Dáil Éireann debate -
Wednesday, 14 May 2008

Vol. 654 No. 2

Leaders’ Questions.

Deputy Enda Kenny

Yesterday, I raised with the Taoiseach the issue of children at risk and the numbers on waiting lists who have had no intervention whatsoever. There were no answers forthcoming from the Government.

Today, I wish to raise the matter of another category of children who need specialist attention and services, namely, those who are awaiting assessment for speech and language therapy for various speech and language disorders. The Taoiseach is well aware of the complexity of this problem. I cannot overstate the importance of early intervention and delivery of service for children who are so afflicted. It is absolutely critical. If early intervention does not take place, the consequences are a lifetime of self-consciousness, speech impediment and under performance.

The Government has recognised this problem because in its programme for Government it states that any child under five years of age who has been awaiting assessment for more than three months will have automatic access to a service provided through the National Treatment Purchase Fund. What happened to that commitment?

In Dublin alone, 4,000 children are now waiting for speech and language therapy assessment. There is further discrimination within that because it matters where a child lives. In Dublin north, the waiting period can be as low as three months, whereas in Dublin south it can be 31 months and in Dublin west, 33 months. In many cases, children are waiting for two and a half years to be assessed.

I am sure the Taoiseach appreciates the frustration and anger of parents when they recognise that their child has a problem for which attention is required. There is no point in the HSE saying "Sorry love, see you in four year's time". There is no cohesion, streamlining or delivery of the service. That says a lot about the constitutional republic to which the Taoiseach refers. There is no delivery of service. A child living on one side of the street in Dublin can obtain a service within three months, while a child on the other side may have to wait 31 months. This is not the way things should be.

I cannot stress enough how important early intervention and delivery of service is for children with speech and language difficulties. What is wrong? Why can we not have a single, overseeing deliverer of this service rather than fragmentation, lack of cohesion and no co-ordination, resulting in a seething anger? In this city alone, 4,000 children this morning are on a waiting list for delivery of services for speech and language disorders. What will the Government do about this?

The Taoiseach

I recognise the provision of such services has been a problem for some time. One of the issues was a shortage of graduates of speech and language courses but we have doubled the number of graduates in the past number of years. Another practice that is causing difficulties, in terms of the need for more flexibility, is that such graduates must be supervised by a senior staff member for the first years immediately after qualifying. We must determine why that should be the case. We must ascertain why that particular work practice has been maintained in a way that means newly qualified graduates cannot be released to do their job more expeditiously than is currently the case.

I acknowledge that there is a problem in this area. The response of the Government has been to double the number of places on speech and language therapy courses. The first graduates since that doubling of places emerged during the course of this academic year. The number of people qualifying was the first major problem that we had to address and that is being addressed currently. However, we have now found that there is an added work-practice issue that has been part of how things are done thus far. That issue must be addressed in the context of a more flexible response.

Deputy Enda Kenny

With respect, that is not good enough. The number of children on waiting lists has doubled in Dublin in the past three years. Newly qualified graduates, who are obviously very bright people, having obtained 450 and 600 points in their leaving certificate, cannot get jobs because they do not have any experience. There is no cohesion or co-ordination of service delivery. We are currently preparing the most costly form of human export. The graduates will not hang around. They will go to countries where they can get jobs. We train them — the taxpayer pays for their training — and then they find that they cannot get a job in this country once they qualify.

The Taoiseach has said that he has doubled the number of graduates of speech and language therapy courses but the waiting list in Dublin has doubled in the past two years. There is no point in telling the parents of children with speech and language difficulties that we have doubled the number of qualified graduates in the field. Such parents will reply that they must wait three years to have their child assessed and to obtain services, which is not good enough. The Government is now preparing for the most costly form of professional export from this country because the graduates will not wait around.

In order to save the bacon of the Minister for Transport, driving tests are now being conducted at weekends so that adequate numbers of people will pass their test by mid-June.

