Adjournment Debate.

Cancer Treatment Services.

Deputy Ulick Burke

I thank the Ceann Comhairle for selecting this important item for discussion tonight. The decision of the Minister, Deputy Harney, and the Government to continue to introduce further cutbacks amounting to €15 million at this time clearly puts at risk many of the front line services at University Hospital Galway which will result in the future loss of 60 beds, 126 front line staff and the closure of two surgical theatres. Surely this will hamper the hospital's ability to act or develop as a centre of excellence. Having already indicated potential cuts of €9 million, any further cuts will have a devastating impact on the provision of services at the hospital.

This is the biggest hospital in the west and it is on the verge of pulling out of the cancer treatment scheme. The hospital manager has made an urgent request in this respect because of the devastating impact these proposed cuts will have on the staff's ability to deliver cancer services in accordance with Government policy. She stated that these cuts will bring the hospital to its knees. When such a statement is issued by a hospital manager and neither the Minister nor the Government has shown any concern, the situation is serious.

How on earth can University Hospital Galway be a centre of excellence when its services are to be slashed so severely? The Government's cancer strategy is in disarray and cancer patients in Galway and across the west have been betrayed by the Government and the Minister. These cutbacks will have severe human consequences and will affect the survival of cancer patients across the west.

While I recognise that public spending must be curtailed, why was €17 million spent by the HSE on spin doctors and management consultants last year? There are 12 staff in the Department, four special advisers involving an expenditure of approximately €500,000 and five press officers involving an expenditure of €241,000. The 12 staff involve an expenditure of just under €1 million. Is it true, as per the Minister's constant rhetoric, that the patient is being put first when there is such expenditure on staff in her Department? Professor Drumm has an adviser who was paid €16,000 per month last year. Surely that shows that the patient is not being put first, unlike what the Minister claims.

Is spin more important to this Fianna Fáil-led Government than the lives of the people suffering from cancer and other serious illnesses? It cost €310,000 for the HSE to produce an information leaflet last year. This would provide an additional ten nursing staff in coal face services. Many of the 126 staff who will lose their jobs at University Hospital Galway are highly skilled with a level of knowledge and expertise necessary for the delivery of a first class service. Unfortunately, they are to be let go.

More than 1,000 women with concerns about breast cancer have had to wait more than three months to be seen at one of the eight specialist centres for diagnosis and treatment of breast cancer this year. This is a breach of the HSE's standards set by the Health Information and Quality Authority.

I tabled a parliamentary question to the Minister less than a month ago asking if the HSE had made provision to recruit additional medical and nursing staff to cater for the extra workload in providing specialist cancer care at the hospital because of it becoming a designated centre of excellence. I was advised then that currently, services at University Hospital, Galway, were led by a team of surgeons with special interest in breast cancer, supported by a multidisciplinary team of health professionals, including radiologists, pathologists, nursing, laboratory and allied health professionals. These are the staff who will be hit by the introduction of these additional cutbacks of €15 million. Can the Minister, Deputy Harney, justify her demand for these cuts, if the jobs that were created only less than a month ago, as I was advised in that reply, are to be cut in this instance?

Another spin doctor, Ms Chris Kane, the regional co-ordinator of Western Hospital Group, was reported in a newspaper article as having said:

"Every hospital has to live within budget. In the case of GUH, this would mean less overtime, fewer locums and getting tough on absenteeism. We may be curtailing elective surgery, but vital front line and emergency services will be protected. The leaked internal letter quoted in . . . [the] newspapers was a discussion paper only. It was never agreed," said Ms Kane.

This comment is totally in denial of the previous statement of the hospital manager.

Will the Minister of State tell us tonight once and for all where the truth lies? Will there be a curtailment of services, particularly in cancer treatment, which is looming as a result of proposed cutbacks of €15 million?

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

As the Minister, Deputy Harney, cannot be here this evening, I will reply to the Deputy's matter.

I welcome the opportunity to address the House on the issue of cancer services in Galway. Contrary to some recent claims, I can assure Deputies that the viability of University Hospital Galway as a designated cancer centre under the national cancer control programme will not be affected by the financial issues it is addressing. I am happy to inform the House of several significant improvements made to cancer services at the hospital which will help equip it for its role as a designated centre.

