Adjournment Debate.

Vaccination Programme.

Deputy Deirdre Clune

I thank the Ceann Comhairle for the opportunity to raise the important issue of the lack of provision of the BCG vaccine in the Cork area to prevent tuberculosis. I am aware of recent national difficulties regarding the supply of the BCG vaccine which arose due to technical difficulties in the manufacturing laboratory that provides the vaccine in Europe. This problem has since been resolved and is not related to the issue I raise.

The problem in Cork was highlighted last year when 17 cases of tuberculosis were diagnosed in the months of March, April and May. While two of the cases involved adults, the balance involved young children in two crèches, one in Little Island and the other in Douglas. As a result of the marked increase in the notification figures, 132 children attending the private crèche facilities in question were given antibiotics as a preventative measure. This created considerable anxiety, worry, frustration and anger among parents who had placed their children in facilities under the regulatory control of the health authorities.

At the time the children contracted tuberculosis, many people were not aware that the BCG vaccine was not being administered in the Cork region for historical reasons. Subsequently, it was decided to administer the vaccine to newborn babies and young children in the Cork area. This welcome change in policy meant that as of October 2007, the vaccination was made available to all newborn babies in the area and take-up was substantial.

According to figures provided to a regional health forum last week, 9,654 children were waiting for a BCG vaccination as of 1 April 2008. Those on the waiting list include many active children who are attending crèche and pre-school facilities, sitting in trolleys in supermarkets or engaging in other activities. These children need the vaccine and their parents want them to have it but find their local health care providers are unable to offer it. Vulnerable children deserve the support of the health services in their area to ensure they are protected against tuberculosis, particularly when they are out and about in the community.

Until last year, it was not considered necessary to provide the BCG vaccination. The health authorities have now recognised the need to provide the vaccination to newborn babies and younger children. Despite the commitment to provide the vaccine, almost 10,000 people are on the waiting list. How does the Department propose to deal with the waiting list? What provisions are being put in place to administer the vaccine? Are sufficient clinicians available to administer it? When will the necessary infrastructure be in place to provide the vaccine?

The lack of BCG vaccination facilities in Cork is extremely worrying and frustrating for parents. Many parents have made alternative arrangements for their children, giving addresses of relatives in Waterford, Dublin or Kerry in order to have their children vaccinated in these areas. The vaccine must be made available in the area in which people reside. While the local health authorities have made a commitment to provide it, we have no idea when the vast waiting list will be tackled. I ask the Minister of State to provide answers.

Minister of State at the Department of Health and Children (Deputy Máire Hoctor)

I am taking this matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I thank Deputy Clune for raising the matter as it provides me with an opportunity to outline to the House the importance the Department of Health and Children and the Health Service Executive attach to this issue.

The BCG vaccine, which protects against tuberculosis, is usually given to newborn babies but can also be given to older children and adults who are considered to be at risk of developing TB. The vaccine has contributed to the dramatic decline in tuberculosis over the past 40 years.

The Department of Health and Children has been informed by the Health Service Executive that in the Cork area, BCG vaccination is currently provided on an ‘at risk' basis. Vaccination is offered to new-born infants where there is a close family history of tuberculosis, such as a parent, immigrants from high incidence countries and their children, or children intending to visit high incident countries for more than one month, or contacts with cases of active respiratory tuberculosis. The HSE South plans to hold BCG vaccination clinics throughout the Cork area in the near future. A BCG vaccination programme for new-born infants was due to be introduced last October, but owing to a shortage of the vaccine from November 2007 until March 2008, a BCG vaccination waiting list now exists. This shortage was a Europe-wide problem, as the manufacturer in question is the only company that supplies the vaccine to the European market. Unfortunately, it is not possible to stockpile the vaccine as it has a very short shelf life.

Parents who request the BCG vaccination for their child have their child's name placed on a waiting list. Plans for additional resources are at an advanced stage and the recruitment process is under way. In the meantime, those children considered to be most at risk are being prioritized.

Immunisation, a safe and effective way to help the body prevent or fight off certain diseases, is provided through vaccinations that are administered to induce immunity. Under the childhood immunisation programme, all vaccines and their administration are provided free of charge for all children. Parental consent is required for the administration of vaccinations to children and young people up to the age of 16. Vaccination is not mandatory in Ireland, but is strongly advised by the Department.

