not impossible. Considerable effort has been already invested in preparing for integration and this effort will continue to ensure that the integration process works smoothly. In the particular case of the National Council on Ageing and Older People, the transition process is facilitated by the fact that the staff of the Council have been located in Hawkins House since February 2008, and that a principal officer of the Department is director of the council for the transition period.
Part 7 of the Bill, which contains section 60, confers the same powers on the Minister for Health and Children as those conferred on the Minister for the Environment, Heritage and Local Government under sections 2 and 4 of the Local Government (Superannuation) Act 1980 in respect of a range of health sector organisations. All powers exercised by the Minister for Health and Children under sections 2 and 4 of the Local Government (Superannuation) Act 1980 since 1 February, 2001 are confirmed and they apply to all of the organisations mentioned in section 60.
The Bill also makes some miscellaneous amendments to other legislation. The Hepatitis C Compensation Tribunal (Amendment) Act 2006provides the legislative basis for setting up an insurance scheme for persons infected with hepatitis C and HIV through the administration within the State of infected blood or blood products. This provision is intended to assist these people with hepatitis C or HIV to obtain insurance where they would otherwise have difficulty in doing so on the open market. The upper age limit of 65 for the scheme is contained in the Act. The Minister agreed last July to remove the age restriction on the travel insurance element of the scheme, on the basis that it discriminates against older age groups who wish to travel.
The Health Act 2007 provided for the establishment of the Health Information and Quality Authority, the office of the chief inspector of social services and a new inspection and registration system for designated centres — that is, residential centres — for older people, children and people with disabilities. Amendments to the Act under the current Bill correct minor typographical errors, and also enhance provisions for the making of regulations requiring registered providers of designated centres to make arrangements for dealing with complaints under section 103(3) of the Act.
The Government’s rationalisation programme for agencies includes the integration of the National Cancer Registry within the HSE. As a first step in this process, the establishment order for the National Cancer Registry Board is being amended to change its provisions for board composition. These currently provide for the Minister to appoint a board of up to ten persons nominated by various bodies, an arrangement which has served the health service well. However, as part of the preparation for integration within the HSE, it is important at this stage to facilitate the forging of closer links between the registry and the national cancer control programme of the HSE. Therefore, the Bill amends the provisions of the establishment order for the registry to allow the appointment of a seven person board with knowledge or experience of the functions of the board, including those related to Government policy on cancer control.
I refer to the principal features of the Bill. Part 1, comprised of sections 1 to 3, inclusive, contains standard provisions dealing with the short title, commencement, definitions and expenses. The legislation will come into operation by ministerial order and different provisions will be brought into operation at different times.
I refer to the National Council on Ageing and Older People. Part 2, comprised of sections 4 to 14, inclusive, provides for the dissolution of the National Council on Ageing and Older People. Section 5 dissolves the council. Section 6 transfers rights and liabilities of the council to the Minister for Health and Children. Section 7 transfers land, other property and any moneys, stocks and shares and securities of the council to the Minister. Section 8 requires the Minister to cause final accounts of the council to be prepared and to submit them to the Comptroller and Auditor General for audit. Copies of the audited accounts and the Comptroller and Auditor General’s report on the accounts must be laid before each House of the Oireachtas. Section 9 requires the Minister to cause a final report of the council’s activities to be prepared and to lay copies of the report before each House of the Oireachtas. Section 10 substitutes the name of the Minister for Health and Children for the name of the council in any pending legal proceedings to which the council is a party immediately before the commencement of Part 2. The proceedings shall not abate by reason of such substitution. Section 11 provides that every contract or agreement made between the council or any trustee or agent thereof acting on its behalf, or any other person, which is in force immediately before the commencement of Part 2 shall continue in force and shall be construed and have effect as if the Minister were substituted therein for the council and shall be enforceable against the Minister.
Section 12 provides that every person who, immediately before the commencement of Part 2, is an employee of the council shall, on the commencement of Part 2, hold an unestablished position in the Civil Service. Save in accordance with a collective agreement negotiated with any recognised trade union or staff association concerned, a person transferred shall not, on the commencement of Part 2, be brought to less beneficial conditions of remuneration than the conditions of remuneration to which he or she was subject immediately before the commencement of Part 2. The previous service of a person transferred shall be reckonable for the purposes of the employment legislation set out in subsection (3) of section 12, subject to any exceptions or exclusions in any legislation. Any superannuation benefits awarded to, or in respect of, a person transferred and the terms relating to those benefits shall be no less favourable than those applicable to, or in respect of, that person immediately before the commencement of Part 2. The pension payments and other superannuation liabilities of the Council in respect of its former employees become, on the commencement of Part 2, the liabilities of the Minister for Finance. A person transferred under section 12 shall undertake such duties as the Minister may, from time to time, direct and shall be subject to and employed in accordance with the Civil Service Regulation Acts 1956 to 2005.
Section 13 transfers each record held by the council immediately before the commencement of Part 2 to the Minister. Section 14 revokes the establishment order for the National Council on Ageing and Older People.
Part 3 comprised of sections 15 to 25, inclusive, provides for the dissolution of the Women’s Health Council. The provisions of Part 3 are similar to those in Part 2 in regard to the National Council on Ageing and Older People.
Part 4, comprising sections 26 to 36, inclusive, provides for the dissolution of the National Cancer Screening Service Board. Section 28 transfers rights and liabilities of the board to the Health Service Executive. Section 29 transfers land, other property and any moneys, stocks and shares and securities of the board to the Health Service Executive.
Section 30 requires the Health Service Executive to cause final accounts of the board to be prepared and to submit them to the Comptroller and Auditor General for audit. A copy of the audited accounts and the Comptroller and Auditor General’s report on the accounts shall be submitted to the Minister who shall lay copies of the audited accounts and the Comptroller and Auditor General’s report on the accounts before each House of the Oireachtas. Section 31 requires the Health Service Executive to cause a final report to the Minister of the board’s activities to be prepared. The Minister shall lay copies of the final report before each House of the Oireachtas. Section 32 substitutes the name of the Health Service Executive for the name of the board in any pending legal proceedings to which the board is a party immediately before the commencement of Part 4. The proceedings shall not abate by reason of each substitution.
Section 33 provides that every contract or agreement made between the board or any trustee or agent thereof acting on its behalf, or any other person, which is in force immediately before the commencement of Part 4 shall continue in force and shall be construed and have effect as if the Health Service Executive were substituted therein for the board and shall be enforceable against the Minister.
Section 34 provides that every person who, immediately before the commencement of Part 4, is an employee of the board shall, on the commencement of Part 4, be transferred to and become an employee of the Health Service Executive. Save in accordance with a collective agreement negotiated with any recognised trade union or staff association concerned, a person transferred shall not, on the commencement of Part 4, be brought to less beneficial conditions of service, including conditions related to tenure, or of remuneration to which he or she was subject immediately before the commencement of Part 4. The previous service of a person transferred shall be reckonable for the purposes of the employment legislation set out in subsection (3) of section 34, subject to any exceptions or exclusions in that legislation. Any superannuation benefits awarded to or in respect of a person transferred and the terms relating to those benefits shall be no less favourable than those applicable to or in respect of that person immediately before the commencement of Part 4. The pension payments and other superannuation liabilities of the board in respect of its former employees become, on the commencement of Part 4, the liabilities of the Health Service Executive. A person transferred under section 34 shall be subject to and employed in accordance with the Health Acts 1947 to 2008.
Section 35 transfers each record held by the board immediately before the commencement of Part 4 to the Health Service Executive. Section 36 revokes the National Cancer Screening Service Board (Establishment) Order 2006.
Part 5, comprised of sections 27 to 47, inclusive, provides for the dissolution of the Drug Treatment Centre Board and the provisions are similar to those in Part 4 for the dissolution of the Cancer Screening Service Board.
