Dáil Éireann debate -
Thursday, 21 May 2009

Vol. 683 No. 2

Other Questions.

Health Service Staff.

Joe McHugh

Question:

6 Deputy Joe McHugh asked the Minister for Health and Children if, regarding plans of the Health Service Executive to establish 530 primary care teams at 200 sites by 2011, and in view of the moratorium on recruitment, she has received a staff relocation plan from the HSE for the transfer of existing staff from hospitals to the community; if not, when she expects to receive same; the number of contracts signed for the development of primary care centres to date; and if she will make a statement on the matter. [20616/09]

Eamon Gilmore

Question:

74 Deputy Eamon Gilmore asked the Minister for Health and Children the number of primary teams that are fully operational; if initiatives are planned to speed up the process of establishing these teams; and if she will make a statement on the matter. [20461/09]

Deputy Mary Harney

I propose to take Questions Nos. 6 and 74 together.

The aim of the HSE's transformation programme is to have 530 primary care teams developed by 2011. A total of 110 teams are in place at the moment. The health professionals in these teams are holding clinical team meetings and delivering integrated comprehensive care to patients. The HSE aims to have a further 100 teams in place by the end of 2009. A number of these teams are at varying stages of development. Many have initial team members identified, while some have staff assigned and are holding team development meetings. The remaining 320 teams will be developed over the period up to 2011.

The continued roll out of primary care teams will be achieved primarily by assigning existing professional and other staff working in primary, community and continuing care services to the teams. Each local health office is developing plans to reconfigure existing community clinical and other staff in this way. Over 850 health professionals have already been assigned to primary care teams and a further 2,700 staff have been identified who will work in primary care teams as the extra teams are rolled out.

The moratorium on recruitment and promotion does not apply to allied health professionals such as speech and language therapists, physiotherapists, occupational therapists and social workers. In fact, these will be increased in order to support the delivery of integrated services to groups like the elderly, children at risk and people with a disability. The HSE also intends, as part of its overall transformation programme, to redeploy into community services a significant number of staff from acute hospitals and corporate functions. The steps necessary to give effect to this are currently being finalised.

A programme to lease 200 new primary care centres from the private sector was announced in the budget. Primary care teams are using, and will continue to use, existing HSE buildings and some of the new centres will accommodate more than one primary care team. The HSE board has already approved the commencement of negotiations in 150 locations and contracts are being finalised for 70 of these. The first group of 80 is due to open next year and the full complement is due to open in 2011.

Deputy James Reilly

This is where we lose touch with reality. Listening to the answers given so far today one would think all is well with our health service when clearly it is a shambles, as evidenced by this attempt to put in place a virtual service in respect of primary care. The reality is there are very few primary care teams delivering new services to patients. The Minister referred to physiotherapy and speech and language therapy. Practically all of those who qualified as physiotherapists last year are either unemployed, working in McDonalds and in petrol stations or gone abroad.

We are only moving around the cushions on the deckchairs on the Titanic . No new staff are being recruited. No doubt the Minister will be able to point to one or two areas to which new staff have been recruited. How many contracts have been signed this year in respect of the new centres? It is no wonder the Minister can come up with hilarious language, such as “commencement of negotiations” given the number of PR gurus working for the HSE and in the Department of Health and Children. We started this process in 2001 and in the middle of 2009 only ten primary care centres have been built. At this rate, it will be the end of the 21st century before all are in place. How many contracts have been signed this year with general practitioners? Does the Minister accept at this rate of progress it will take decades to put in place all the centres, without which we cannot fix the health service? What plans does she have to expedite this process?

Deputy Mary Harney

I am the first to admit that all is not well in the health service. That is the reason we are involved in a massive programme of transformation in terms of how we do things and the way people work. Primary care is about bringing together under a new working arrangement existing health professionals who very often treat the same service users. I recently visited Ballymun health centre, with which I believe the Deputy is familiar, where I heard firsthand from a public health nurse that, as a result of the bringing together of all services in a physical building, she had been able to cut down by about half of one day a week the length of time she spent on the telephone speaking to colleagues, social workers and other professionals. This is about people working differently and together.