The objective of the primary childhood immunisation programme is to achieve an uptake level of 95%, which is the rate required to provide population immunity and to protect children and the population generally from the potentially serious diseases concerned. Ireland's recommended immunisation programme is based on the guidelines of the national immunisation advisory committee of the Royal College of Physicians of Ireland. These guidelines are prepared with the assistance of an active committee from associated disciplines in paediatrics, infectious diseases, general practice and public health.

I take this opportunity to urge all parents to have their children immunised against the diseases covered by the childhood immunisation programme, in order to ensure that both their children and the general population have maximum protection against the diseases concerned.

Health Service Staff.

Deputy Aengus Ó Snodaigh

I wish to speak about the cut of 120 temporary positions in Our Lady's Children's Hospital in Crumlin. It is a disgrace that it has come to this. Short-term contract workers will be greatly affected, especially agency staff and dieticians. This has occurred in the same week that a diabetes and endocrinology unit was opened. Last year the Minister opened a new medical wing in the hospital, yet the HSE is now laying off staff and claiming that this is due to cost containment measures. No jobs have been cut at the top of the HSE, yet staff that are already over-burdened are being cut.

What will be the state of Our Lady's Children's Hospital if nearly 10% of the staff are laid off? The Minister of State needs to tell us. Will it be downgraded? Will it be closed or relocated? Will it suffer death by a thousand cuts? The staff, the patients and the public are entitled to know what the future holds, so that they can make alternative arrangements. We cannot have continual cuts such as those occurring at the moment. The Minister of State will tell us that there has been increased investment in this hospital for the last number of years. That has occurred after generations of severe under-funding, but these increases do not take into account the increased workload of staff and the ongoing modernisation programme.

The only reason these are agency jobs is the HSE freeze on full-time jobs. The Minister for Health and Children should step in and ensure that these cuts are reversed and that the hospital has enough staff to carry out its work.

Deputy Mary Upton

I welcome the opportunity to speak on this important matter for the staff at the hospital in Crumlin, as well as the parents and the sick children who will be most affected by these cuts. Our Lady's Children's Hospital is widely recognised as a quality hospital for paediatrics. People across the country avail of the services and the very high quality facilities there.

The hospital has been forced to employ agency staff because of the recruitment freeze by the HSE, and now it is being forced to let them go. Cutting front-line services is not the way to deliver a quality health service and to ensure the best outcome for patients. That must be the bottom line. Cutting front-line staff numbers in the HSE will only lead to further pressures on the remaining staff. Ultimately, it will mean longer waiting times for the children who urgently need treatment. It is inevitable that the service to sick children will be affected if 100 staff are removed. There is no question about that.

Parents with sick children cannot afford to wait for treatment and they do not want to be told that there is a two-year waiting list for essential treatment for their small child. They do not want to know about service planning and they do not want to know about meeting efficiencies. They simply want their sick children treated as quickly and efficiently as possible.

I urge the Minister for Health and Children to review the HSE structure to allow for cuts to be made in areas that do not affect patients. The logic of spending €19 million on a report on the hospital service in the north east does not stack up when compared to cuts of 100 temporary and agency staff in the leading children's hospital in the State. There is a question of priorities when deciding where to impose cuts. The Minister of State and the Minister should find a way to ensure that front-line staff are not sacrificed for what is effectively a book-keeping exercise.

Deputy Máire Hoctor

Our Lady's Children's Hospital in Crumlin provides acute, secondary and tertiary hospital services for children. The hospital receives a significant proportion of its funding from the Exchequer via the Health Service Executive. In 2008, the hospital has an allocation of €137 million, up from €128 million in 2007. The hospital's budget has risen by over €38 million since 2004, which represents a 38% increase.

