Dáil Éireann debate -
Thursday, 26 Jan 2006

Vol. 613 No. 2

Adjournment Debate.

Hospital Staff.

Mr. Deenihan

I thank the Ceann Comhairle for allowing me to raise this matter on the Adjournment this afternoon. This is not the first time I have raised on the Adjournment the issue of nursing shortages experienced at Kerry General Hospital. Almost eight months ago I warned the Minister that Kerry General Hospital was so under-resourced and understaffed that it could not conceivably continue to deliver the present level of service and that services would need to be curtailed if a commitment to provide additional nursing posts was not given.

At the end of May 2005, the industrial relations officer of the INO, Mr. Michael Dineen said:

Our members within Kerry General Hospital are under severe pressure to deliver an appropriate level of care to the patients in their charge due to staff shortages. If the present position continues, it will only exacerbate the difficulties being experienced as nurses will inevitably leave rather than continue to work in the current environment.

At that time I was informed by the Minister of State, Deputy Tim O'Malley, that representatives of the southern area of the HSE had offered to meet the INO representatives shortly afterwards to discuss the hospital staffing issues. Unfortunately, it took until today, when the INO was forced to threaten industrial action, for progress to be made between the Health Service Executive southern area and the INO. I welcome the outcome of today's meeting.

A staffing review will take place at a meeting between the Health Service Executive and the INO next Wednesday. At that meeting, in the event of staffing deficiencies being identified, I ask both the HSE and the Minister of State in his reply on behalf of the Tánaiste and Minister for Health and Children, Deputy Harney, that a clear commitment be given to have these deficiencies addressed. Otherwise, we may have a recurrence of this threat of work to rule.

I am not privy to what happened at the meeting but I understand a clear commitment was given by the representative of the HSE that vacancies would be filled as they arise and because of that industrial action at Tralee General Hospital was averted today. I understand that a bank of nurses within the hospital will be established for additional shift work if called upon, which will be done in a structured way. The services of agency nurses will also be retained in a structured fashion. They will fill any temporary vacancies that may occur as a result of absenteeism or so on.

The level of under-staffing at Tralee General Hospital stems from the failure to take the need for the relief component into account when staffing arrangements were being made. I understand that a hospital's nursing staff relief component is usually 25% of the total nursing staff level, which is approximately 410 in Tralee. When one considers the need for a relief component, the hospital should, therefore, have between 490 and 500 nursing staff. Provision is made for a relief component at all other hospitals in the country.

Tralee General Hospital should be upgraded to a band one hospital. It has a turnover of 22,000 patients per annum between inpatients and day patients. Hospitals with a throughput of more than 16,000 patients per annum generally fall into the band one category. It is clear that Tralee General Hospital thoroughly deserves band one status and funding should be increased commensurate with the activity level in the hospital.

When the hospital first opened in 1984, 15,000 patients used the accident and emergency department annually. This figure has jumped to more than 30,000. A nurse was absent from the unit today but a replacement nurse was not provided for the day. This is a regular occurrence. I call on the Minister of State to visit or ask that his senior Minister visit Tralee General Hospital during her forthcoming visit to County Kerry to meet the management, staff and consultants to discuss service levels.

Minister of State at the Department of Health and Children (Mr. B. Lenihan)

I am taking this Adjournment on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney. As Deputy Deenihan is aware, operational responsibility for the management and delivery of health and personal social services lies with the HSE, including responsibility for the provision of services at Tralee General Hospital. It would not be appropriate for the Tánaiste to intervene in industrial relations matters in Tralee General Hospital. Existing industrial relations mechanisms and procedures are in place to discuss and resolve issues of dispute.

The Department of Health and Children has been informed by the HSE that the threat of industrial action by the INO to which the Deputy referred has been withdrawn. The HSE has reported that a review of nurse staffing levels at Tralee General Hospital to commence on 1 February 2006 has been agreed. The review will be undertaken by an external consultant.

