Liam Twomey
Question:1 Dr. Twomey asked the Minister for Health and Children the status of her co-location project to have private hospitals on the grounds of public hospitals; and if she will make a statement on the matter. [12265/07]
Priority Questions.
Hospitals Building Programme.
Liz McManus
Question:2 Ms McManus asked the Minister for Health and Children the terms of the tendering process for co-location of private hospitals on public hospital grounds; her mandate for pursuing this policy; the time-line for signing off on this process; and if she will make a statement on the matter. [12267/07]
I propose to take Questions Nos. 1 and 2 together.
In July 2005, following Government approval, I issued a policy direction to the Health Service Executive to develop co-located private hospitals on the sites of public hospitals. The aim of this initiative is to transfer private activity from within the public hospital system to new privately-financed and managed facilities and thereby free up approximately 1,000 additional beds for public patients.
The Health Service Executive is at an advanced stage in a public procurement process on the co-location of private hospitals on the sites of public hospitals. I understand that the HSE proposes to issue invitations to tender to the short-listed bidders in the next few days and that tenders are to be returned by the end of April. The HSE will then evaluate the tenders and the successful bidders should be selected in May. Following that a "standstill" period of two weeks is required by procurement law before project agreements can be signed with the successful bidders.
There will be a rigorous value for money assessment of all proposals. Any transaction will be on a commercial basis and will fully protect the public interest. In addition, there will be full adherence to public procurement law and best practice.
It has been two and a half years since I first stood here facing the Minister in my role as Fine Gael spokesperson on health and children and today will probably be my last day in the present Dáil standing facing her in this role.
I hope Deputy Twomey will be re-elected. He should not be so pessimistic.
In the present Dáil, it most definitely will be our last time facing each other on this issue. In case we do not get that opportunity again, I wish her well in the election.
As the Minister will be aware, there is outright opposition from my party to the co-location plan. It is a bad plan. I dislike the way the Minister is going about it. She should not sign these contracts unless she has a new consultants' contract. I want to know will that be the case and will she hold off on signing this. I am also concerned that the HSE has full authority in this regard. If that is what she is stating, the HSE could sign these contracts on the day of the election, regardless of what the Government elected that day feels about this. That is a frightening concept.
The Minister is turning her back on the public health care system in seeking this solution and we need to look at a few matters in that regard. First, I ask the Minister to clarify the full costs of this to the taxpayer. If the public system had to pay for these beds it would cost approximately €1 billion. The Minister states that the solution delivers these 1,000 beds in a roundabout way to the taxpayer for €400 million, which is the amount of the tax concessions she is giving for the construction of these private hospitals. Has she taken into account the €286 million estimated in 2007 in charges for maintenance in private and semi-private accommodation in public hospitals and how will this €286 million be replaced for the taxpayer, who must now make up that shortfall within the €14 billion that is spent on the public health care system?
More importantly, it brings to mind what the Taoiseach stated in December last when BUPA was pulling out of Ireland, that he was not going to let BUPA screw the old people. In this situation, because the Minister is not dealing with reforming the public system and making it work, one can see from the Health vote which we dealt with on Wednesday last that each person pays a significant amount of money. We are paying €4.9 billion——
Acting Chairman
Define the question, please.
What will this cost the private patient in the long term? The private patient will now end up paying not only €268 million which will be transferred to the private sector but, according to Mr. Finn when he was in front of the Joint Committee on Health and Children, probably double that figure. Does the Minister accept that private patients may find their premiums increasing dramatically because a sum in excess of €500 million will be required?
First, I thank Deputy Twomey for his good wishes for the forthcoming election. I am not certain we will not have another health Question Time before the Taoiseach goes to the President to dissolve the Dáil. I return his compliments and wish him and all the spokespersons well in the election.
The purpose of this policy is to free up approximately 1,000 beds that are ring-fenced for private patients to use for public patients. The capital cost of providing these beds in a co-located facility is less than 50% of the traditional cost. The cost to the eight hospitals of not getting the money from the insurers is €96 million, as we heard yesterday from Mr. Finn. Therefore, we get 1,000 beds for €96 million. That is incredible value relative to the cost of financing beds. Of course, the reason for that is the nurses, the managers, the administrators, all the people who work with the diagnostics, etc. are already on the public payroll.
I do not understand an approach that favours capital allowances for private hospitals but not if they are beside public hospitals. The reason for this plan is to free up these beds. It is also to keep the doctors on site. It is not an efficient use of key manpower in the health care system to have doctors working in two, three or four hospitals. Travel time alone is an issue. There are a great many issues involved.