Under the programme, there are four managed cancer control networks and eight cancer centres. The designation of cancer centres aims to ensure that patients receive the highest quality care while allowing local access to services, where appropriate. The HSE has designated University Hospital Galway and the Mid-West Regional Hospital Limerick as the two cancer centres in the managed cancer control network for the HSE west region. In particular, University Hospital Galway is the designated cancer centre for the north west. Since Professor Tom Keane took up his post as interim director of the national cancer control programme, enormous progress has been made in reorganisation and development of cancer services and in University Hospital Galway some significant developments have been made.

Deputies will be aware that the reorganisation of breast cancer services has been the first task of the national cancer control programme. In this context the symptomatic breast cancer service at University Hospital Galway has been greatly enhanced with significant additional resources provided. Funding was provided by the national cancer control programme in 2008 for additional staff to support the expansion of this service. Once-off funding of €403,000 was provided for equipment in 2008 while in 2009 funding of €863,000 was provided for operating costs. Additional pathology equipment was funded to support the breast cancer services as well as theatre equipping at a cost of €l million. This service is now located in a purpose-built premises on the University Hospital Galway campus. There are eight examination suites in the clinical area and each has access to digital radiology and laboratory results. There is a separate radiology area with its own waiting room and changing facilities and this is equipped with a fully digital mammography suite and state-of the-art ultrasound machines. Both the clinical and radiology areas are equipped for biopsy procedures under local anaesthetic. The breast care nurse team has a custom-designed facility which includes counselling rooms with video facilities and light refreshments.

Deputy Ulick Burke

There is no one to work there.

Deputy John Moloney

I am outlining the funding that has been allocated.

A new theatre located in the main hospital block for dedicated use by the breast service is expected to be commissioned within the next two weeks.

Deputy Ulick Burke

Two of them are to be closed down.

Deputy John Moloney

Services are led by a team of surgeons with a special interest in breast disease supported by a multi-disciplinary team of health professionals, including radiologists, pathologists, nursing, laboratory and allied health professionals. Mammography and breast ultrasound are on site in the breast clinic to facilitate ease of access to triple assessment for patients.

UCHG also provides an outreach service to Letterkenny General Hospital so that breast diagnosis and surgery may take place there under a managed clinical network. Video-conferencing on cases allows the extension of multi-disciplinary decision making to Letterkenny General Hospital.

With the reorganisation of breast cancer services almost complete, priorities in 2009 include the development of rapid-access diagnostic clinics for both lung and prostate cancer. Outcomes in these cancers have been poor by international standards and earlier diagnosis is a key factor in improving these. With this in mind, rapid access clinics will be developed in each of the eight designated cancer centres, and UCHG is in the vanguard as one of the first two hospitals to open a clinic. This is a significant development for UCHG and for the cancer programme. The clinic provides fast-track access to early diagnosis for men whose symptoms indicate they are at higher risk. Patients can now be diagnosed more quickly — within two weeks of referral — and if prostate cancer is confirmed, the patient has immediate access to a multi-disciplinary specialist cancer consultation to determine how he should be managed.

I emphasise that the enhanced services at Galway for breast and prostate cancer, which are two of our most common cancers, are significant markers of the real and tangible progress that is being made.

General Medical Services Scheme.

Deputy Pádraic McCormack

I wish to be associated with the matter raised by my colleague Deputy Burke, which he has dealt with adequately.

I am glad to have the opportunity to raise the matter of the proposal by the Government, through the HSE, to transfer medical card and GP visit card services to the primary care reimbursement service and to centralise these services in Dublin. How could this possibly make sense? The transfer is being put forward as a saving or an improvement of the service when it will actually cause a reduction in the level of service available. There are 87,000 medical card holders in Galway who will be left without a local service. Centralisation to Dublin is contrary to Government policy. Why not decentralise it all to Galway? Medical card-related dealings with the over 70s have already been transferred to Dublin. This is creating a major problem for older people, who are now unable to contact the service and are left waiting for long periods on the freefone line. I have had occasion to telephone the service several times on behalf of people who came to my office, and was left waiting for a considerable length of time. How can we expect people over 70 to contact the service in Dublin when they could have had a walk-in service in Galway?

