Adjournment Debate.

Hospital Services.

Deputy Simon Coveney

I am disappointed the Minister is not present to take this matter, particularly in view of the fact it has been raised by Deputies from three different parties, one of which is in government. I do not normally comment in detail on health policy or health cases. I usually leave that to my party's spokesperson on health. However, what is happening at Our Lady's Children's Hospital, Crumlin, is such a disgrace that as many people as possible must see to it that the cases of the individuals affected by ward and theatre closures are raised. There is also an obligation on all Members to speak for their constituents when they are directly affected by what is taking place at the hospital.

It is not an exaggeration to say that keeping five and six year old children who have complicated, painful and severe spinal deformities and who require surgery on waiting lists for up to six months, or indefinitely in some instances, is a form of State-imposed child abuse. I do not make that comment lightly and I am particularly aware of the debate that took place in this House in the past seven days.

I wish to focus on the case of Conor Coughlan, a young boy from my constituency, who is seven years of age. Due to the fact that his spine is S-shaped and he is a growing child, Conor had what are referred to as "growing rods" inserted into his back on 17 April 2008. Essentially, these steel rods are inserted into one's back in order to try to straighten one's spine. On 13 November 2008, those rods were extended. Conor had been informed that as he grows, the rods will have to be extended. He was due to have them extended again last month. However, when his parents contacted the hospital they were informed he should return in November, one year after the rods were previously extended. This was despite the fact the rods are supposed to be extended on a six-monthly basis.

The Taoiseach recently stated here that necessary emergency surgeries in Crumlin are not being affected by cutbacks. It may well be the case that there is a need to identify further efficiencies at the hospital and that the staff to patient ratios do not compare well with hospitals in other jurisdictions. If we need to bring about change in this regard, that is fine. However, such change should not be achieved at the expense of five and six year old children who face enough challenges without being asked to wait six months for vital surgery. These children have deformed spines and a series of other complications that could be solved through the carrying out of basic operations provided by highly skilled professionals at Our Lady's Children's Hospital, Crumlin. The latter cannot carry out such operations as a result of ward closures and a lack of availability of theatre time there and at other locations.

I am glad Deputy White is also raising this matter. I appeal to her party, which has significant influence over the major party in government, to be brave and to take a stand on this issue. Children and their families are relying on people such as Deputy White to take a stand.

Deputy Mary Alexandra White

I am raising the tragic case of Jamie Murphy because I want to obtain the facts. Jamie and her family are constituents of mine in lovely Graiguenamanagh in County Kilkenny. This little girl suffers from spina bifida and scoliosis, and she requires an extremely delicate operation to address the latter. The Murphy family were informed that their daughter would have the necessary operation. A few days later, however, they were informed that, due to cutbacks, ward closures and problems with intensive care units, it would not be performed. Jamie's parents are very clear in their understanding of what was said during their conversation with her consultant.

I wish to be seek information on two matters. First, has this little girl's operation been deferred as a result of severe limitations on the service from a resource point of view? Second, if this is not the case and if Jamie is fit enough for this difficult surgery, when will she have her operation. If Jamie's operation is considered an emergency and has been deferred as a result of resource constraints, then that is a shocking indictment of our society and how it cares for children who are very ill. The hallmark of a civilised society is how it cares for the old, the young and children who are very ill.

It may be the case that conflicting signals are emanating from Our Lady's Children's Hospital, Crumlin. In such circumstances, I want its representatives and Jamie's parents to sit down together in order to chart a way forward for her. Jamie should have her operation as soon as possible. I am well aware that there are many children like Jamie. Recession or no recession, we must care for those in need. Jamie Murphy is a little girl in need.

This case is extremely distressing. I met Jamie's parents and I am aware that they are extremely stressed with regard to her health. I cannot and will not accept the cancellation of Jamie's surgery, particularly if the latter is considered an emergency and also if the decision not to proceed was due to resource constraints.

Deputy Jan O’Sullivan

It costs a great deal of money to treat and operate on children who are seriously ill. Many of them spend months, even years, in hospital. The parents of four such children — Jamie Murphy, Dakota Rudd, Jack McNiffe and Sarah Dorney — are so desperate that they allowed them to be photographed by the media this week. As public representatives, we all know their heartbreaking stories and we have heard about many more from families who have contacted us.

