Dáil Éireann debate -
Wednesday, 25 Jun 2008

Vol. 657 No. 4

Adjournment Debate.

Hospital Staff.

Deputy Simon Coveney

We want to know what is happening in Cork University Hospital in terms of the relationship between management and consultants. We also want to know whether the contents of a leaked e-mail are true. I suspect the Minister will tell us this evening that the consultants and management at Cork University Hospital have resolved their differences and are now moving on and getting on with their job. That is not good enough. Either management or the consultant was wrong. We need to know the truth; the public has a right to know.

There were disturbing reports in the Irish Examiner at the start of the week, with extracts from a leaked e-mail written by a consultant plastic surgeon, Mr. Jason Kelly, who described the hospital as being in crisis and miserably failing patients:

The article states:

The correspondence [. . .] highlights how on just one shift, one critically ill woman was left without morphine on an A&E trolley after undergoing an emergency breast removal. A second patient, a 70-year-old, had to wait five hours for an emergency amputation of her forearm after a "devastating injury"." The email describes how the 42-year-old woman "was admitted with a full thickness burn to her left breast and arm pit — it resembled a battlezone injury. She spent the night outside the plaster room in A&E. She did not get any morphine and her dressings were inadequate. She was also critically ill and did not receive adequate nursing care". Similar incidents at A&E "have happened before", the surgeon wrote, and "I have taken them through the usual channels without any obvious resolution". The surgeon says problems at the hospital need to be "fixed immediately".

He expresses concern at the proposal to move breast cancer services from the South Infirmary-Victoria University Hospital to CUH, adding a further 300 or 400 breast cancer patients a year when its operating theatres cannot cope with the existing workload. What is happening at CUH? Is it true that the hospital cannot deal with its existing workload? Is it the case that the two patients were treated as outlined in the e-mail?

All consultants at CUH held an emergency meeting following the publication of the article in the Irish Examiner on Monday. They formally backed their colleague, standing over the claims that were made. The response from management at the CUH stated that the accusations were erroneous and inaccurate. We want to know if the Minister of State is satisfied with the resolution agreed.

Deputy Bernard Allen

I congratulate the Irish Examiner on its courage in publishing the story on Monday and the journalist, Ms Claire O’Sullivan. Much of the content of Mr. Kelly’s e-mail has been denied by senior management at CUH but since that denial the consultant group has stood by Mr. Kelly’s report of systematic failures at the hospital and disagreed fundamentally with statements coming from the management at CUH. They are demanding a review of the management structures.

I have been an advocate of strong management boards in our acute hospitals and I advocated it during my time as a member of the southern health board. This proposal has been rejected by management and consultant representatives on a number of occasions. We are hearing two sides of the story but the patients' story is not being told. It is important that future developments include representatives of the patients on the management boards. CUH is a major hospital on an overcrowded site but is sucking in services from other hospitals, such as breast cancer services from the South Infirmary-Victoria University Hospital and cardiology services from the Mercy Hospital. The Minister for Health and Children has given the go-ahead to a private hospital on an overcrowded site.

Where is the Minister for Health and Children and why is she hiding from her responsibilities? Where is the required leadership? Going down a level from ministerial accountability, Professor Drumm visited Cork recently but failed to make a statement of clarification on any of the issues affecting health services in the Cork area. There is an agenda to downgrade the South Infirmary-Victoria University Hospital and the Mercy Hospital in favour of an overcrowded site at CUH. Bureaucrats are making decisions on balancing budgets rather than dealing with the needs of people. This is a scandal.

Another scandal is the advertisement by the Mercy Hospital of a 2,000 sq. ft. clinical space available in the hospital. Is this advertising the rental of St. Catherine's ward, which closed with the loss of 31 beds and which is due to reopen at the end of the year? Will we ever see St. Catherine's ward reopen in light of the recent advertisement seeking interested parties to take on the space? There is more happening in Cork than meets the eye. The Minister for Health and Children should come into the Chamber to tell those who represent the people of Cork what is happening. People protest in the streets because they are not getting answers. We should get answers in this House, otherwise we are failing those whom we represent.

