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Dáil Éireann debate -
Thursday, 19 Feb 2009

Vol. 675 No. 3

Other Questions.

Hospital Staff.

Deirdre Clune

Question:

6 Deputy Deirdre Clune asked the Minister for Health and Children the progress that has been made in implementing the European working time directive for non-consultant hospital doctors which limits the working week to 48 hours; the manpower implications this will have; and if she will make a statement on the matter. [6626/09]

Under the European working time directive, the current maximum average working week for non-consultant hospital doctors is 56 hours. This limit will be reduced to 48 hours with effect from 1 August 2009. The directive also specifies minimum daily and weekly rest periods. I am aware that the working hours of non-consultant hospital doctors in our public health service are, in general, not compliant with the requirements of the European working time directive. The matter has been the subject of extensive analysis in recent years.

Negotiations on a new employment contract to facilitate the introduction of reduced working hours for NCHDs have been the subject of protracted negotiations under the auspices of the Labour Relations Commission, but without resolution.

A national implementation group which was established in 2005 to provide guidance and oversee local implementation projects, produced its final report in December 2008. The report indicated the potential for specific actions which could be taken for compliance with the European working time directive.

My Department has requested the HSE to develop a robust plan for achieving compliance with the working time directive by August of this year. The HSE is identifying specific measures to further compliance in each acute hospital over the coming months such as flexibility of work practices; rationalisation of overtime hours; reconfiguration of hospital services; an increase in the number of consultants with a corresponding decrease in the number of NCHDs through savings achieved from the overtime bill. These measure will all be of assistance in this regard.

On 30 January 2009, the HSE advised the IMO of its intention to proceed with implementing changes to the working arrangements of non-consultant hospital doctors, with effect from 18 February 2009. On foot of this proposal, the IMO balloted its members for industrial action. The Labour Relations Commission facilitated a meeting between the HSE and the IMO earlier this week where it was agreed that both parties would engage in intensive discussions on all issues of dispute between them. These discussions will continue to take place until the end of this month, following which any unresolved issues will be referred to the Labour Court.

I thank the Minister for her reply. Notwithstanding the industrial relations issues with non-consultant hospital doctors, I am concerned at the plan to take up the slack. Many doctors are working extraordinary hours — up to 80 a week. If such doctors are now going to be working 48 hours, where are the additional staff to take up that slack? I certainly do not approve of either the overtime bill or of asking doctors to work such hours because I do not believe it is safe. Truck drivers would not be allowed drive for that number of hours in a week. Doctors making life and death decisions when they are half asleep on their feet from exhaustion is not the way to run a safe health service and it is designed to cause trouble. I fully agree with this drive to reduce hours but where are the additional staff? A reduction in staff means a reduction in service unless additional non-consultant hospital doctors are employed and this is not what the Minister wishes to do as she wants a consultant-delivered service and I agree with her. However, where are the consultants?

An tAire to reply.

May I ask a final supplementary question for clarification?

How many new consultants will be appointed this year? When I say, "new", I do not mean people who are new to the job, rather I mean additional posts. How many additional posts will be filled this year?

I appreciate the Deputy's point about patient safety because tired doctors are certainly not safe doctors. The first HSE initiative was to take effect from 18 February and this led to the ballot, which was about three things — a training grant of €3,810 per doctor per annum; a meal break of €25 million per annum; and a living out allowance of €11 million. This is a total of €45 million. These are archaic allowances that are in the system. Much of the change will come through work practices. The new consultant contract which I believe can now be activated, will mean consultants working an extended working day and providing cover in hospitals at weekends. This will mean that daily discharges are possible. A clinical director will be responsible for making all this happen. This will fundamentally alter how our hospitals work. Much of the overtime bill in our hospitals results from not having consultants available in the hospitals up to 8 p.m. or 9 p.m. in the evening or over the weekends. I do not know the precise number of consultants to be recruited this year but we must recruit them in order to reduce the amount of money paid for non-consultant hospital doctors. In the mid-west we are recruiting two accident and emergency consultants, one dermatologist, some for rheumatology. I know the numbers by region but I am not certain what the total number is. There will be many recruited for the cancer area and we are currently recruiting a number of physicians in radiation, oncology and surgery. I understand some of those doctors will be starting very soon.