It has been acknowledged by all sides in this dispute that every effort will continue to be made to maintain current nurse staffing levels using all available resources. Hospital management has stated that the same high quality of patient care will continue to be delivered by Tralee General Hospital.

Variant CJD Incidence.

Mr. Gilmore

I thank the Ceann Comhairle for permitting me to raise this issue. It is the second time I raised the sad case of a 24 year old constituent who contracted CJD. I raised it on 5 May 2005 when the young man was still in hospital. Jason Moran of Shankill, County Dublin has since died. At his recent inquest, the Dublin County Coroner called for a State investigation into Jason's death and the possibility that there may be a CJD cluster in the local area.

It has emerged that three cases of variant CJD were closely linked geographically, namely, the case of Jason Moran from Shankill, a second case in Bray and a third case with close family ties in Ballybrack. The total distance between the places where all three cases occurred is approximately five miles.

As I stated in May, Jason Moran contracted variant CJD in Ireland. He had not been out of the country prior to the time in which he could have picked up the disease and it follows that he must have contracted CJD from a meat product purchased and consumed in Ireland. That two other cases have such close geographic links to Jason raises obvious questions as to whether there are CJD clusters.

The State authorities have a duty to investigate how Jason Moran contracted variant CJD in the first instance and whether there are any links to the other cases. I understand that the HSE has been asked to carry out some inquiries. I would like to know more about their nature and whether it is intended to publish the outcome. I do not wish to raise an alarm about the cases concerned but, given the Jason Moran case and two others, the possibilities must be fully examined and the results made public.

Separately, the Government should introduce a compensation scheme for the families of variant CJD victims. Such a scheme was introduced in the United Kingdom following the publication of the Southwood report in 1989. The Government should do the same. The most immediate requirement is for the State to accede to the request of the county coroner, hold an investigation into these cases and publish the results.

Mr. B. Lenihan

I am also taking this Adjournment debate on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney. I thank the Deputy for raising this matter as it provides the Tánaiste an opportunity to outline to this House the position in regard to this issue.

Late in 2004 the Tánaiste learned with regret of the occurrence of a case of variant CJD in a young man in Dublin. This young man subsequently died in 2005 and the recent inquest into his death confirmed that he died of variant CJD. The Tánaiste and I again wish to extend our deepest sympathies to his family.

Following the inquest on 10 January last, the Dublin County Coroner wrote to the Tánaiste and to the Minister for Agriculture and Food requesting an investigation into the apparent geographical connection of this case with two others. The chief medical officer of my Department has requested the HSE to examine these cases to investigate any possible link between them. In addition, the CJD advisory group, which operates under the aegis of my Department, will discuss this issue at its next meeting to be held on 7 February. However, on the information currently available to the HSE, it can see no basis for the suggestion that there may be a cluster of such cases but it is making further inquiries in this regard and will keep my Department informed of any developments.

At this stage it can be said that the probability is that this case of variant CJD was contracted before the current very strict controls on the sale of meat in Ireland were brought into force in 1996. Given that the incubation period for variant CJD is considered to be up to 15 years, it is virtually impossible to identify a specific source of infection. The long incubation period would also make it difficult to establish a common exposure time between individual cases.

The CJD advisory group provides scientific, professional and technical advice on all aspects of CJD and recommends appropriate policy responses in light of the evolving information and evidence on this topic. The group comprises experts in public health, communicable disease surveillance, neurology, transfusion medicine and food safety. The group will continue to monitor all developments nationally and internationally and, along with my Department's chief medical officer, will advise on any relevant developments. The Tánaiste has been briefed by the chairman of the CJD advisory group on any possible broader public health implications that may have arisen from this case.

There are no public health issues in this case in regard to the blood supply or any surgical procedures. New variant CJD, vCJD, is a rare degenerative fatal brain disorder in humans. It is believed the vast majority of persons who have developed vCJD became infected through the consumption of cattle products contaminated with the agent of BSE.