How can such children be the victims of the country's financial problems? This is the worst of all cutbacks. No civilised society would delay treatment for children who are seriously ill. Like Deputy Coveney, I am disappointed the Minister for Health and Children, Deputy Harney, is not present. However, I call on her to intervene and to provide the money required by Our Lady's Children's Hospital, Crumlin, which is over-budget because it is responding to the needs of sick children. It is frequently very expensive to cater for such needs.

The priority in this instance must be the children. I accept that belts must be tightened, that budgets must be controlled and that major reforms must be introduced with regard to certain aspects of health spending. However, the question of children's health should not be an area where such considerations apply. This is an issue on which the Minister must be for turning.

Our Lady's Children's Hospital, Crumlin, requires in the region of €9.3 million this year to maintain its services. Management at the hospital made severe cutbacks last year in order to balance the books. Despite this, the hospital still managed to increase its caseload. Management has made cuts where possible but it has now been forced to close at least one ward and an operating theatre and to reduce the number of front-line staff. The direct result of this is obvious — sick children must be placed on longer waiting lists. It is estimated that 3,000 fewer children will be seen this year.

The sum of €9.3 million is a tiny fraction of the €15.957 billion that will be spent on health services this year. Surely 3,000 children are more important than most of the items covered under that budget.

They are more important than outside advisers and spin doctors and layers of management. What is the point in having a Minister for Health and Children if she cannot intervene on an issue such as this? She must use her political authority and insist that the funding required is diverted to Crumlin hospital and that it is spent to address the needs of these children.

I have before me a quotation from a parent of one of those children in Monday's Irish Daily Mail: It states:

How can they do this to children? It is one thing loading taxes on adults — we can complain, children can't. Our Lady's Hospital is the only centre in the country for many of the services provided there — how can you cut the only services available in the country? It's going too far.

Minister of State at the Department of Health and Children (Deputy John Moloney)

At the outset I must apologise that the Minister for Health and Children, Deputy Mary Harney, cannot be here this evening.

Deputy Jan O’Sullivan

She should be here.

Deputy John Moloney

She cannot be here this evening, and I am standing in for her by way of making a response.

Hospital care for children is provided in Dublin at three hospitals, Our Lady's Children's Hospital, Crumlin, Temple Street Children's University Hospital; and the National Children's Hospital, Tallaght. Each hospital funded by the HSE is required to deliver services within the financial allocation provided. The priority of the HSE and hospital management is to ensure that services for children at the hospital are maintained at an optimum level. The HSE is fully aware of the financial challenges being faced by the hospital. It is involved in ongoing discussions with hospital management regarding its 2009 financial allocation and service plan. The priority is to ensure that services are maintained at an optimum level.

In common with all hospitals, Our Lady's Children's Hospital, Crumlin is faced with 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 service plan for 2009. The top priority will be to protect patient care.

Deputy Simon Coveney

That is rubbish. That is what the staff want to do, but they are not being allowed.

Deputy John Moloney

That is the commitment given and I accept and believe it.

It has proven necessary for Our Lady's Children's Hospital, Crumlin to take measures to stay within budget. However, the hospital has confirmed that it is committed to delivering on the full level of its service plan commitments for 2009.

Deputy Jan O’Sullivan

How can it?

Deputy John Moloney

The hospital is committed to that. I am not suggesting that the Government is covering up for decisions taken. I am making the point that the hospital has committed and confirmed that it can live up to its service plan for 2009.

So far this year, Crumlin hospital has delivered more treatments to patients than for the same period last year. In the first four months of 2009 there were 3,704 treatments for children as in-patients and 5,095 as day cases — up by 234 over 2008. The allocation to Crumlin for 2009 is €139.6 million, an increase of some 39% over the last 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 has been operating at some 91 posts above its employment ceiling — it employed 1,641 people whole-time equivalents at the end of April compared with its ceiling of 1,550. This is contributing to the current financial difficulties.

