Vol. 683 No. 2
1 Deputy James Reilly asked the Minister for Health and Children her view on the impact the planned ward closures at Our Lady’s Children’s Hospital, Crumlin, Dublin, will have on patient care and treatment; if she will call on the HSE to meet the board of management of Crumlin hospital with a view to securing savings without affecting front-line services; and if she will make a statement on the matter. [20912/09]
In common with all hospitals, Our Lady's Children's Hospital, Crumlin, is addressing the challenge of delivering a high quality service to its patients while remaining within budget. The hospital is committed to providing the full level of services that it promised in its 2009 service plan. The top priority will be to protect patient care.
So far this year, Crumlin hospital has delivered more treatments to patients than in the same period last year. In the first three months of 2009, there were 2,745 treatments for children as inpatients and 3,841 as day cases, an increase of 244 over 2008. Crumlin also had 21,252 attendances at the outpatient department, an increase of 1,041 from the first quarter of last year.
The 2009 allocation to Crumlin is €139.6 million, an increase of some 39% over the past five years. This includes a reduction of 3% this year over 2008 in line with the budgetary constraints facing the entire public sector and the wider economy. A particular challenge for the hospital is that it is operating at some 100 posts above its employment ceiling. It employed 1,650 people at the end of March compared with an approved 1,550. This contributes to its current financial difficulties.
The HSE is working closely with Crumlin hospital to achieve an agreed programme of savings totalling €6.5 million this year. The focus of these savings will be on non-pay areas of expenditure and on protecting front-line services. On this basis, the HSE believes the hospital will achieve a break-even position this year.
We need to consider more strategically the way in which we provide paediatric services in Dublin. In 2009, the Government will provide more than €250 million for the running of three paediatric hospitals in the Dublin area. We can achieve significant cost savings if services and practices are more closely integrated across the three hospital sites, even before the new national paediatric hospital has been completed. With this in mind, the HSE is pursuing ways in which services across the three hospitals can best be co-ordinated to avoid unnecessary duplication and to achieve savings that can be put into patient care.
The Minister has had a long time to consider how to make the hospitals more efficient. The issue before the House is of serious concern to people across the country, no more so than the Deputy on my right, Catherine Byrne, whose constituency contains the hospital in question.
Crumlin hospital looks after 80% of children's tertiary needs. The Minister was right to point out that it has increased its activity and efficiency, but this was necessary in light of the increasing population. The Minister acknowledged this fact by increasing the allocation to the maternity hospitals.
The Minister does not seem to have taken into account some of the newer technologies that are available, such as extracorporeal membrane oxygenation, which has reduced the cardiac surgery death rate by nearly half. The hospital was given no extra money in this regard. There is a growing number of cardiac conditions that, unlike previously, are now treatable, such as hyperplastic left heart syndrome. The incidence of sickle cell disease has increased significantly, resulting in Crumlin hospital having the largest outpatient clinics for that illness in Europe.
Why is the Government spending €5 million per year on a virtual new hospital, which no one believes will proceed in the current economic climate, when it is enforcing cutbacks at the very hospital delivering care today? Since all Cork orthopaedic operations are to be brought to Crumlin, any delay in scoliosis operations will result in children having two operations, leading to tremendous suffering. How much——
I will call the Deputy again.
What are the Minister's plans to address this problem and why is the Government spending €5 million per year on the new hospital?
Regarding the last point, we need a new hospital badly. If there is no single new hospital, major work will need to be done at the Temple Street Children's Hospital, which is not fit for purpose, and at Crumlin hospital. The decision was made two years ago, the project is proceeding, money will be provided and there is a great deal of interest in making provision for the hospital.
As I recently stated in the House, the HSE has shown that a minimum of €25 million per year can be saved in duplication costs by combining the three hospitals. Much work has been undertaken to bring them closer together. There will be a joint department of surgery and seven surgeons. There are five currently, one of whom is retiring, so the increase will be two. The surgeons will work in at least two of the hospitals. There will be a single paediatric critical care service between Temple Street and Crumlin hospitals, the implementation of which will be overseen by Dr. Des Bohn of the Hospital for Sick Children in Toronto. Much work is under way.
As I have stated in the House previously, three accident and emergency departments will be open in this city between midnight and 8 a.m. tonight, with theatres and staff on call. On average, they see approximately 29 patients between them. I had a good meeting recently with Professor Brendan Drumm and some of Crumlin hospital's medical team, led by Dr. Pat Doherty, the chairman of the hospital's medical board, Dr. Michael McDermott and others to discuss how to better integrate services and paediatric services generally in the Dublin area.