Part 6, comprised of sections 48 to 59, inclusive, provides for the dissolution of the Crisis Pregnancy Agency. The provisions are similar to those in Parts 4 and 5. In addition, there is provision under section 50 for the transfer of functions from the Crisis Pregnancy Agency to the HSE in view of legal advice that the executive does not currently have the statutory authority to carry out these functions.
The functions transferred under the Bill are: preparation of a strategy to address the issue of crisis pregnancy in consultation with specified Departments and other appropriate persons; to work with appropriate agencies to promote and co-ordinate the attainment of the objectives contained in the strategy; to produce periodic reports on progress and to propose remedial action where required; to further the attainment of the objectives of the strategy by promoting public awareness, developing, promoting and disseminating information and informational material and by fostering the provision of education and training; to draw up codes of best practice for consideration by agencies and individuals involved in providing services to women with crisis pregnancies; to furnish advice to the Minister for Health and Children and to other Ministers on issues relating to crisis pregnancy; and to perform any other function in respect of crisis pregnancy that the Minister may assign.
I refer to superannuation. Part 7 comprises section 60 of the Bill and confers the same powers on the Minister for Health and Children, from 1 February 2001, as were conferred on the Minister for the Environment, Heritage and Local Government under sections 2 and 4 of the Local Government (Superannuation) Act 1980 in respect of the organisations set out in that section.
I refer to miscellaneous amendments including those relating to hepatitis C. Part 8, comprised of sections 61 to 63, inclusive, provides for miscellaneous amendments to other legislation. Section 61 provides for the amendment of the Hepatitis C Compensation Tribunal Act 1997 to remove the age limits in respect of the travel element of the insurance scheme established for persons infected with hepatitis C or HIV through the administration within the State of infected blood or blood products.
Section 62 makes technical drafting amendments to the Health Act 2007, including that regulations for arrangements by registered providers of designated centres under that Act may encompass arrangements for dealing with complaints made on or on behalf of persons who are no longer receiving a service at the centre.
Section 63 amends article 5 of the National Cancer Registry Board (Establishment) Order 1991 to provide for the appointment by the Minister of a seven person board with knowledge or experience or relating to particular functions and other relevant competencies to assist the board in the performance of its functions.
On behalf of the Minister for Health and Children, I acknowledge the contribution to the health service made by the National Council on Ageing and Older People, the Women’s Health Council, the National Cancer Screening Service, the Drug Treatment Centre and the Crisis Pregnancy Agency throughout the years.
The Minister acknowledges the commitment of these agencies over the years. They have performed a significant public service for which we thank them. The policy areas and services will not be diminished by the integration of these bodies with the Department of Health and Children or the HSE but will, on the contrary, continue in their new environments. I commend the Bill to the House.
I will ask a few questions and raise a couple of concerns about the Minister of State’s comments. In terms of the National Women’s Council of Ireland, NWCI, some 300 jobs will move to the public service. Will this rationalisation save any money or reduce the amount of administration or rent on buildings? There will be no loss of employment, not that anyone would want to see someone out of a job in this climate. We must ask why the Bill is being introduced and whether we are using the opportunity to achieve real rationalisation and savings for the taxpayer.
The legislation will enable the Government to subsume five State agencies, including the NWCI and the Crisis Pregnancy Agency, into the Department of Health and Children or the HSE. I do not have an issue with the technicalities addressed by the Minister of State that ensure that people’s rights do not suffer. However, the NWCI and the National Council on Ageing and Older People should not be subsumed in such a fashion as to neutralise their overall effect. For instance, the Bill does not propose a review mechanism to monitor or measure the change of policy direction against outcomes.
There will be a transfer of employees from non-established positions within the Civil Service, but what does “non-established” mean in the context of the Bill? The legislation might not safeguard the knowledge or institutional memory built by the agencies since their inceptions. The staff have built a high degree of competence and expertise in their fields and should be regarded as assets to the public service. What commitments have been made to ensure that the Department and the HSE will continue to work in partnership with civil society and other relevant sectors after the bodies enter the system, which were seen to have been outside it previously?
The NWCI has provided a board representative to the Women’s Health Council on ministerial appointment since the latter’s inception. The health council has provided a useful forum for representatives from the NGO sector, statutory bodies, the private sector, the medical profession and academia in tackling women’s health holistically. In turn, the forum has provided independent advice to Departments. Will the good working relationships fostered by this direct participation be safeguarded? How can the continued commitment be protected under the terms of the Bill?
The NWCI and the National Council on Ageing and Older People can directly link with and provide an independent voice, but they are being subsumed. On the face of it, this rationalisation would save money, but will it have a net effect of quietening — I will not use the word “silencing”— necessary criticism, which can only be made when people are independent as opposed to being State employees? The Official Secrets Act does not apply to them currently, but will it apply to them when they assume non-established positions within the Civil Service?
The Women’s Health Council has played an important role in the implementation of the National Women’s Strategy 2007-16, particularly under objectives 8 and 18. Under this plan, the Department has undertaken to establish a gender mainstreaming unit. Will the establishment occur or is the Minister considering whether to use the staff of the Women’s Health Council to fulfil the role? Many people would be interested to know the answer to that and I am interested to hear the answer to the question on the Official Secrets Act.
The National Drug Advisory and Treatment Centre has been in operation for 40 years and has developed a significant amount of knowledge and expertise. It is the type of organisation that should fall under the remit of the HSE, but only as long as its tertiary addiction service, the only one in the country, continues. As the centre is being funded by the HSE and works with it closely, joining the HSE makes perfect sense.
I have no problem with the inclusion of the National Cancer Registry, the proper place for which is in the HSE. It is a bad reflection on the country that the registry has only been running for a few years. Only certain parts of the country had one ten years ago.
In terms of hepatitis C, I welcome that the age limit for travel insurance has been moved, as the current provisions are out of date. It puts me in mind of another group of people seriously affected by an arbitrary age limit, namely, Patient Focus, which comprises the victims of mistreatment by Dr. Neary at Our Lady of Lourdes Hospital. Unlike younger victims, many who suffered at his hands have been unable to avail of compensation because of their dates of birth. Ms Justice Maureen Harding Clark has ruled on the matter, but I am sending an apolitical message. The Chairman and Deputies Jan O’Sullivan and Ó Caoláin have been heavily involved in the issue. There has been cross-party support for the group. Perhaps the Bill is a missed opportunity for the Oireachtas to correct what we all agree is an unjust anomaly. On later Stages, will the Minister use the Bill to address this? I will not say any more, as all sides of the House are in agreement.
I will revert to the comments that I made at the outset. There has been much discussion of rationalisation and removing quangos. Yesterday, during the same week in which the Bill is before the House, the Minister issued a press release on the formation of another quango, an expert group on resource allocation in the health sector. The group comprises many excellent people, but what is going on? The Minister seems to be setting another group as a buffer between herself and her responsibilities. The clear implication of the press release is that the Minister, after four odd years — some would say that they have been very odd — in her portfolio, has finally admitted that she does not know how to allocate resources and wants to get an expert group to help her. She will move her responsibility to the group, which will report to her.
It would be laughable, were it not so serious, and goes a long way towards explaining the reason, after countless billions of taxpayers’ money has gone into the health service, that we have been left with an unholy and real mess. It is real for the 12 people with brain tumours who await lifesaving brain surgery and who are on a waiting list to get into Beaumont Hospital’s neurosurgical unit. One 34-year old woman with two children from west Dublin was diagnosed on 18 January and it now is April. Although she could walk when diagnosed, she now is confined to her house and awaits a telephone call and our modern health service of 2009 is unable to look after her. Her husband is unable to understand how the health service can do this or how the Government can preside over a health service in which this is the position. She is not alone, as I have been informed that 11 other people await lifesaving brain surgery in Beaumont.