Deputy Kathleen Lynch

I wish to share time with Deputy Ciarán Lynch. Last Tuesday, Professor Drumm and the Minister for Health and Children appeared at a meeting of the Joint Committee on Health and Children. I put questions to both and was dismissed as if I did not know what I was talking about.

I referred to the two theatres at the maternity hospital, which is a magnificent facility, that have never been opened. I spoke about two consultants there, one of whom told me he is drained by the constant battling with management to get more resources so that he can deal with his private and public list. Both told me they could clear their lists within a 12-month period if they had the theatre space available. In any week, they told me there are ten consultants waiting for theatre space who cannot get it. This is happening in the same hospital that Professor Drumm told me had no problem and should get about its business. If we believe the Minister and Professor Drumm, we are looking at additional consultants who will sit around drinking coffee because there is no theatre space in Cork in which to operate. This is what happened with Mr. Kelly. An unfortunate woman, who must have been in pain and quite traumatised by her injuries, had to wait five and a half hours to find a space in a theatre. It was not that the consultant was not available — the theatre space was not available. This is the same theatre space that Professor Drumm told me there was no problem with.

The question that must be answered is straightforward. Someone is telling the truth and someone is telling lies. There can only be one person telling the truth because the two statements contradict each another dramatically. An entire team of consultants and medical staff say that this happened, that it happens regularly and that the hospital is in crisis. These people have nothing to gain from this being made public. They must return, work under the same conditions and treat people every day and night.

On the other hand, the manager says that there is nothing wrong, that the e-mail is erroneous and that it never happened. The manager needs to say that because it looks as if the hospital is doing well and that nothing is wrong. There are two conflicting statements and someone must be telling the truth. I know who I believe. There should be a board of management established in what is a major industry, given the numbers that work in it. Where is the Minister for Health and Children? Absent, as usual.

Deputy Ciarán Lynch

We have nothing short of an unprecedented crisis at the CUH. Last week I questioned the removal of the breast cancer unit from the South Infirmary-Victoria University Hospital to the CUH. The question has been answered tonight. There has been a litany of mismanagement at CUH over the past three years, in respect of referral rates to the national treatment purchase fund, which are the worst in the country, the opening of the maternity unit, the gynaecological services and an overdeveloped, inefficiently run campus. It is proposed to place a co-located hospital on the site. Serious questions must be asked. The Minister has abdicated her responsibilities on managing the health service through the HSE and the managers are now abdicating their responsibilities, apparent by their removal from the operation of the hospital itself.

Minister of State at the Department of Health and Children (Deputy Mary Wallace)

I thank Deputies Simon Coveney, Kathleen Lynch, Bernard Allen and Ciarán Lynch for raising this important matter. I assure the Deputies that the Minister and the HSE are committed to the highest level of patient safety in our hospitals and throughout the health service. The issue of safety in the delivery of health services lies at the heart of any care system which has the confidence of the people using these services. While the health sector is one of the most complex areas of activity in every country, it must by its very nature command the confidence of those who use it. To obtain this confidence, the measures which must be undertaken are fundamental. The patient safety and quality agenda is, in effect, fully prioritised.

Two major initiatives in the past 18 months have addressed and reinforced this message. In May 2007 the Health Information and Quality Authority, HIQA, and the Office of the Chief Inspector of Social Services were established to bring about a safer health and social services system which embeds quality at all levels and in all settings. HIQA is responsible for setting and monitoring standards across health institutions and services in the public sector.

In January 2007 the Minister established the Commission on Patient Safety and Quality Assurance. One of its functions is to examine and develop proposals for a health service-wide system of governance based on corporate accountability. Other key areas which the commission is examining are clinical audit, critical incident reporting and the participation of patients and carers in health service planning and provision of feedback on quality of care. The commission is expected to report by July 2008. The Minister looks forward to receiving this report, which will build on and inform the further development of the current system. The foregoing initiatives are firm indicators of the Minister's commitment in the area of patient safety.