Deputy Simon Coveney

While I am aware he did not write his script, does the Minister of State believe that this is an answer with which the parents will be happy?

Deputy John Moloney

I take account of the concerns the Deputies are reflecting on behalf of the families, and I want to respond as honestly as I can. I must come back to the point, however, that the hospital is committed to working within its service plan and I believe it will do so.

Either way, the HSE is working closely with Our Lady's Children's Hospital to achieve an agreed programme of savings, totalling €6.5 million this year. The main focus of these savings will be on non-pay areas of expenditure and on protecting front line services to the maximum possible extent.

The way to provide the best possible tertiary care most cost effectively involves the creation of one single national paediatric hospital, alongside a major teaching hospital, bringing together all the medical and nursing expertise for complex conditions. The concept of bringing together all three present services is widely accepted. It is therefore entirely appropriate that we should now move towards that model of care in terms of closer integration and co-operation in the medical areas and in the most cost effective use of resources.

In 2009 the Government will provide over €250 million for the running of three paediatric hospitals in Dublin. 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 back into patient care. For example, the three children's hospitals in Dublin have agreed and developed a model for the development of a joint department of paediatric surgery. The clinical network across the three hospitals will make the best use of the resources that are available and will ensure a single system of care. The early retirement of an orthopaedic consultant in Cork has increased pressures on the scoliosis waiting list at Crumlin. The National Treatment Purchase Fund has identified a number of cases from the waiting list for treatment at Cappagh Hospital. Further cases are being reviewed.

In addition, discussions are ongoing with the three paediatric hospitals with regard to the provision of orthopaedic services generally and in particular the treatment of children suffering from scoliosis. The hospital has reiterated that no child has been denied access to emergency life saving surgery due to its break-even programme.

Deputy Simon Coveney

It has to be life saving.

Deputy John Moloney

I would not belittle that statement, as it is very important to be able to assure parents that talk of cutbacks are not relevant where it is a matter of life that is at stake.

Deputy Jan O’Sullivan

These are extremely ill children.

Deputy John Moloney

I accept that, but it is also important to nail down the specific commitment in that regard.

The hospital's medical team continues to prioritise each patient on the basis of clinical need.

Deputy Simon Coveney

I accept that, the consultants are excellent but they do not have the resources.

Deputy John Moloney

I do not want to be adding to the response as prepared but it is fair to emphasise that the hospital has said it can remain within its service plan and deliver on the commitments in that.

The hospital does not discuss — I take the points raised by Deputy White — individual patient cases due to confidentiality agreements with the patient and family. I understand that the family in the case mentioned here today have asked the hospital to respect its privacy and not release information in relation to the case. The funding and provision of the best standard of complex hospital care for children will continue to be a priority for the Government.

Sexual Abuse Inquiry.

Deputy Fergus O’Dowd

This is a very serious issue. The findings of the Medical Council against Mr. Michael Shine, following its fitness to practise committee investigation in respect of nine male patients was that in the case of three patients he had abused his professional position by:

. . . making sexual advances to each of these patients; making indecent suggestions and/or behaving indecently to each of these patients; assaulting/indecently assaulting these patients; undertaking inappropriate and/or improper medical examinations and/or treatments of each of these patients; failing to treat each of these patients with due dignity and respect; breaching the trust inherent in the doctor/patient relationship; and bringing the medical profession into disrepute.

The committee found Mr. Shine guilty of professional misconduct in respect of each allegation set out above.

The story did not begin or end with those nine allegations. It appears to go back a long time, almost 30 years, when Mr. Shine first began working in Our Lady of Lourdes Hospital, Drogheda. We in Fine Gael are backing a call by Dignity 4 Patients for a full independent inquiry and are proposing terms of reference to investigate how complaints against Mr. Shine were dealt with over the period of his work as a consultant in Drogheda, by the hospital, the Garda, the Director of Public Prosecutions, the HSE — or the health board at the time — and the Department of Health and Children. We believe, notwithstanding the fact that further complaints have been made to the Garda, that a statutory inquiry can, and has, proceeded in the past during criminal investigations. Such an inquiry, held under the Commissions of Inquiry Act 2004, is held in camera and witnesses are compelled to give evidence. The Ryan inquiry was carried out while criminal investigations were taking place, so there is no reason why this inquiry cannot proceed immediately. We believe that it can keep working, notwithstanding the fact that criminal investigations are proceeding.

