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Dáil Éireann debate -
Tuesday, 29 Apr 2008

Vol. 653 No. 2

Priority Questions.

Departmental Expenditure.

James Reilly

Question:

9 Deputy James Reilly asked the Minister for Health and Children if she is satisfied that the finance allocation to the Health Service Executive in 2008 will enable it to deliver the 2007 level of services in addition to specific service improvements; and if she will make a statement on the matter. [16775/08]

Our democratic system means that, fundamentally, there is no public spending decision without a tax decision. The two cannot, and should not, be separated. That is why both expenditure Votes and taxes are set by the Oireachtas annually around the same time, and both have to be adhered to. The Oireachtas has voted a budget for the HSE for 2008 from resources provided by taxpayers. Excluding the long-stay repayment scheme, the gross current amount is €14.2 billion which equates to approximately €3,380 for every person in the country or €9,732 for every income taxpayer. This amount is more than a quarter of voted Government current expenditure. It is almost the equivalent of total estimated income tax receipts. This allocation is an increase of 8% on the 2007 outturn of the HSE. By any national or international standard, that is a high level of increase for a national health service. Few other countries maintain such levels of increases year after year. The OECD reported yesterday our rate of increase in public health spending was the second highest in the developed world between 1995 and 2005. Many people say recent levels of annual increases are unsustainable.

No health system in the world operates without implicit or explicit budget limits and benefit limits. It is also the case that every health system, including our own, needs to deliver the most effective services for given resources and to constantly improve, that is, to make value for money and efficiency gains. The HSE has incorporated value for money targets within its service plan. Those who support increased efficiency in public services will fully understand and support the fact that a 1% increase in efficiency for the HSE means, in financial terms, providing the same level of services at a cost of €142 million less; a 2% efficiency gain means providing the same level of services at a cost of €280 million less.

Additional information not given on the floor of the House.

The services and targets to be provided by the HSE in 2008 are set out in the national service plan, which I approved in November 2007 and the addendum to the service plan which I approved in February 2008. Both of these documents have been laid before this House and published. In its Exchequer issues return to end April, the HSE is reporting an overspend against profile of €95 million, excluding the long-stay repayments scheme. I have had discussions recently with the chairman and CEO of the HSE about these emerging budget pressures. The imperative for efficiency gains and more effective practices is all the greater to deliver services, consistent with Government priorities, and within the annual budget allocated by the Oireachtas and the profile of expenditure planned for each month. The HSE is considering the steps it should take in this regard. When I receive the HSE's proposals in this regard, I will report to Government as part of the normal expenditure management process.

It is no surprise we have the second highest increase in spending while we have come from being the second lowest out of 28 countries only a few years ago. I have a letter from Mr. Woods, the national director of finance. The HSE sought €14.7 million to maintain existing services but the Minister has decided to give them €14.1 million. Was there an agreement to that effect or was it determined by her Department that this is how it should be? This being the case, is this the reason we have had promises of such a run of cutbacks in this coming year? I refer to a reduction of 25% in orthopaedic elective surgery in Our Lady's Hospital, Navan, a reduction in surgical activity in Louth County Hospital, including elimination of on-call and the establishment of a shorter working day, a reduction in outpatient clinics in Our Lady of Lourdes Hospital, possibly being reduced by one day per week, Friday, reduced outpatient clinics to four days a week——

A question please, Deputy.

The question is coming.

It had better come quickly.

——the reduction of elective surgery to four days a week in Cavan-Monaghan; the closure of ten beds in Cavan-Monaghan; and Monaghan to be taken off call. I also refer to the intended closure in August of UCHG, the hospital which is designated to be the regional centre of excellence for cancer care in the west and is the centre of tourism for this country. How clever is that? An embargo on staff, cutbacks in Connolly Hospital——

A question please, Deputy.

Was this by agreement or is this the reason we have this never-ending list of cutbacks, including cutbacks to home help for the elderly, home care packages for the disabled and now the hospital in the home scheme to be removed? While we are talking about cutbacks, has the Minister made any progress on redundancies in the HSE and how much does she hope to save? I ask her to answer my first question clearly and concisely, as I know she will. How did the Minister reach the figure of €14.1 million when the HSE sought a figure of €14.7 million? I ask her not to mention the extra €200 million for particular new services.