Cork University Hospital is the largest acute hospital delivering health care in the HSE southern region. It is a multi-specialty hospital in which many clinical and infrastructural challenges are faced on a day-to-day basis. The hospital has more than 26,000 admissions each year, excluding day cases, with more than 50% of these patients admitted via the emergency department. The Minister was concerned to learn in recent days of the matters which the Deputies have raised this evening with regard to the alleged lapses in the care provided recently to two patients at Cork University Hospital. The HSE has advised the Minister that Cork University Hospital operates a quality and accreditation programme which incorporates a process for managing adverse incidents for patients and staff. The Minister understands that the general manager, together with senior nursing, medical and clinical governance personnel at the hospital, and of the HSE southern region, has undertaken a detailed investigation of the matters concerned and is satisfied that the care in these cases was appropriate.

The HSE advises that the key facts regarding the care of the two patients in question are as follows. With regard to the woman who was alleged to have waited an inordinate amount of time for an amputation operation, from initial notification of the theatre team to their achievement of a state of readiness to accept the patient, the time elapsed was one hour and 25 minutes, not five hours as may have been suggested.

Deputy Simon Coveney

We are not talking about notification of the theatre team.

Deputy Kathleen Lynch

No.

Deputy Simon Coveney

We are talking about when she was admitted into hospital. Please do not try to make a fool of people.

Deputy Mary Wallace

In so far as the second patient is concerned, the HSE has indicated that she was admitted on the patient administration system at 2.11 p.m., first received morphine within 20 minutes and was administered additional doses of the drug after that time. She also received one-to-one special nursing care prior to her admission to theatre and afterwards.

This afternoon, the HSE personnel involved met with medical staff at the hospital. The division of plastic and maxillofacial surgery met with the executive management board, the membership of which includes three consultant clinicians including the chairman of the consultant medical staff, general manager and the director of nursing. Arising from this, the HSE has advised that all parties concerned regret the potential for misrepresentation consequent upon the leaking of correspondence, subsequently interpreted out of context and without the consent of the parties concerned.

Deputy Bernard Allen

On a point of order, what the Minister of State is saying is meaningless. Will she appoint an independent investigator to examine all aspects of this case? As Deputy Kathleen Lynch stated, somebody is telling lies here.

Acting Chairman (Deputy Jan O’Sullivan)

The Deputy cannot raise a point of order. He can raise it in another way.

Deputy Bernard Allen

We want an independent external investigation to find out what is happening in there.

Deputy Simon Coveney

As opposed to a cover-up to smooth things over.

Acting Chairman

I understand, but there are other ways to raise the issue.

Deputy Bernard Allen

This is a cover-up.

Deputy Mary Wallace

The HSE accepts that patient advocacy is the prerogative of all staff and that the consultant in question acted and continues to act in the best interest of patients at all times.

Independent of the events of the past few days, Cork University Hospital has been developing and continues to progress structures that reflect the scale and complexity of the hospital. The intention of the executive management board is to implement governance structures which will have flexibility and innovation to respond to the continuing challenges of health care delivery. This is being done in the context of the hospital being selected as an exemplar site for the implementation of the clinicians in management programme being developed by the HSE in the context of the new consultant contract. This will involve a reorganisation and restructuring of the current clinical divisions and the participation of key staff in the leadership development programme.

Child Abuse.

Deputy Caoimhghín Ó Caoláin

An extension of time was recently agreed to allow the Commission to Inquire into Child Abuse to fulfil its statutory mandate to publish its report. I hope the report will be published as soon as it is completed. It will tell a terrible story of injustice in our country.

