Vol. 615 No. 6
1 Dr. Twomey asked the Tánaiste and Minister for Health and Children her views on extending the working date for hospital consultants; if it is part of the present contract negotiations; the negotiations which have taken place to date; and if she will make a statement on the matter. [8735/06]
Under the terms of the 1997 consultant contract, each consultant is contracted to work within the normal working week from Monday to Friday. Most consultants are also available on an on-call basis outside these hours. In 2003, the national task force on medical staffing recommended that health professionals should work as part of a multidisciplinary team centred on delivering quality patient care over the full 24-hour period. Since 2003, management has sought to begin substantive negotiations on a new contract with the medical organisations. For a number of reasons, including the organisations' opposition to the extension of the clinical indemnity scheme to consultants, both the IMO and the IHCA did not begin talks until November 2005.
Talks on a new contract began on 24 November 2005 under the independent chairmanship of Mr. Mark Connaughton SC. At that meeting and at a further plenary meeting in December, both the IHCA and the IMO indicated that they required a number of issues to be addressed before they could engage in substantive negotiations on a new contract. A position paper outlining proposals on a new employment contract for consultants working in the public health system was tabled by management at a plenary meeting on 26 January 2006. The medical organisations have refused to engage in substantive discussions on these proposals. The talks were adjourned at a further meeting on 9 February. While a further meeting between management and the consultant representative bodies has not yet been arranged, the independent chairman is maintaining contact with both sides with a view to arranging a formula to effect the resumption of substantive and intensive negotiations at an early date.
In its proposals to the medical organisations, the management team has outlined the need for consultants to work a 39-hour commitment over the 24-hour, seven-day period agreed and detailed in an annual work plan for each consultant. Work plans will follow a framework developed at national level and will be reviewed and agreed annually by consultants, clinical managers and management.
Additional information not given on the floor of the House.
The key objective of the new contract is to address the needs of all patients by achieving greater equity and increasing productivity in a consultant-provided 24-hour, seven-day hospital service. This will ensure that patients have access to senior clinical decision makers, that is, the consultants, when they need them. Rapid access to consultants will speed up diagnosis and treatment and reduce the need for repeated reviews by junior medical or other staff. It will also mean that patient or clinical need determines the nature of rostering arrangements for consultants and that patient access to care and the speed with which care is delivered is determined only by clinical need.
Has the Department ever seriously considered extending the consultants' working day from its current format of 8 a.m. to whenever? If work was done on the issue in the Department, what were the difficulties encountered in extending the consultants' work time? The four-page document given to the consultants by the Health Service Executive on behalf of the Minister did not mention extending the consultants' working day. I thought such an extension would have been an integral part of both the European working time directive and the Minister's plan, namely, the Hanly report. Why does this aspect not feature in the renegotiation of the consultants' contract? Has the Department more or less rejected the idea of extending the working day?
I understand what the Minister says about the negotiations with consultants not happening, but there is nothing coming from the Department indicating that she has any great interest in it either. What background documents does she have? What difficulties does she think she will encounter, apart from those with the consultants? The extension of the consultants' working day would make outpatients clinics more available, but that idea seems to have fallen off the radar.
The Deputy is correct. The idea is to provide a 24-hour, seven-day service delivered, rather than led, by the consultants. There are 4,000 non-consultant hospital doctors and 2,000 consultants working in this country and we need to change that ratio around if we are to have consultant delivered services. The commitment in the current contract is for 39 hours to public service work and we want to change that. We want to introduce a new contract for full-time public consultants so that consultants are not incentivised to see one patient over another and that all patients who enter a public hospital will be seen by a consultant who is salaried to see them. As part of any new contract of employment, we want to have consultants employed on a 24-hour, seven-day basis. These issues must be agreed in the negotiations. It is not correct to say that we are trying to have an 8 a.m to 5 p.m. day for consultants. Consultants will be expected to work evenings, nights and weekends. Perhaps that could be excluded for older consultants, but it would be the norm for younger consultants and part of their contract of employment.
My question has not been answered. The idea was to extend the core working day. Discussions on this issue went back to 1999 when we first raised the idea of extending the consultants' core working day. That seems to have fallen off the radar completely. Why is that the case?