Next week, a new clinical affairs director, a doctor, will start at the HSE. Bringing clinicians further into the management of services such as paediatrics will greatly help to get better value for money and more services for patients.
I want to allow Deputy Reilly back in for a brief supplementary question.
Many of the Minister's comments on clinical directorships, etc. are sensible. However, they fail to answer the questions of why we are cutting front-line services to children, why the money cannot be found elsewhere and why we are spending money on a virtual hospital when the existing hospital is being put under such strain. New PR people are to be appointed to the virtual hospital's team. Yet again, the Government seems to be more interested in spending money on spin than on service.
Since 2005, we have increased the budget to Crumlin hospital by39%, which is considerable. We are not engaged in spin. A significant amount of work is under way by the development board to put in place the new children's hospital.
I compliment the chairman of Crumlin hospital, Archbishop Diarmuid Martin, on his tremendous work in trying to advance the project. It does not meet with universal approval, but everyone knows that, were we to establish a paediatric service for the city and country, we would not start from our current position. We must improve on the situation with a modern, state-of-the-art facility co-located with an adult teaching hospital. This aim is being pursued and will be achieved.
He is not spending a fortune on PR gurus.
2 Deputy Jan O’Sullivan asked the Minister for Health and Children the number of cases of children at risk who have not been allocated a social worker; if she will address the shortage of social workers to keep children safe; if she will implement the recommendation of the Monageer inquiry that a social work service should be available out of hours in order that there can be effective intervention in crisis situations; and if she will make a statement on the matter. [20739/09]
According to a 2008 HSE survey, 6,473 cases were unallocated at the end of 2008. However, all such cases are managed by a social work team leader or principal social worker. The majority of unallocated cases are also receiving input from other members of the staff in that department, such as family support workers. All child abuse reports are subject to a phased process of initial screening and assessment by a social worker under the supervision of a team leader and I am informed by the HSE that all cases where there is an immediate and serious risk to the health or welfare of a child are provided with services.
Regarding staffing levels, social workers are exempted from the Government's moratorium on recruitment. Proposals for an ICT system to support social work services for children has received HSE approval and is with the Department of Finance for review. If approved, the objective is to have this system operating as quickly as possible to enable better exchange of information and improved communication between relevant staff throughout the HSE.
As regards out of hours services, the HSE is putting in place a nationwide system, whereby gardaí can access an appropriate place of safety for children at risk out of hours. This service aims to ensure that such children are provided with an appropriate emergency place of safety, thereby reducing or eliminating social admissions of children in an acute hospital setting.
In addition, and instead of developing a stand alone social work out of hours service, it has been agreed to develop alternative proposals based on a more integrated multidisciplinary approach, which builds on the HSE's existing out of hours services, including GPs, acute hospital services and mental health services, with access to specialist staff working in areas such as mental health and suicide prevention.
We heard the dreadful litany of abuse in the last day or two, with the release of the report on the Commission to Inquire into Child Abuse. We do not have that kind of abuse any more in schools or institutions because, thankfully, we have learned lessons and moved on.
However, with more than 6,400 children at risk without an allocated social worker, I must put to the Minister of State there is a danger that in future we will find the scandal of child abuse will be in family homes and other places where children live because there are not adequate resources for social workers. Does the Minister of State agree? The Sophia McColgan case is an example of where, if the powers that be do not intervene in families, we could have similar situations going on.
Will the Minister of State and the Government reconsider not having a proper out of hours social work service in place? The proposal under the Childcare Act that gardaí would move children into foster homes is not adequate. How can it be adequate? One listens to foster parents saying they do not have access to social workers whom they need. Putting children into foster homes who do not have access to social workers simply will not work. Will the Minister of State reconsider that decision?
In his reply, he referred to the fact that if children are at immediate or serious risk, there will be intervention. How does one know children are at immediate or serious risk if they do not have a social worker working with them?
I share with Deputy O'Sullivan the horror everybody who has read parts of the report to which she referred feels. It makes for extremely harrowing reading.
On her question on an out of hours service, 12 months ago a case came to light regarding a child who was in a Garda station overnight in Cork. At that time, many people asked why there was no service where a phone could be picked up and a child placed appropriately until social work services were available. That will be in place from next month.