Another man who sent an e-mail to me has gone blind while waiting for an outpatient’s appointment because of his diabetes. He was diagnosed with diabetes and was told he needed to visit an eye clinic. While he made an appointment, it was subsequently postponed. He then went to England to work for a while and awoke one morning blind in his left eye. Had he not been able to attend the Moorefields Eye Hospital to receive urgent treatment, he would have lost the sight of that eye permanently. Although he has managed to regain some sight in his left eye, he is permanently visually impaired in that eye as a consequence. He was told in no uncertain terms that had he received treatment before this happened, it would not have happened and he would have full sight.
The frustration that led him to send that e-mail to me arose because he is aware there are hundreds of others like him. The Minister of State will be aware of the debates that have taken place in this House on diabetic retinopathy, the need for screening and that €750,000 which was set aside in 2007 and 2008 was left unspent. It is now at last being spent in the west. What about the rest of the country and the other diabetics? There are 140,000 such people and there is a 10% incidence of this eye problem. Consequently, 14,000 to 16,000 people may go blind. The cost of 100 people going blind equals the cost of a countrywide service that would prevent thousands from going blind.
One is found out in a time of tight budgets. That is when priority decisions are made. It is when decisions are made on whether people in the HSE get bonuses or those needing them receive eye-saving services. It is when one makes a decision to spend money on hotels and meetings or on people, in order that they may have life-saving brain surgery. These are the hard decisions that must be made.
This also relates to the issue regarding cystic fibrosis, which will come before the House next week. Young people in the Republic are dying ten years younger than their cousins in the North of Ireland. At a meeting of the Oireachtas Joint Committee on Health and Children, I heard Professor Drumm making the point that there are 600 people with cystic fibrosis in Toronto and the system there is managed with six beds. He neglected to state or perhaps did not know, although he must know now, that Ireland has the most severe mutation for cystic fibrosis and consequently has the sickest group of people with the condition. They are not suitable for outpatient home treatment and need inpatient treatment. This issue will come before the House and there will be an opportunity for all Members to vote on it. While people can talk the talk, they will be asked to walk the walk.
I now wish to speak briefly about some of the agencies that are not being rationalised but which should be. The figures published in 2008 in respect of the National Treatment Purchase Fund show that 20,000 adults and children are on waiting lists, half of whom have been waiting for treatment more than six months. This does not include the patients waiting for three months before being entered onto the NTPF waiting lists. When such patients are included, the figures double to 40,000 patients. As for outpatient waiting lists, the figures do not take into account the thousands of patients waiting for outpatient appointments. There are estimates of up to 200,000 such patients, some of whom have been waiting for as long as up to seven years for an appointment.
In 2002, the Government promised an end to waiting lists by 2004 but everyone knows this has not happened. Moreover, people were informed that the problem associated with accident and emergency services, which was to be considered as a national emergency, would also be solved and a ten-point plan was produced. However, in recent weeks, there have been figures of 387 and 380 people lying on trolleys nationwide. As a result, 216,000 bed days were lost last year because of delayed discharges. This is taking place at a time when the Minister of State, who has responsibility for older people, will have been made aware by Nursing Homes Ireland that between 240 and 250 beds around the greater Dublin area are available for use. I visited St. Vincent’s Hospital this morning and there were 62 people whose discharges were delayed while they awaited placement in the community. The figures for Beaumont, St. James’s and the Mater are worse. Unless patients can be moved out of hospital back into the community, such beds will not be made available to those people in accident and emergency units who require admission. I refer to those who, having been assessed by doctors, need to be in hospital but who cannot be admitted.
The consequence is that the problem backs up onto the ambulances. Last month, I learnt of two ambulances which were held up in Beaumont Hospital’s accident and emergency department for seven hours and five hours, respectively. They comprised two out of the 13 Dublin Fire Brigade ambulances that are available for the entire city. In itself, that number is extraordinary, given that 20 years ago, when half a million fewer people lived in the city, it was served by 12 ambulances. In other words, a single additional ambulance has been provided.
This raises the issue of the ambulance at Swords, which has been funded by the Dublin Fire Brigade and for which the HSE refuses to pay. The city manager now threatens to withdraw it. I have informed the House previously of an incident that occurred during the election, in which one of my patients fell ill outside a church and required urgent transfer to hospital. We waited for an ambulance for more than an hour and when I inquired as to the reason, I was told that five ambulances were tied up between Beaumont Hospital and the Mater Hospital that day.
Why do we not have spare trolleys, even stored in a portakabin, to allow patients to be left on such trolleys in the care of the accident and emergency staff, while the ambulance collects a spare trolley and heads back out onto the road to be available to save life and limb? It does not make sense as such a measure would cost very little. The real answer to the problem is to provide the community beds. The State has not built them yet, spare capacity exists within the private sector at present.
Previously, I have called for the putting in place of premodular units within six months that would contain rehabilitation facilities in order that people could continue the acute phase of treatment. One then can shorten the bed-stays about which Professor Drumm talks all the time. One will not achieve a shorter bed-stay by moving people out of hospital when there is nowhere in the community for them to go and when community supports do not exist. In that instance such patients will be readmitted directly.
As for the National Treatment Purchase Fund, €100 million has been spent plugging holes in a broken system and this constitutes throwing good money after bad and paying twice or three times as much. Patients were transferred from Cappagh National Orthopaedic Hospital to the Mater Private to have orthopaedic procedures performed. That cost a multiple of what would have been the cost, had Cappagh been given the resources to do it. Moreover, theatres in Cappagh were being closed down for one day per week. In other words, the public facilities were closed down so the public patients could not avail of them. They then were transferred to the NTPF, which cost three time more, while leaving idle the public facilities through nonsensical budgeting systems. I was astounded when the Minister informed me within the last two weeks that €4 billion is being spent on private health care in Ireland. When added to the €16 billion allocated to the HSE and the Department of Health and Children, one arrives at the enormous sum of €20 million. It is all going round in circles in the NTPF.
In the North of Ireland, the Minister for Health, Social Services and Public Safety rolled up his sleeves and became personally involved. He formulated a special delivery unit that visited each hospital to ascertain its waiting list problems and then returned every week until such problems were resolved. Heads rolled and there was accountability and transparency. People could see where there were problems and if those who were part of the problem were not prepared to get it fixed, they got the gate. Some people lost their jobs but that is what accountability is about. Accountability is difficult without transparency but that is what this unit did. The health service in Northern Ireland spent €36 million over 18 months and brought a 57,000-person waiting list down to zero. It costs very little money to keep it right. What are we doing? Multiplying by three their population of 1.7 million gives 5.2 million but we have only 4.2 million. Multiplying €36 million by three comes to just over €100 million, which we spend every year. They spent it once and fixed the problem. Why can we not do the same? It is because we are not addressing the problem and looking for solutions. We got lazy during the Celtic tiger period, throwing lots of money at problems. The NTPF is one quango I would get rid of because it is wasting public money and is not addressing the problem.
It is frustrating for those working in the public service to find they cannot carry out an operation in a hospital but can do so at the weekend and get paid for it. They do not understand it. Eminent surgeons such as Mr. Michael O’Keeffe have verified this. He is a man who does not mince his words and I ask the Minister of State why that doctor can do as many procedures on a Saturday as he can for the rest of the week in a public hospital. He gives reasons such as lack of organisation, people not being where they should be on time and various staff out sick or missing. There is no secondary line to replace a person who is ill. How many operations have been cancelled because the surgeon was present, the theatre staff were present but there was no bed in the intensive care unit? Perhaps there was a bed but no intensive care unit nurse available. These are management issues, not issues of medical personnel. Management should put in place a fallback position to fill the gap when a person is sick in order that the entire system does not creak to a halt. The system sometimes suits hospital management because of the crazy budgeting arrangements.
I have not said the following in the House before. If it costs €1,000 a week to keep a patient in a public bed and it costs €1,000 a day to have him or her languish in a hospital bed when the acute phase of treatment is over, it makes good sense to move that patient to the community. However, because there are two separate budgets, the primary and continuing care team does not allow the hospital to touch its money and the hospital team cannot access the money. The patient is locked in that system. There is a more sinister perversity in the system. From the hospital’s perspective, if the patient is moved out, the next patient in the bed could cost €3,000 to €4,000 a night if acutely ill. This is costing the hospital money.