The over 70s are being treated shamefully. They are being terrorised by the new system, which is causing them unnecessary stress and anxiety. It looks as though this may be deliberate, because some of them are now so confused that they will not proceed with their applications for medical cards even though they are eligible. For example, one person who contacted me received a letter in early January of this year stating:

Based on the information available to us in the HSE, you are not affected by this decision [to remove the automatic entitlement to medical cards for the over 70s].

You keep your Medical Card and all associated entitlements.

You do not need to respond to this letter or do anything else.

Please continue to use your Medical Card as normal.

Then, on 24 March, the person received a letter stating:

If you consider that you are still eligible for a Medical Card and wish to continue to avail of the General Medical Service you should complete and return a form MC1a(R) (attached) to the address below before 1 June 2009.

This is completely contradictory information for medical card holders. It was unnecessary to set them up in such a way, first telling them they did not have to do anything and then telling them they must fill in a form. This is complicated and stressful for people over 70, who have already been assessed and means-tested for the card.

The HSE has spent more than €1 million of taxpayers' money on two reports on health reform and then ignored the key recommendations. A recommendation in the McKinsey report was that health care be delivered in six to ten regions with a catchment population of between 500,000 and 700,000. Yet the HSE is proceeding to transfer the medical card service to Dublin, which makes no sense. It will save the HSE nothing because, naturally, staff who have families in Galway — with children in school and houses with large mortgages on houses which are worth much less than they were a few years ago — will not be able to transfer and will have to be redeployed somewhere else.

The centralisation of the medical card service is of no benefit either to the public or to the HSE. It has been the policy of the HSE to have service based locally — for example, primary care teams — yet one section, which is the basis for entitlement to all those services, is now being transferred to Dublin. The front-line staff of the medical card service provide a valuable service locally to people who are ill, vulnerable and elderly. These people will now be left without a core walk-in service or a local number they can telephone. This displays a total lack of understanding of the work being carried out in local offices by the dedicated staff and shows a cruel and complete disregard for medical card holders. The staff in Galway have been working flat-out and providing an excellent service, and the transfer of the service does not make any sense. This is a Government decision, as stated recently by an official at a HSE briefing. For the Government to make such a decision in this day and age is baffling.

Deputy John Moloney

I thank Deputy McCormack for raising this matter on the Adjournment and apologise that the Minister, Deputy Harney, cannot be here this evening.

The assessment of eligibility for medical cards and GP visit cards is statutorily a matter for the HSE. Eligibility is determined following an examination of the means of the applicant and his or her dependents. Up to the start of this year, medical card and GP visit card applications were processed in the 32 local health areas. However, under the HSE's 2009 service plan, the processing of medical card and GP visit card applications will be centralised in the primary care reimbursement service in Dublin. The change is being implemented on a phased basis.

The decision by the HSE to centralise the processing of applications has been made in the context of the requirement to realise savings in the challenging economic environment. The change will provide an enhanced standardised service to the client population. It will deliver services for the public within sustainable levels of expenditure and with the aim of achieving efficiencies through greater use of shared services. The processing of applications centrally will result in the application of a more consistent and transparent approach. There will be no adverse impact on patient care or the quality of service provided, and there will be no adverse affect on the assessment of people whose incomes exceed the income guidelines but who have a case to be considered on medical or hardship grounds.

Under the new arrangements, the HSE will be aiming for a turnaround time of 15 days or less for all applications. Emergency applications will be dealt with immediately, with a card issuing within 24 hours.

Deputy Pádraic McCormack

That is impossible.

Deputy John Moloney

That is the commitment we have made.

There are no plans to close any of the local health offices that currently process medical card and GP visit card applications. However, the process will involve a reassignment of existing staff within the Health Service Executive. Local health offices will continue to provide advice and necessary supports to persons applying for medical cards and GP visit cards. They will also deal with queries of a general nature about the medical card scheme. Together with the Health Service Executive's national helpline, they will handle inquiries from clients in respect of their medical card and GP visit card entitlements.