Unless we can change the current consultant contract, it is not feasible to negotiate the extension of the working day either from a personnel perspective or a financial perspective. To address one issue in isolation is not satisfactory. Consultants have a contract of employment that lasts their working career. Either side can break or alter the contract, but there are serious financial implications if that is done.
We want a new contract for new consultants which is more modern and which involves consultants working in teams with clinical directors and so on. The clinical director would be responsible for ensuring that consultant cover is provided on an ongoing basis. However, it would not be satisfactory to negotiate it in isolation from the other issues.
2 Ms McManus asked the Tánaiste and Minister for Health and Children if she has received the report of the inquiry chaired by Judge Maureen Harding Clark into the activities of the former Drogheda obstetrician, Dr. Michael Neary; if medical records of a number of patients who underwent caesarean hysterectomies under the care of Dr. Neary at Our Lady of Lourdes Hospital were deliberately removed from the hospital; the action she intends to take arising from the report; if she will establish a process for providing compensation for women who were treated in this way; and if she will make a statement on the matter. [8731/06]
5 Caoimhghín Ó Caoláin asked the Tánaiste and Minister for Health and Children if she has received the Harding Clark report on the obstetrics and gynaecology unit at Out Lady of Lourdes Hospital in Drogheda; the actions she proposes to take arising from the report; and if she will make a statement on the matter. [8742/06]
I propose to take Questions Nos. 2 and 5 together.
The report of the Lourdes Hospital inquiry, chaired by Judge Maureen Harding Clark, was published on Tuesday, 28 February. The inquiry was established by the Government in 2004, following the decision of the Medical Council to remove Dr. Michael Neary from the register of medical practitioners, having found him guilty of professional misconduct.
I am conscious that the last few years have been particularly difficult and traumatic for many former patients of the maternity unit at Drogheda. Yesterday, I met Patient Focus to discuss the findings of the report. The question of compensation will now be considered by my Department in the light of the report's findings and in consultation with the Office of the Attorney General and the Department of Finance, with a view to bringing a proposal to Government.
This is a damning report and it is clear from the findings that many lessons need to be learned and changes made to ensure that such events do not occur again in hospitals. The findings and recommendations are being examined in detail by my Department, which will consult the Health Service Executive and the various professional regulatory bodies. The recommendations in the report will act as a significant catalyst in the reform agenda. They confirm the appropriateness of the actions being taken in the preparation of the new medical practitioners Bill, the reform of the current consultant contract and the changes in management systems within hospitals.
The forthcoming medical practitioners Bill will make continuing professional development and education compulsory. It will also ensure that competence assurance will be given a statutory basis. In the current consultant contract talks, the management side has put forward proposals to ensure that consultants work in teams with clear clinical leaders who will ensure that individual clinical practice is in line with best practice.
One of the many disturbing findings in the report is that the obstetric hysterectomy records of 44 patients are missing and that they were intentionally and unlawfully removed from the hospital with the object of protecting those involved in carrying out the hysterectomies or in protecting the reputation of the hospital. The inquiry is satisfied that a person or persons unidentified who had knowledge of where records were stored and who had easy access to those records was responsible for a deliberate, careful and systematic removal of key historical records which are missing, together with master cards and patient charts. In respect of the conclusions on the deliberate removal of patient records, I have invited the Garda Síochána to examine the report to determine whether further investigation is now warranted.
I welcome the fact the Minister for Health and Children met Patient Focus yesterday. I also welcome the women in the Visitors Gallery who were injured so brutally. I appreciate that the detail of the compensation scheme may not be available yet but the Minister can give us certain assurances today. Will she ensure that all women affected will be included in the compensation scheme, that is, not just those who came within the terms of reference of the report but also women who had their ovaries removed or women whose babies died in the unit? Will Patient Focus and the women be involved in drawing up the terms of reference of the compensation scheme, as was indicated by the Minister?
With regard to how the scheme will be managed, will the Minister ensure that the women will not have to endure undue delay while the Minister, the insurers and the hospital wrangle about how much money each will contribute? Can the Minister state that the women will get their compensation and that she will then live up to her responsibility to protect the taxpayer? The women must come first. Will the report be referred to the Oireachtas Committee on Health and Children after next Wednesday's debate? The Taoiseach, rather curiously, said yesterday that some of the recommendations would be implemented and some would be taken into account. The phrase "taken into account" is code for not being implemented. Will the Minister differentiate between the ones that will and will not be implemented?