The Deputy will be aware — I believe he supported the proposal — that the infrastructure will in the main be provided by the private sector. There have been huge expressions of interest in the investment, which is worth approximately €1.5 billion. The HSE board has approved 150 different locations and contractual arrangements have been put in place in respect of 70 locations. Given this was only announced in the budget last year, it has been incredibly successful. This is not alone about buildings but about existing health professionals working together.

As I stated, we are moving to a situation whereby there will be recruitment this year of key therapists, who are not covered by the moratorium or the voluntary early retirement scheme.

Deputy Jan O’Sullivan

We all agree that primary care teams are good. What is at issue is how to achieve them. Perhaps the Minister would drop her ideology for a minute in dealing with this matter. The Minister said it was stated in the budget that the private sector would provide premises and so on. That is not working. I know it is not working. I know of general practitioners who are receiving letters from auctioneers asking if they would like to locate in particular primary care centres.

Last week, the Joint Committee on Health and Children visited an excellent primary care centre in Mitchelstown, County Cork led by general practitioners from Mitchelstown. It provides a number of services and works in co-operation with hospitals in the north Cork area and in Cork city. It is really good. A point made to me during that visit is that this service should be professional rather than developer led and it should be a not for profit service.

I am asking the Minister to ensure a model is set up that works, involves the professionals who deliver health care and works for patients.

Deputy Mary Harney

The Deputy is wrong; the service is not developer-led. Primary care centres cannot go ahead without general practitioner involvement. That is a fact. The Deputy will be aware that many of the successful projects have been promoted by general practitioners. I note a facility involving practically all general practitioners in the Killarney area has just been refused planning permission, which is unfortunate.

Who owns the building is not of concern to me nor, I believe, to patients. The State does not have €1.5 billion to invest over the next couple of years in buildings for primary care teams. I have no problem with general practitioners or general practitioners in conjunction with others, raising money to provide them, as has been done in some cases. The key requirement is to have these teams in place as quickly as possible. As I stated, currently 110 are in place and it is hoped that will increase to 200 by the end of the year. Also, 2,700 people are currently in discussions in relation to working on those teams. These are people currently employed by the public health service.

Deputy Caoimhghín Ó Caoláin

Enhanced primary care teams have been presented as a way of addressing overcrowding in hospitals and, unbelievably, as a substitute for acute hospital care in the context of the downgrading of local hospitals in areas such as Monaghan, Dundalk, Nenagh, Ennis, Cork and Kerry. How is this enhanced care in the community to be delivered under the embargo on recruitment? From where will these additional frontline health care workers come?

Everyone in the State is entitled to free inpatient hospital care but there is no universal entitlement to primary care services such as public health nurses, physiotherapists, speech and language therapists and so on. How is the Minister going to square that circle? Why is there no provision of psychiatric nursing services on primary care teams? Mental health nurses working in the community provide a different service in that they deal in the main with cases already diagnosed. To give an example, currently in the Monaghan area, owing to the non-replacement of nurses on the community mental health teams, there is a reduced ability to conduct assessments. All health care providers in the community need to be able to refer people about whom they have concerns to a qualified psychiatric nurse who is part of a primary care team. Will the Minister provide psychiatric nurses as an integral part of primary care teams? Currently, no such provision is made. What are the Minister's real plans?

Deputy Mary Harney

We have, in the past few years, employed an additional 12,000 nurses in the public health system. Deputies will be aware from the OECD report which examined regulation and public sector services in Ireland that we have the highest ratio in the entire OECD. In fact ours is double the ratio in France and is substantially higher than the ratio in Northern Ireland and the UK.