The idea here is that one is supposed to complement the other. In Waterford, Sligo and other places, as Deputy Twomey heard, they will use the same entrance. These hospitals, by virtue of the tax allowances, must make services available for public patients at a discounted price. They must accept all patients, not just private patients, from the accident and emergency department. There will be service level agreements between the public and private providers where they will work with each other. They will share profits with the public hospital. This is a win, win situation. That is why it is so strongly supported in all those hospitals.
Acting Chairman
I ask the Minister to bring her reply to a conclusion.
The greatest guarantor of keeping the cost of health insurance down is competition. One does not keep the cost of health insurance down by restricting the capacity of private beds. If one does that, one is insuring people who cannot get services. That does not make sense. In all markets competition drives innovation and keeps prices down. That is why I welcome the entry to the Irish market of Quinn Direct. As there is a question about insurance, I will deal with that matter then. The changes we must make here to make this market more competitive will guarantee that all consumers with private health insurance get better value for money.
First, is the Minister aware that there is significant public and, indeed, professional opposition to this project, that she does not have a mandate for what she is doing and that it is surely better practice to ensure that the election is held before any irrevocable decisions are made?
Second, I challenge her statement here that the aim of this plan is to transfer private activity and ask her how she intends to do that. Every patient in the State has an entitlement to a public bed. The vast majority of patients, regardless of whether they are public or private, who come into public hospitals come through accident and emergency departments. If a private patient gets a bed in a public hospital, how does she intend to remove him or her?
What exactly is the loss of funding that will be experienced by public hospitals, which will still see some private patients in beds but will not be able to charge them for those beds? I note, for example, that Beaumont Hospital stated in its most recent report that 40% of its private capacity was used to provide for emergency and isolation cases.
Will the Minister outline the exact position with regard to the consultants' contracts? Does she expect the contracts to allow consultants to work in both types of hospital and to provide private and public care, as is currently the case? How will that be different from the current arrangement, apart from the distance factor? Will she make the terms of the tender available to the Members of this House?
I do not accept that I have no mandate. The Government made a policy decision in 2005 and it is a matter for the HSE to implement it. We do not put the implementation of policy on hold in advance of or during elections.
Everybody is entitled to access the public hospital system. Universal coverage is available in Ireland, which is not the case in other places. At present, however, not everybody accesses the system on the same basis. Those with private health insurance — I understand Deputy McManus published data in that regard — have easier access to the public hospital system, which is not good. I believe everybody should be equal and that is why I disagree with, for example, charges for accident and emergency services. When it comes to the public hospital system, which we are all entitled to use, we should allow access based on medical need and not because some of us have insurance and therefore can get into beds that are ring-fenced for private patients. Recently, I wrote to the HSE to recommend the prioritisation of these beds, many of which are in small or single rooms, for infection control purposes where necessary.
With regard to the charge to the hospitals, I said in my reply to Deputy Twomey that the eight hospitals concerned received €96 million last year for the beds being moved from public to private hospitals. That figure will be the revenue cost to the hospitals, excluding the moneys raised from leasing the land, which exceeds the commercial valuation because of the advantages offered by collocation.
The current contract of employment for consultants, which cannot be broken other than by agreement, gives consultants the right to 20% private practice on public hospital sites. In all eight hospitals, the intention is that the consultations will carry out work on the site and not in the public hospital, in line with their contract. We are seeking to negotiate a new contract with the consultants and the Government extended the period for negotiations by a further three weeks to 17 April because of the optimism expressed by the chairman of the talks. We want to see public-only contracts for public hospitals, which I understand has been well received, and a range of other contracts. Certain existing contracts will have to be red-circled because they cannot be broken except by agreement. I hope we can have a new contract of employment which attracts many of the existing consultants to work in teams under clinical directors and to provide greater flexibility, longer days and different rosters, all of which have been very successful in other hospitals around the world.
Will the Minister make the terms of the tender available to us?
I do not know whether that information is commercially sensitive but I have no problems with making it available. There are a number of bidders on each site and the HSE is following the new procedures introduced by the Department Finance of negotiating in advance. The process has continued for the past year and has been very successful in terms of addressing many of the issues which concern public hospitals.
Was that a "Yes"?
I do not know whether issues of commercial sensitivity arise. There is no question of hiding anything.
I look forward to receiving a reply.