The Food Safety Authority of Ireland and the Department of Agriculture and Food are responsible for BSE controls in Ireland. The FSAI stress that BSE controls in place in Ireland since 1996 are very strict and there are layers of robust control measures to ensure maximum consumer protection from BSE.

The incidence of BSE in Ireland continues to decline in the Irish cattle population, demonstrating that the controls introduced in 1996 and 1997 are working. There are fewer cases of BSE, and the vast majority of current cases are in animals born before the introduction of these enhanced controls.

One of the key factors for establishing the FSAI in 1996 was the BSE crisis. The FSAI bases its decisions on the best scientific data and knowledge, and develops inspection and audit controls to ensure maximum consumer protection for meat and meat products. A rigorous policy of safeguards is firmly established throughout the food chain.

In Ireland, there is a sequence of controls for BSE along the food chain. The feeding of meat and bone meal is prohibited to all farm animals and there are stringent controls at rendering plants and feed mills. The main consumer protection measure has been the removal of specified risk materials, SRM, from the human food chain. SRM are the parts of an animal most likely to contain BSE infectivity if that animal is incubating the disease.

All cattle are examined by veterinary inspectors before slaughter at the abattoir and rapid BSE testing is carried out on all animals over 30 months of age. Veterinary inspectors, under service contract to the FSAI, ensure slaughtered cattle have had SRM removed. At boning plants, the carcasses are inspected again. In butcher shops, environmental health officers under contract to the FSAI inspect carcasses at this level. In addition, all butchers operating in Ireland are aware that it is illegal to sell meat products containing SRM.

The FSAI and the Department of Agriculture and Food have been at the forefront in the EU with the most aggressive controls to protect both animals and humans from the BSE agent. The FSAI, the Department of Agriculture and Food and the other agencies involved in policing the food chain are working to ensure full compliance and maximum consumer protection.

The Tánaiste has also been assured that the measures in place to protect public health, particularly on the protection of the blood supply, are in accordance with best international practice. A number of technical sterilising measures are taken on blood supplies and a number of donor deferral measures, especially in respect of people who lived in the UK, form the cornerstone of this activity.

Following discussions with the chairman of the CJD advisory group and the medical director of the Irish Blood Transfusion Service, IBTS, the conclusion is that the circumstances presented by the occurrence of this case do not require that any other measures need to be taken. The IBTS undertook a review of its policies following the case of transfusion infection in the UK in 2004 and will continue with those policies.

The CJD advisory group has also endorsed the most up-to-date infection control guidance in respect of the management of CJD in the hospital setting and the Department has ensured the circulation of the guidance through the hospital system. The disease continues to be notifiable and the national CJD surveillance unit in Beaumont Hospital continues its activity in monitoring the occurrence of CJD in Ireland.

The results of the HSE investigation into possible links between three variant CJD cases is awaited and it will be referred to the CJD advisory group for consideration.

Social Welfare Benefits.

Mr. Costello

New rules and regulations on the Department of Social and Family Affairs lone-parent family payments are being introduced from the middle of February. From that point on, payments will have to be collected from the post office within five days.

Mr. B. Lenihan

The monitor in the Chamber states the Minister for Transport is responding.

Mr. Costello

I did not realise the ministerial changes were so radical.

A new regulation has been circulated to postmasters and postmistresses throughout the country. The payment is due on Thursday and must be collected by the following Tuesday. There is no provision made for retention of the money if the collection is not made. This seems too rigid as it leaves no scope for a bereavement where someone may have to travel to England or another part of the country. No scope is allowed for holidays or sickness and no hardship provision is made. No margin of error is allowed for in these regulations. It would be more beneficial to allow 15 days, two weeks encompassing three Thursdays, for collection. This would cover all eventualities.