This is a harrowing experience for all those males abused by Mr. Shine. It has shocked the country because if it went on for 30 years, who knew about it and why did they not act? What happened when, in 1995, the former health board gave 60 complaints to the Garda? Why were they not all prosecuted in full? What was going on? Very serious players in the HSE and the community and the victims have raised serious concerns about the delay in the process, the fact that there appeared to be no action and the fact that gardaí did not tell other people who made complaints that they had numerous other complaints. People were left in utter isolation and have suffered greatly as a result.

We want transparency in the amount of money set aside by the hospital and the health board. A sum of €2 million was originally set aside to deal with legal issues and actions that might arise against the Medical Missionaries of Mary. That fund now stands at approximately €4 million. While compensation is not the most important issue, it is important that victims are vindicated in their right to privacy and not to be abused and it is important that some method of compensation is found in this case.

There is deep unease that abuse was allegedly inflicted over 30 years. In this inquiry we need to ensure that the perpetrator is jailed, the victims can tell their story and get closure on the case and this never happens again. Whatever recommendations come from the statutory inquiry should ensure the processes and the skilled professionals who have the extra professional knowledge that is required to deal with cases of sexual abuse, are in place. This happens in other countries but has not yet happened here. I urge the Minister to take on board what I have said.

Deputy John Moloney

Again, I apologise to Deputy O'Dowd that the Minister, Deputy Mary Harney, is not available this evening. In 1995, the Irish Medical Council instigated a fitness to practise inquiry but this was delayed pending the outcome of separate legal proceedings, including criminal and judicial review proceedings. Following a Supreme Court judgment in July 2008, the Medical Council recommenced an inquiry and, on 25 November 2008, formally notified the Minister of its decision to remove the name of the consultant from the medical register. The Medical Council made its decision after considering the report of its fitness to practise committee, which found the person concerned guilty of professional misconduct in respect of three out of the nine allegations made by male patients.

In 1995, a review of the hospital's response to the allegations against the consultant was conducted by an independent review group chaired by Dr. Miriam Hederman O'Brien. The review group recommended that common written protocols for dealing with allegations of sexual abuse by members of staff be introduced and applied in all health care institutions. The Trust in Care guidelines, which were published in 2005, deal with the recognition, prevention and management of cases of abuse.

In line with the review group's recommendations, a chaperone system and an intimate examination protocol and procedure has been put in place in the hospital concerned. The review group emphasised the importance of having a complaints system in place to deal with allegations of sexual abuse. A regional complaints policy and procedure is in place for the former north eastern health board. Statutory delegated complaints officers are also in place in the hospital.

A staff support service, staff care, is available to all staff in the hospital on a confidential basis. The Hederman O'Brien review has helped inform the development and updating of policy in this area. This learning has been given practical effect through, for example, the publication of the Children First guidelines, the establishment of the Office of the Ombudsman for Children and the Office of the Minister of State with special responsibility for children and youth affairs and the implementation of the Children Act 2001.

It is clear, therefore, that the issues raised by this case have been the subject of extensive review and action by the Medical Council, the 1996 review and the initiatives taken since then in relation to protecting children. In these circumstances, the Minister has indicated that she does not propose to establish a further inquiry.

Deputy Fergus O’Dowd

That is disgraceful.

Deputy John Moloney

Instead the Minister believes that our focus should be on supporting those affected and ensuring that every possible protection is given to vulnerable people in the future. I have been informed by the Minister for Justice, Equality and Law Reform that gardaí are continuing to investigate complaints relevant to this case, and the investigation has the assistance of members of the Garda national bureau of criminal investigation. I am also informed that appropriate liaison arrangements are in place between gardaí and complainants and groups representing the complainants. The Minister for Justice, Equality and Law Reform has already urged victims to come forward to the investigation team to make statements of complaint.