For the first time, the Minister’s press release referred to money following the patient, something about which I have been talking for 18 months. This is clearly the way to go forward, making the patient king or queen, where every patient that crosses the threshold is seen as a resource, not as someone to be left languishing on a trolley in accident and emergency units. If hospitals had a maintenance sum and any further budget was predicated on a per patient or per procedure basis, the efficient hospitals would be rewarded and would do more procedures. This is unlike the current situation where the hospital gets a budget whether it is efficient or grossly inefficient, and that is it for the year. As we have seen in Navan, operations can cease in October, which is a crazy set-up.
The Mental Health Commission is currently sitting on a report on a psychiatric institution in Clonmel. Stories in the newpaper refer to unreported fractures picked up on screening that are healing. There is a major issue of abuse of patients. In 2004 an investigation was conducted at St. Michael’s Unit in St. Luke’s Hospital on the serious concerns at the high level and frequency of fractures. Although the report has never been published, media reports reveal that between July 2002 and January 2004, 19 residents at St Luke’s Hospital suffered fractures, 18 of which were unwitnessed by staff. There is serious concern that fractures were the result of non-accidental injuries.
The Inspector of Mental Health Services identified problems with the service at St. Luke’s Hospital in the annual inspection reports of 2005 and 2006. These concerns were outlined repeatedly to the local health manager and senior management team, but nothing changed. The fracture report and the concerns raised in the annual inspection report led to the decision of the Mental Health Commission to establish an inquiry, only the second occasion on which the Mental Health Commission has used its power to set up an inquiry under section 55 of the Mental Health Act 2001. According to an article in the Irish Examiner, the Mental Health Commission was made aware in 2008 of the appalling conditions at the hospital. Rather than ensure that immediate action was taken to protect these patients and to promote their welfare, all of them continued to follow procedures. Nothing was done and patients were left in terrible conditions. The article confirms that none of the 145 findings and 11 recommendations has been implemented. The HSE has had the draft report since June 2008. Where is it? We still await it. What action was taken on it?
This is a recurring theme. One thinks of the poor people in Drogheda, Louth and Cavan walking around with tumours growing in their lungs. People knew there was a problem in September 2007 and did nothing until May 2008. The same ethos applied in Portlaoise, where the files of 97 women were left thrown in a corner. Any number of these women could have had breast cancer but nobody would do anything until a cohort of a round figure of 100 was reached. I do not know what a cohort is. The attitude is that information is available but we do not act on it. We await some official report before addressing the problem immediately to ensure patients are kept safe. This refers to the most vulnerable people in our society, who cannot speak for themselves. When made aware of it, people do nothing but sit on the report. When will the report be available?
I allude to another aspect of the NTPF, the co-located hospitals. Three or four years ago the Minister for Health and Children assured us this was the quickest way to bring public beds into our public health service to ensure sufficient bed capacity. Since then, 500 beds were taken out of the system last year, there are plans to take out 600 more this year and there is not a single co-located bed available, nor a sign of one. Not a sod has been turned on any site and, if one were living in dreamland, one might believe it would be a couple of years if they started building tomorrow. They will not start tomorrow, next month or next year because everyone knows this concept is dead. There is neither financial backing nor an operator who can get a bank to stump up money for this because there is no guarantee of a return, unless, of course, the hospital is guaranteed a return from the NTPF, which will send public patients, paid for by the taxpayer, to be treated privately.
The Minister should get off the fence, admit co-location is going nowhere and come back to the House with a realistic plan to address the health requirements of our people. The budget will include cutbacks next week but they should address waste. They should not hit capital projects.
The Minister has acknowledged that building costs have dropped by between 20% and
25%. Why, therefore, was there a need to cut the capital budget as there was already an inherent 25% saving? Why cause all the upset to those poor girls with cystic fibrosis and their parents who were outside the House today? Why ask the very brave Orla Tinsley to put herself through all this media hype when she is not well? She thought the deal was done and the matter was closed. Last year, having received a person of the year award for her work for cystic fibrosis, she believed the unit in St. Vincent’s was going ahead. Why are we putting these people through such an ordeal?
Why not look to more clever ways of financing, deferred payment models or the very competitive market where builders, just to be sure of work, will jump through hoops and accept all sorts of conditions and terms they would not have even considered two years ago? In that respect, I cannot see where this Bill is saving money, although I can see rationalisation in some respects. Are any jobs to be shed or efficiencies being achieved in administration, building or rent? I want assurances on the very valuable work of some of these groups — in particular the Women’s Health Council, the Rape Crisis Centre and the National Council on Ageing and Older People — and a guarantee they will not lose their voice and independence when they are subsumed into the Department of Health and Children and the HSE.
The Government must ensure the Mental Health Commission report is published and action is taken. Even if it is not published, no delay should be allowed in the protection of patients if an issue exists.
Deputy Jan O’Sullivan: I thank the Minister of State for her presentation on the Bill and the Department officials for the briefing we were given earlier in the week. We do not have any major issues with the substance of this legislation, but I have a number of questions and concerns regarding its results and the work carried out by the various agencies which are to be subsumed into the Department of Health and Children and HSE.
In particular, I ask the Minister of State to preserve the functions carried out by the agencies and ensure such functions are continued while not being in any way reduced from what they were under the specific agencies. I do not see anything specific in the legislation that would safeguard the work being done. Despite the fact that the employees are being transferred under the designation “unestablished positions” within the Civil Service, I do believe that gives any great assurance. Although the same individuals will be staying in their posts, it will be at the whim of the Minister and the HSE as to whether they will continue to work as they have done. Those individuals will not stay forever. We must safeguard this work into the future.
The Women’s Health Council referred to by Deputy Reilly has spoken of safeguarding the knowledge or institutional memory built up by these organisations. That is a good way of putting it. They have obviously developed a high level of competency, expertise and interest in those areas. It is important this is not diluted in the new context. They would also have worked with civil society and with various organisations under the different headings, such as crisis pregnancy, older people, women’s health, drugs issues etc. They have worked with different agencies and organisations and in some cases these bodies have even funded those agencies and organisations. It is very important that this voice and connectivity is retained. These are general concerns regarding the functions carried out by the various organisations and bodies that are being abolished and brought under the umbrella of the Department and HSE.
I do not have a problem with the principle of eliminating the significant number of organisations we have, not just under health but throughout our Departments and public bodies. If we can save money and bring about a co-ordination of effort while eliminating duplication, people on all sides of this House would be very happy to see such a process. A number of Bills like this were announced under various Departments but not many are being progressed. I do not know if the Minister of State will respond in general to this. We do not have a major difficulty with the substance of the legislation.
Will there be a review or monitoring mechanism to ensure the work carried out by these agencies will continue? Will the issue be considered from time to time? Will the Bill save money? Even the briefings gave no great clarity on whether money is likely to be saved. I note the Minister of State indicated in her speech that, while there is a clear need to secure efficiencies from the rationalisation programme, the primary aim is to streamline service delivery and policy making in these areas, while efficiencies will be gained over time from economies of scale and the elimination of duplication in areas such as recruitment, procurement, payroll and ICT systems. There is no indication of where savings might be made.
We already have a significant number of people working within the Department of Health and Children and the number working there decreased by only a very small number when the HSE was set up. There are proposals for rationalisation within the HSE, in particular, and we strongly endorse such proposals, particularly in the middle management and other management grades. That was announced as an intention, but I do not know if it is to be progressed this year. There has been no information on that as yet.
In the current context, I am concerned about a slash-and-grab or panic approach within the HSE because of the amount of money it must save this year. It must save approximately €1 billion if one considers the various stages at which it has been told to save money, including the end of last year, early this year and the most recent amount of €72 million. It reported to the Minister this week on that issue but the Minister has not responded. There is a kind of desperate attempt by the executive to save money where it can, and unfortunately much of that will hurt patients and frontline services.