My colleague, the Minister of State, Deputy Moloney, is rolling out A Vision for Change in respect of which I accept there have been some delays. A number of additional mental health teams, in particular in respect of children and adolescents, will be put in place this year. There is a robust debate about who should comprise membership of the primary care team. Pharmacists have made a case for their involvement. Deputies will be aware pharmacies are a commercial enterprise. There are many issues arising in regard to the precise make up of the team. It is important that, within the new primary care centres, the services being provided in a region are provided in one location and that staff treating the same clients or patients do so as part of a team.

An Leas-Cheann Comhairle

I will allow a final brief supplementary question from Deputy Reilly.

Deputy Caoimhghín Ó Caoláin

There is no universal access. How will the Minister square that circle in relation to universal entitlement? These are not alternatives to existing acute hospital services.

Deputy Mary Harney

We can have a debate about universal access but at a time when we are under pressure to provide services for those who need them most, that is quite a bit away.

The promised eligibility and entitlement legislation is——

Deputy Caoimhghín Ó Caoláin

It has been promised for nine years in the programme for Government.

Deputy Mary Harney

I accept that. It is major legislation.

Deputy Caoimhghín Ó Caoláin

It is also included in the current programme for Government.

Deputy Mary Harney

It is incredibly complex legislation in regard to who is entitled to what, an issue on which we need clarity as soon as possible.

Deputy Caoimhghín Ó Caoláin

The Minister cannot say when it will be published. That is not a response. None of that is a response.

An Leas-Cheann Comhairle

I call Deputy Reilly on a brief supplementary question.

Deputy Caoimhghín Ó Caoláin

I do not think it is very far away given the closure of acute services at Monaghan General Hospital.

An Leas-Cheann Comhairle

I call Deputy Reilly.

Deputy Mary Harney

I understand Deputy Ó Caoláin is to see the new service tomorrow at 11.30 a.m.

An Leas-Cheann Comhairle

I have called Deputy Reilly.

Deputy Mary Harney

I hope the Deputy will go to see it.

Deputy Alan Shatter

The Minister will have her spies out.

Deputy Caoimhghín Ó Caoláin

That is not an alternative.

Deputy James Reilly

I asked the Minister a question earlier which she has not answered. I will ask it again. However, before I do I point out that the new Fine Gael policy, "Fair Care", will provide free GP care, a free medication package and robust community mental health facilities in each of our primary care centres.

An Leas-Cheann Comhairle

A question, Deputy, please.

Deputy James Reilly

Seo í an cheist. Chuir mé an cheist chéanna cúpla nóiméad ó shin.

An Leas-Cheann Comhairle

Go díreach, le do thoil.

Deputy James Reilly

How many contracts has the Minister signed with GPs for these new centres in the past 12 months? I do not want to know about the commencement of negotiations, sites identified or virtual primary care teams. I have heard about all of that.

Deputy Mary Harney

I would like Deputy Reilly to get the independent unit in the Department of Finance to cost his "Fair Care" proposal. It proposes that nobody will pay any more money. Who will pay for this universal access?

Deputy James Reilly

We are paying €5,000 a head and in Holland they pay less than €4,000.

Deputy Mary Harney

The last time the Deputy was involved in universal access, he nearly broke the bank with what we had to pay the doctors.

Deputy James Reilly

I am only trying to be helpful to the Minister.

An Leas-Cheann Comhairle

Allow the Minister to give a brief final reply.

Deputy Mary Harney

As the Deputy knows, I am not involved in any negotiations nor would it be appropriate for me to be involved in negotiations.

Deputy James Reilly

The Minister does not want to answer.

Deputy Mary Harney

That is entirely a matter for the procurement service within the HSE. No contract will be signed unless general practitioners are involved as the Deputy knows as well as I do.

Deputy James Reilly

For the record of the House only one contract has been signed at the moment despite all the hype and spin that has come from the far side of the House.

An Leas-Cheann Comhairle

The tradition is that the Opposition asks the questions and the Government answers them.

Deputy Caoimhghín Ó Caoláin

The Leas-Cheann Comhairle should mention that to the Minister. She has not responded once.