I also accept that in the interests of both the safety of patients and doctors that the hours must be reduced in accordance with the working time directive. However, until such time as those consultants are appointed, the same junior hospital doctors are still going to have to work the same hours as before or else patients will be left unattended. I had a long conversation with a young doctor who is training to be a GP. He told me the doctors cannot leave the patients; there will not be extra non-consultant hospital doctors but the consultants have not yet been appointed. There is a real problem in the meantime which the Minister needs to address. It is unfair on those doctors to be expected to do the hours but their pay is going to be cut by more than half in many cases although I am not defending the long hours. With regard to the cuts in study and training time I remind the Minister that non-consultant hospital doctors must train and study and surely they should be recompensed for that.

I am not referring to training and study time, but to allowances for meals and so on, amounting to €25 million for meals, €11 million to live out and €17 million for training. There must be training, but these allowances are not paid to others in the modern era and are not appropriate.

Last year, the bill for overtime amounted to more than €200 million. Among the issues that arise is that, while junior doctors support the idea of implementing the working time directive, they want to be paid the same salary, including overtime, despite working a shorter week. In the current circumstances, no one would regard that as reasonable. The reconfiguration of hospital services and the consultants' extended hours will alleviate significantly pressures on non-consultant hospital doctors.

Some hospitals have shown considerable innovation. For example, hospitals' overtime bills vary considerably across the country. Some have large bills in respect of junior doctors while others, despite treating the same number of patients, have substantially smaller overtime bills. Were hospitals to follow best practice, the bill would be reduced. We have no alternative but to take this measure this year, given the considerable pressures on the HSE's budget stemming from the rising level of unemployment.

Clinical Indemnity Scheme.

Michael D'Arcy

Question:

7 Deputy Michael D’Arcy asked the Minister for Health and Children the action she will take to address the legal expenses claimed by lawyers when their clients are awarded damages under the clinical indemnity scheme; and if she will make a statement on the matter. [6638/09]

The management of claims covered by the clinical indemnity scheme has been delegated to the State Claims Agency, SCA, under the National Treasury Management (Amendment) Act 2000. Therefore, I have no direct involvement in their management. The 2000 Act imposes an obligation on the agency to ensure that the expenses incurred in the management of claims are contained at the lowest achievable level.

The establishment of the clinical indemnity scheme in 2002 has already produced significant savings in legal and other transaction costs by eliminating the multiple defendants who would each have had separate legal representation under the previous arrangements. The elimination of separate representation for hospitals, consultants and junior doctors has made it easier to settle cases. As well as eliminating multiple costs, it delivers compensation to patients with legitimate claims much more quickly. It also makes it easier to defend cases that have no merit.

The SCA minimises its own legal costs through the use of a panel of specialist solicitors selected following a competitive tender. Through these solicitors, it agrees the fees to be paid to counsel. However, in dealing with the costs of successful plaintiffs, it is obliged to work within the rules and conventions of the courts system where these matters are determined. Where the costs cannot be agreed between the parties, they are submitted for taxation. The agency is examining how legal costs might be further reduced.

The legal costs of the average catastrophic injury case, such as one involving cerebral palsy, amount to approximately €1 million. This is a particularly relevant issue. From my general practice, I know that vaccination is the most dangerous thing that general practitioners do because of untoward effects, which are rare but possible. Why is it the case that, the higher the award to the patient, the greater the professional fee? It does not make sense. We are paying approximately 56 cent in legal costs for every euro that a plaintiff gets. Under the NHS in the UK, only 43p is paid out on every pound. It is a hell of a difference.