It does not mean a child will be placed in ordinary foster care families, rather, he or she will be placed in specially trained foster facilities until social work services are available. They will be very short placements and it is not intended that such placements, made under section 12 of the 1991 Act, would last for more than two or three days before normal working hoursresume.
The Deputy also asked if we could be satisfied that these events will never happen again. Anybody will agree that the circumstances which pertained in the 20th century are left behind us. We have a vastly improved system of child care compared to what happened before. There are extremely dedicated staff and much better facilities. The vast majority of children in care are in foster families.
The details and recommendations of the report to which the Deputy referred underline the fact we have no cause for complacency. It is an issue and area of great sensitivity. It is emotive and we have to apply every resource, to the best of our ability, to this area.
Will the Minister of State listen to all the expertise and views out there that we need an out of hours social work service? Will the Government reconsider the decision it made in that regard? It seems to be about money. It is a relatively small amount of money. I understand it is €15 million. The HSE spent €17 million on consultants in the last year.
The overall policy of the Office of the Minister for Health and Children, in line with the HSE, is to try to move towards early intervention and prevention. If there were 50 or 60 social workers employed, as would be required under the proposal made regarding an out of hours service, I would love to put them into the families most at risk and try to avoid a situation that leads to children coming into care. There is not enough throughput to justify employing 50 or 60 social workers who would receive very irregular phone calls about children at risk.
I am sure it could be done in a different way.
The appropriate response is, first, to provide a place of safety, as outlined in section 12, and then tie in, under the HSE reconfiguration, to the primary care system, so we can also tie into the acute hospitals and the out of hours services that are available.
3 Deputy James Reilly asked the Minister for Health and Children her views on the high numbers of patients waiting on trolleys in accident and emergency departments here; the date the Health Service Executive six hour target waiting time for all patients attending accident and emergency departments from arrival to admission or discharge will be recorded; and if she will make a statement on the matter. [20551/09]
Last year, hospital emergency departments treated 1.15 million people, of whom 368,000 were admitted to hospital. In 2005 the average number of patients on trolleys awaiting admission each day was 259. The average to date in 2009 is down to 141, and figures to date in May show a further reduction to 116. Data collected by the HSE over recent months indicate that the vast majority of those patients requiring admission are transferred to the ward areas without undue delay.
We need to continue to reduce waiting times for all patients presenting as emergencies to our hospitals. With this in mind, the HSE has set a lower waiting time target of six hours for all patients in its 2009 service plan. The aim is that all patients, irrespective of whether they are admitted or not, will be assessed, treated and discharged or admitted within six hours of arrival.
The HSE is working to measure and report on the time it takes to manage each patient's care from the point of arrival in the emergency department until they are discharged or admitted. As an interim measure, a sampling approach is being adopted at a selected time period each day, which involves collecting registration, admission and discharge data from emergency departments at all hospitals, either electronically or manually.
Preliminary results from the HSE's performance monitoring reports for March 2009 for a sample of 19 hospitals indicate that of all patients who did not require admission, 92% were seen and discharged within six hours. Approximately one third of patients who attend emergency departments are admitted to hospital. Currently, almost half of these patients are admitted to the ward within the new maximum target time of six hours. The challenge for hospitals is to ensure this new target is reached for all patients.
I am confident the introduction of the fair deal in September this year will have a positive impact on the number of patients in hospital whose discharge has been delayed. As a result of the introduction of the new scheme, nursing home care will be more affordable and acute beds will be freed up for acute patients.
There have been significant improvements and we will continue to work for more progress by reducing inappropriate admissions, reducing average length of stay and moving activity from inpatient to day case procedures. These measures will be essential in further improving the experience for patients attending emergency departments.
It is now three years since the Minister, Deputy Harney, declared the problems in accident and emergency departments should be treated as a national emergency. She set up an accident and emergency task force and its report was published in June 2007, notwithstanding the fact it was completed in 2006. It set a date of 1 February 2007 to have determined a timeframe from which a maximum wait of six hours from arrival at accident and emergency department to admission or discharge will apply.
What the Minister has just told us beggars belief. She is trying to tell us the situation has improved. The INO figures show it has not improved, but has disimproved. At one stage last month there were 398 people on trolleys. In the last week a very ill patient of mine sat on a chair for 18 hours awaiting admission and was then put onto a trolley. I do not know how many more hours she spent on a trolley because I have not checked.