Health Service Inquiries.

Deirdre Clune

Question:

7 Deputy Deirdre Clune asked the Minister for Health and Children if she will make a full copy of the Monageer inquiry report available to the Houses of the Oireachtas; the reason seven out of 26 recommendations have been blacked out; and if she will make a statement on the matter. [20576/09]

Deputy Barry Andrews

As I have indicated, I am considering the option of apprising the Oireachtas Joint Committee on Health and Children on the substance of the redacted recommendations in a manner and context which 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. Some seven of the recommendations of the report were redacted following legal determination. I cannot comment on aspects of the report that have been redacted or the basis for the redactions, nor am I in a position to publish the full report.

I take this opportunity to restate my assertion that there is much to be learned from the report despite the legal necessity to redact certain aspects. Recent initiatives aimed at improving services to children and families include the establishment of an emergency place of safety service for children; the putting into place by the HSE of a more integrated multidisciplinary approach to out-of-hours services; the commencement of a comprehensive review of nursing services in the community, which will cover public health nursing services; the preparation of a framework for the delivery of early intervention services, covering both statutory and non-statutory providers to ensure a standard and consistent approach to service delivery; and the establishment by the HSE of a task force to standardise policies and procedures for child protection and welfare services across the country.

The Garda Síochána has committed to incorporating the findings of the Monageer report into Garda practices and procedures, which I welcome.

An Leas-Cheann Comhairle

I call Deputy Reilly.

Deputy Caoimhghín Ó Caoláin

On a point of order, why has Question No. 7 not been grouped with similar questions as was the practice with the first non-priority question? I refer to Question No. 22, which would be the first and there are others.

Deputy Jan O’Sullivan

Including Question No. 36.

Deputy Alan Shatter

Logically they should be grouped.

An Leas-Cheann Comhairle

The Chair has no control over grouping, which is a matter for the Minister or Minister of State.

Deputy Caoimhghín Ó Caoláin

It is very poor that questions that are exactly the same are not being grouped under this response.

An Leas-Cheann Comhairle

It is a procedural matter that the Deputy might like to raise subsequently.

Deputy Caoimhghín Ó Caoláin

I would like to ask a question that is appropriate at the end.

An Leas-Cheann Comhairle

Absolutely.

Deputy James Reilly

I support my colleague in this matter. It is normal that they would be grouped.

An Leas-Cheann Comhairle

As a number of Deputies have an interest in the matter, I will be flexible with the time.

Deputy James Reilly

I thank you, a Leas Cheann Comhairle. As Deputy Shatter has said, never before have we had recommendations blacked out of a report. The Minister of State's assertion that it is only the most hard-hitting recommendations that are left in beggars belief. Does he think the public will buy that? The public only has his word for that. That will not do. At a time when we need to protect our children we need transparency. That is the first step towards accountability which needs to occur before we get fairness. We have not had fairness for our children. This has been the case in the past and it continued until the not distant past.

An Leas-Cheann Comhairle

A question, Deputy,

Deputy James Reilly

Has the Minister of State accepted recommendations 8.1 to 8.14 and 8.22 to 8.26? A simple "Yes" or "No" will do in response. Will he supply the details of the implementation plan, which has been put in place for each recommendation? Will he identify who has ministerial responsibility for ensuring each of the recommendations is implemented? How can we be sure they will be carried out when we do not know what they are? Will the Minister of State issue them to an Oireachtas committee for its perusal? That is the only way we can get some transparency. After 50 years of people being kept in the dark, this is no way to treat this report.

Deputy Barry Andrews

I did not say the most hard-hitting recommendations were left in and less hard-hitting ones left out. I simply said that those recommendations that were published were hard hitting. I was trying to underline the point that we were not in the business of censoring or covering up whatsoever.

Deputy Alan Shatter

The Government has censored it.

An Leas-Cheann Comhairle

Allow the Minister of State to continue.