The Deputy may not be aware but what happens in the Estimates bid from every Department, including when the health boards existed, was that those health boards would make their bid. The Minister for Health and Children engages in discussions with the Minister for Finance and a budget limit is agreed.

We no longer have health boards.

Allow the Minister to continue without interruption.

I am explaining there is a finite amount of money which the Minister for Finance can allocate across Departments. The line Ministers discuss this with the Minister for Finance and this is how the budget is agreed for health, education or whatever it might be.

The Deputy's colleague, Deputy Bruton, has been lecturing us about slicing off 2% for value for money initiatives across the public service and this year we expect the HSE to achieve value for money initiatives. In the first two months of this year, there has been an increase of 7.6% in the number of inpatients discharged and day cases, and a total of more than 14,000 extra people being treated in our hospitals in the first two months of 2008, as against the first two months of 2007. This is an increase in activity.

In that case how can the Minister explain this long list of cutbacks? Will she answer the question in respect of progress made on redundancy packages within the HSE, especially in light of the threat to strike by IMPACT trade union because of the recruitment ban?

As I informed the Deputy on a number of occasions and as I have repeated publicly, I have discussed this with the chairman and board of the HSE, which I addressed recently, and with the chief executive officer of the HSE. If there are people in one area in the health service who are superfluous to requirements while there are shortages in other areas, we must make decisions. A manpower analysis has been carried out in recent months within the HSE and the hospitals and community services operated by the HSE. A new human resources director will start work on either 3 June or 4 June. In that context I expect the HSE to be in a position to make proposals about where it intends to make reductions in some areas so that more people can be employed in other areas.

Accident and Emergency Services.

Jan O'Sullivan

Question:

10 Deputy Jan O’Sullivan asked the Minister for Health and Children her views on figures provided for the board of the Health Service Executive which indicate that 44% of patients in hospital emergency departments had to wait longer than the maximum target time of 12 hours in the first two months of 2008; her further views on whether this is still a national emergency; the measures planned to address this situation, which is causing great distress to patients; and if she will make a statement on the matter. [16329/08]

A total of 184,159 people attended accident and emergency departments in January and February this year. Of these, one third, about 61,000, were admitted as inpatients. The vast majority of these patients were admitted without delay. The HSE reports daily at 2 p.m. on the numbers of remaining patients who have not been admitted immediately. The report cites the waiting times as being either between zero to six hours, six to 12 hours, 12 to 24 hours and more than 24 hours. The number of patients waiting in each category as a proportion of the total who are not admitted immediately can be calculated on a daily basis.

The number of patients waiting in each category as a proportion of total admissions is not immediately apparent from the published data. For example, yesterday was Monday which is traditionally a day of heavy demand and approximately 3,100 people attended accident and emergency departments. Of these, 1,000 would have been admitted for care, 870 were admitted immediately and 123 people were reported as waiting for admission. The total number of patients reported by the HSE as waiting for admission for more than 12 hours was 46 persons. I would much prefer if that number were much lower or even zero but it represents 4.6% of admitted patients and 1.5% of all patients presenting at accident and emergency departments.

It is important to set clear targets for improvement and to measure performance accordingly. This was never done in the past. In line with this approach, the HSE has introduced a target waiting time of no more than 12 hours from the time a decision is taken to admit a patient. A number of hospitals have commenced reporting information from the time the patient presents, and the HSE expects to be in a position to publish data on up to 18 hospitals in the next few weeks.

Significant additional resources have been provided to address problems arising in accident and emergency departments. These include additional long-stay beds and a range of community-based measures aimed at reducing the need to use acute hospital services.

Is the Minister disputing the figures that 44% of patients must wait 12 hours or more in accident and emergency departments to get into hospital? This is the figure published from a report given to the HSE and the target is 12 hours.