We get answers saying everything is fine and hunky dorey, and things are moving apace, but the reality for people on the ground is different. At one stage some weeks ago, 50 people were on trolleys in the accident and emergency department in Beaumont Hospital. Let us deal with reality.
Instead of talking about what she might do in the future, why does the Minister not use the existing beds available in the greater Dublin area for long-term care and alleviate the congestion? I have a newspaper article from last which refers to an approximately 50% increase in "bed-blockers", as it pejoratively refers to them. They are people who are inappropriately trapped in wards. Up to 757 patients a week cannot get discharged because there is nowhere for them to go. That is what is causing the backlog in accident and emergency departments. That matter is not being addressed. I wish to ask the Minister a simple, straightforward question. Why are we not using the existing long-term care beds that are available in the greater Dublin area to alleviate the problems of accident and emergency departments in Dublin?
I wish to offer a number of responses to what the Deputy said. Everybody in the country acknowledges there have been significant improvements, including the INO, which has said so to me. That is not to say challenges and difficulties do not remain, because they do. One of the challenges is long-term care. As Deputy Reilly is aware, a significant number of people in this city, in particular but not exclusively in Dublin, have finished their acute phase and have not yet moved to more appropriate settings. The fair deal will bring equality of treatment between those in public nursing homes and private nursing homes. I have no doubt it will greatly alleviate those pressure points. Many of the people in acute hospitals are waiting for the introduction of the fair deal. I understand Deputy Reilly's party opposed the introduction of the fair deal but nobody has put forward an alternative to it. That will help in particular in the autumn of this year.
Our party has not opposed the fair deal yet. The Minister should correct the record.
I got some literature from a Fine Gael candidate in the constituency in which I live saying that the party will not proceed with the fair deal. I am not trying to make a political point. I was surprised to see that because, in fairness, I think Deputy Reilly is supporting it and it has great support from older people and their relatives. The introduction of the fair deal will greatly alleviate the pressure on acute hospitals. We do not have the money to procure more beds in the private nursing home sector for the kind of numbers that require them. It is not fair that 90% of the cost of care is paid for by the State if one is in a public bed or in a public facility but if one is in a private nursing home, on average, one has to pay 60% of the costs oneself.
We have a question later about primary care. There are a number of good pilot projects currently under way.
We must move on but I wish to allow Deputy Reilly to ask a brief supplementary question.
I do not accept that we do not have the money. We are spending approximately €5,000 a head in this country on health care while the spend in Holland is €4,000. That country seems to be able to do it but we are not doing it. I can only attribute that to the Minister.
To what does the Minister refer in the context of the six-hour target? Does she mean six hours from the time of arrival in an accident and emergency department? That could not be true. Does she mean six hours from the time the accident and emergency doctor decides a person needs admission, or is it six hours from the time the admitting doctor comes from elsewhere in the hospital, which could be 12 hours from a patient's original arrival in the accident and emergency department? To which of the three does the Minister allude when she refers to patients being treated within six hours?
In Holland, a visit to a GP is €24.80. If we could have a similar cost in Ireland we would be able to do far more.
What is the cost?
GPs receive €24.80 for a visit to their practice and the cost of a telephone consultation is €12.40. In comparing Holland to Ireland we need to compare like with like.
I was talking about six hours from the time of arrival, not six hours from the time a patient is seen. That is the new measurement tool. A total of 92% of patients who attend accident and emergency departments in the 19 hospitals who do not require admission are seen within that six-hour timeframe.
What about the ones who require admission? They are the ones who are waiting on trolleys.
4 Deputy James Reilly asked the Minister for Health and Children if she made Professor Brendan Drumm and the Health Service Executive aware of the loss of income to hospitals in fees from private patients admitted by new type A public-only consultants, which is estimated to cost in the region of €50 million; and if she will make a statement on the matter. [20549/09]
I do not believe that there will, in fact, be a loss of €50 million to public hospitals arising from the new consultants' contract, and I will set out the reasons. A central objective of the new consultants' contract is to improve access for public patients to public hospital services. It ensures, for example, for the first time in public hospitals, that patients needing outpatient or ambulatory diagnostic care will be seen on the basis of medical need, with no distinction between public and private status.
Consultants holding the public-only, type A contract do not undertake any private work and no patient admitted under the care of such a consultant can be accorded private status. Public hospitals may not, therefore, impose a private accommodation charge where a patient is admitted under the care of a type A consultant, nor may another consultant involved in the treatment of such a patient charge a fee. Approximately 560 of 1,550 consultants who have accepted the new contract have this type A contract.