Deputy Alan Shatter

We are going backwards.

Deputy James Reilly

The Minister of State appears to be saying, "I told you everything, but I am not telling you that".

An Leas-Cheann Comhairle

Allow the Minister of State to respond.

Deputy Barry Andrews

The point I am trying to make is——

Deputy James Reilly

It is abuse of the English language at its meanest that disturbs me.

Deputy Barry Andrews

You are suggesting that there is a cover-up and we are trying to protect reputations.

Deputy Alan Shatter

Yes, you are.

An Leas-Cheann Comhairle

We will have the debate through the Chair.

Deputy Barry Andrews

That is simply not the case.

Deputy Alan Shatter

Reputations are of more concern to the Government than the welfare of children.

An Leas-Cheann Comhairle

A number of Deputies would like to contribute. It is a very serious matter. Please allow the Minister of State to speak without being interrupted.

Deputy Barry Andrews

The recommendations will need to be taken on board by the relevant statutory authorities and the Ministers responsible. Regarding their implementation, I am seeking advice on how I can circulate to the Oireachtas Joint Committee on Health and Children the substance of the recommendations and also ensure that the committee would be satisfied that those recommendations would have been followed through. I cannot say what the outcome of that process will be. It is very serious to have recommendations in this fashion. I am constrained by legal advice, there is no other constraint. I have not directed any redaction. I am doing what I can within the confines of the law, and within the rights of people to their privacy and good name. I am motivated by trying to improve circumstances in social work services for adults and children, and to publish as much of it as possible.

Deputy Alan Shatter

I come back to a question I asked the Minister of State previously and he might do us the courtesy of responding to it fully. Why should the reputation of individuals get priority over the welfare of children? I have previously drawn this matter to the attention of the Minister of State. In order to overcome any legal difficulties with regard to privilege, in 1996 the report into the tragic case of Kelly Fitzgerald was referred to an Oireachtas committee, which then published it. Why can that not be done in this case? To what extent has that option been considered? Does the Minister of State seriously want to stand over the reason for not so proceeding that he gave in a recent Irish Independent article? He said that in the case of the Kelly Fitzgerald report the parents implicated in the report had already pleaded guilty to charges of neglect and the same legal constraint did not apply. Is the Minister of State telling the House that because the parents in that case were convicted of neglect the report could be referred to an Oireachtas committee for publication but because the parents in this case died the report could not be furnished to an Oireachtas committee? Is the Minister of State seriously putting that to us?

I draw to the attention of the Minister of State that the principal recommendation is the provision of the out-of-hours service that the Minister of State has said he would not implement for financial reasons. To what extent can we take seriously any pledge he gives of an intention to implement redacted censored recommendations of which no one in this House has any knowledge?

Deputy Barry Andrews

I replied to the first question. I do not believe there is a choice between reputations and protecting the interests of children. I believe that is a false dichotomy as I said before.

Deputy Alan Shatter

It is the choice the Minister of State relied upon.

Deputy Barry Andrews

It is possible to do both and it is not an either-or situation. It is a very simplistic analysis of the situation. I have tried to do that. I have tried to protect the reputations and the legal rights of individuals as well as to——

Deputy Alan Shatter

Are there any circumstances in which it would be possible to make adverse findings or should nobody be held to account?

An Leas-Cheann Comhairle

Please allow the Minister of State to reply.

Deputy Barry Andrews

I want to publish of as much of the report as possible for the benefit of the general public and health professionals. I recall that the morning after the Monageer report was published, Deputy Shatter admonished the Taoiseach on his lack of historical memory of the Kelly Fitzgerald case. To refresh the Deputy's own memory, the Minister of the time, who was a Fine Gael Member, was heavily criticised for not publishing that report for five months.

Deputy Alan Shatter

Rightfully criticised.

Deputy Barry Andrews

The only difference between then and now is Deputy Shatter is sitting on the Opposition benches.

Deputy Alan Shatter

That is why we solved it.