Will the Minister consider a no fault compensation fund for the victims of the childhood vaccination schemes? If a doctor gives a vaccine in good faith, manufacturers produce it in good faith, parents have it administered to their child in good faith and an untoward event occurs, as occurs rarely, the parents will be left mortgaging their house to get justice and care for their child. Everyone is sued, everyone has legal costs, the legal profession has a heyday and the families and professionals who have done no wrong are traumatised. If there is neglect, that process is fair enough, but there is none in most cases. Has the Minister considered a no fault compensation scheme and what are her plans to reduce horrendous legal costs?

That was a specific expansion on the question, but I ask the Minister to reply.

I share the Deputy's opinion on legal costs in Ireland and the plethora of lawyers, from junior and senior counsel, solicitors and so on, involved in various actions. A previous Minister for Justice, Equality and Law Reform established a group on legal costs, the recommendations of which are being considered for implementation by the current Minister.

The Deputy's point on percentage costs is valid. It also applies to pharmacists, who receive a 50% mark-up on the cost of drugs. I have a strong opinion in that regard. When I am doing business in my private capacity, such as it is, I usually negotiate a fee. More people should do likewise. We pay substantially more in terms of legal costs and doctors than is paid in the UK. Professionals in this country do much better than their counterparts in Northern Ireland or the UK. As the Deputy is aware, the legislation on emergency provisions in respect of the levy, which is before the House, provides for the renegotiation or resetting of fees for health, legal and other professionals.

To be fair, the introduction of enterprise liability has been of major benefit from the point of view of hospital claims. Instead of different professionals having their own lawyers and insurers, each trying to ensure that their clients are not blamed, and the cases going on forever, cases are settled more cheaply than used to be the case.

Regarding a no fault scheme, a group under Professor Peter McKenna, an obstetrician from the Rotunda Hospital, was established prior to my appointment as Minister for Health and Children. The group's focus is on children who have suffered brain injuries at birth. If my memory serves, there are few such cases each year. The Deputy is correct in that the parents must litigate, a process that is traumatic and expensive. I am awaiting the group's report. It was trying to reach agreement between parents and the various interest groups before making a recommendation, which, judging by initial indications, was for a no fault system. I would have much sympathy for it. If we could target money to the children and their families instead of through a legal process and litigation that results in trauma, it would be attractive. Beyond this, the matter has not been considered. If we could have a no fault system that did not open the flood gates, I would be in favour of it.

For that reason I was careful to refer to childhood vaccinations specifically, not to people receiving travel vaccinations. Will the Minister focus on her plans or other initiatives to address the plaintiff's legal fees?

These are generally determined by——

I will allow Deputy Naughten to ask a brief supplementary question.

Before the Minister responds, will she update the House on the report on her desk concerning vaccine-damaged children? When does she hope to publish it?

My question is more or less the same. Does the Minister have a timescale for publication of that report? Every Deputy would consider it eminent sense that the money should go to the children and their families instead of to the legal profession.

Regarding Deputy Reilly's question, a plaintiff's costs are generally determined under court procedures. Unfortunately, we pay more in such costs than is paid in other jurisdictions. We also pay our doctors much more for screening programmes. In the new economic circumstances, all these matters must be reviewed.

I will revert to Deputy Naughten as I am not in a position to answer his question. I would welcome a dialogue on some of these issues with the Opposition as they should not be contentious and are not ideological. We could hold a good discussion on vaccinations via the Joint Committee on Health and Children.

I have already met the working groups and they would have no problem in that regard.

I would happily have it.

Health Services.

James Reilly

Question:

8 Deputy James Reilly asked the Minister for Health and Children if she will publish the Health Service Executive Health Information and Quality Authority and social services inspectorate reports on hostels for unaccompanied migrant children; and if she will make a statement on the matter. [6686/09]

All residential services for separated children seeking asylum are provided by non-statutory service providers on behalf of the Health Service Executive. The registration and inspection service of the HSE is responsible for the inspection of these residential services. The Health Information and Quality Authority, HIQA, does not inspect residential services operated by non-statutory service providers. However, when the relevant sections of the Health Act 2007 are commenced, the remit of HIQA will include inspections of both statutory and non-statutory children's residential centres.