I refer to what the Minister said shortly after she became Minister for Health and Children:

I expect real and measurable improvements to take place in the coming months in the delivery of A and E services. A and E is the litmus test for me, for the Government and for the people of this country.

In view of those figures and of the stories in the media, is the Minister passing this litmus test? I met a man a short time ago who told me that he was in the accident and emergency department in the Mater hospital recently and he described it as being like a scene from the Crimean War. We have constant descriptions of what is happening in accident and emergency departments. Statistics were published in the newspapers last week from official figures given to the HSE.

Has the Minister given away her power? Is this something she wishes to be measured by? Has she any control as Minister over this situation? Can she do anything about it or is she a powerless Minister who has given the power to the HSE and who has stated she wants something done about accident and emergency departments? The HSE has stated it may cut accident and emergency services as one of the cutbacks.

We have made significant progress and this has been acknowledged by every single group. I refer to the significant progress made in dealing with waiting times in accident and emergency departments. There has been a 60% improvement in the past three years. I remind the Deputy that up to then, waiting times were never measured and we had no target times whatsoever.

Targets were set and they were not reached.

The accident and emergency initiatives we have funded through the HSE and for which we have set targets through the HSE are the final responsibility of each hospital. Among the changes that have taken place and the manner in which the health service is delivering services, greater accountability is achieved by measuring in the first instance. If one does not measure something one will not be able to manage it. We never measured in the past.

If Deputy Jan O'Sullivan is suggesting that 44% of the 3,000 people going daily to accident and emergency departments have to wait for more than 12 hours, that is not the case. She referred to a man she met recently. I met somebody on my way here who told me that a member of his family was in an accident and emergency department in this city at the weekend and they were astonished at how fast the person was seen and how clean the hospital was compared with previous visits. We can all refer to isolated cases.

I would love to get to a situation where nobody in an accident and emergency department would have to wait more than six hours to be seen and discharged or kept for observation, which is often the case, and admitted to a ward. This has to be the ambition. However, one does not achieve the ambition overnight, there has to be steady progress on the way and we have made enormous progress in the past few years with regard to accident and emergency attendances and waiting times.

Is the Minister saying it is not true that a total of 44% of patients in accident and emergency departments are awaiting admission and had to wait longer than the official maximum target period of 12 hours in the first two months of this year? This is what was in the report that went to the board of the HSE and either it is true or it is not true. If it is true, it is the Minister's responsibility.

What will the Minister do about the fact that so many people in acute beds, in the beds that the people in accident and emergency departments hope to occupy, are not able to leave those beds and go back into the community because of closure of respite beds? What will the Minister do about the overall problem, which is the great difficulties experienced by patients attending accident and emergency departments?

We are now clinically supporting 10,000 older persons who require respite care by providing them with medical supports in their own home. Four years ago, no such home support with clinical back-up was available. This represents great progress. There are 28,000 older people in residential care, which is higher than the international average for people over the age of 65. In the past, many people with low levels of dependency ended up in residential care because in-home and community supports were not in place.

The new nursing home support scheme, A Fair Deal, will make a major impact on the ability of families to afford long-term care. We currently have an unsustainable situation where 90% of the cost of care is funded in respect of public facilities and effectively only 40% in the case of private facilities. The increased affordability of long-term care will have a significant impact in terms of what are broadly referred to as late discharges in our acute system, which number approximately 700. This presents a major challenge for the acute system.

Are the figures to which I referred correct?

The figure of 44% of people attending accident and emergency departments is not correct.

The Minister is rejecting her own figures.

Only one third of people who present at accident and emergency departments are admitted to hospitals. Deputy O'Sullivan is using the wrong statistic in the wrong context.

I am referring to the figures published by the Health Service Executive.

They do not relate to those attending accident and emergency units.

Cancer Screening Programme.