Deputy Michael Kennedy

That is what many of them wanted.

Deputy Enda Kenny

These services are not available, however, in the way they should be. In his capacity as Taoiseach and knowing that this problem exists, why can he not issue a direction that cross-departmental influence should be brought to bear and that there should be one umbrella organisation under the auspices of the Department of Education and Science to deal with this? All these professionals are contracted to the HSE and are working in schools whereas the children have a problem that is intellectual and educational, not medical. Many of the services are funded across a range of organisations so there is no co-ordination or cohesion and no service is being delivered. I would like to hear the Taoiseach repeat that he recognises the scale of this problem because the status of what is in the programme for Government is either just another noble aspiration, as the previous Minister for Education and Science said, or another broken promise.

I cannot overstate or describe strongly enough the depth of frustration, concern, anxiety and, indeed, anger that is out there among the parents of children — 4,000 in Dublin alone, a figure that has doubled in the past three years, for whom there is no delivery of service for their children when it is clear a problem exists. I repeat that this is condemnation to a lifetime of underperformance, self-consciousness, speech impediment and under delivery. We can stop it now if the Taoiseach provides one service deliverer, one umbrella organisation, and sees to it that the professionals, who are being trained by the taxpayer, are allowed to do the job and provide early intervention. What is the status of the programme for Government commitment that children will have automatic access under the National Treatment Purchase Fund when it is clear we are going in the opposite direction?

The Taoiseach

We have established new schools for speech and language therapy and occupational therapy in Dublin, Galway, Trinity College and Cork and a master's degree in physiotherapy is offered in Limerick. There has been a response in terms of improving the resource and ensuring we have sufficient people. The reason for the existence of this problem is that insufficient numbers of people were coming through the system. Part of our health service reform programme includes the question of achieving more flexible working arrangements whereby newly qualified speech and language therapists can take up tasks and not be required to be supervised by senior staff, which is currently part of the work practice in the public service.

Deputy Jan O’Sullivan

There is a need to fill vacant posts as there are lots of vacant posts out there.

The Taoiseach

That flexibility is something that has to be achieved. I am glad to hear that Deputy Kenny supports at least some health sector reforms, such as that one. He might not be as selective and perhaps he should support them all so that we can deal with all these work practice issues. The way work practice issues are operated within the system is the reason we are not getting the outputs we would expect for the resources we are allocating. That is precisely the issue in this case as it is in other areas. We might see a change in the Opposition's view and it might start supporting reforms rather than coming in here defending vested interests——

Deputy Richard Bruton

How about answering the question?

Deputy Paul Kehoe

What about the parents of the country?

An Ceann Comhairle

Allow the Taoiseach to continue without interruption.

Deputy Jan O’Sullivan

That is not the main problem; the main problem is the embargo on posts.

The Taoiseach

With regard to the number of speech and language therapists coming into the system, the basic problem, as I have outlined, that has been in existence for some time is that there were not sufficient numbers of speech and language graduates coming through the system while at the same time there was an increased demand from the public. This has been addressed and we must ensure that the work practices within the public service are such to enable those people to deal with the demand. As the Deputy said, in some parts of the country and the city, that issue is being dealt with adequately while in other parts it is not.

Deputy Richard Bruton

The Taoiseach has committed to using private sector people instead of the National Treatment Purchase Fund and he is refusing to answer the question. It is disgraceful. The Taoiseach is refusing to answer the question.

Deputy Paul Kehoe

It is a disgrace.

Deputy Richard Bruton

He is ignoring the problem and has his head in the sand.