The HSE has, year on year, increased the level of resources to separated children seeking asylum. This has allowed services to develop from the rudimentary service in 2000 to the level of support and care that exists today. The task is not yet complete and work will continue this year to develop the service to an appropriate standard.

There is recognition within the HSE that this service needs to be considered on a national basis. Plans are in progress to move the focus away from Dublin as a service point and, in the future, separated children will be placed in appropriate placements across the country. As a parallel process the hostels currently in use in Dublin will be wound down.

In or around 2000, when large numbers of asylum seekers began to arrive in this country there was an emergency response across all relevant agencies, including the Department of Justice, Equality and Law Reform, the former health boards and local authorities. Large hostels were used to accommodate asylum seekers and separated children seeking asylum were mixed in with single adults and families in such units. The former health boards' response regarding separated children was to put together a dedicated team to deal with the issue. Initially, a principal social worker was assigned with a number of staff. This team has grown over the years and now includes nearly 30 full-time staff including social workers and project workers, as well as clerical, medical, nursing and psychology inputs.

The first key task in respect of securing the safety of separated children was to place them in dedicated accommodation. This was done over a period, although many of the hostels then in use contained too many children and some contained up to 80 children. The next task was to reduce the number of children in each hostel to more appropriate numbers and this was achieved over time to the point where most hostels now have less than 30 children in each. In addition, a registered children's residential unit with six places was opened in the Tallaght area.

The current service provision to separated children includes foster care, residential care, supported lodgings and hostel care. The number of fostering placements has increased year on year. The most vulnerable of separated children are placed with foster parents. All separated children under the age of 12 are either cared for in a foster care setting or alternatively in a registered children's home.

Additional information not given on the floor of the House.

There currently are two registered children's homes in operation for separated children with two others in the process of being commissioned. These will accommodate children up to the age of 16. There also are seven hostels which provide accommodation for such children who are aged 16 years and over. As the HSE does not consider these hostels to be registerable, it is moving to phase out the hostel care arrangements starting next month. On this basis, these hostels are not being inspected by the registration and inspection service of the HSE. However, the HSE receives regular reports from the project workers attached to the team for separated children seeking asylum in respect of each hostel.

While the HSE is moving towards placing children across the country, in the medium term it will be necessary to continue to refer some children into the remaining hostels, although this will diminish with time. To date, three residential centres for separated children have been inspected. Two of the inspection reports have been completed and will be made available to the Deputy.

The HSE, in currently progressing plans to move to a more comprehensive model of care for these children, aims to ensure that all accommodation for separated children meets the relevant national standards. The HSE is working with the registration and inspection service to achieve this aim. It is anticipated that by the end of 2009 the number of registered children's residential centres that comply with the standards will have increased to four. It is the objective of the HSE that all separated children will, in the future as soon as is feasibly possible, be placed in foster care, in a registered residential care placement or the equivalent.

While I thank the Minister of State for his reply, one might think while listening to it that something is being done. If that is the case, how could a further 16 children have gone missing during the 11 months of 2008 for which information is available? Is it not the case that reports have been completed on such hostel accommodation by the HSE or its agents? The NGOs have reported that nearly all the hostels failed that inspection. Will these inspection reports be published and put into the public domain?

First, it is not correct to state that nothing has been done. The Deputy is correct to state that a number of unaccompanied children seeking asylum went missing. However, that figure has fallen dramatically in the last four or five years, from 66 in 2005, to 22 by the end of 2008. I believe the Deputy referred to 18 such children. The figure fell by two thirds during that period. While I acknowledge that the number of children who sought asylum also fell by half, the number of that went missing came down more dramatically.