Deputy Barry Andrews

He is allowing himself to bathe in self-righteousness in the typical way he addresses this House every time he enters the Chamber.

Deputy Alan Shatter

I solved that problem and criticised that Minister.

An Leas-Cheann Comhairle

Allow the Minister of State to continue.

Deputy Barry Andrews

In the Kelly Fitzgerald case, of course I am not trying to suggest——

Deputy Alan Shatter

The welfare of children comes first, not politics.

Deputy Barry Andrews

——that because the tragic Dunne family——

Deputy James Reilly

The Minister of State is attacking the messenger and ignoring the issue. That is his only defence these days.

An Leas-Cheann Comhairle

I have a duty to allow free speech in this House. Please do not shout down Members.

Deputy Alan Shatter

The Minister of State is attempting to make a crass political point——

An Leas-Cheann Comhairle

Please allow the Minister of State to answer.

Deputy Alan Shatter

——without realising that I was one of the former Minister's most vigorous critics.

An Leas-Cheann Comhairle

I will have no option but to adjourn the debate if Members are not allowed free speech without interruption. Please allow the Minister of State to respond to these very serious questions.

Deputy Barry Andrews

I did not intend to suggest that the tragic deaths of the parents of the Dunne family were distinguishable from the Kelly Fitzgerald case. I was trying to underline that, as Mr. Justice Seán Ryan alludes to in his report, where a conviction has already been achieved there are fewer constraints on the publication of matters causing reputational damage. The publication of the Kelly Fitzgerald report was facilitated for that reason. My legal advice is that the publication of the Monageer report in full would result in reputational damage. I believe the extent of its publication ensures that we have as much information as possible about how this tragedy came about. We lose sight of that in concentrating on matters which are of importance to Members of this House rather than on what we need to learn from the report in regard to our responsibilities as members of the public and health professionals.

An Leas-Cheann Comhairle

We have gone over time but I wish to facilitate other Deputies. I call Deputy Jan O'Sullivan.

Deputy Jan O’Sullivan

In his initial reply to Question No. 5, the Minister of State noted that he may apprise the Joint Committee on Health and Children of the content of the redacted recommendations of the Monageer report. I put it to him that he will build greater public confidence in the Government's good intentions if he finds a way to publish the recommendations rather than apprise the committee of them. Does he agree that the writers of this report must have intended that the recommendations be studied because they would not have made them otherwise? There is little point in making recommendations if it is not intended for them to be implemented. Is there a way for the Minister of State to publish the recommendations in full, if need be after removing personal references, rather than apprising us of the seven blanked out recommendations?

Deputy Barry Andrews

I would like to publish as much of this report as possible because I agree that public confidence could be restored by publication. The extent to which it remains redacted will be based on legal advice and I will push as far as I can to ensure the maximum amount is published through whatever device is available to me. I am open to suggestions in this regard from Deputies.

Deputy Jan O’Sullivan

Presumably whoever wrote the legal recommendation received legal advice.

Deputy Caoimhghín Ó Caoláin

I put it again to the Minister of State that precedents exist for putting the uncensored report before the Joint Committee on Health and Children so that it can be published under Oireachtas privilege. Apart from the crutch of legal advice, he has not explained why he will not do this. If he rigidly insists on refusing to allow publication of the full report in any form, will he at least publish the uncensored recommendations? How does he expect the HSE to act on the recommendations contained in the Monageer report if only its CEO is able to read them?

The report states that the public health nursing service offered to children under the age of five is critical to the identification of children in need of intervention but that it is unclear whether the systems in place at present are sufficient to this task. Does the Minister of State agree this is a serious admission and will he immediately undertake a review of this service, as recommended, with a view to its development?

Deputy Barry Andrews

I reiterate that I am seeking legal advice on the extent to which I can apprise the Committee on Health and Children or a sub-committee thereof on the recommendations and whether the committee can prepare a report based on that.