Deputy Eamon Gilmore

Almost three years ago, the Minister for Health and Children, Deputy Harney, announced plans to hand over sites of public hospitals for the building of super-private clinics. She argued at the time that there were two reasons for this decision. First, she said if she provided 1,000 private beds in the hospital system a similar number of public beds would be freed up. Second, she said that doing it this way would fast-track the provision of hospital beds. We are now three years into the fast-track and none of those beds has yet materialised. The Taoiseach knows there is much opposition to this strategy among medical professionals. Several medical people have expressed the same view as the Labour Party about this strategy, that it is effectively creating one hospital system for people who are well-off and a different system for the poor, for those who are not well-off.

This time last year we were in the middle of the general election campaign and it is clear that a majority of the people who ended up being elected to this House were people who opposed that strategy, including some of the people on the Taoiseach's side of the House. I remember Deputy Mary O'Rourke opposing it and I remember the Minister for Foreign Affairs opposing the private clinic in his constituency.

I have a couple of questions for the Taoiseach about this plan. First, is he still proceeding with the plan? Is the Government proceeding with what has been called the co-location plan? Second, will the Taoiseach today give the House a list of the hospitals that will be built under this plan? Third, will the Taoiseach tell the House when they will be built? Fourth, will he tell the House what will be the total cost of this plan to the public purse, both in terms of the tax reliefs that are being provided to the private developers who are to build these hospitals and the loss to the public hospital system of the income which the public hospital system would have received from insured patients?

The Taoiseach

With respect, I do not have specific answers to the questions being asked by the Deputy——

Deputy Eamon Gilmore

The Taoiseach was Minister for Finance for the past five years.

The Taoiseach

They are more appropriate to a parliamentary question. However, I can deal with the policy issues.

Deputy Brendan Howlin

General election.

The Taoiseach

On the question of the provision of more beds in the system through the co-location method, under the traditional public service delivery system of going through the various stages of capital programme requirements, it would take between seven and ten years before all the beds could be brought on stream. The purpose is to introduce into the public service delivery system another method of delivery that we believe would be more expeditious. We believe it would be on line more than would be the case with the traditional mechanism. This is one of the reasons the Government was attracted to this particular arrangement.

The second point I would make in response to the Deputy is that it continues to be characterised as an effort to bring in a two-tier health service when the opposite is the case. The whole purpose is to, first, bring beds on stream more expeditiously than would otherwise be the case and, second, by means of the various service agreements that would be entered into, these arrangements and facilities would be available to all patients, not simply to private patients. As the Deputy will be aware, under the system currently in place there are public and private beds in public hospitals. The Minister's reason for coming forward with this idea of co-location was that the quickest way of getting more public hospital beds into the public hospital system was to de-designate what are currently private beds in the public system and turn them into public beds. The quickest way to replace those private beds, since we have a mixed system of health care delivery in this country, was to use the private sector, co-location, method to deliver private beds on public hospital sites so that the work of the consultant staff who work on the site for all patients could be integrated. The service agreements are there to ensure those facilities are available to all patients and that is the whole purpose of the plan.

Each individual hospital is coming forward with solutions in that respect to augment existing public service facilities with the co-location proposals to improve the service. The simple motivation behind this process was to free up 1,000 more beds for public patients in public hospitals and this is the reason the Government put forward this proposal. It will result in quicker delivery than the traditional public delivery method.

Deputy Eamon Gilmore

I have to wonder what Seán Lemass would have thought of that answer. He was a champion of public service and I cannot see him providing medicine for profit in the way the present Government is doing. I did not ask the Taoiseach for the rationale behind the strategy. I understand the rationale, but I do not agree with the thinking behind it. I did not ask the Taoiseach to repeat that here today. I want some facts.

The Taoiseach

If I am on notice of questions I can give the Deputy the facts.

Deputy Eamon Gilmore

The Taoiseach was Minister for Finance for the past five or six years.

The Taoiseach

The Deputy's questions are quite specific.

Deputy Eamon Gilmore

This, presumably, crossed his desk and, in fact, he answered Dáil questions about it last year when he told the House that the total cost in terms of tax reliefs for this approach would be somewhere between €400 million and €500 million. That is what it is going to cost the taxpayer.