There is no doubt that the women come first. It is heartbreaking to hear their stories at first hand, as I did yesterday and on a previous occasion, and to hear of the experience of so many women, many of them as young as 20 years of age, when this happened. It is just incredible. It is extraordinary, as many have acknowledged, including the Deputy, that this went undetected for so long. That is probably one of the most extraordinary aspects of this sad episode. The cause of the women comes first and that is my main focus at present. In the discussions I had yesterday I gave the women that assurance. They have waited eight years to get to this point and it has taken longer than anybody could have anticipated. However, they, together with everybody else who has read it, welcome the report. They see it as thorough, robust and fair.
Next Monday, I hope to meet Judge Maureen Harding Clark. She is currently in The Hague and will return to Ireland on Monday. I am anxious to hear her ideas about routes for compensation. The Government has not formalised any compensation scheme but the Taoiseach and I have acknowledged that we want to do this. I want to do it as quickly as possible. I certainly do not want the affected women to be forced to take the legal route to get compensation in this case. In any event, given that 44 files have been stolen, it would not be possible for those women ever to vindicate their rights through the judicial process. We have, therefore, an obligation to ensure they are taken care of.
I am happy to ensure the report goes to the Oireachtas Committee on Health and Children after the debate next Wednesday. I have already arranged to meet the Medical Council on Monday to discuss the report. I am not aware of any recommendation that will not be implemented or cannot be acted upon. I have not had an opportunity to study all the recommendations but it is my intention to take on board the recommendations of Judge Maureen Harding Clark. In all the circumstances, they are reasonable.
Yesterday, my meetings with four members of the medical board of the hospital and, separately, with the management of the hospital were focused on putting the remaining recommendations relating to that unit into effect as quickly as possible. John O'Brien from the national hospitals office in the HSE and his team will be in the hospital next week to put a process in place to make that happen as quickly as possible.
A Cheann Comhairle, may I ask a supplementary question?
Deputy Ó Caoláin also submitted a question. I will call the Deputy after Deputy Ó Caoláin.
Will I have an opportunity to ask a supplementary question?
If time permits.
I hope both Deputy McManus and I will have time for a brief supplementary question later. Can the Tánaiste indicate if legislation will be required to establish the redress scheme she envisages so the women victims of Mr. Neary and others can win redress? I stress, as I did yesterday, the phrase "and others". It was not only Dr. Neary who was involved. What is the timescale for the commencement of processing the cases through the redress scheme? How soon does she expect such a process can get under way?
The Tánaiste stated that the Harding Clark report confirms the appropriateness of the actions being taken with regard to reform of the current consultant contract and changes in management systems within the hospitals. I asked the Taoiseach questions about this yesterday but he did not reply to them. The reform of the consultants' contract has been overdue since 2002. Judge Maureen Harding Clark made particular reference to this. What is the position with the renegotiation of the common contract? Has it reached a brick wall? What is the Minister's intent in that regard?
I hope the Tánaiste studies all the recommendations of Judge Maureen Harding Clark. The judge stated in the report that consultants at the Our Lady of Lourdes Hospital currently spend too much of their time on private patients. Has the Tánaiste noted that point and does she accept that it is an ongoing problem, as Judge Maureen Harding Clark does, and is directly related to my earlier question about the consultants' contract? Has the Tánaiste noted from the report that while it is acknowledged that much has changed for the better at the Lourdes hospital, Judge Harding Clark also states that there are still worrying things ongoing at the hospital? Has she noted the judge's criticism of the risk management among some of the consultants and the judge's statement that no elective major gynaecology operations are carried out as there are no dedicated gynaecology beds available for elective operations?
What will the Tánaiste do about the failure to designate gynaecology beds to cater for elective surgical procedures at Our Lady of Lourdes Hospital, the only site with such a specialist team in the north-east region?