Yesterday, Mr. Finn addressed the Select Committee on Health and Children in private session and it is fair to say he was very open in his remarks.
Industrial Relations.
John Gormley
Question:3 Mr. Gormley asked the Minister for Health and Children the progress made to date in negotiations with the INO and the psychiatric nurses on pay and conditions; if she expects a successful conclusion to these negotiations before the general election; and if she will make a statement on the matter. [12269/07]
The issues of nurses' pay and working hours have been fully processed through the State's industrial relations structures and procedures, the Labour Relations Commission and the Labour Court. While health service management has accepted the Labour Court recommendation, the Irish Nurses Organisation and Psychiatric Nurses Association state they have neither accepted nor rejected this recommendation and have instead served notice of industrial action.
The INO and PNA had been due to commence industrial action on 12 March. This action would have involved a nationwide work-to-rule and short work stoppages. Following contacts between Government representatives and the Irish Congress of Trade Unions, it was agreed to put in place an intensive time bound process of engagement under the aegis of the national implementation body, NIB, to address the issues underpinning the dispute and take account of the relevant Labour Court recommendations. The INO and PNA agreed to postpone their industrial action until 2 April.
The talks commenced on 12 March and are due to conclude tomorrow. In addition to the INO and the PNA, SIPTU, which is not in dispute, is represented at the talks. The negotiations concentrate on two main issues: the claim for a reduction in the working week from 39 to 35 hours and the perceived pay anomaly in the intellectual disability sector. The NIB has requested both sides to refrain from public comment on the discussions while the process is ongoing, and this has been agreed by the parties. At the end of this week, a detailed position statement is due to be prepared by the NIB and presented to both sides for their consideration. I believe this process is the best prospect of finding a satisfactory solution and officials from my Department and the HSE are fully and positively engaged in the process.
I welcome the positive engagement of the Minister's officials and the HSE because that is what the INO wanted. Does the Minister accept the INO is also positively engaged and has made an enormous contribution to our health service? Does she agree nurses are the backbone of the health service in many ways?
I was struck by the Minister's reply to a previous question which impacts on this matter. Did she state nurses in private hospitals will be on the public payroll?
No.
Clarification is needed on this because she cited Sweden as an example in the comments she made yesterday to the Select Committee on Health and Children. Is it correct that some of the nursing facilities in Sweden are provided by the private sector? The INO is not enthusiastic about the proposal to co-locate hospitals. Will the nurses who operate in these hospitals act in a private capacity and will they be members of trade unions? Does the Minister foresee any difficulties in that regard?
I agree that nurses are the backbone of the health system. They represent 35% of those who work in the system and are there 24-hours per day, seven days per week. They spend considerably longer periods with hospital patients than any other group of workers and do a fantastic job. In recent years, we have elevated nursing to a graduate level profession, with eight applicants for every place, and have greatly increased the number of nurses. I am a strong fan of enhancing the role of nurses and that is why I recently provided for nurse prescribing.
With regard to the private hospital initiative, all the nurses who care for patients in private beds in public hospitals are on the public payroll, so we will not have to employ additional nurses or incur further payroll costs. To the best of my knowledge, the nurses who work in the private health system have the same pay and conditions and belong to the same trade unions as public nurses. I am not aware of any issues in that regard. It is not for me to decide whether a facility is unionised but I do not think anyone is suggesting that freedom of association should be curtailed.
I wanted a transcript of Mr. Finn's presentation. Under the Minister's proposal, it is interesting that private operators can provide these services at a cheaper rate. Could they also, therefore, provide public beds at a cheaper rate? Could public beds not be built using private operators?
Building costs are the same but that is not the issue. I visited Sweden where I met the managers of St. Goran's Hospital. It used to be managed by the state until the socialist government transferred its management to the private sector. The private company received the same amount the year it took over as the government had provided the previous year. Not only did the company make a profit but it exceeded all its targets. No issues or difficulties have arisen with the employees. I made a reference yesterday to doing that here and the hullabaloo that would result. I am not even contemplating it but governments all over Europe are doing this. For example, hospitals have been transferred in France, Germany and the Netherlands.
All beds are built by private contractors and, whether they are contracted by the State or privately, the construction costs do not differ. However, the issue is the cost of running the beds and the speed at which they can be delivered. We have an endless public procurement process and projects such as schools take a considerable period from the time the green button is pressed until completion.
Cancer Screening Programme.