James Reilly

Question:

11 Deputy James Reilly asked the Minister for Health and Children if, in view of the reported plans to outsource the reading of all 300,000 cervical smears outside this State to another continent, causing the closure of all cervical smear laboratories here and the consequent loss of more than 100 highly skilled specialised jobs involved in the teaching and reading of cervical smears at a time of economic downturn, she will confirm that the accuracy rate of the non-Irish tender was only 85% compared to 95% in the Irish laboratory at University College Hospital, Galway; her views on whether it is untenable to leave Ireland in a position where we will have no laboratories for cytology screening, and that Ireland will be at the mercy of the vagaries of the international commercial laboratory operators; if she will reconsider the path she is taking and instead properly resource, update and fund adequately the screening laboratories here as formerly agreed by her Department and all the stakeholders in Limerick in 2005 as per the Dr. McGoogan report on cervical screening services; and if she will make a statement on the matter. [16776/08]

I confirm the planned roll-out of a national cervical screening programme. The absolute priority in the roll-out of this programme is to provide a quality-assured service for women availing of the service. This includes an acceptable turnaround time for cytology results.

The national cancer screening service is in the process of procuring cytology providers as part of the planned roll-out of the screening programme. It commenced in December 2007 and was open to laboratories in Ireland and internationally. The procurement process is being run in accordance with national and EU procurement requirements. The necessary entry criteria in choosing a cytology partner included accreditation status and a laboratory dealing with a volume of a minimum of 25,000 smears per annum. These criteria were chosen in line with international acceptable criteria for cervical screening programmes. The initial contractual period with laboratories will be for a two-year period. As this process is ongoing, it is not appropriate for me to comment on the specific aspects of the competition such as those referred to by the Deputy. However, in more general terms, taxpayers are entitled to expect the best value for money in terms of the cost of the service being provided.

The Dr. McGoogan report recommended that cervical screening be managed as a national call and recall programme via effective governance structures that provide overall leadership and direction in terms of policy, quality assurance, accountability and value for money. This report, among others, was taken into account by the national cancer screening service in determining the process for roll-out of the cervical screening programme nationally.

The HSE has undertaken a review of its laboratory medicine services. I welcome steps being taken by certain HSE-funded laboratories to secure accreditation. If all those involved work together in partnership, there is scope to provide high quality and cost effective services within HSE-funded laboratories.

The Minister's reply is incredible. A cervical cancer screening programme was piloted in the mid-west in 1999. Either the Department of Health and Children or the Health Service Executive engineered the tender for this contract. Why was action not taken in recent years to encourage, assist and resource the laboratories in this State to be in a position to tender for the contract?

Some important facts must be put before this House. The data arising from the smear tests undertaken in the United States will be available in that jurisdiction and may come under the remit of the Patriot Act. Information relating to Irish women will be in the hands of the Department of Homeland Security to do with as it wishes.

Under the national screening programme, women are to undergo smear tests every three to five years. Given the way in which this Government has been funding the health service, it will be every five years. In the United States, where women are offered smear tests every year, an 85% efficiency rate is tolerable as opposed to the 95% efficiency rate required here. This means we are putting patients at risk by outsourcing smear tests to a jurisdiction in which women undergo tests yearly and where a greater margin of error is therefore allowed.

Deputy Harney observed that several of the State's laboratories expect to achieve accreditation in the near future. Many of these laboratories have leased expensive new equipment but no advice was offered to them on how to tender for this contract. They are not accustomed to this type of approach.

I am sure there is a question among Deputy Reilly's statements.

Will the Minister reconsider this tendering process, particularly in light of the patient safety issues, to which I referred? In addition, smear tests are reported in a different manner in the United States. We are building into the system more room for human error that may impact on the patient in a negative fashion.

It is extraordinary that the Deputy who has been screaming at the Government to introduce the cervical screening programme, a Deputy who understands that we do not currently have the capacity in this State to provide quality-assured cytology services, is now screaming at me because we are proceeding to introduce that programme this year. I am also surprised that Deputy Reilly is raising the prospect of private patient data being made widely available in the United States. I do not understand his concern. Others may have something to say about it

Our tests will meet the standards laid down by the British Society for Colposcopy and Cervical Pathology. That is the most important issue. It is our intention to bring the laboratories in this State up to the standard required and to achieve accreditation. However, we will not be in a position to do so between now and the summer.