Each hospital funded by the HSE is required to deliver services within the financial allocation provided. The HSE is fully aware of the financial challenges faced by the hospital. It is involved in ongoing discussions with hospital management regarding its 2008 financial allocation and service plan. The hospital has an overrun of €10 million from last year and a projected overrun of €14 million for this year. As part of the discussions on the budgetary position, the HSE has made an agreement with the hospital, on a once off basis, to provide a further €7 million this year. The hospital must now work within its budget, which will be amended from €137 million to €144 million for 2008. The priority of the HSE and the hospital management is to ensure that services for children at the hospital are maintained at an optimum level.

There has been an increase in activity at the hospital in 2008. The hospital is ahead of its service plan targets. The number of day cases is up by 12.3%, outpatient activity is up by 7.7% and the number of inpatients treated has increased by 1.6%. The number of staff employed at the hospital has increased by 433 whole-time equivalents since 2004. At the end of March the number of whole-time equivalents employed at the hospital was 282, or 20% above the approved employment ceiling.

The initial focus of the discussions between hospital management and the HSE is on ensuring that all areas of non-pay expenditure are critically examined. Pay costs represent over 70% of the hospital's expenditure. The hospital has indicated that there will be a need to reduce the number of temporary and agency staff numbers, but it is not in a position at this stage to confirm the number of posts involved.

Significant investment has been put into developing services at the hospital in the last number of years in areas such as cardiac, haematology, oncology and MRI services. Discussions are also at an advanced stage to create additional intensive care facilities at the hospital. The development of the national paediatric hospital is a priority project for the Government. Our objective is to provide a world class specialist paediatric service for children. The McKinsey report to the HSE recommended that the population level and projected demand can support only one world class tertiary paediatric hospital which should ideally be co-located with a leading adult academic hospital. Each of the three existing paediatric hospitals, including Our Lady's Children's Hospital, expressed strong support for the development of a single national paediatric hospital. In October the HSE announced the details of the high level framework brief for the new hospital which will be built on a site at the Mater Hospital. The brief was prepared by RKW, an established UK-based health care planning company.

The brief includes a detailed assessment of the capacity of the selected site at the Mater Hospital. The analysis indicated that all the requirements can be accommodated on the site and still allow expansion capacity beyond the year 2021. The total projected bed requirement for the hospital to 2021 ranges between 352 and 454 beds. The estimated space requirements have been calculated on the upper figure. The brief sets out the recommended model of care, the core services to be delivered at the new hospital, and the additional range of services to be provided outside of the main hospital through an ambulatory urgent care service. The first of these centres will be developed at Tallaght. The services to be provided will include urgent care consultations, outpatient appointments and day surgery.

The national hospital development board was established last year to develop the new hospital. The board is in the process of procuring professional project management support services. Following this, the next stage of the project will involve the preparation of a detailed development brief for the new hospital. The target of the board is to have the development brief completed by the end of the first quarter of 2009. The Minister looks forward to continuing progress on this important development.

Hospital Services.

Deputy Bernard Allen

I thank the Ceann Comhairle for the opportunity to speak on the closure of the Mercy University Hospital, Cork. I tabled a question to the Minister for Health and Children four weeks ago. She replied that it was a matter for the HSE. The HSE eventually sent a response but I decided to raise the matter on the Adjournment. Although it is no reflection on the Minister of State, Deputy Hoctor, whom I wish well, it is frustrating that the Minister who is directly responsible and who, in conjunction with the HSE, made the decision to close an essential ward of the Mercy University Hospital does not come into the House to answer important questions on the health and well-being of people in my constituency and the adjoining constituency of Deputy Clune, who is present.

The Mercy University Hospital took up the slack when the North Infirmary Hospital in Cork was closed in the late 1980s. This was a tragedy for the north side of Cork city but the Mercy University Hospital, located in the middle parish, took up the slack. Through the commitment of medical, nursing and non-medical staff, it delivered a service to the people of the area and never turned any paying or non-paying patients away from its doors.

To say that I received an answer is to be charitable to the author of the response. It was confirmed that the 31-bed St. Catherine's ward closed on 3 May 2008 and will remain closed until at least the end of 2008. This has resulted in the closure of 19 surgical and 12 medical beds. That will have a devastating effect on the health and well-being of people in my constituency and in the adjoining constituency that Deputy Clune represents. I take issue with the contents of the response. It is an insult to state that the plans were formulated with a view to maintaining all existing and essential services and minimising the impact on patient care. That is pure codswallop. The hospital is now being humiliated by the Minister, the HSE and the local senior management. This was done without informing public representatives, who cannot get information. The humiliation of the hospital was done in the interests of balancing the books.