Liam Twomey
Question:4 Dr. Twomey asked the Minister for Health and Children the status on the roll-out of the cervical cancer screening programme; and if she will make a statement on the matter. [12266/07]
It is my objective to have an effective national cervical screening programme rolled out, beginning late this year. The programme will provide free cervical screening for women in the 25 to 60 year age group nationally and aims to reduce mortality from cervical cancer by up to 80%. For that purpose, on 1 January 2007, I established a national cancer screening service, which amalgamates BreastCheck and the Irish cervical screening programme. The total allocation to the new service is €33 million which is a 71% increase on the 2006 allocation to the programmes. This includes additional funding of €5 million for 2007 for the service to commence the roll-out of the programme by the end of the year. The national cancer screening service plans to have cervical screening managed as a national call-recall programme. This will be done through effective governance structures that provide overall leadership and direction, in terms of quality assurance, accountability and value for money. All elements of the programme, including call-recall, smear taking, laboratories, colposcopy and treatment services will be quality assured, organised and managed to deliver a single integrated national service.
In 1997 the then Minister for Health decided to set up a cervical screening programme and in 2000 a pilot scheme was introduced in Limerick. Does the Minister accept Irish women are dying at a rate twice the European average from cervical cancer? Our cervical cancer rate is higher than the UK even though when the programme was proposed in 1997 our rate was half that of the UK. Does she accept that in the past ten years little or nothing has been done in this regard? Could she be realistic about what will happen in the future given that a patient registration scheme is not in place and she does not know how much that would cost? The Minister referred to an additional allocation of €5 million but I do not know where that money will go. The HSE is still working on a report on laboratory capacity. When will that be presented, given that it will take another year at least if there is a need to build capacity?
It is ten years since the Minister for Health decided to set up this programme and the cervical cancer rate among Irish women has dramatically increased during that decade but nothing has been done to address it. Smear tests were sent to the US during 2006, which means capacity is a problem in our system, particularly when women must wait six months for test results. Will the Minister be realistic in outlining how long it will take to implement a cervical cancer screening programme? It is amazing that the rate of cervical cancer among Irish women exceeds that in the UK, given it was half that in 1997. That is the reason we must move quickly on this. Nothing the Minister said in her reply gives me confidence that she understands how far behind we are and the serious consequences involved, especially in protecting women who are most at risk.
The former Minister, Deputy Noonan, established a pilot project in the mid-west, which was not the beginning of a national roll-out and much has been learned from that. I do not disagree with much of the Deputy's contribution. Cervical smear testing was introduced in Canada in the late 1960s while it was introduced in the UK in 1988.
It was also introduced in the UK in the 1960s but the programme was reviewed in 1988 to upgrade it.
Since 1988, results in the UK have improved. Approximately 73 women a year die from cervical cancer in Ireland, even though significant numbers of opportunities for smears are conducted. There is a number of issues. The HSE did not go to tender because of the emergency resulting from a five-month backlog for such tests.
On a point of order, I was informed the reason the HSE did not go to tender was there was no capacity in any laboratory in Europe.
It was done to speed up the process on an emergency basis because generally one is required to go to tender. Two issues are involved relating to capacity and quality. We all accept BreastCheck is a quality assured programme. It must be ensured cervical screening is quality assured and, therefore, that the laboratories are accredited and meet the standard required, which has not been the case in many instances to date. The HSE has appointed a group to examine laboratory capacity and I am not sure when it is due to report. However, whether domestic laboratories will be available or we have to continue to outsource, that will be done. Staff must be recruited for the new programme. It takes a long time from agreeing the policy to writing to women to come forward for smear tests but that will happen later this year.
The Minister is almost in agreement with my comments. The Government's commitment to the cervical screening programme is weak. No progress has been made on patient registration and the Minister has no idea how women who need smear tests will be identified. She has acknowledged the HSE has no idea what is the laboratory capacity in this regard. These are two basic issues before one considers where sufficient doctors and nurses are available to conduct the tests and whether additional investment is needed in colposcopy clinics. That highlights a serious lack of commitment, ten years after the programme was proposed.
We know the age group and the programme will operate similarly to BreastCheck. Everybody accepts that is a terrific programme and the same people will be responsible for the cervical screening programme. When a screening programme is rolled out, quality assurance is essential. The roll-out will begin later this year and it will take a while to roll it out to the entire population. The programme will cover approximately 250,000 women annually.
Hospital Services.