We already have evidence of the purloining of funds that were allocated for areas such as mental health, palliative care, disability and Traveller health. Money specifically set aside for development programmes in these areas was used to plug the HSE funding hole. I am concerned that the money for such important activities will get thrown into some vast effort to plug the hole in HSE finances. My questions about preserving functions and monitoring are asked in the context of the experiences we already have had, where money for certain areas has been used for other purposes in the HSE in particular. Will the Minister of State provide reassurance on that?
I wish to focus particularly on the Crisis Pregnancy Agency, which had very specific functions when it was set up. It has fulfilled those functions very well. It was set up as a direct response to a recommendation made by the all-party Oireachtas Committee on the Constitution and was to have a very singular focus on crisis pregnancy. It was given specific responsibility to develop a strategy to reduce the number of crisis pregnancies and to ensure that women faced with a crisis pregnancy are offered real and positive alternatives to abortion.
Official figures indicate that since the agency’s establishment, the number of abortions carried out on Irish women has decreased by approximately 2,000. In anybody’s language, this must be a success. I first became involved in politics in the early 1980s, when abortion was a major issue. We were all battered around the head for opposing the abortion referendum in the early 1980s and from time to time it has come up on the agenda again. The attacks on people who were trying to make reasonable arguments regarding family planning, etc., should never have been made. Regardless of one’s point of view, however, the Crisis Pregnancy Agency clearly has been a success in the context of reducing the number of abortions in Ireland. As a result of its work, parenting is by far the most common outcome following a crisis pregnancy, adoption has decreased significantly — this is just a fact of life in this country and it is a matter we must address in the context of crisis pregnancy — and approximately 15% of women experiencing a crisis pregnancy choose to have an abortion.
The mandate of the agency was to reduce the number of crisis pregnancies, to reduce the number of women choosing abortion as an outcome of crisis pregnancy and to safeguard women’s physical and mental health following termination of pregnancy. In statistical terms, there has been a decrease of 30% in the number of women who travel from Ireland to the UK to have abortions, a 20% decrease in the number and rate of births to teenagers and a 43% decrease in the number of teenagers travelling to the UK for abortions. In addition, the number of crisis pregnancy counselling services nationwide has more than doubled and free services are now provided at 50 locations.
The Crisis Pregnancy Agency has succeeded in bringing to the table services with opposing ideological viewpoints, keeping them there and encouraging them to work collaboratively on developing standards, resources and advertising. In that context, I am concerned that the work of the agency should continue. The agency had an extremely precise brief and it promoted public awareness and brought together those of opposing points of view in its efforts to reduce the number of abortions carried out on Irish women.
The Crisis Pregnancy Agency has stated that in sustaining and progressing the advances made to date, people must focus on a number of critical issues. These include: better access to and information on contraception and contraceptive devices, particularly for identified groups at risk of crisis pregnancy; improved standards and quality in respect of contraceptive services; measurable improvements in consistent contraceptive use; measurable improvements in knowledge among adolescents regarding relationships and sexuality; improved access to and delivery of crisis pregnancy counselling services and post-abortion medical and counselling services; recognised standards and regulations in respect of crisis pregnancy services; improved range of supports to making continuation of pregnancy more attractive; strengthened understanding of the contributory factors and solutions to crisis pregnancy, using research to promote evidence-based practice, communications initiatives and resource and policy development; tracking new emerging issues relating to abortion and crisis pregnancy; influence policy makers and key players on prevention of crisis pregnancy; reproductive decision-making and crisis pregnancy outcomes; continued positive engagement with service providers, particularly organisations which provide crisis pregnancy counselling where relationships are sensitive and require effective management; and effective management of the issue of crisis pregnancy in challenging economic circumstances.
I wish to ensure that the agency’s good work in respect of reducing the number of women from Ireland who travel abroad to have abortions will continue. However, the Bill does not appear to contain any provisions in respect of maintaining the agency’s functions, engaging in a review or ensuring that the funding relating to this issue will be ring-fenced and will not be used for other purposes.
Deputy Reilly referred at length to the concerns of the National Women’s Council of Ireland, NWCI, regarding the Bill and the fact that the Women’s Health Council is to be subsumed into the Department of Health and Children. I support the points he made in that regard. The Women’s Health Council has played an important role in liaising with and obtaining feedback from women’s groups, both directly and through the NWCI. It will be difficult for the council to fulfil this role when it is mainstreamed.
Deputy Reilly also referred to the fact that the Department of Health and Children has undertaken to establish a gender mainstreaming unit. It is important that such a unit should be set up. I am not concerned with singling out women’s health — no more than I would single out men’s health — I merely wish to ensure issues relating to women’s health will be given the priority they require by the Department of Health and Children.
The National Council on Ageing and Older People is of particular concern to the Minister of State, Deputy Hoctor. It is important that the work of the council is maintained and that its voice should remain strong within the Department. I presume the council will come under the remit of the Minister of State when it becomes part of the Department. A number of concerns arise in respect of the elderly. Short, medium and long-term demographics indicate that the number of older people in society will increase dramatically. As a result, the demands placed on our health service will become greater. It will be important, therefore, to protect the rights and health of older people.
The recent debacle involving medical cards highlighted this issue. The medical card for those over 70 has given rise to better health outcomes among older people because when they were given their cards, they felt able to attend their GPs or to access primary health care — be it provided by home helps, public health nurses or therapists. A scientific study that was carried out indicated a measurable improvement in the health of these people. There is a concern that these individuals will not access primary health care to the extent they should and that, as a result, they will be obliged to access the more expensive acute care services.
Concerns have also arisen in respect of the fair deal legislation, particularly in the context that a resource cap will be put in place and that tight controls will apply in respect of the relevant budgets in the next couple of years. There is a real fear that people will not be able to access long-term private or public nursing home care as a result of the existence of the resource cap.
I spoke to a number of carers this morning regarding their concerns. The carers strategy has not been published. Reports emerged earlier in the week to the effect that the cuts that have been recommended to the Minister for Health and Children by the HSE may include reducing the number of home help hours available. I was informed by one carer that access to resource care — by means of which carers are able to take a break from their caring role — is becoming more difficult and that carers may be asked to make a financial contribution towards the provision of such care. I also spoke to carers who do not qualify for the carer’s allowance as a result of the means test. One woman told me she cares for her adult son who has Down’s Syndrome and who requires constant care. She is now a widow and because she saved her money over the years she does not qualify for the allowance.
These are the kind of stories older people are relating to us. Such people are concerned that as a result of resources becoming more scarce, the fact they no longer qualify automatically for medical cards and that carer’s allowance is means tested and a variety of other reasons, they will come under pressure. Subsuming the National Council on Ageing and Older People into the Department of Health and Children may be a positive development because it may place the concerns of those to whom I refer at the centre of the decision-making process. However, people are concerned that this will not prove to be the case and that the Department’s focus will lie in other areas. I wonder if the Minister of State is in a position to provide assurances in that regard.
The national cancer screening service speaks for itself. I do not have a concern about that because we knew this was coming and that it is part of the cancer strategy. I am not concerned about it being mainstreamed, although issues arise such as the fact that BreastCheck has not yet been fully rolled out throughout the country. It is not yet in my city. It is in the county but it is not in the city, nor is it in other areas of the west and the south.
On the other areas of the cancer strategy, we had hoped there would be funding to begin putting in place bowel cancer screening this year. So far that money has not been allocated, and I urge that it be allocated before the end of the year. I understand a report is to be made available before it is decided upon but it is vital that be rolled out. The cervical screening programme is progressing, which is welcome.
I do not have a difficulty with the issue of the drug treatment centre. It makes sense that should be part of the mainstream. The hepatitis C provision in the Bill is welcome. It is a practical proposal which is welcome.