In regard to the specific recommendations to which Deputy Ó Caoláin referred, gaps certainly exist in our child welfare and protection service. That is why I have set this as a priority. We have made significant progress over the past 12 months and for the first time a specific person in the health service will have sole responsibility for the implementation of policy on children and families. A taskforce which is due to report in the coming weeks will standardise the way referrals and assessments of children at risk are conducted. The legacy inherited from the health boards has to be overcome, however. The HSE has announced a review of community nursing and further significant improvements will be made to our child welfare and protection services. Next Tuesday I intend to put before the House a report for 2007 arising from section 8 of the Child Care Act.

Deputy Alan Shatter

Hallelujah. It is only 18 months late.

Deputy Barry Andrews

The 2008 report, which was released recently on foot of a freedom of information request, contains a more detailed analysis of children at risk in various local health service areas. These matters give the HSE and my office opportunities to make a contemporaneous analysis of where problems arise and improvements achieved.

Deputy Caoimhghín Ó Caoláin

My question was specific to the public health nursing service for children under the age of five. The report highlights major deficiencies in that regard.

An Leas-Cheann Comhairle

We have used more than double the time allocated to this question. I will allow Deputy Shatter to ask a very brief supplementary question.

Deputy Alan Shatter

Can the Minister of State tell us the number and identity of the people working in the area of children and social services for the HSE who have access to the full and uncensored report and the seven recommendations?

Can he confirm to the House that the terms of reference given to the Monageer inquiry, which was essentially private, are of the same nature as those applied in respect of the Roscommon inquiry into the neglect and abuse of six children over a period of years? Will the latter report be similar censored and redacted and, if so, will he change the format of that inquiry to ensure its reports and recommendations are fully published?

An Leas-Cheann Comhairle

The latter questions asked by the Deputy are beyond the scope of this question and are a matter for another day.

Deputy Barry Andrews

The only person in the HSE who has a full and unredacted version of the report is its CEO, Professor Brendan Drumm.

Deputy Alan Shatter

Nobody working with children knows the seven recommendations or the full content of the report. That is absolutely insane.

Health Services.

James Bannon

Question:

8 Deputy James Bannon asked the Minister for Health and Children the reason the Health Service Executive Arthritis and Allied Conditions Report completed early in 2008, has not been published; and if she will make a statement on the matter. [20561/09]

James Reilly

Question:

94 Deputy James Reilly asked the Minister for Health and Children the reason the Health Service Executive Arthritis and Allied Conditions Report completed early in 2008 has not been published; and if she will make a statement on the matter. [20552/09]

Deputy Mary Harney

I propose to take Questions Nos. 8 and 94 together.

The working group on arthritis and related conditions was established by the HSE in 2006. The group's report is expected to be completed shortly and will be then considered by the HSE senior management team. It is intended that the work of the group will inform the future planning and delivery of services for people suffering from arthritis and related conditions.

There have been significant developments in this area as a result of the 2005 report of Comhairle na nOspidéal, which recommended the recruitment of a number of additional consultant rheumatologists. The number of consultant posts overall increased from 16 in 2002 to 25.7 currently, including a post for children and young people at Our Lady's Children's Hospital, Crumlin. The recruitment of a second consultant rheumatologist in the north west is underway. In addition, in the period 2005 to 2008, more than 2,700 people were facilitated with rheumatology appointments by the National Treatment Purchase Fund.

Deputy James Reilly

Arthritis is the greatest cause of disability in Ireland today, affecting one in every six people or 714,000 people, yet the Minister referred to the NTPF facilitating more than 2,500 patients, which puts this issue in perspective. The World Health Organisation recommends that Ireland should have one rheumatologist per 80,000 people but the reality is we have one per 400,000 people, which means patients must wait up to five years to see a rheumatologist.

In May 2006 the Minister established a working group on rheumatology. It was announced that the group would conduct a review of the provision of services for people with arthritis and publish a report outlining a comprehensive framework for the development of rheumatology services in Ireland. It was completed in 2008 but the report remains unpublished. When will it be published? What plans has the Minister to address this major shortfall in rheumatology services? How many new posts are planned? When will they be advertised? When will they be filled?