The Minister and the Government of which she is a member have had ten years of economic boom to achieve this. It is difficult to accept her undertaking to do so in the coming years as we face into an economic downturn. The public will not swallow that.

We are providing the service. That is what is important.

It is my understanding that one of the main United States tenderers for this contract is currently taking ten weeks to turn around results.

I have already told the Deputy what is required under the terms of the tender. The specified turnaround time must be met. The quality control standard in the United States is similar to the high standard set by the British society. That standard will be met. There is no point in having cytology without accuracy.

What about the 85% efficiency rate versus the 95% efficiency rate?

The Deputy knows that much of the opportunistic screening that took place here was not reliable because the quality-assured facilities were not in place.

Health Service Staff.

James Reilly

Question:

12 Deputy James Reilly asked the Minister for Health and Children her estimation of the number of general practitioners needed in the next ten and 20 years; her views on whether under current education and training arrangements there could be a serious shortage of GPs in the very near future; the action she will take to address this impending shortage; and if she will make a statement on the matter. [16777/08]

The number of general practitioners in active practice is 2,500. This equates to approximately 0.5 GPs per 1,000 of the population, a ratio that is low by comparison with other EU and OECD countries. I recognise there is a need to increase the number of GPs to take account of the projected growth in population, the aging of the population and the aging of the GP workforce.

The Government has taken several initiatives to address this. In February 2006, we announced that the number of medical school places for EU students would be more than doubled by 305 to 725. The quota of 305 had been in place since 1978 under successive Governments. The new graduate entry stream will provide an additional 240 places and increase the number of EU undergraduate places by 180.

A total of 170 extra medical school places have been provided between 2006 and 2007 for Irish and EU students in the existing undergraduate courses and the new graduate entry programme. A further 95 places will be made available in 2008, with the remaining 155 places coming on stream in the next two years. In 2004, it was agreed with the Irish College of General Practitioners, ICGP, that the number of GP vocational training places should be increased from 84 to 150 on a phased basis over three years. I am informed by the Health Service Executive that, to date, 36 of the additional 66 places have been provided, bringing the total number of training places annually to 120. The further increase to 150 places is being kept under review by the HSE in light of the current budgetary situation.

There are currently 12 GP vocational training programmes in the State and these programmes are accredited by the ICGP. Three hundred and seventy-six trainees are currently participating in these programmes and the HSE has advised that this number will increase to 449 in July 2008. The HSE has indicated that there have been capacity issues within these training programmes and that this is the principal reason that it has not been possible to increase the number of training places as quickly as had been hoped. The HSE continues to work with the ICGP with a view to addressing these issues.

A joint Department of Health and Children-HSE working group on workforce planning was established in June 2006. It includes representatives of the Departments of Finance and Education and Science and the Higher Education Authority. Research is currently being undertaken by FÁS on behalf of the joint working group. This research will analyse the labour market for 11 health care grades and professions, including GPs, and will help determine future GP training needs.

The Minister referred to 0.5 GPs per 1,000 persons. We have 52 GPs per 100,000 while France has 164 and Austria 144. To put this in context, throughout the country GPs are closing lists, with 35% of GPs in the north east closing lists because they are overworked and cannot take any more patients. This has been coming down the line for some time. In her reply, the Minister alluded to the fact that 150 GP training places were supposed to be made available. This year, the funding for the final 30 places was supposed to have been provided but because of budgetary constraints, this will not happen. I remind the Government that we have a manpower crisis. It is not coming down the line, it is here now. Within the next 12 years, 50% of the general practitioner population in the country will retire and we are already in trouble before we go there.

Two out of three young doctors cannot access GP training. The problem is not that we do not have enough qualified doctors who want to be GPs. We have plenty but they cannot access training positions. This is why it is so important that the Minister accedes to requests for the funding for the 30 additional places. I spoke to the college and even if we want to stand still, we need an average of 200 GP training places a year. However, given that we will lose 50% of them during the coming years, we need 300 places for the next four or five years.