The commission has been dealing with matters of life and death, the health and well-being of thousands of citizens and a system of deplorable abuse amounting to a catalogue of crimes carried out over decades. This system of abuse claimed the lives of many children. We may never know exactly how many children died of neglect and ill-treatment in Irish institutions. Our first and last concern should be the survivors of abuse and the memory of those who did not survive. Many survivors became so marginalised and damaged from their abuse that they were never able to avail of the commission or the redress board. We know that many of them ended up homeless on the streets of London and other foreign cities. While many people have availed of the commission and redress board, others are not satisfied that they have received answers.

I want to raise one case, that of the late Michael Flanagan, whose arm was broken by a Christian Brother in Artane Industrial School in 1954. His brother Kevin is still fighting for full information about what exactly happened and, in particular, why their mother was only allowed to see her son eight days after the assault was inflicted. This was an horrific example of what went on in these institutions. The passage of time in no way erodes the importance of addressing these matters. Michael Flanagan was then only 14 years of age. A Christian Brother used a brush handle to break his arm. The boy was locked in a shed at the back of the school for a full two and a half days. The Christian Brother responsible was neither prosecuted nor expelled from the order. The order admitted to the commission in 2005 that this member had simply been moved from Artane to another school. After release from Artane, Michael Flanagan emigrated to England. He was unable to read or write because Artane was, for him and many others, a school in name only. His health never recovered and he died at a relatively young age. His brother Kevin was asked by the commission to seek the information from them through a solicitor but he has informed my office that although he has done this, he has still not received the information requested. These issues need to be resolved and I urge the Minister of State to give his full support and co-operation to the securing of same.

The second main point is about the lessons that should have been learnt about the protection of children. Have they been learnt? The recent "Prime Time Investigates" programme exposed the woefully inadequate state of our child protection services, with insufficient social workers and other front-line workers in place. The HSE knows of cases where children are in grave danger but the services are not in place to make the interventions required. The nightmare of child abuse is not a thing of the past. It is happening every day and most of this abuse takes place in the family home. If the services are not in place, then the State today will be just as culpable as it was in the past when it conspired with the church to cover up the abuse of children in their joint care.

Minister of State at the Department of Education and Science (Deputy Seán Haughey)

Following the Taoiseach's apology to victims of abuse on 11 May 1999, during which a series of Government measures were announced for the redress of abuse, the Commission to Inquire into Child Abuse was formally established in May 2000. The commission is independent in its functions and its operation is governed by the terms of the Commission to Inquire into Child Abuse Act 2000 and the Commission to Inquire into Child Abuse Amendment Act 2005.

The broad terms of reference of the commission are to afford victims of abuse in childhood an opportunity to tell of the abuse they suffered to a sympathetic and experienced forum; to establish as complete a picture as possible of the causes, nature and extent of the physical and sexual abuse of children in institutions and in other places during the period from 1940 to the present; and to compile a report and publish it for the public on the activities and findings of the commission, containing recommendations on actions to address the continuing effects of the abuse and actions to be taken to safeguard children from abuse in the future.

The commission acts through two committees which will provide the commission with a general report on the issues encountered in its work. The confidential committee provides a forum for victims of abuse to recount their experiences on an entirely confidential basis. The purpose of this committee is to meet the needs of those victims who want to speak of their experiences but who do not wish to become involved in an investigative procedure. The confidential committee received evidence from 1,090 witnesses. The committee's report will be a compilation of the evidence provided by the 1,090 witnesses and will form part of the commission's overall report.

The investigation committee facilitates victims who wish to both recount their experiences and to have allegations of abuse inquired into. The work of the investigation commission is broken down into three main phases. In phase one, public hearings were held into a number of institutions where opening statements were provided by the relevant religious managerial bodies of such institutions. In phase two, private hearings were held to investigate complaints of former residents of institutions. This process finished in early 2006. In phase three, public hearings were held during which a number of religious orders, Departments and the ISPCC gave evidence. Religious orders who testified at the phase one public sessions returned for further examination on issues of relevance to the inquiry. The Departments included Education and Science, Justice, Equality and Law Reform and Health and Children.