Liz McManus
Question:5 Ms McManus asked the Minister for Health and Children her plans for dealing with the crises building up in maternity hospitals here in view of the inefficiencies built up in maternity hospitals regarding the long delays in accessing antenatal care for pregnant women and the ongoing industrial relations problems in Cork city; and if she will make a statement on the matter. [12268/07]
I am familiar with difficulties that have recently arisen both in Cork and in Drogheda regarding the provision of maternity services. As the House will be aware, the new state-of-the-art Cork University Maternity Hospital was due to open last Saturday but did not because of non co-operation on the part of the Irish Nurses Organisation, which has been claiming that midwifery staffing levels at the hospital would compromise patient safety. The HSE, together with medical consultant staff at the hospital and midwifery managers, are completely satisfied that the level of midwifery staffing currently available is sufficient for the safe opening of 128 of the 144 beds. The HSE has been in regular contact with midwives in the course of the week. It is encouraging that more than 300 midwives have attended orientation programmes at the new hospital during the week. The HSE has set a new date of Saturday next for the opening of the hospital. I sincerely hope that common sense will prevail in ensuring the facility is opened next Saturday.
In the case of Our Lady of Lourdes Hospital in Drogheda, my Department has been informed by the HSE that the number of women in the Louth-Meath region presenting for assessment during pregnancy has increased significantly in recent years. The projected figure for 2007 is more than 4,500, an increase of more than 100% since 2000 when approximately 2,100 women presented at the hospital. The HSE acknowledges this has placed additional pressure on services and has resulted in women having to wait longer than planned for assessment by a consultant obstetrician. My Department is advised that the HSE has recently approved 22 new midwife posts, two specialist nurse posts and three new consultant anaesthetist posts to relieve the current pressures. That will be closely monitored in the maternity unit at the hospital relative to demand.
I also wish all the best for a resolution at Cork University Maternity Hospital. People were astonished to learn that this magnificent hospital could not open due to industrial relations difficulties. Does the Minister have concerns regarding poor management at HSE level? She might investigate why a major brand new hospital remained closed due to issues that would have been resolved well before the new project's opening in any well-managed organisation. Will she investigate to establish the exact difficulty to ensure best practice within the HSE?
The Minister should respond to the fact that an expert group, the Institute of Obstetricians and Gynaecologists, produced a report on maternity hospitals last October that alerted her to serious staffing problems therein. The report produced last October made it clear that the basic infrastructure of maternity services is grossly inadequate and staffing problems exist across the board in that regard. Had the Minister taken action when the report was published, situations such as those affecting Our Lady of Lourdes Hospital probably would not have arisen.
I understand the Central Statistics Office brought out its final report today, which shows a highly significant increase in population. Although I cannot recall the exact figure, there has been an increase of approximately 400,000. This will affect metropolitan areas such as Cork and Dublin, as well as the regions surrounding them. No preparatory work has been done by the Minister, her Department or the HSE to meet this need, which explains the stresses and strains in Cork, as well as the spectacle of pregnant women waiting for five months before receiving full ante-natal care.
I am not familiar with the CSO figures that were released today as, in common with the Deputy, I have been very busy. However, the population is undoubtedly increasing in the eastern region in particular, which puts pressure on the system. I understand the number of births in County Louth has doubled in a six-year period, which constitutes a considerable increase.
As for Cork University Maternity Hospital, while efforts were made at local level to resolve the issue, eventually it ended up going through all the State's industrial relations machinery. The Labour Court recommended that it should open and staffing levels were recommended and have been agreed. The ratio of midwives to births in the Cork hospital will be 1:23, while the equivalent ratio in the National Maternity Hospital is 1:32. The director of midwifery and the obstetricians there have stated that it was safe. While I do not wish to say anything that might inflame the situation, I hope the difficulty can be resolved and that the hospital can be opened next Saturday. One of the issues to be addressed is the speed at which the required additional staff can be recruited.
The report from the Institute of Obstetricians and Gynaecologists in respect of nationwide maternity services has many good features. I have read the report, which suggests that all existing maternity units should be retained. This came as a surprise because previous advice from obstetricians did not seem to take that view. In recent years, insurance issues and other factors led to the closure of maternity units in locations such as Dundalk, based on patient safety and best practice.
It is clear that the number of consultants, including obstetricians, in the health care system must be greatly increased. Undoubtedly, their number must be doubled. Other staff are also required, which is why a new contract with consultants is particularly important in order that recruitment may take place. While I am aware it does not affect the recruitment of nurses and midwives, it certainly affects the recruitment of doctors and substantially more must be recruited in both anaesthetics and obstetrics.