The Government has taken a range of measures through legislation to deal with child abuse, including the Child Care Act 1991, the Protection for Persons Reporting Child Abuse Act 1998 and the Sex Offenders Act 2001. Children First, the national guidelines for the protection and welfare of children, was published in September 1999. These are national, over-arching guidelines that apply to all individuals and agencies that deal with children. The key message of the Children First guidelines is that anyone who works with, has responsibility for or comes into contact with children should be aware of the signs of abuse, be alert to the possibility of abuse and be familiar with the basic procedures to report their concerns.

It is very important to ensure that appropriate counselling is available to all those who have been in contact with the HSE or the hospital following the recent Medical Council inquiry. The HSE has made arrangements for counselling support for all those who have been in contact with it following the recent Medical Council inquiry using the national counselling service. Over 100 people have made contact with this service and it will continue to be made available as required. The need for additional support will be monitored by the HSE. The Minister and the HSE are anxious that all former patients of the consultant are made aware of the free counselling support that is available.

The HSE has assigned co-ordinating responsibility for these matters to the area manager for consumer affairs in the north east, who will continue to liaise as required with former patients and support groups. The support group, Dignity 4 Patients, has been advised by the HSE on how to make an application for funding under the Health Act 2004 and for national lottery funding. The Minister, Deputy Mary Harney, has indicated publicly that a meeting is being arranged with the group Dignity 4 Patients. I would like to emphasise the Government's commitment towards the protection of the most vulnerable in our society.

Agricultural Colleges.

Deputy Jim O’Keeffe

I make a special plea on behalf of the farming community of the south west following an approach made to me by a number of farming families there. As everybody knows, dairying is the centrepiece of farming activities in the south. County Cork has one third of our dairy production and in the wider context, two thirds of the entire dairy production for the country is in Munster.

The primary educational centre for the dairy industry is the college at Darrara, near Clonakilty, in west Cork. This college is in the heartland of the dairy industry with four major co-operatives in my constituency nearby, with many others throughout the entire south west. My colleague, Deputy Michael Creed, recently described it as an engine of the commercial agriculture sector. The college has done a magnificent job over the years and there has been significant investment over that time, no doubt helped by the support of my former colleague, former Deputy Joe Walsh, who came from Clonakilty.

If we believe in the future of the agricultural industry, there must be great emphasis on practical agricultural education for young farmers. This brings me to the point of this motion on the Adjournment. The recent rationalisation changes have been announced by Teagasc, but the demand for places in Clonakilty Agricultural College is greater than ever and there is major concern among farming families that the college will not be able to accommodate that demand. The college took in 76 new applicants last year from a total application list of upwards of 100. Already this year there are approximately 130 applications with an expectation that this will rise to 200 before the college term begins.

The rub is that on current indications there will be fewer teaching staff next year than this year. There will be a principal, five teaching staff plus two technicians and one job-sharing technician to cover the college's entire student population. The issue is whether the extra demand can be accommodated which is why I am making this special plea to the Minister of State. I am not interested in the business of status but rather the practical nuts and bolts on behalf of the farm families and the parents of young applicants who are already fretting about the problem and concerned that their family members, the young farmers of the future, will not be able to go there.

This issue was recently addressed in the Oireachtas Joint Committee on Agriculture, Fisheries and Food and when the chairman of Teagasc, Professor Gerry Boyle, gave evidence it was clear that his heart was in the right place. In seeking to assure Deputy Creed, who raised the issue, he stated that no student would be turned away because of the rationalisation exercise. He described Clonakilty as the regional educational centre for the south west and spoke about the progress that would be made there. He made it clear that what is being done in Clonakilty would enhance the stature of the college. It is not the stature that I am concerned about. I am concerned for the farm families and what will happen to the young farmers of the future.

The bigger demand is probably attributable to the lack of apprenticeships and jobs from builders etc. There is more of an emphasis on farming for the future. In a way we are back to the future. I firmly believe that farming will be one of the engines from the point of view of exports and otherwise that will help to lift us out of the current recession. It would be totally shortsighted to ignore the pool of young farmers in the country — of course I am mainly concerned about the south west and the dairy industry — and not give them the practical agricultural education they need. We are talking about an investment in the future. I make this special plea to the Minister of State not to turn them away.