Under the terms of section 5 of the Commission to Inquire into Child Abuse Act 2000, as amended, the commission is statutorily obligated to prepare and publish a report to the public. The report "may contain findings that abuse of children, or abuse of children during a particular period, occurred in a particular institution and may identify the institution where the abuse took place and the person or, as the case may be, each person who committed the abuse, but only if he or she has been convicted of an offence in respect of abuse...". The report shall not, however, "identify, or contain information that could lead to the identification of, persons the subject of abuse in childhood". Similarly, it "shall not contain findings in relation to particular instances of alleged abuse of children".

The legislation provides the framework for the commission's report and is quite specific in setting the parameters pertaining to its permitted content. It is a matter for the commission, which is entirely independent in the performance of its functions, having regard to the relevant legislation to determine the content of the final report and the manner in which it will be released and published to the public. In particular, the commission is obliged, in all circumstances, to ensure the confidentiality of witnesses and is not entitled to give judgments or make decisions in relation to individual cases. Consequently, it is not open to me, in my capacity as Minister of State, to intervene in this matter or to influence the content of the commission's report.

Both Houses of the Oireachtas have recently approved an extension to the specified period of the commission to the end of January 2009. This extension was sought to allow the commission to complete its report and to make the necessary preparations for its publication. It is expected, therefore, that the commission's report will be published by the end of January 2009.

Literacy Levels.

Deputy Catherine Byrne

"Written Off" is a series I have watched over the past number of weeks. It was a joint project between RTE and the National Adult Literacy Agency, NALA, and it was well worth watching. It followed the lives of 11 Irish adults aged between 17 and 50 as they attended an intensive eight-week course. These people came from different parts of the country and from very different backgrounds. The one thing they all had in common was that they all had difficulties with reading and writing and the series, which was the first of its kind in Ireland, followed their progress as they returned to education and faced the challenge of learning to read and write as an adult. It also followed the highs and lows that this challenge brought, as well as the new friendships they made over the eight-week course.

I watched this series with great interest because it struck a chord with my own brush with adult literacy. I was one of the many who left school at 14 not because I wanted to, but because I had to. I was pushed out the door because I was one of 56 in the class and I was not a "A" or a "B" student. After leaving school, I started work in a small family printing firm, where it occurred to my boss that maybe I had something to offer. He sent me to do a course in typing at night and that is where my education began. I was one of the lucky ones. I am still not the best speller in the class but I have learned invaluable life skills along the way.

In Ireland today, the problem of illiteracy, especially among adults, is more common than we might think. Agencies and organisations work to help people with this problem but the first and most important hurdle is for people to admit they have difficulties reading and writing. NALA was established in 1980 and since 1985 it has received funding to run a national office. It offers advisory services in adult literacy work and the agency has done great work in highlighting the adult literacy problem in the State. However, more can and should be done to highlight the extent of the problem, to provide extended support services and to encourage people back into education.

According to NALA, more than 28,000 people participate in VEC adult literacy programmes across Ireland. This is a fourfold increase since 1997, when 5,000 people attended literacy services. However, this is less than 5% of adults who experience literacy difficulties. What about all the others who slip under the radar because, according to them, the services are not available? This is where the problem lies. A large number of illiterate people do not want anyone to know they cannot read or write and, therefore, they never obtain the help they need. Incredibly, the most recent statistics the Department of Education and Science can provide on illiteracy date back to 1995 when approximately 25% of Irish adults aged between 16 and 64 were at level one, the lowest literacy level. The Department assures us that the position has improved since then, but there is no proof of this.

Although Ireland has experienced a huge surge in wealth in recent years, the level of illiteracy remains worryingly high. According to the latest international survey, approximately 500,000 Irish adults have problems with basic reading, writing and mathematics. Illiteracy can affect all strands of society, not just the marginalised. Almost 30% of the workforce has only attained the junior certificate or lower, while a staggering 10% has only primary level or no formal qualification at all. Furthermore, 25% of adults still lack basic skills in literacy and numeracy. It is, therefore, vital that we put in place every support to encourage people to return to education, no matter their age. The problem is people can be reluctant to admit they cannot read or write and feel a stigma attaches to being illiterate.