A number of general issues arise under this legislation on which we can take the opportunity to comment. In the overall cuts atmosphere we are in, and I have already expressed my concern that the functions of these particular agencies should be preserved, we must find ways to make the entire system more logical in terms of the way money is spent and save wherever we can do so.
Before I discuss yesterday’s announcement from the Minister, Deputy Harney, and the new group she is setting up I want to highlight ways in which we can save money. There is one area in particular that has been highlighted in the past few days, and I raised it previously by way of parliamentary question. It may be a relatively small area but it concerns something that annoys the public, namely, that patients cannot bring back the crutches, walking frame or wheelchair they got from the Health Service Executive when they no longer need them. They may have only used the crutches for a week to move around but when they bring them back they are told the hospital cannot take them back because if they are given to somebody else they might claim against the hospital if something happens to them, or some infection the patient had might be transferred to somebody else.
In the past it was possible to return such items, although people were given decrepit wheelchairs then, which is the negative aspect of it, but throughout the country perfectly reusable aids and appliances are not being taken back and reused. I urge that that practice be re-examined because it does not make sense. These items can be checked to ensure they work properly and I presume they can be decontaminated in some way to ensure infections are not passed on. I tabled a question on the matter and the answer I got was to the effect that these were the reasons they were not being reused but I have tabled another question to determine if that might be re-examined. The general public who deal with the public face of the HSE on issues to do with their loved ones find it illogical that they must hold on to a perfectly good walking frame that they know could be used by somebody else.
There are other areas where money can be saved. I support what the Minister said yesterday about the money following the patient. We have been saying that since 2002 when the Labour Party first put forward its proposals on a universal health insurance system. We wanted that system of collecting the money from the public through a universal health insurance system. The Minister said yesterday that her new group was not about gathering resources but allocating resources. However, it is important that we focus on how we take in the resources as well as on the way we allocate them, and I am disappointed the Minister is not examining in more detail the area of universal health insurance in particular because it is a fair system. It is a one tier system that eliminates the difference between public and private patients and takes from the public on the basis of their ability to pay. In other words, if someone is in the higher economic sector they pay their health insurance just as more than 50% of the population are doing at present. If they are in the lower area they get it free, as do people with medical cards. If they are in the middle, they pay a certain amount in accordance with their income.
As Deputy Reilly said, the expert group on resource allocation in the health sector is a very good group. I have no objection to the members of the group except that there is no patient representative on it. That is an important element that is missing. The members are excellent people but I am not aware of anyone who is representing the interests of patients. I ask that that important interest group be included in the group. There are people like Dr. Charles Normand, who has done very good research work, along with his colleagues. The Minister of State may know him because he is connected to the Adelaide Hospital Society, which has some interest in the Chair’s constituency. It has done excellent work, specifically on the area of universal health insurance. Dr. Normand’s contribution would be very valuable, as will that of the others.
It is vital that we do not simply dish out a budget to a hospital regardless of the work it is doing, and the HealthStat will help in that. I again acknowledge some actions within the health area because we have to measure the work being done and give the resources in accordance with that work.
I am concerned we are constantly being given these top down solutions. That is present in HealthStat where the specific measurements are all being done from the top. I frequently talk to people working on the front line of health, as I am sure the Minister of State does, and they constantly tell me of measures that could be taken in their hospital, community unit or whatever to save money and make things easier for the patient but it appears to be difficult for the people on the front line to get their voices heard in the type of proposals being made.
That is the contrast between what was done in Northern Ireland and what is being done here. The Department of Health, Social Services and Public Safety in Northern Ireland visited the hospitals, examined what they were doing, figured out better ways of doing things in co-ordination with the people working on the ground and came up with solutions that are working. In Britain, Mr. Robinson did something similar in that they went into hospitals.
There are hospitals here that already have very good systems. Kilkenny, which is often given as an example, has very good systems working particularly in co-ordination with the community care services, general practitioners and other people who deliver community care. I again acknowledge that some progress has been made in that regard because there will now be a realignment of community care and the acute hospital sector. The silos will be broken down, but they should never have been set up. That is part of the problem with all of this. The HSE was set up with all these separate units, a layer of management on the top and with most of the people already working in the various health boards cobbled together in what turned out to be a camel rather than a streamlined horse. That has turned out to be a system that does not work, and that must be acknowledged. It is being brought back again to bring community care and hospital care together but if it had been done right in the first place all of that could have been avoided. We could now have a streamlined, effective system. We could have got rid of the layers of management and deal with the downturn in the economy within the health services with a system that was geared to do that and respond in a positive way that would be good for patients. That is not what we got, however. Instead we have this system but according to the Minister this group will not report for another year when she will begin to figure out how to allocate resources in a way that the money follows the patient and that will encourage more treatment of patients and better use of resources. Another year will have passed by then and it will be more than five years after the setting up of the HSE. We have lost all that time and in the meantime the economy has collapsed and we do not have the money to do this in a way that can be effective and efficient.
I endorse everything Deputy Reilly said about the National Treatment Purchase Fund. It is madness to pay doctors to treat their patients on a Saturday after closing their beds and not providing them with theatres to treat the same patients during the week in a public hospital. If we are to save money, the entire system must be re-examined, particularly in light of the consultants’ contracts, because they are now obliged to spend more time in the public hospitals. There is a better way to do this, it is PD ideology and we must change it.
We should maintain the valuable functions being carried out by these agencies, putting in place timeframes so that we can see if they are being done effectively with the expected outcomes or if they have disappeared under this amorphous way of doing business which often happens in the HSE, where money is assigned for one purpose and used for another.
I disagree with the remarks of Deputies O’Sullivan and O’Reilly’s on the National Treatment Purchase Fund. I find it is a useful mechanism. Constituents approach me who have been waiting six months for a hip operation, I contact the NTPF and the constituent is given a date for the operation. I do not subscribe to the general opprobrium being heaped upon the National Treatment Purchase Fund.
Section 61 of the Bill provides for the amendment of the Hepatitis C Compensation Tribunal Act 1997, to remove the age limits in respect of the travel element of the insurance scheme established for persons infected with hepatitis C or HIV through the administration within the State of infected blood or blood products. I welcome that proposal because the legislation discriminated against older people in travelling and related insurance.
I have no difficulty with rationalisation or moving agencies into the Department or the HSE. My difficulty lies with the HSE itself. Where is the guarantee that if the Crisis Pregnancy Agency is moved within the HSE, the HSE will not decide to take its money for another purpose? That is how the HSE operates.
I do not understand why, when we are rationalising one agency, we are establishing another to allocate finances within the health service. The Minister, the Department and the board of the HSE decide on strategy, yet now another agency will distribute the money. What is the purpose of that agency, even if the people on it are very good? There will be four layers, with a superior sounding agency to deal with the distribution of health finances. Will the Minister of State explain that in her reply? I tabled a written question in that regard because I do not understand it.
Deputy Mary O’Rourke: It does not matter what she supports, she has a formidable intellect and a pioneering spirit. She ensured the Crisis Pregnancy Agency moved along with its difficult remit when it was set up during difficult times. Ms Catherine Bulbulia is the present director and she is equally formidable in intellect and acumen. She appeared before the Committee on the Constitutional Amendment on Children and I was struck by the vast range of research and consultation the agency has done. Such work needs that level of research because it is about more than accounting or talking to someone. It is real research that is to be supported.
The agency has helped cause a decrease in the numbers of women travelling to Britain for abortions and has also included the route to the Netherlands. There has been a recorded decrease of 30% in the number of women travelling from Ireland to Britain for abortions and a 20% fall in the number of births to teenagers, a significant achievement. We all love to thump our chests and claim we disagree with abortion, and most political parties do not agree with it, but for many years we turned a blind eye to the number of women travelling to Britain for abortions. An agency that can tackle those numbers deserves our praise. There has been a 43% decrease in the number of teenagers travelling from Ireland to Britain for abortions.