The current teacher complement will not be able to cope with the demand. Action is needed now so that the college can make the necessary plans to accommodate the demand, if not in full, as far as possible. While the Minister of State's heart will probably be in the right place, I want a commitment that will allow the college to plan the next academic year to accommodate the great demand now pressing in on top of it.

Minister of State at the Department of Agriculture, Fisheries and Food (Deputy Tony Killeen)

Gabhaim buíochas leis an Teachta Jim O'Keeffe as ucht an méid atá ráite aige agus as ucht deise a thabhairt dom freagra a thabhairt ar an ábhar tábhachtach seo.

The Government fully recognises the importance of agricultural education and training for the development of the agriculture and food industries. This is reflected in the commitment, contained in the programme for Government, to "invest in our Agricultural Colleges and restructure the environment through which they are supported". Due to its important role in supporting the Government's strategy for the agrifood sector, Teagasc receives substantial Exchequer resources each year to enable it to provide first-class training, research and advisory services. The total funding provided by the Department to Teagasc for non-capital purposes has increased significantly in recent years, from €82 million in 2000 to an average of €137 million in the years 2007 to 2009. While this year's allocation to Teagasc of €132 million is inevitably somewhat less than the previous two years, due to the necessary curtailment of public finances, it is nevertheless a substantial amount and an indication of the Government's continuing commitment to supporting the agrifood sector and recognition of the important role of Teagasc in that regard.

I am glad that in recent years we have also been able to provide very substantial extra funding to Teagasc for capital development purposes. This has enabled Teagasc to commence a major capital investment programme with a particular focus on the development of research centres of excellence.

Currently, Teagasc delivers its education and training programme through a network of eight colleges, 80 local Teagasc centres and the Teagasc e-college. It is, of course, entirely a matter for Teagasc and its board to prioritise its activities and to allocate its resources in accordance with these priorities. In this regard a review of college infrastructure, undertaken for Teagasc by an outside consultancy body, was finalised last year and agreed by the Teagasc authority. Arising from this review the authority will be making decisions on priorities in terms of future capital expenditure.

I understand that Teagasc is fully committed to the development of the college in Clonakilty as a first class educational facility. More than €4 million has been invested in upgrading the student and farm facilities since 2001. Earlier this year the dairy herd from Mellows was transferred to Clonakilty and it is planned to bring the herd up to 200 cows in the near future. It is also planned to carry out a comprehensive applied dairy research programme in conjunction with the Moorepark research centre. This, along with increased utilisation of the facility for extension and demonstration activities, will ensure the viability of Clonakilty and enhance the overall student experience.

I understand that the college currently has a staff complement of five teachers, a principal and three technicians, and that Teagasc is exploring the possibility of redeploying some advisory staff to Clonakilty.

Within the various colleges and at a local level, Teagasc provides a wide range of education and training courses targeted at young people planning to embark on careers in farming, horticulture, in the equine industry or forestry, and adult farmers wishing to acquire a skill set or training in a particular area. Further education and training courses are available in agriculture, horticulture, forestry and horses at the agricultural and horticultural colleges. In addition, higher level education courses in agriculture, horticulture, agribusiness, agricultural mechanisation and equine studies are provided jointly with institutes of technology.

All of Teagasc's education and training programmes are accredited within the national framework under the National Qualifications Authority of Ireland. I was pleased to see that there was a very significant increase in college enrolments in the current academic year, which augurs well for the future of the Irish agrifood sector. I am sure that Teagasc will ensure that education and training are provided in the most effective and efficient manner in the years ahead. I am satisfied that Teagasc, with the ongoing support of the Department, can deliver through its integrated research, advisory and education and training programmes, the innovation and technology transfer necessary for the sustainable development of the agrifood sector.

Deputy Jim O’Keeffe

I hope we will now see action on the ground to accommodate all these extra applicants.

Deputy Tony Killeen

Tá an Teachta sásta.

The Dáil adjourned at 9.05 p.m. until 10.30 a.m. on Wednesday, 17 June 2009.

Dáil Éireann debate - Tuesday, 16 Jun 2009