No inspections per se are carried out in respect of hostels. However, the HSE is constantly in receipt of reports from project workers and insists on the highest standards of accommodation being provided in such hostels. Moreover, the HSE has made clear that from next month, it will move towards the phasing out of such hostel-style accommodation and will insist that younger children are cared for either in foster care or in residential children’s homes. Certainly, no younger children are cared for in hostels. While older children are cared for in this way, we have two registered children’s homes at present and hopefully will have four by the end of the year. We wish to treat all unaccompanied children seeking asylum in the same way as all children in the State are treated.

Does the Minister of State not accept the imperative to have an inspectorate of such hostels to protect the most vulnerable children in our society? This is particularly true given that 22 children went missing last year. Although the Minister of State noted that this was a reduction, there also has been a significant reduction in the number of children coming here.

We are aware of the standards but the inspections to be undertaken by HIQA will come into play on the commencement of the Health Act 2007. The original question pertained to those inspections and as I indicated in my response, the registration and inspection service of the HSE is responsible and does take reports from project workers on a constant basis as to the standards in such hostel-style accommodations.

This is a particularly disturbing aspect of child care for everyone concerned. While it is welcome that the numbers have fallen, the idea that young children can go missing at all is highly worrying. The Minister of State spoke of inspection but in the case of young children, the issue does not pertain to physical inspections as much as to the care system and whether such children are watched and cared for on a 24-hour basis as one would expect. Moreover, the Minister of State stated that younger children are being moved to homes, foster homes and so on. What is the cut-off age in this regard?

On the last point, being under 12 is the strict cut-off point at which hostel accommodation is completely inappropriate. However, the vast majority of children in hostel-style accommodation are in the 16 to 17-year old age group. As for the care system, 24-hour care is provided for such children. Two project workers are located in each hostel and provide the highest standard of care for the children. In general, the development of policy in this area has been considerable in the past ten years. This issue has received high prioritisation. Much intergovernmental work has taken place, as has much work with statutory and non-statutory agencies, including the Garda, the Garda National Immigration Bureau and the Garda missing persons bureau regarding the sharing of information through all such groups.

This issue has attracted a high level of concentration on the Government's part. Although there has been a dramatic fall in numbers and although we know from our colleagues in Europe that many of the children who go missing simply are reuniting with families that already are here or else are going to other European countries, the reduction does not give us cause for complacency.

The HSE has stated that many of these children have been rescued from desperate situations. Is this true?

Is it true that some of these children have been rescued from brothels, in which they have been engaged in the sex industry? How can the Minister of State assert in this House that such children are being provided with the highest standards of care when no controls are in place? The Minister of State himself has admitted that no inspection of such facilities has taken place since 2000. When will an inspection take place? When will Members have sight of the reports that have been collated by the HSE? Does the Minister of State believe it is acceptable that 16 children went missing last year from such hostels during the 11 months for which figures are available? I believe that one child is one too many and the disappearance of a single child constitutes a damning indictment of the existing system.

Clearly, one child going missing is a challenge. However, I must say that——

It is a scandal, not a challenge.

Deputy Naughten should wait a second. One must be balanced about this issue. I already have made the point that many of the children who go missing are reunited with their——

Some of them are.

Please allow the Minister of State to respond.

——Members should be balanced about this issue. One also must be honest and acknowledge that children have been rescued from abusive situations, be they sexual or pertaining to employment. That is the reason for the Criminal Law (Human Trafficking) Act, which prioritises child trafficking. It is the reason for the existence of an anti-human trafficking unit within the Department of Justice, Equality and Law Reform. It is the reason the Garda has devoted so many resources to Operation Snow, which is an effort to both support children and to secure prosecutions in this regard. However, I also should point out that since the Criminal Law (Human Trafficking) Act came into force last year, no prosecutions have been taken in this area. This does not mean there are no instances of such activity.

It is because some of those who gave evidence have disappeared.

This is a developing area of law and a balanced approach must be taken.

Health Service Staff.