Public hospitals earn income from health insurance companies for private patients admitted only to designated private beds. The only way that the HSE could be at a loss of €50 million, as a result of the new consultants' contract, would be if designated private beds in public hospitals went unoccupied by private patients for a significant part of the year. I do not expect that to happen, because approximately 1,400 consultants will still be in a position to treat private patients in public hospitals. It can be expected that the 980 consultants on the new contract who are allowed private practice, plus the approximately 400 consultants remaining on the old contract, will continue to admit and treat sufficient numbers of patients, so that there will be little, if any, loss of private bed income to the hospitals concerned. Thus, in practical terms, I do not expect a €50 million loss, or any material loss, to public hospitals as a result of the new contract.
Then the Minister disagrees with her Government colleagues who raised the matter at the Committee of Public Accounts. I do not accept what she said, in the sense that if a person is admitted under a particular consultant who is on-call on the night, who is a type A consultant, that patient will be a public patient and that income will be lost to the hospital. Time will tell which of us is right.
Let us consider what has happened in the past, especially in regard to other undertakings that have been given, for example, the plan in 2008 to reduce the reliance on outside consultants. In 2007, a total of €16.45 million was spent in that area and the princely sum of €100,000 was saved in 2008. Can the Minister explain why additional funding for outside consultants is required when she has more than 113,000 people working in the HSE?
There is a misunderstanding. The hospital does not get a fee for every private patient who goes into a public hospital. A hospital only gets a fee for a patient if he or she is in a designated bed and only approximately 20% of beds are private beds. Sometimes half the numbers of patients in a hospital can be private patients but the hospital does not get any fee for them. It can only charge the insurer for the people in the designated private beds. That is a fact. The doctor on the other hand can get a fee regardless of where a patient is located. We sought to eliminate some of the perverse incentives that existed. I make no apology for saying that if taxpayers fund a public hospital in the State, pay for the capital infrastructure, pay for all the staff and the diagnostics then there should not be preferential treatment for one class of citizen over another.
The reliance on consultants is being reduced all the time. Out of a €16 billion budget, by any standards the amount spent on outside consultants is relatively small. We do not have all the expertise in the public sector. It is not uncommon across the public sector in Ireland, Northern Ireland, the United Kingdom, and across Europe, including the Netherlands, for outside expertise to be recruited from time to time to advise and help. It would not be cost effective to have that expertise within the public system.
I find it interesting that the Minister compares us to the North of Ireland, the United Kingdom and other countries. It might be interesting to do a comparative study to find out what they spend on outside consultants in health, and also to compare the number of people they have working within their health service who are engaged in PR and other advisory roles. Will the Minister carry out such a study?
The administrative costs of the Health Service Executive and the National Health Service, NHS, are approximately the same at 16% of the budget. As Deputy Reilly is aware, the NHS is outsourcing a significant amount of activity to the private sector. My point is that we should become less obsessed with whom pays whom to do what. We should be more concerned with patients and getting access for patients to good quality treatment, which is what we are seeking to do.
5 Deputy Alan Shatter asked the Minister for Health and Children the details of the seven recommendations made in the report published on 12 May 2009 on the Monageer inquiry which are blacked out in the report; and the reason submissions to the committee of inquiry by persons in respect of whom adverse findings were on page 10 of the report to be published with the report in redacted form and appended to the report have not been so published. [20740/09]
I am not in a position to comment on any of the content of the report that has been redacted following legal advice, and that includes recommendations so affected. I indicated at the outset that I was determined to publish as much of the report as was possible following legal advice and in the public interest, and that is the context in which the redacted report was published on 12 May 2009. The report is very strong in its criticisms, and the Government is determined to meet its commitment to address issues around service provision for children and families most in need of assistance.
The CEO of the HSE and the Garda Commissioner received the full report in their capacities as heads of the statutory bodies with responsibilities in regard to matters which were the subject of the inquiry. It is intended that this will enable all the recommendations, including those redacted, to be addressed in so far as they apply to their respective organisations. At the time of seeking legal advice I also asked for a determination in regard to the publication of the submissions appended to the report. The legal advice I received was that the content of the submissions should not be published. All the redactions in this report have been done solely on legal advice. I am considering the option of apprising the Oireachtas Joint Committee on Health and Children of the substance of the redacted recommendations in a manner and context that ensures the rights of those involved are protected and no reputational damage is suffered. That process is ongoing and I am seeking legal advice in that regard.