The Taoiseach

That is the cost delivered indirectly.

Deputy Eamon Gilmore

It is going to cost the hospital system €145 million per year in lost income from insured patients. I ask the Taoiseach again, and I want him to provide answers, where will these hospitals be provided? That is not a hard question. Presumably the Taoiseach has been looking at this issue for the past couple of years. Will he give the House the list of hospitals that will be provided under this co-located proposal? We were told this would be a fast track. Will the Taoiseach give the House an estimate of the timescale for the building of these hospitals? I invite him to tell the House the cost of this proposal to the taxpayer and to the family that has health insurance. This plan of building private hospitals will end up being paid for by the taxpayer, through tax reliefs, and paid for by the ordinary families of this country, whose health insurance will be increased to pay for it. On top of that we will end up with a hospital system where one will go in one gate if one is well off and a different gate if one is not well off.

The Taoiseach

This is continual ideological blindness by Deputy Gilmore and his party to recognise that what we are trying to do here is improve the system for all patients, including public patients. That is the whole purpose of it.

Deputy Joan Burton

It is not being done.

Deputy Eamon Gilmore

That is what the Taoiseach said he would do but he is not doing it.

The Taoiseach

In the same way that if we did not introduce the nursing homes tax incentive scheme——

Deputy Eamon Gilmore

Never mind nursing homes. I will ask about that some other day.

The Taoiseach

Let me explain. I am trying to explain something. The public is entitled to know the context in which we are bringing forward this proposal. The Deputy was misrepresenting both the motivation and the outcome of what we are trying to achieve.

Deputies

Hear, hear.

The Taoiseach

He is deliberately and continually misrepresenting the position.

Deputy Eamon Gilmore

I asked a simple straightforward question.

The Taoiseach

Had we not used the private sector mechanism to provide thousands of nursing home beds in a short space of time, relative to had we tried to build them through the traditional system, many people in this country would not now have the beds that are required. That is a fact.

Deputy Joan Burton

The Taoiseach——

An Ceann Comhairle

The Taoiseach without interruption.

The Taoiseach

That is a fact. That is the first point. The whole purpose of bringing forward this proposal is about trying to improve the capacity for public patients by providing more beds as quickly as is possible.

Deputy Eamon Gilmore

Will the Taoiseach answer the question I asked?

The Taoiseach

I do not have the facts in front of me here this morning——

Deputy Eamon Gilmore

Will the Taoiseach get them?

The Taoiseach

I will have them for the Deputy in half an hour. That is the answer to that aspect of the question. In terms of the detail he wants, there is no problem in getting that. The context in which Deputy Gilmore is putting the question is to suggest that this Government is interested in having a different level of treatment for different patients.

Deputy Eamon Gilmore

Yes.

The Taoiseach

We are not.

Deputy Eamon Gilmore

The Government is——

The Taoiseach

Allow me to answer the question. In the same way as we did in regard to nursing home care——

Deputy Eamon Gilmore

We are not asking about that.

The Taoiseach

——we are not trying to provide differentiated treatment. The whole idea of bringing in the fair deal scheme is to give equality of treatment and equality of eligibility for people, whether public or private. That is what we are trying to achieve. It is the same with the hospital system. All we hear from people who, on the one hand, want to see capital developments in the hospital system refused, because they are blinded ideologically by the facts——

Deputies

Hear, hear.

The Taoiseach

——is the suggestion that the only way one can build it is go the traditional route. If we are to have an improved health care system, as the OECD suggests, we need to look at different types of delivery systems and different models of delivery so that we can get outcomes for patients. That is what we are doing.

Deputy Eamon Gilmore

There is no delivery.

The Taoiseach

We are getting delivery and it is far faster than under traditional systems.

Deputy Michael Ring

Try that with the HSE.

(Interruptions).

Deputy Eamon Gilmore

The Government has not provided any systems. It has done things its own way.