Joe McHugh

Question:

9 Deputy Joe McHugh asked the Minister for Health and Children the position regarding the proposed voluntary retirement scheme for Health Service Executive staff; and if she will make a statement on the matter. [6668/09]

Kathleen Lynch

Question:

46 Deputy Kathleen Lynch asked the Minister for Health and Children the estimated number of redundancies and early retirements being sought within the Health Service Executive; the levels at which these reductions in staff are being sought; and if she will make a statement on the matter. [6545/09]

I propose to take Questions Nos. 9 and 46 together.

The Government has not yet decided on the scale or scope of a voluntary redundancy or early retirement scheme for the Health Service Executive. I have confirmed to the House on a number of occasions that I believe that a managed voluntary redundancy scheme could have an important role to play in helping to improve the delivery of health services to patients by streamlining management and administration within the HSE. The Minister for Finance, in his Budget Statement of 14 October last, reaffirmed the Government's commitment to such a scheme.

The immediate priority for the Government was to put in place the necessary legislation and other measures to implement the €2 billion public expenditure savings announced on 3 February. When this has been dealt with, the Government then will consider other matters, including the introduction of a voluntary early retirement scheme for the HSE and other areas of the Government.

To put this issue in context, I met nursing representatives yesterday, who told me that in the last 18 months approximately 2,700 nurses have left the system. This may not represent the loss of 2,700 whole-time equivalent posts but it is nonetheless 2,700 people. How many managers and administrators have gone in that time? The Minister's answer was not greatly informative. How many health service staff have expressed an interest in taking redundancy and when will they be let go?

The Minister for Finance has responsibility for public service staffing. Therefore, this is not a matter for me. The Government would have to approve a redundancy scheme and the terms thereof. The intention is that the Minister for Finance will bring a joint memorandum to the Government in regard to the health service.

In the past three years, we have increased the number of nurses by 25% and reduced the number of general support staff by almost 9%. I do not know what the level of interest would be in a voluntary redundancy scheme. Much would depend on the terms, the age of prospective applicants and so on. Obviously, from a strategic point of view, we are anxious to retain the best people. A voluntary redundancy scheme must be appropriately managed so that we do not end up, as has happened before, letting go vital staff who subsequently have to be replaced. The intention is that there will be no replacement of those staff who avail of voluntary redundancy. Instead there will be redeployment of remaining staff. Redeployment is a critical aspect of any voluntary redundancy scheme.

The Minister replied to a similar question tabled by me on 25 November 2008, when she provided far more information than she gave in her initial short reply today. How much work has been done in this area? There is little point in letting go any staff who express a wish to retire regardless of their role or the area in which they work. Is there any strategy attached to the proposed redundancy scheme in terms of, for example, taking out administrative grades? One of the criticisms of the Health Service Executive is that its establishment involved the imposition of additional staffing structures on the existing structure of 11 health boards and other organisations. The common perception is that the various layers of management are causing delays in the system. Is there a strategy in terms of taking out layers of management rather than retiring people out of the system in a willy-nilly fashion?

A considerable amount of work has been done by my Department and the Department of Finance in regard to the proposed redundancy scheme. The intention is that the Minister for Finance and I will take a memo to the Government. This would probably already have been done in the past month if not for the necessary focus on the financial stability of the State and the measures required to be taken to that end. I hope we will be in a position to make progress on the redundancy scheme shortly.

The Deputy is correct that it would make no sense to introduce a voluntary scheme under which significant numbers of staff were lost in one area, leading to staff shortages and a need for fresh recruitment. Redeployment must be a key component of any scheme.

Considerable work has been done in regard to structuring issues in the Health Service Executive by Professor Drumm and his team, hospital management and so on, with the support of external consultants. That is a different issue. One of the issues that arises is whether the management structure needs to be more devolved.

It is not a separate issue. The point is that the executive has too many layers of management and that is why staff numbers must be reduced.