The agency has established many other campaigns and put in place a counselling service, with 14 service providers and free services in 50 locations nationwide, providing a range of choices for potential clients, increasing the number of hours and making a real difference to women of all ages because crisis pregnancies do not just happen to teenagers but to women right into their 40s.
Those who have spoken to me about the agency’s work tell me its help is hugely important to those who find themselves in difficulties, and I applaud the work it has done. How can we guarantee this fine work will not be shoved under some other subhead of the health budget when the going gets tough for the HSE? We should guard against that.
I attended a briefing in Buswell’s Hotel a year ago at which the Headway initiative was launched. This was a service for young people who were experiencing mental health problems. Money was provided for that in a subhead, but it disappeared and no one knows where it went. I am not saying it was purloined, it simply disappeared as if it had never been granted. This was because it was an easy target for the number crunchers in the Health Service Executive. I do not want the Crisis Pregnancy Agency becoming an easy target for those who wish to purloin its subhead moneys. When it is absorbed into the Health Service Executive, I want its budget and finances to remain at what they were set for this year.
The agency has recently embarked on a fine consultation process with young people on sexual health from which it will have a report by the end of 2009. It is endeavouring to show to young people that it is not cool to have early and unprotected sex. It is, in fact, most unmodern and wrong. The agency is not claiming it is wrong in a moral sense because it does not, quite rightly, go into that area which is for another arm of civic society. It is not correct that young people do not know or learn about properly conducted relationships in education classes. In such classes, they can be alerted to the fact that just because one wants to keep up with one’s peers does not mean one has to have easy sex with whatever guy crosses one’s path. It is most unmodern and most uncool to so engage.
The Women’s Health Council, which I established during my short tenure at the Department, has made great advances in bringing many important health matters concerning women to the forefront. I look forward to hearing the Minister of State’s responses to my questions.
Deputy Niall Blaney: I thank Deputy O’Rourke for sharing time. I welcome the opportunity to speak on the Health (Miscellaneous Provisions) Bill. The legislation marks welcome and bold steps being taken by the Minister of State, Deputy Hoctor, and her colleagues in streamlining and reforming the health service. The legislation’s proposals have been welcomed by many because there are too many unanswerable agencies in the health services. I hope these are the first of many steps that will be taken to streamline health services.
The Bill gives effect to the Government’s policy to establish an office for older people in the Department of Health and Children. I find it hard to fathom the Opposition spokespersons’ claims these steps are going too far. For months, they have called for health service reform. Yet when one step is taken in that direction, they fear it is one step too far. It is typical of the Opposition at present, given a budget will be introduced next week.
Deputy Niall Blaney: I did not interrupt when Deputy Jan O’Sullivan was speaking. It is typical of the Opposition’s moves. We have seen more of that regarding the budget in recent weeks. It is probably why Fianna Fáil is so strong when it comes to issues such as this. Our Ministers——
The agreement on the consultants’ contracts is welcome news. The faster it is up and running, the better. The agreement whereby consultants must have 80% of public patients before they can have 20% of private patients will act as a great incentive to our hospitals. It will lead to further reductions in waiting lists. The quicker this is streamlined for outpatient services, the better. Currently, some waiting times in outpatient services are extreme. Some of our consultants have little regard for patients when it comes to outpatient appointments. In many cases, the patient is not even dealing with a consultant but a junior doctor. I look forward to the time when consultants instead of junior doctors will be dealing with outpatients. I believe this would reduce waiting times too.
Many hospital services are renting accommodation which requires serious investigation by the relevant Minister or the Health Service Executive. In north-east Donegal I am aware of several hospital services renting buildings when some Health Service Executive properties could be used. Major savings would be made if this area was investigated.
I welcome the Bill and it is only right for the Government to streamline the agencies in question into the Department of Health and Children, making them more accountable. The public may be concerned that these services will be removed but that is not the case. It is more a case of good housekeeping. I commend the Bill to the House.
Deputy James Bannon: I listened with interest to my esteemed Longford-Westmeath constituency colleague, Deputy O’Rourke, as she always tends to dispute comments made by previous speakers. This does not just happen in this House but also in constituency debates. She is a lady who seems to me at times to be out of touch with reality.
Figures for the waiting lists for the National Treatment Purchase Fund were published before Christmas. While I accept Deputy O’Rourke may not have read them, they showed 20,000 adults and children are on waiting lists with half waiting more than six months for treatment. These figures do not include patients waiting three months before they are entered on to the waiting list. When they are included, the figures double to 40,000 plus patients. How can Deputy O’Rourke explain these figures?
We do not take into account the estimated 200,000 patients waiting for outpatient appointments. Some of those patients are waiting up to seven years for appointments. That is a reality about which I hear on a daily basis in the constituency I share with Deputy Mary O’Rourke. She cannot be proud of that. It shows how much she is out of touch with reality in the constituency of Longford-Westmeath, the one she purports to represent. She must have got her inspiration from the former Taoiseach who is from that constituency, Mr. Albert Reynolds, who read only the first page of any document. Deputy O’Rourke has shown she does not read through all of the reports that have been presented by the Health Service Executive and others. Approximately 146 reports, some of which were produced by former health boards, are awaiting action. I am disappointed that a constituency colleague is so much out of touch with reality in the heartland of this country, the midlands, which has been denuded of health services in recent years.
Promises were made in the lead-up to the 2002 and 2004 elections. A total of €57 million was ring-fenced for the completion of phase 2 of Longford-Westmeath General Hospital in Mullingar, the only acute hospital between Dublin and Sligo. However, that was never delivered upon because when Deputy O’Rourke’s friend, Deputy Cowen, now Taoiseach, was Minister for Finance he put a stay on developments in the health service in Longford and Westmeath to the benefit of his own constituency, Laois-Offaly.
Deputy O’Rourke took her eye off the ball in the constituency she was elected to represent. She will not continue to hoodwink the people in my constituency, nor will Deputy Kelly. He has also taken his eye off the ball in the constituency. That is evident from the people of Longford and Westmeath whom I met protesting outside the gates of Leinster House who were with the Cystic Fibrosis Association, Irish Autism Action and the Carers Association. I wish those two Deputies, who also represent those people, had gone to meet them. Politics is all about listening to people and Fianna Fáil Deputies are not doing that at present. The sooner we give the people an opportunity to change the Government the better. I was listening to——
Deputy James Bannon: We have heard fine contributions from Deputies O’Reilly and Jan O’Sullivan. Either of them would make a wonderful Minister for Health and Children. I have no doubt the country would benefit greatly if either of them were in charge of the health portfolio in this House. That would greatly benefit the nation as we move forward.
The integration of 15 health agencies as part of an efficiency drive was announced in budget 2009. However, when one takes into consideration the fact that no staff reduction will be effected, it makes a mockery of the efficiency element of the so-called drive to create a more efficient health service. The reality is more likely to be that areas such as those concerning the elderly will lose their focus and the Government will continue its assault on the vulnerable, as they will be without specific representation, leaving them unable to stand up for themselves. I compliment our elderly citizens, the grey vote, as they are called, on the way they protested outside the House when the budget was announced. They were rightly angry. Some back-tracking did take place. The Government should keep its hands off the elderly and the most vulnerable next week.
We have seen centralisation followed by decentralisation, in an ever continuing attempt by the Government to bring rationalisation to the health service. That is evident all over the country. The end result is that important health areas fall victim to cutbacks, while a top heavy executive continues to blunder its way from initiative to initiative, and report to report. I referred to the 140 reports that are gathering dust on shelves within the offices of the Health Service Executive. I note that an expert group has been set up to examine how money is spent in the health system and to come up with innovative ways to reform the system, in order to make money follow the patient, as Deputy Jan O’Sullivan outlined. While that is welcome in principle, it will be interesting to see whether the group’s report gathers the usual dust that covers the ever mounting pile of reports within the HSE.