This is a good example of the type of innovation signalled in the transforming public services programme announced by the Taoiseach last November. It demonstrates how the Health Service Executive can deliver improved services within the more limited resources available in a way which meets the needs of citizens in a modern society. The number of persons with a medical card has increased by more than 240,000 since the start of 2005, with more than 1.38 million now covered. In addition, more than 88,000 have a GP visit card. In other words, in excess of 33% of the national population is covered by the General Medical Services scheme.

Health Service Reform.

Deputy Michael McGrath

I thank the Ceann Comhairle for allowing me to raise this important issue for the community I represent, particularly in the Carrigaline area. Carrigaline is a vibrant and thriving town with a population of some 16,000. In 1971, when it was designated as a satellite town and earmarked for significant growth, it had a population of less than 1,000. Like many other satellite towns, it has grown substantially in recent years. However, it has a deficit of infrastructure and community facilities.

This deficit is best exemplified by the health centre which currently serves the town. Situated in the centre of Carrigaline, it is a very old, small building. Its staff make the best of the situation, working in exceptionally difficult conditions. The community welfare officers work out of the health centre and it is not unusual in recent months to see people queuing on the street for appointments with them. The facility is inadequate to meet the needs of a growing and vibrant town of Carrigaline's size.

It was with this in mind that the Health Service Executive, some years ago, acquired a suitable site for a new health centre. I commend the executive on the purchase of this site, which is strategically located in the heart of the town and within walking distance for a large portion of the population. The executive has since advanced plans to develop a state-of-the-art health facility. I also welcome the inclusion of this project in the Health Service Executive's capital programme in recent years, indicating its commitment to advancing the project.

However, I am disappointed with the pace of progress in developing this essential facility. Last month, I received a reply to a parliamentary question I submitted. I suspect that reply will form the basis of the Minister of State's response tonight. However, I hope he will have some additional news. The Health Service Executive was given approval in October 2006 to appoint a design team and to commence the planning process. However, a planning application was not lodged until January 2008. At the end of February of that year, the local authority wrote to the Health Service Executive requesting more information. It was a full six months before a response was issued. Eventually, however, planning permission was granted in November 2008. I understand there is a budget of €250,000 to advance the project through detailed design and to publication of tender documents this year. A capital allocation for the construction of €4.1 million was ring-fenced last year. However, because of the delay in advancing the project, it did not proceed to construction last year and the Health Service Executive must now seek approval from the Department of Finance to proceed once the contractor has been identified.

It is important that a town of Carrigaline's size should have a health centre that can be the cornerstone of the primary care strategy, as announced by the Government in 2001. That strategy noted that primary care is the appropriate setting to meet 90% to 95% of all health and personal social service needs. Some of the facilities that could be provided at the Carrigaline health centre include speech and language therapies, physiotherapy and occupational therapy. The new health centre could be a centre of excellence for public health nursing. It could be the headquarters out of which the community welfare officers work. Counselling services could be provided. In the evening time, when most of the facilities are closed, it could be used as a meeting area for bereavement support groups, suicide awareness groups, Alcoholics Anonymous and so on. Parent and toddler groups could use the premises in the mornings.

I urge the Health Service Executive to progress this project without delay. Carrigaline urgently needs this new health centre. There is no better time to go to tender for a major construction contract of this type, with excellent value to be had. I am sure the Health Service Executive will be well able to bring this project to completion within budget or even ahead of budget. I ask it to do so as soon as possible. I commend Cork County Council on its support for this development through the Carrigaline priority project. The council has identified it as a key development. I hope the Minister of State will confirm the Health Service Executive's commitment to developing a state-of-the-art health centre for Carrigaline at the earliest possible time.

Deputy John Moloney

I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney. The Government's strategy, Primary Care: A New Direction , is the roadmap for the development of primary care services over a period of ten to 15 years. The development of such services is an essential component of the health service reform process. As the Deputy observed, it has been estimated that in a developed primary care system, 90% to 95% of people’s day-to-day health and social care needs can be met in the primary care setting.