There are no more layers than there were before the establishment of the executive. The intention is to devolve to a greater extent to the four networks and to ensure services are reconfigured in a way that makes sense, not only on the hospital side but also on the community side. A substantial amount of work has gone into that. As I see it, the initial focus of the redundancy scheme will relate to administration management, not only within the Health Service Executive but within many of the hospitals. There are 13 or 14 chief executive officers of hospitals in Dublin city alone. In addition, there are the various human resources departments, finance directors, deputy chief executive officers and so on. One would never organise any system in that way. The manner in which we have organised services has led to large numbers of people in administration and management. Operating on the basis of networks of hospitals should deliver greater efficiency in this regard.

Deputy Jan O'Sullivan has put her finger on the vital issue. There has been much talk about redundancies in the wake of the general outcry about what is perceived as the enormous level of administration within the Health Service Executive while, at the same time, front line services are under such pressure. No matter what the Minister tells us in this regard, we hear every day about people waiting on trolleys, cancelled operations, delayed discharges and so on. The Department's figures back this up.

What has been done since the Minister responded to Deputy O'Sullivan on 25 December and to Deputy McHugh on 16 December in terms of progressing this issue? When will the first redundancies take place?

I answered that question. As I said, a substantial amount of work has taken place involving my officials and officials from the Department of Finance. As I explained earlier, the Minister for Finance, not the Minister for Health and Children, has responsibility for public service staffing. I am not free to devise and implement a redundancy plan. The Minister for Finance must be centrally involved in any such scheme because it will not apply only to the health service. Members will appreciate that the Minister has been busy in recent weeks with financial and budgetary developments. However, I envisage we will be able to make a determination in this matter shortly, hopefully in consultation and agreement with the social partners.

I am sure the Minister accepts that she must play an integral part in a proposed redundancy scheme, even if the Minister for Finance is involved. Surely, therefore, she should be in a position to indicate when the first redundancies will take place.

The intention is that the first redundancies will take place this year.

Seán Barrett

Question:

10 Deputy Seán Barrett asked the Minister for Health and Children the number of managers in the Health Service Executive who have been paid bonuses since the start of October 2008; if the payment of Professor Drumm’s bonus is still being considered in view of the economic climate; and if she will make a statement on the matter. [6613/09]

No performance-related awards have been paid to the chief executive officer and eligible senior managers in the Health Service Executive in respect of 2008. The executives' payment-related award scheme operates in accordance with the principles set out by the review body on higher remuneration in the public sector. Given the current difficult financial circumstances, the Health Service Executive scheme is currently on hold pending a Government decision on the future of such schemes in the wider public service.

Awards were paid for 2007 in 2008, but no awards have been determined for 2008.

The Minister has told us that the awards paid out in 2008 relate to 2007. At what point in 2008 were these bonuses paid to staff in the upper echelons of the Health Service Executive? Are bonuses for 2008 on hold for a defined period or indefinitely? In other words, are bonuses still under consideration in the current climate for those earning vast sums of money in operating a health service with which few people are satisfied?

The bonus scheme was introduced as part of the remuneration process for higher public servants. Therefore, it applies not only to the Health Service Executive but to the entire public sector. It was introduced many years ago, long before I became Minister for Health and Children. The Minister for Finance indicated in the House some time ago that this review scheme was being suspended. I understand he intends to bring forward proposals for the implementation of this process.

If I recall correctly, the 2007 bonuses were determined in the summer of last year in respect of 124 people on the recommendation of the chief executive officer. The board has made no determination in regard to a bonus for the chief executive officer for 2007 or 2008. It is part of his contract of employment that he may receive a bonus of up to 25% of salary.

Will the Minister confirm that the chief executive officer of the Health Service Executive did not receive any bonus in 2008 for 2007?

That is correct. The board has made no determination in that matter.

National Health Strategy.

Frank Feighan

Question:

11 Deputy Frank Feighan asked the Minister for Health and Children if funding has been identified and ring-fenced for the implementation of the new national men’s health policy 2008-13; and if she will make a statement on the matter. [6651/09]

One of the main purposes of the national men's health policy is to bring a greater focus on the needs of men as a population group. The policy, which aligns itself with existing policies and strategies, focuses on the need to ensure services are reconfigured to reflect best available evidence of what will work to deliver the desired outcomes.