There are many calls for a return of the health board structure in some form as it had the benefit of local accountability. When I served on a health board people contacted me regularly in advance of the monthly meetings to bring to my attention issues of concern. Currently, there is nothing to compare to the local political involvement they provided. We were at the coalface and we knew what was happening. We had a say and we improved systems for the betterment of patients. I do not see the benefit from the change to the HSE. Waiting lists have grown longer and there is more discontent with health services across the board since the HSE was set up. I have heard Deputies from the Government side complain about and criticise the HSE. Some of them are like me; they have their ear to the ground and they know exactly what is happening. That raises the spectre of the disastrous decentralisation initiative which, literally, like an Irish reel saw Departments moving in and out of Dublin with the massive costs involved in such manoeuvres.
The health service in this country can be best visualised as a vast, clumsy overweight dinosaur, burdened with thousands of people clinging to its back, whom it refuses to shake off no matter how superfluous or draining to its economic well-being. That is evident all over the country. When the HSE was established, recommendation R3.3 stated there should be no net increase in staffing levels within the health service. The reality, which is to the detriment of funding for basic patient care, is that between 2005 and 2008 there was a 14% increase in its administrative staff. Following the appointment of Professor Drumm and what could not in hindsight be referred to as “best practice”, vast centralised services were divided into “pillars” with national directors, an abundance of assistant national directors and local health officers. Last year that error of judgment was somewhat alleviated by the recognition that there was scope for several thousand managerial and clerical staff to leave the HSE voluntarily. The executive accepted that its structure was overly-bureaucratic. There is evidence of that everywhere one turns. Nobody can deny it.
What has happened in terms of the implementation of such cutbacks? Precisely nothing. The Minister of State, Deputy Hoctor, is sitting sombrely across from me but she has done nothing to deal with the issue. According to the HSE’s office of human resources and the national employment monitoring unit of the executive, no redundancies have been implemented. In what can be only compared to the waste of millions of euro on prefabs for schools, the HSE is now prepared to carry dead weight to avoid paying redundancies, which it claims it cannot afford. Even in the current economic climate, it would make sense to offer some redundancies, as this would save money in the long run. The HSE has proposed cutting 10,000 staff from its 111,000-strong workforce, with 1,000 jobs expected to be cut this year. It was hoped that up to 4,000 staff would take voluntary redundancy in the long term. The HSE has an annual wage bill of €7.5 billion and could make a saving of €67 million a year for every 1,000 redundancies. This situation is a farce. When we think of the speed with which the axe falls on essential local and national health services, on provision for the elderly, the young and the disabled, this is a massive indictment of the priorities of the Minister and her Department.
I wish the Minister had gone out to the gates of Leinster House today to listen to the people gathered there. They started to gather there at 9.30 a.m. because of their serious concern about what is happening with community services throughout the length and breadth of the country. I have an autism society badge in my lapel. I support its grievances and those of carers, the cystic fibrosis organisation and others who gathered at the gates. I went out to speak to them. I have a humane approach to their problems. I spoke to them and wished them well with their campaigns. They need all the support they can get in the current climate.
Despite the failure to curtail staff numbers in the administrative and managerial areas of the HSE, I was shocked to hear that staff at Longford-Westmeath Regional Hospital, in my constituency, were informed yesterday that all contract personnel would be let go on 27 April. These contract workers are front line staff who are delivering services at the coal face to people in the midland region. People are dying daily due to health cutbacks. It is a sobering thought that lives are being lost due to lack of funding for essential services, while the massive cost of the public sector payroll and the huge expansion of managerial grades across the HSE eat into health funding. As a result we have a badly configured hospital system, underdeveloped primary care and an unfair allocation of services that favours private health patients and penalises the elderly, with certain treatments being refused to older people.
I learnt of a sad case in my constituency yesterday. A 78 year old woman was crying on the phone to me. She has a serious eyesight problem and her doctor has advised her to go for treatment to a hospital in Dublin. If she does not, she will be completely blind by July of this year. That poor woman is on a medical card and is pleading for help and assistance towards the cost of transport. If she is to take a taxi from the constituency to Dublin, it will cost approximately €170 per visit. She needs to make two visits per month for her eye treatment. It is a shame that such a poor old woman must delve into the savings she has made for her burial to pay these transport costs. This is scandalous in this day and age. The Minister must have no heart if she allows this sort of thing happen to elderly human beings who have given life service to their communities. It is these people who are being affected by the Minister’s behaviour and her failure to provide essential services for the elderly.
The OECD has recognised that the majority of State agencies were created since the start of the Celtic tiger era — an era that seems an illusion now — with approximately 200 non-commercial agencies operating at national level, some 34 of which are in the health sector. Therein lies the answer to where at least a portion of the wealth of the boom years went. At the same time, necessary retrenchment brings the great fear that voices will go unheard and the most vulnerable will be left further out in the cold, like the poor old crathur in my constituency who was left in a state of panic yesterday. She is only one of many in society in that boat.
I take this opportunity to raise the ongoing position with regard to phase 2B of Longford-Westmeath Regional Hospital, which is a long and ongoing saga of Government neglect. I hoped Deputy O’Rourke would wait and give me the courtesy of listening to me. She talks out of both sides of her mouth when she is in the constituency. It is regrettable she is not here.
Deputy James Bannon: I am delighted that Longford-Westmeath Regional Hospital has scored so highly in the new HSE monthly performance table published through HealthStat, which sees it placed among the top three hospitals in the country. It has achieved this position due to the initiative of the staff rather than because of any support from the Minister. Mullingar Hospital is a valuable facility for the midlands and has proved time and again that it is working to a very high standard — I compliment the staff on that — despite the Minister’s failure to meet promises to complete phase 2B of the hospital’s infrastructural development. It has also suffered as a result of the removal of the cancer unit, which left seriously ill patients forced to travel long distances to access services which had been more than adequately provided locally. We had a good service, but it has been removed.
We have waited for well over a decade, but the essential health infrastructure for the midlands, namely the completion of phase 2B of Longford-Westmeath Regional Hospital, remains an aspiration. Lives will be lost if the Government continues to turn its back on its completion. Anything that is in place in Mullingar was put in place by Fine Gael Ministers. The late Gerry L’Estrange, when he was Minister of State at the Department of Health, ensured that Mullingar had a hospital. When Deputy Michael Noonan was Minister some 13 years ago, he opened the extension that this Government has failed to equip.
The hospital is situated in the heart of Ireland and is the only acute hospital on the N4 between Dublin and Sligo. It is a life-saving centre of the highest standard that can match any other facility in the country. One obstacle after another has been overcome by the hospital and a very fine facility has emerged, of which we can all be justifiably proud. This is due to the hard work and dedication of the staff, who must be rewarded by the Government. The farce of dragging out the Government’s commitment to phase 2B must end and the outstanding ring-fenced funding must be provided. I call on the Minister to stop releasing the money in phases and sub-phases, which delays the development of the hospital. I call on her to finalise the initial plans, which were approved well over a decade ago, by providing the promised funding. We want it now.
Deputy Seymour Crawford: I welcome the opportunity to speak on the Bill. I must bring the problem of the elderly to the attention of the House. It is time the situation was streamlined and that we ensured front line staff get what they need. My secretary received a note this morning from the neighbour of somebody who has spent six weeks in Cavan General Hospital and two weeks in respite care. This person is now at home, on a ventilator and very ill. The nurse was to call to visit him yesterday, but has not yet called, according to the neighbour. There appears to be no back-up service whatsoever. What is the position on the home care packages we were all promised? We were promised that if hospital services were wound down, people would be guaranteed home care packages. What is the position on the individual to whom I refer and how can we ensure he will receive help?
Deputy Seymour Crawford: The only reason I am interfering is that I called to see how ill the man was and witnessed for myself the seriousness of the case. We cannot be sending people home from hospital without organising proper home care packages. If this Bill addresses nothing else, it should address this.
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