Can I put it to the Minister of State that the culture of secrecy and cover-up is alive and well in his Department? Can I put it to him that it is the type of culture that led to the tragedies depicted in the report published by the commission yesterday? Can I put to him that his response to this issue is an entirely institutional response and not a common sense human response on how matters should be dealt with? This tragic case resulted in the lives of two children being taken. The report that was published on it has disclosed serious systemic problems within our child care services of a nature that we have seen in other reports.
In the report published yesterday, the Department of Education and Science was criticised for giving undue deference to the church and church bodies, and not giving priority to the welfare of children. The congregations were criticised for giving priority to avoiding scandal and publicity as a consequence of the perpetration of abuse on children, rather than giving priority to the safety of children. It seems that the priority of the Minister of State and the Government is to protect reputations of State agencies and State employees, and that is the reason given for not publishing this report and its recommendations in full.
The priority that needs to be given is a priority to the welfare of children. Will the Minister of State accept that he is not giving that priority? There is no possibility of transparency or accountability in circumstances in which seven specific recommendations are blacked out of this report, which is the first time in the history of the State that this has happened. An inquiry has been conducted and recommendations made to improve services or change laws — I do not know what is in them — have been censored and concealed from the public and from Members of this House. The Minister of State's alternative suggestion of briefing a committee of the House is grossly inadequate.
I have said it before and I will repeat that I had no obligation to publish anything in this report. I was anxious to publish as much of it as I could, subject to the legal advice that I received. If we were in the business of cover up, none of the report would have been published. The most hard hitting recommendations would not have been published. Those parts that were not published were not published for specific, legal reasons and not for any other reason. The suggestions by Deputy Shatter that we are in the business of protecting reputations at the expense of the welfare of children is a false dichotomy. We must respect the fact that this was a non-statutory inquiry with which people co-operated on the understanding that no adverse findings would be made against individuals.
I wanted to publish as much of the report as possible for both the public and health professionals to understand the circumstances that led to this terrible tragedy so that, in so far as possible, this would not happen again in the future.
One of the central recommendations of the report published yesterday by the commission of inquiry into child abuse was that "management at all levels should be accountable for the quality of services and care". While the conclusions of this report were that even if the services had operated properly, the lives of the people concerned may not have been saved, nobody knows this for certain. There were major failings within the services, such as a lack of communication, a lack of availability of professionals, and wrong judgments made. The very out-of-hours service on which the Minister of State now wants to rely, whereby gardaí are to make judgments as to whether children should be taken temporarily into care on an emergency basis is contradicted by the report, which states that the gardaí did not regard themselves as qualified to make that assessment. That was the reason given for the drive-by of the house of this tragic family by the gardaí who visited the house.
For the Minister of State to suggest that he had no obligation to publish this report is to deny the fact that he is accountable to this House for children's services and social services that are applied to protect the welfare of children. Is the Minister of State telling this House that no matter what happens with regard to the areas that fall within his remit, he is not accountable? Will he accept that it was his predecessor and this Government who chose to make this a non-statutory inquiry? A statutory inquiry could have been held within the framework of the new legislation enacted during Michael McDowell's time as Minister for Justice, Equality and Law Reform. It would have created no difficulty. In so far as there are legal difficulties, the redacted portion of the report, furnished by individuals in respect of whom some findings were made and allowing them to comment on it, addressed any such legal difficulties.
The Minister of State's response is an institutional response obsessed with protecting reputations, with no concept that any State employee, any State agency or even the Minister of State himself are accountable to this House for the manner in which our social services and child care services are run.
I reject all of that. I consider myself fully accountable to this House and to its committees. I discharge my responsibility with a great seriousness. I do not discharge it on an institutional basis, but to the best of my ability. Deputy Shatter referred to section 12 of the Child Care Act and the obligation of the Garda Síochána. That obligation exists and should be discharged. The HSE needs to co-operate with the Garda Síochána, which was one of the issues that came up regarding Children First. It is something on which we need to work all the time, to make sure that the relationship between the Garda and the HSE——
Gardaí are getting no special training on how to operate on that.
——and their obligations are understood among each other.
The Ryan commission report is an absolute catalogue of failure and neglect by the State and religious congregations. The Cabinet has undertaken to consider it next week, and a debate will take place in this House on 9 June. We will be able to go into it in more detail then.