Will the Minister re-examine the situation and fund these critical jobs? Will she also examine another method of training qualified and experienced doctors to be general practitioners? They have completed much of their training but they cannot get on to a training scheme or access their MICGP exam. What hope does Professor Brendan Drumm have for his great new vision of the future in which we do not need more beds and we have primary care facilities provided by general practitioners if we do not have GPs to deliver services today let alone tomorrow?

A number of years ago we were told we had a shortage of nurses and we greatly increased the numbers. Now we are told in another report that we have too many. I hope we can get it right with regard to doctors. We will double the number of Irish and EU medical students, either as postgraduate or undergraduate entrants. This was the first important thing to do and it was not without considerable resource implications. The number of general practitioner training places will also be increased. I accept we did not achieve 150 this year.

Deputy Reilly made a valid point with regard to people who cannot get on to the programme but have considerable experience and I would like to explore this with the college. I would certainly be open to this. As Deputy Reilly knows, we have 6,000 non-consultant hospital doctors and 2,000 consultants and it should be the other way around. People in a hospital environment may be suitable for general practice if they can access appropriate training.

I have met general practitioners who cannot access a GMS list because of a previous industrial relations agreement. This also needs to be examined so any doctor qualified here as a general practitioner can take on GMS patients. In some areas, this has been challenged.

Child Abuse.

Alan Shatter

Question:

13 Deputy Alan Shatter asked the Minister for Health and Children if the Health Service Executive has submitted to her a report for the first quarter of 2008 pursuant to the HSE national service plan which requires the provision of performance indicators for each HSE region on the number of notifications of child abuse or neglect received, the number of assessments conducted following notifications, the number of children on waiting lists for assessments following notification of child abuse or neglect and the average time spent on a waiting list for assessment following notification of child abuse or neglect; if she will provide detailed information on these matters received by her in respect of each HSE region; the initiative she proposes taking with regard to the number of children on waiting lists for assessments; and the average waiting time spent on such lists following notification of child abuse or neglect. [14413/08]

I have been informed by the Health Service Executive that its 2008 national service plan commits it to developing from the end of the second quarter of this year a means of collecting information on the following for each administrative area: the number of notifications made of child abuse or neglect, the number of assessments conducted following notifications, the number of children on waiting lists for assessments following notification of child abuse or neglect and the average time spent on a waiting list for assessment following notification of child abuse or neglect. Reporting against this information will be based on the phased implementation of standardised business processes through the child care information system project.

Since the inception of the Office of the Minister for Children, there has been a significant build up in both the flow and quality of management information available. Key components of this information management include the analysis of the child care interim data set prepared annually by the HSE and the regular service plan monitoring reports submitted to the Department of Health and Children. The further development of this information strategy is set to continue with the completion of the joint Office of the Minister for Children and HSE knowledge management policy and its subsequent implementation plan. This implementation will include a pilot scheme which will integrate the children service data sets with other relevant HSE data sets.

All of these initiatives, if accompanied by planned commentary and analysis, will allow for much enhanced management of children's services by cross-referencing a series of relevant data and research sources via the shared health atlas tool. It is anticipated that this capacity will begin to be available to HSE and Office of the Minister for Children policy makers, managers and frontline staff in 2009 in line with the requirements and approach of the Office of the Minister for Children developed agenda of children services, the overarching policy for children services in Ireland.

The Office of the Minister for Children meets regularly with the HSE to monitor such service provision and policy related issues. These meetings are an integral part of the response to the issues raised by Deputy Shatter in the context of the overarching policy, the agenda for children's services, which I launched in December 2007.

I am trying to digest all of this. I wish to ask the Minister of State an extraordinarily simple question. How many children reported to the HSE throughout the country's various sub-regions as being at risk of neglect or abuse are awaiting assessment at present?

As Deputy Shatter knows, reports were made available for 2005. We have preliminary data for 2006 which has not been analysed. With regard to the performance indicators to which the Deputy referred, the January report has come to the Department as has the February report. We await the March report and expect to have it within the next two weeks. When we have this, it will enable us to provide a quarterly report. I asked the HSE to ensure that as soon as it has analysed its March data to forward it to Deputy Shatter.