Adult learning is an excellent resource and needs to be fully supported by the Government and the Department of Education and Science. Last week, I had the privilege of presenting 20 FETAC awards to young people who had left school. Their enthusiasm showed on their faces. I told them that it was only their first step and that I hoped they would continue to learn. To reach one's potential, one must learn. I ask the Minister of State for his support.

Deputy Seán Haughey

I thank the Deputy for raising this important issue. As the Minister of State with responsibility for lifelong learning, I am aware of the importance of adult literacy. The acquisition of adequate literacy skills is necessary for adults to derive benefit from any education or training courses in which they want or need to engage. Adult literacy, in addition to reading and writing, extends to such basic education as numeracy, social and personal development, learning to learn and IT skills. In the modern context, adult literacy is as much about an individual's self-esteem and confidence as it is about the traditional reading, writing and arithmetic. Literacy in all its guises enables an individual to participate more fully in society, to contribute more in relationships, both personal and professional, and to make the most of himself or herself in our competitive, globalised economy.

In concrete terms, funding for adult literacy has increased from €1 million in 1997 to €30 million in 2007. This has increased participation in literacy tuition from 8,000 learners in 1997 to 44,000 in 2007. Targets in the national development plan have consistently been met or exceeded. Under Towards 2016, an extra 7,000 places are to be provided during the period 2007-09. Some 3,000 of these were allocated in 2007 and provision has been made for a further 500 in 2008. Adult literacy also features prominently in the national action plan for social inclusion and the programme for Government.

Ireland is participating in the feasibility study for a new OECD survey, the programme for the international assessment of adult competencies, which will survey adults between the ages of 16 years and 64 years in their homes on a range of skills covering their interest, attitude and capacity to access, manage, understand, integrate and evaluate various types of information as well as to respond and communicate with others in the information age. Participation in the survey will be decided after the results of the feasibility study.

My Department supports a number of other initiatives in the field of adult literacy, not least of which is part-funding the television series "Written Off". My Department has part-funded a number of television series organised by NALA over the years with the express aim of increasing awareness of adult literacy and encouraging individuals to participate in adult literacy classes or initiatives. I am glad to report that this series is proving just as successful as its predecessors in these aims and I would like to commend NALA on its work in this area. Hopefully, the example set by the courageous learners featured in the series will serve as an inspiration to individuals in a similar situation. As the Minister of State with responsibility for lifelong learning, I attended the programme's formal launch and had the pleasure of meeting its participants. I agree with the Deputy that they are inspirational.

The delivering equality of opportunity in schools action plan, DEIS, has seen the extension of literacy and numeracy programmes and the commencement of a family literacy project that addresses literacy from the intergenerational perspective. The key principle of early intervention underpins many of the initiatives being adopted under DEIS. My Department also funds the intensive tuition in adult basic education programme, ITABE, which provides up to six hours of tuition per week to learners instead of the normal two hours. As well as these initiatives, literacy tuition is available under the back to education initiative through which funds are also made available to community education programmes.

There are specially targeted literacy programmes for those in need of particular literacy services, for example, deaf people, people with dyslexia and native Irish speakers in Gaeltacht areas. There are a number of workplace literacy and basic education schemes in operation around the country, such as the return to learning scheme for local authority outdoor staff nationwide and the FÁS-VEC return to education scheme for participants on the community employment scheme operated by FÁS.

I would like to reiterate my Department's commitment to addressing the issue of adult literacy to enable all people, particularly the low-skilled and disadvantaged, to participate as fully as possible in our modern, globalised society and economy.

The Dáil adjourned at 9.35 p.m. until 10.30 a.m. on Thursday, 26 June 2008.