I am satisfied that much can be done within existing resources to re-orientate services to improve men's health, including in the case of primary care services and in making good quality "male-friendly" health information available and accessible to men. The policy document has been extensively researched and will be an invaluable resource for policy-makers across various Departments in providing research evidence for the development and roll-out of services appropriate to the needs of men as a population group.

Has funding been identified and ring-fenced? What is the funding figure?

No additional resources have been allocated to this because much of what is contained in the report can be done within existing resources with regard to reorientating services. Before launching the document I went through it to establish what can be done within existing resources. This is a matter of doing business differently and making it more accessible to men. We know the traditional circumstances in which men go to the doctor. We also know that married men are more inclined to go to the doctor because their wives send them.

I hope the Leas-Cheann Comhairle goes to the doctor.

That put me in my spot.

In many cases it is a matter of making places more accessible and encouraging men to know more about their health and to do something about it. I refer to health in a broader sense than just medical health, including well-being. This involves many Departments and it involves people taking more physical activity, and what the Department of Arts, Sports and Tourism should do. We need to change our habits. Considering the recommendations, we can identify persons in the various HSE areas to take responsibility for this policy. People must be aware of the policy and the policy must be applied within the existing resources.

We met the National Women's Council of Ireland today and were challenged on what we are doing in respect of women's health. It is good that we are redressing the balance this afternoon. Are there specific measures in this or is it a case of encouraging more men to go to the doctor and care for their hearts better? Are there specific screening programmes for men?

There are many specifics in respect of this and some may be of interest to Deputy O'Sullivan. I will move away from the medical health aspect because sometimes we think this is what health is all about. The plan is to review the adequacy of existing legislation to deter risk-taking behaviour in men, which involves the Department of Transport, the Department of Justice, Equality and Law Reform and the HSE. Minimal costs arise because this involves reviewing what we are doing and proofing various items of legislation. The programme also involves the SPHE programme, bullying in schools and masculinity. Costs involved are mainly included in the delivery of the existing programme through the Department of Education and Science. It is a matter of examining existing programmes and proofing them.

Years ago, Deputy O'Sullivan and I sat on the women's rights committee and dealt with gender proofing issues. This is a case of gender proofing in the opposite direction. For example, the Health and Safety Authority supports the implementation of this policy by continuing to play a key role in maintaining standards of safety in the workplace. There is minimal cost involved. It is a case of ensuring workplaces are safe.

I am disappointed with the response of the Minister of State. She referred to bullying being gender orientated. Girls bully and are bullied also.

Only when provoked.

The Minister should not bully me. The question refers to men's health and the ring-fenced funding that is available to promote this issue and to implement policy. There appears to be no ring-fenced funding for this, nor is there any real initiative regarding men's health. What action is being taken on men's issues, such as testicular cancer and prostate cancer? Where is the meat in this? The Minister and the Ministers of State will forgive me for using the following word when the former Taoiseach did so, but this answer is waffle.

The Deputy is aware of the excellent work of Professor Tom Keane on breast cancer and he is now moving on to the area of prostate cancer. I refer to the work being done in St James's Hospital. Many things are being done at present within existing services. This document is to policy proof that in respect of men.

I find myself on the opposite side of the table from where I have been for 20 years, with the Oireachtas women's rights committee. We examined how women in the workplace were not being treated equally, how many women in the Dáil were not being treated equally, the fact that so many teachers were female and the fact that so many principals were male, despite the fact that boys and girls were equal in school. Sometimes it is difficult to say that one thing will make a difference.

Sometimes it is waffle.

The last recommendation will be of interest to Deputy Reilly. It refers to managing stress in the workplace, something we can all take on board.

We have given enough time to men's health.

Written Answers follow Adjournment Debate.

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