To the best of my knowledge, legislation will not be necessary for a redress scheme but it might be necessary to pursue insurers. However, we do not need to wait for that legislation to proceed with the scheme. In other words, we can pursue the legislation while the scheme is under way. I am determined to ensure, if possible, that the State pursues the insurers and that the taxpayer does not carry all the cost of a compensation scheme.
The intention is to go to the Government on this quickly. I told Patient Focus yesterday it will certainly be during March and as early in the month as possible. I have already had discussions with the Attorney General and I will meet the judge next Monday as well as the Attorney General. As soon as all the pieces are together, I will go to the Government to secure approval for a scheme. We will not be found wanting in terms of the speed at which we make this happen. It is important that, in so far as one can bring closure to this sad episode, it is done as quickly as possible.
With regard to the consultant contract, the reason we want a public only contract is precisely that identified by Deputy Ó Caoláin. There is increasing evidence throughout the country that more private patients are coming into the public hospital system. The Government's decision to move up to 1,000 private beds out of the public hospital system is made with the intention of converting those beds into public beds. That will apply in Drogheda, hopefully, as much as it applies everywhere else.
To be fair, the number of consultants in Drogheda has increased from 31 to 62. Last year, €75 million was spent in that hospital. There are still issues in the hospital and I discussed them last night with the management and the representatives of the medical board. Next week, the national hospitals office will be on site with the management to ensure these recommendations are implemented quickly. There will be no excuse for not implementing the recommendations as quickly as possible.
With regard to the new consultant contract, we need arrangements for clinical governance. It is a fact that some staff knew what was happening at the hospital, which was not appropriate. Some staff complained but their complaints were ignored. We need clinical governance at every level in the hospital. We need to have a clinical director in charge of the surgeons and a clinical director on the medical side so that best practice can be implemented on all occasions. If best practice had been in operation in this case, the tragedy would have been avoided for the women affected. It will be part and parcel of the new consultant contract that consultants will work in teams and not as sole operators, and that they will be responsible to a clinical director who will have overall responsibility.
A question was not answered. With regard to the women who were not covered by the terms of reference of this report and who, for example, had their ovaries removed or whose babies died, will they be included in the compensation scheme? I take it from what the Minister has said that the women will be paid compensation ahead of any difficulties she may have with regard to insurers or getting the hospital to contribute, and that they will not be left waiting for the negotiations to be completed before they are compensated.
I have a brief question.
I am sorry, Deputy. We are running over time. I call the Tánaiste.
The Government has not yet approved the compensation scheme but I have indicated my strong support for one, as has the Taoiseach. The women will not be left waiting; they must come first. However, if it is the case that we need legislation to pursue insurers, we can do that at the same time and it should not cause delay. I envisage that the State would pay the compensation and would then seek to recoup it. That is what I have discussed with my officials and with regard to the legal advice from the Attorney General's office.
The report focused on a particular group of patients. The judge met the women to whom the Deputy referred, as did I. Although they are not specifically referred to in the report, I have great sympathy for the position in which they find themselves. I will make that clear to the Government.
I call Question No. 3.
I have a brief question.
Sorry, Deputy. We have gone three minutes over on this question.
I thought Question No. 2 and Question No. 5 would have parity.
I appreciate the Deputy's point. I suggest that Standing Orders be changed to allow longer time for questions.
I will find another mechanism.
3 Mr. Gormley asked the Tánaiste and Minister for Health and Children if she is satisfied with the preparations for avian flu and a possible flu pandemic; the reason Dáil Éireann was not informed about the purchase of a vaccine which was announced through the media; and if she will make a statement on the matter. [8740/06]
I am satisfied with progress on preparations for a possible flu pandemic and with public health actions in response to a possible outbreak of avian flu in Ireland. The health sector's role in regard to avian flu relates to the human health implications that would arise were there to be an outbreak of avian flu. Guidance on the investigation and management of suspected human cases has therefore been developed and circulated within the health system.
My Department and the Health Service Executive are working closely on pandemic planning. The influenza pandemic expert group is updating the expert guidance and the pandemic influenza operational response plan is being updated in line with the expert advice. In addition, my Department has established a standing interdepartmental committee to consider issues which go beyond the health aspects of a flu pandemic.