Let us consider the alternatives. If someone does not collect payment within five days, he or she must make a fresh application to the Department. This must be queried and checked, resulting in bureaucracy and expense. Even though the Minister intends to streamline the procedure, that is not the result.

Additional strain will be placed on the post offices because the alternative is for someone to open a bank account, receiving their payments directly and bypassing the post office. This will be beneficial to banks but not to post offices and most people who attend the post office do not have bank accounts. What appears to be a simple streamlining regulation has major implications. The number of people who do not collect the entitlement within the one week period is not high, unless there is a serious problem. I suggest the Minister review the regulation, allowing 15 days rather than five and allowing the post office to retain the money for that period. This will avoid bureaucracy and make the system more humane and compassionate.

Mr. B. Lenihan

I am responding on behalf of the Minister for Social and Family Affairs, Deputy Brennan. The one-parent family payment, OPFP, is the income support scheme for separated, unmarried and widowed persons and also for prisoners' spouses who are bringing up a child or children without the support of a partner. At the end of December 2005, the total number of one-parent family recipients being paid by the Department was 83,066. Included in this figure are payments to 906 widowed persons.

The current scheme was introduced in 1997 when it replaced a number of schemes for different categories of lone parent. These schemes included lone-parent's allowance and deserted wife's benefit. Under the current scheme lone parents are encouraged to maximise their income from different sources and the means test for this scheme makes provision for the exemption of significant levels of earnings and maintenance payments.

Lone parents may earn up to €146.50 per week from employment without affecting the payment. Above that level, half of any earnings are assessed, up to a maximum of €293 per week. The maximum limit of €293 is being increased to €375 per week with effect from June 2006, as a result of changes introduced in last month's budget. Lone parents may also be eligible to avail of the range of employment support services operated by the Department.

Until recently, most of the claim processing work relating to one-parent family claims has been done in the social welfare services office in Sligo. In 2000 the Department undertook a review of the payments arrangements for lone parents. This review recommended that administration of the scheme should be moved to the Department's local offices to bring lone parents into closer contact with the various support services available in those offices. The move to local office level is intended to improve customer service through closer linkage with the local investigative officer network as well as providing more direct local contact for lone parents with the Department's employment support services.

Local one-parent family payment, OPFP, claim processing commenced on a trial basis in the Department's local office in Tallaght in 2001. Following the success of this project, the process has been gradually extended. One-parent family payment applications are processed in 35 social welfare local offices. It is planned that all one-parent family claims will be administered from social welfare local offices early in 2007. Traditionally most one-parent family payment claims using the personalised paying order, PPO, book at their local post office. However, in order that these customers can avail of the services of their local social welfare office, it is necessary to transfer them to another computer system and change their payment method.

From 16 February 2006, the OPFP will no longer have a book of payable orders. Recipients will still collect their payment at post offices utilising their social services card. The card will be swiped at the post office counter for validation purposes and the cash will then be handed to the customer. This form of card-based payment is known as electronic information transfer, ElT, payment. Under this system, the payment must be collected by close of business on the Tuesday following the Thursday payday. If the payment is not collected by then, the payment is returned to the Department. If the customer has been unable to collect the payment, for instance due to illness, work commitments or holidays, arrangements are made to have the payment reissued. The Department is reviewing the possibility of extending the period during which the payment may be collected. That is the substance of the issue raised by Deputy Costello in moving this Adjournment.

A total of 13,795 one-parent family payment recipients receive their payments using the ElT method of payment. Approximately 44,000 customers are being issued with social services cards via the An Post network to enable them to avail of the ElT payment method in preparation for their claims being processed on a localised basis. An information sheet has been enclosed with the cards advising customers on the change in their payment method and when the change will come into effect. If a customer has ongoing difficulty collecting the payment promptly every week, he or she should contact the one-parent family payment section in Sligo.

The Dáil adjourned at 5.10 p.m. until 2.30 p.m. on Tuesday, 31 January 2006.