Deputy Mary Harney

I agree there is a major deficit in rheumatology services. Among the reasons for that is that while we have a large number of doctors, there is an overemphasis on junior doctors with too few consultant posts. If we could get the ratio right, the amount we are spending would cover the cost of consultant appointments. As a result of the new consultants' contract, we are in the process of recruiting more consultants across a range of specialist areas, including rheumatology, and this will be financed by shrinking junior doctor posts on a two for one basis. This has been recommended for many years and it is acceptable to the clinical community and to the HSE. Since 2005 I have increased the number of rheumatologists from 16 to 25.7 and we are currently recruiting for a post in the north west.

The publication of the report is a matter for Professor Drumm and the HSE management team. I understand among the issues they are considering is the designation of up to ten specialist centres around the country for rheumatology and linking rheumatology and orthopaedics and so on in a number of centres. Implementation work is delaying the publication of the report.

Deputy Jan O’Sullivan

Will the Minister take cognisance of geographical areas if ten centres are designated? If she repeats what she did under the cancer strategy and leaves a vast swathe of the country without a service, that would not be acceptable, particularly in regard to rheumatology services, which many people need.

We have a lost a great deal of time in the appointment of consultants because of the time it took to renegotiate the consultants' contract. Will that be taken into account in the context of the number of consultants appointed this year and next year? If the negotiations had not taken so long, presumably many of the additional consultants would have been in place at this stage.

Deputy James Reilly

The Minister stated she will shrink the number of junior hospital doctors and the 2:1 ratio will result in more doctors at consultant level. The average working week of a consultant is between 33 and 38 hours while the average working week of a junior hospital doctor is almost 100 hours. If she takes them out of the system, how will she replace the hours? That does not stack up.

It is three years since the working group began its work but its report has not been published. When will it be published? She is the Minister and she must take responsibility. She cannot continually point to the HSE. How many posts will be filled? When will they be advertised? When will they be filled? Her non-answer that the recruitment process is ongoing is the same as saying Christmas is coming but which year?

Deputy Mary Harney

I take responsibility for reports I commission but not for those commissioned by others. Under the Deputy's grand plan, responsibility will be handed over to insurance companies and taken out of ministerial control and, therefore, I will not take a lecture on that.

Deputy James Reilly

They will be directly answerable to the Minister through the regulator. Answer the question.

Deputy Mary Harney

The Deputy referred to the average working time of consultants. The majority of consultants in the public hospital system work considerably longer hours that he says. They work way beyond their contractual commitment, which is 37 hours. The new team approach with a clinical director will ensure hospitals are appropriately covered. Safe care cannot be delivered through the manner in which we organise doctor services in our hospitals and that is one of the issues driving the reconfiguration. What has happened in the mid-west with the 12 surgeons in the region working as a team will deliver much safer, better and more care for patients there.

A large number of consultants have been recruited in recent years. We have almost doubled the number of consultants in the system over the past 15 years and we need to go further. Between 3,000 and 4,000 are probably needed. I encourage all Members to read the new HealthStat information and perhaps the Joint Committee on Health and Children can examine it. It highlights a significant variation in activity across, and within, different specialties. That information could, hopefully, alleviate many of the pressure points relating to access to consultants. One neurologist in Dublin can see 95 new patients a month while another can see between 12 and 20 a month. In addition to increasing the number of consultants, it needs to be ensured that activity levels are appropriate when we make these key appointments.

Deputy James Reilly

How many posts will be advertised? When will they be filled?

Deputy Mary Harney

A number will be filled this year. I cannot say whether that will happen in July, August, September or October. I am not in a position to give the Deputy that information.

Deputy James Reilly

Will the Minister provide it by way of written reply?

Deputy Mary Harney

Yes.

Written Answers follow Adjournment Debate.