Arrangements have been made to procure a stockpile of H5N1 vaccine for key health care workers and other essential workers and we are stockpiling 1 million treatment packs of the antiviral drug, Tamiflu. Arrangements have also been made to purchase a supply of the active pharmaceutical ingredient to treat children aged one to five years of age and further arrangements are being finalised for the stockpiling of additional supplies of the other suitable antiviral drug, Relenza.
I do not understand the Deputy's reference to this House not being informed with regard to the purchase of H5N1 vaccine. On 31 January last, in reply to a parliamentary question, I stated that arrangements to procure a stockpile of H5N1 vaccine for key health care workers and other essential workers were in train. Officials from my Department and the HSE informed the Joint Committee on Health and Children on 16 February of our plans in this regard and the Joint Committee on Agriculture and Food was briefed on 25 January. The announcement with regard to the purchase was made last Friday at the earliest possible opportunity.
I attended the meeting to which the Tánaiste referred and have checked the minutes. No reference was made to the purchase of 400,000 doses of vaccine. Will those 400,000 doses be given on a voluntary basis only? How many people does the Tánaiste expect to use the vaccine? When will the 400,000 doses arrive? Does the Tánaiste agree with the assessment of Dr. Kevin Kelleher, who addressed the Joint Committee on Health and Children, that the health service as it stands probably could not cope with a flu pandemic? Can she confirm that the full stock of antiviral drugs has not yet arrived and probably will not arrive until next September? Can she confirm that a new national emergency plan will not be finalised until the end of the summer, that the plan for dealing with a pandemic has not been updated since 2004 and that hospital isolation units are inadequate and sometimes non-existent? Given all of this, does she agree we cannot face a possible flu pandemic with any degree of real confidence?
I totally disagree. We have shown in recent times, in particular with regard to how the foot and mouth disease was handled, that we are very good, as a country, at handling emerging issues of this kind and can work closely together. Our planning is very much in line with that of the World Health Organisation. We follow its instructions and the 2004 plan is in line with its instructions. The WHO is constantly updating its plans and we do the same. Therefore, it is not correct to say we have no plan. We have a plan, which is constantly revisited. The new plan will be available this summer.
The vaccine would be taken on a voluntary basis but it is clear that health care professionals would want to use the vaccine to protect themselves. It has been 40 years since the last pandemic. This morning our national expert, Professor Hall, who is one of the world experts in this area, told me it could be another 40 years until the next pandemic. However, we must be vigilant and cannot be complacent. Therefore, when we are creating stockpiles in Ireland of vaccines, Relenza and Tamiflu, we do so to have enough to cover 40% of the population, which is a higher proportion than in any other European country. Indeed, we have been commended for our proposals.
In the event of a pandemic, it is undoubted the health system would be under pressure, as it would be in any country. We would have to respond to that pressure and would do so at different levels, in the first instance using Tamiflu, Relenza and the vaccines. We are acquiring these products as quickly as we can. We joined with the UK to access the vaccine because as a small country we do not have much muscle in dealing with the producers of these products. We joined with the UK for a single procurement of the vaccines and I am pleased to acknowledge the support of the UK in allowing us to operate with it. This gave us greater clout in negotiating with the producer of the vaccine, which is not yet available. We also have a sleeping contract for any vaccine that might be manufactured after the strain of the disease is identified, which would not be for four to six months after a pandemic would arise.
The vaccine to which the Tánaiste referred was discussed at the committee meeting. The Tánaiste referred to 40% coverage. The committee was told there would be 25% coverage. Has it increased in the meantime? The Tánaiste also stated the threat might arise 40 years from now. The committee was clearly told that it is not a question of if, but when. Does the Tánaiste agree that, given that there has been a case of the virus spreading to a mammal in Germany, it will probably not be 40 years hence and that we are dealing with an urgent situation?
I am quoting Professor Hall, who said it was 40 years since the last pandemic and that nobody could say for certain when it will happen, and that it could be 40 years from now. It is not significant that the disease transferred to a cat in Germany. Last year 45 tigers had to be put down in Bangkok zoo because they ate raw, infected chicken — I stress that it was raw, infected chicken and that it happened a year ago. What happened in Germany is not new.