Will the Minister of State confirm that the HSE has a statutory obligation under the Child Care Act 1991 to publish an annual report relating to child welfare services? Will he also confirm that the HSE is in breach of this in that it took until the end of February 2008 to produce a report for 2005? The Minister of State does not have a report for 2006 or 2007.

Am I right in understanding that the Department has absolutely no idea how many children were reported to the HSE during 2006 or 2007 as being at risk? The Minister of State does not know the average waiting times before children at risk are assessed. He does not know how many children are at risk at present because they are on a waiting list. He does not know how many children are being abused having been reported as being at risk six or 12 months ago.

Will the Minister of State also confirm that in reply to a Dáil question which I tabled on 31 January 2008 seeking this information I was promised a response from the HSE containing the information? It has been incapable of producing this in four months. Will he also confirm that in a reply in early April he informed me he would have in his Department the quarterly figures? He still does not have them. Will the Minister of State explain in what way he suggests his Department can function in the absence of any detailed information of any nature whatsoever which is up-to-date and current concerning the manner in which our child protection services are working?

I am anxious that we have the up-to-date information available as soon as possible. As Deputy Shatter knows, the first year for which the HSE——

It is a disgrace. The whole thing is a disgrace.

——had responsibility for this report was 2005. This report was completed.

It was completed in February 2008.

It was completed prior to that.

It was not published until February 2008.

That is different.

It languished in the Department from July 2007.

Just one second, Deputy Shatter. The scheduling and publication of the report is a matter for the HSE. It is not a matter for the Office of the Minister for Children.

Did the Minister of State discover why it took it three years to publish it?

Deputy Shatter must allow the Minister of State to provide him with a reply without interruption.

The HSE completed its report for 2005 in 2007. The report for 2006 is nearing completion. I am informed by the HSE that the report on 2007 will be completed in the summer of this year. We want a more timely publication of reports. We want the information to be more accessible and a better quality report. I stated the reports in respect of January and February of this year have been made available. The March report will be completed within the next two weeks and this will provide us with the quarterly report. We are developing a new system whereby the information available will be put to the best possible use to ensure the best possible outcomes for children. The HSE informed me it was prioritising the——

The Minister of State does not know how many children are not being investigated having been reported as being at risk.

Deputy Shatter should allow the Minister of State to speak.

There is no point having a constitutional referendum as window dressing if the Department does not have this basic information.

We are not involved in any window dressing.

If I can interrupt the Minister of State for a moment——

I already told Deputy Shatter, if he had listened——

If Deputy Shatter wishes to obtain an answer to his question it would be useful if he would allow the Minister of State to conclude his reply.

I appreciate what the Leas-Cheann Comhairle is saying but we have learned enough about children at risk who have been abused in this country——

Deputy Shatter, I have not finished speaking.

It is an absolute disgrace that we have a Department that is masquerading as knowing what is going on in this area.

If the Deputy would allow the Chair to speak——

The Department does not have a clue what is going on.

Deputy Shatter must resume his seat.

I will not accept Deputy Shatter's use of the word "masquerading".

I will allow the Minister of State to conclude his contribution. However, both Deputies must observe the direction of the Chair. This is a parliamentary House of debate. Debate means listening as well as speaking.

If questions are asked, Deputies must allow the Minister charged with giving an answer to give that answer uninterrupted.

I have been since the beginning of January trying to get specific information. I am aggrieved it is not available.

Deputy Shatter has put his question. We will move on to Other Questions unless there is no further interruption from Deputy Shatter. The Minister of State to respond without interruption, please.

The HSE has informed me that the delay in preparing the 2005 report was due to the prioritisation of a service delivery mechanism as it was a relatively new body. Previously, reports were produced by individual health boards. The HSE on its establishment developed a template for a national reporting procedure. As I stated, preliminary data for 2006 has been supplied to the Department but it has not yet been analysed. I will ask the HSE to send preliminary data in respect of 2006 to Deputy Shatter. The full report in respect of 2006 should be finalised soon. The 2007 report will be finalised during the summer.

How can policy decisions be made without this information?

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