Fianna Fáil made a big issue many years ago of health cuts affecting the elderly and the sick. That is what will happen in this case. To say that all existing and essential services will be maintained is untrue. In tandem with the closure of this ward, an accident and emergency unit that cost €5 million to build has been idle since January 2007. It will open on 1 June but will offer a service only during office hours. It is an emergency service but people do not meet accidents or have mishaps only during office hours. The claim in writing that all existing and essential services will be maintained is untrue. I will not say anything stronger than that because I would be reprimanded.

Having fulfilled its role through the years, the hospital is being humiliated. The response also stated that the local management board of the hospital took the decision to close the 31-bed unit. In theory, the board may have taken the decision but the gun was put to its head by the faceless people and some who are well known in the HSE. The choice was to close or face the consequences. To say that this was a decision made by local management is the washing of hands of responsibility for this closure, which will have a serious impact on people's well-being.

The HSE is running a dysfunctional system. It is out of control and has lost its direction. While people are suffering and administrators and medical staff are losing their jobs, Professor Drumm and his senior cohorts are taking their bonuses. If leadership is to come from the top, senior administrators and those who have failed to deliver should not take bonuses. This is a matter I will address tomorrow at the Committee of Public Accounts. It is a scandal that these people continue to take performance bonuses when services are not being delivered.

Deputy Máire Hoctor

I am taking the matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. The Government is committed to the provision of a high level of quality health services throughout the country, including in the Cork region. The HSE is obliged to provide services in line with available funding. In turn, all its managers and agencies have a clear responsibility to operate within their designated budgets and achieve the service levels for 2008 as set out in the HSE's national service plan. These include service level targets for the acute hospital services nationally of over 2.7 million outpatient attendances, almost 600,000 in-patient discharges and over 580,000 day cases. HSE management at national, regional and local level reviews expenditure and activity levels on a weekly basis in order to ensure that hospitals are adhering to the service levels of activity for which they have been funded.

The HSE has advised that to ensure that they remain within their approved expenditure levels, all hospitals within the southern hospitals group have put together a budget break-even plan for 2008. These plans are based on a realistic assessment of achievable objectives for the hospitals within the group. The plans were formulated with a view to maintaining all existing essential and emergency services while minimising the overall impact on patient care. Hospitals within the southern hospitals group have identified a number of value for money and income generating initiatives that will realise some savings in 2008. These measures include a reduction in the use of agency cover, locum cover and overtime. Several areas of non-pay expenditure have also been targeted for reduction, most particularly staff travel and non-essential training.

Over the past three years, the HSE allocated significant funding to the Mercy University Hospital to enable it to cope with service pressures. In 2006, the budget allocation was €67.7 million, in 2007 it was €72.2 million, while this year €73.6 million was allocated to it. An analysis of the Mercy University Hospital expenditure by the HSE in the early months of this year indicated that the hospital would significantly exceed its budget allocation unless corrective action was taken. With this in mind, management at the Mercy University Hospital was required to readjust the hospital's expenditure levels. Accordingly, the hospital introduced a number of value for money and efficiency initiatives along the lines already mentioned. It has also promoted initiatives which support the concept of working better and smarter, such as pre-operative assessment clinics, same-day admission process and reducing the length of stay. However, as these steps would not in themselves have been sufficient to bring projected expenditure back in line with permitted levels, management at the hospital decided to close a 31-bed ward. St. Catherine's ward was closed on 3 May 2008 and will, I understand, remain closed for the remainder of 2008.

Management at Mercy University Hospital and the HSE continue to monitor carefully the impact of these initiatives on the hospital's overall budgetary position. The Minister has been assured by the HSE that every effort will be made to ensure the measures outlined will have a minimal effect on patient services. The HSE has indicated essential, elective and emergency services will not be affected and that planned hospital service activity levels at the Mercy University Hospital for 2008 will be met.

Dáil Éireann debate - Wednesday, 28 May 2008