The decision to purchase Relenza is new. Together with the vaccine, the use of Relenza will mean that 40% of the population is covered. To the best of my knowledge, no country is aiming for anywhere near that target and certainly none are going beyond it. We have decided to buy Relenza, an inhaler-type product, which we believe is suitable for certain categories of patients, as well as the Tamiflu in addition to the vaccine for health care and other workers. The H5N1 virus first arose in South-East Asia in 1997. We must be vigilant. I met Professor Hall today and regular meetings of the expert group are held. I recently sat in on a European planning meeting in the event of a pandemic. Among the issues on which we have yet to make decisions is what we should do with schools. Should we advise people to stay at home? Many health care workers are parents and may stay at home with their children, and other major issues remain to be resolved. We are working with other countries to establish clear areas of co-operation and co-ordination in these matters.
4 Dr. Twomey asked the Tánaiste and Minister for Health and Children if she will list the 75 to 100 existing primary care teams to which she referred in her Estimates announcement in November 2005; and if she will make a statement on the matter. [8736/06]
The Government is fully committed to the implementation of the principles contained in the primary care strategy, which provides a template for the reform and development of primary care services. The chief executive officer of the HSE has also emphasised the importance of developing primary care services, both as the appropriate service for the delivery of the majority of people's health and social care needs and to complement the services provided by acute hospitals. This is an important priority of the executive and has my full endorsement.
In order to support further implementation of the strategy in 2006, additional revenue funding of €16 million has been provided. Of this funding €10 million is to support the establishment of 75 to 100 primary care teams nationally. This will enable the provision of 300 additional front-line personnel to work alongside GPs to provide integrated and accessible services in the community. Work by the HSE to establish these primary care teams is under way. The executive will be targeting the funding so as to provide each local health office of the HSE with the potential to develop up to three primary care teams. The executive hopes to focus where possible on areas of disadvantage and with health inequalities in planning for the establishment of these teams.
A sum of €4 million has been provided for the establishment of additional general practitioner training places and €2 million to enhance general practitioner out-of-hours co-operatives. This means that, taking into account development funding provided since 2002, €28 million will be available in 2006 specifically to support the implementation of the primary care strategy.
Wider implementation of the primary care strategy will focus on developing new ways of working and of reorganising the resources already available to the health service in line with the service model described in the strategy. This whole-system approach to implementation means change will be required in many sectors in the health service and not solely within the primary care system.
The Tánaiste announced that 75 to 100 existing care teams nationally would receive funding. If they existed I would expect two or three of them to exist in County Wexford and like the Taoiseach, having gone up every tree in County Wexford, I still do not know where the primary care teams are for County Wexford. Nobody knows what she is talking about. These are phantom primary care teams. This deserves some scrutiny. Many of the Tánaiste's recent announcements come to nothing. Only 7,000 doctor-only medical cards and just over 1,000 of the full medical cards announced have been issued. Rather than making a statement about the €10 million and 300 personnel, I would like to know where they will be and with whom the HSE has consulted. In County Wexford, where I feel I know most of the people, and across the country I have met nobody who has been in discussion with the HSE regarding the existing primary care teams, to which the Tánaiste refers. I would like to see the breakdown of where the 300 personnel are located. They have been announced, but we do not know where they are.
Obviously the Deputy is ill informed, as there are three in each local health office. In Dublin we have nine local health offices, which would mean 27 in Dublin. I recently discussed the matter with Dr. Seán Maguire who is spearheading the project for the HSE. I believe he is familiar to the Deputy. Perhaps I can ask him to communicate to the Deputy the precise location of the discussions taking place in the Wexford area. The idea is to develop primary care services, which are not just about general practices, but also about supporting general practitioners with other therapists such as physiotherapists, chiropodists and occupational therapists in the community so people can have the range of services at that level to allow a primary care strategy to be rolled out across the country.
I do not have the details of the location of the 75 to 100 people. However, I am sure if the Deputy speaks with the representative of the HSE he can discover where and who they are. There are three in each local health office. I am not sure how many local health offices Wexford has and whether it is more than one. Dublin has nine.
The Tánaiste should ask the HSE to publish this information on our behalf. We should not need to look around to find where this is happening. It is not a new way: the Tánaiste is losing her way regarding the primary care strategy.
Question No. 5 answered with QuestionNo. 2.