The key objective in primary care policy is to develop services in the community that give people direct access to integrated multidisciplinary teams. The Health Act 2004 provides the Health Service Executive with responsibility for the management and delivery of health and personal social services. The executive has identified 530 primary care teams and 134 health and social care networks to be developed by 2011. There are 111 teams currently holding clinical team meetings, which involve a range of health professionals meeting to discuss and plan integrated care for individual patients. The overall target is to have 210 teams holding clinical team meetings by the end of 2009.

A total of 21 teams is planned for the south Lee area of Cork. Of these, I understand three are planned for the Carrigaline area, one of which is at an advanced stage of development. Reconfiguration of Health Service Executive personnel to staff this primary care team has recently been completed. It is staffed by professionals from the fields of nursing, physiotherapy, occupational therapy, dietetics, addiction counselling and community liaison. Clinical team meetings have taken place.

With regard to the development of a primary care facility to replace the current structure, approval was granted to complete the design phase and progress the project to tender stage. A design team is in place. Planning permission to proceed with the development of the facility was received in late November 2008 and work is continuing on the completion of the tender document stage. In determining its capital programme, the Health Service Executive is required to prioritise the capital infrastructure projects to be progressed within its overall capital funding allocation taking account of the targets for division of capital investment between the acute and primary, community and continuing care programmes. The Health Service Executive is currently revising its capital plan to take account of the capital funding envelope available for the period to 2013, following the supplementary budget in April. Details on the plans for the health facility at Carrigaline will emerge following the executive's deliberative process and approval of its revised capital plan.

Post Office Network.

Deputy Chris Andrews

I appreciate the opportunity to raise this matter, which revolves around social isolation and the impact a lack of social infrastructure can have on communities. I wish to refer to the community that will be affected by An Post's decision to close the post office in Ringsend. The closure of the post office will have a detrimental effect on the old people who live in this community and who use the services provided at the post office, which is situated right in the heart of Ringsend. The communities in the Ringsend-Irishtown area are long established and many elderly people live there. Everyone who lives in the area — the old and young families and couples — frequent the local barber shop, the butcher's shop and the newsagent. All of these individuals will be affected by the decision to close the post office.

The decision was taken to close the post office because the business was no longer viable. However, instead of identifying another shop in the area that might host the post office, An Post decided to move it out of Ringsend village altogether. In my opinion, not enough research was carried out in respect of transferring the business to another shop in the area. I understand An Post is currently carrying out such research but it is far from certain whether the post office will remain in the Ringsend-Irishtown area. An Post wants to move the post office a significant distance from Ringsend to Barrow Street. As a result, the elderly will not be able to access it.

Most older people go out each Friday to meet their friends, chat and collect their pension payments from their local post office. Post offices are part of the social infrastructure not just in Ringsend, but in towns and villages throughout the country. They ameliorate the effects of social isolation and allow people, particularly the elderly, to be independent and to meet their friends. The community in the Ringsend-Irishtown area is great. Removing the post office from the village would represent a real blow to the older people who live there. In many ways, its removal amounts to ripping the heart out of the community in the Ringsend-Irishtown area.

It is astounding that the Minister with responsibility for An Post is unwilling to meet the residents or the public representatives who have expressed concern about this matter. This issue is too important to be managed by a Minister at arm's length. The Minister must intervene and take charge of matters.

If we are going to protect our urban villages, we must also protect our post offices. In recent days I met a woman who was on her way to the post office in Ringsend and who was devastated when I informed her that it was intended to close it. Her main concern was that she would no longer be able to travel to the post office on her own and would in future be dependent on a neighbour to get her there. This woman is going to lose her independence as a result of what is happening.

Saving the post office in question is vital to the survival of the villages of Ringsend and Irishtown. If the post office closes down, the butcher, the newsagent, the other shops and the public houses in the area will all lose out financially. The effect of the closure will be extremely detrimental. I ask that the Minister, Deputy Eamon Ryan, intervene and take some responsibility for this matter. He should not allow the mandarins in An Post to determine whether our urban villages survive.

Deputy John Moloney

I apologise to Deputy Chris Andrews that the Minister was unavailable to take this matter. As he will be aware, the issue of social isolation is not a new phenomenon, nor, in light of its broad-ranging impact, is it one in respect of which the Department of Community, Rural and Gaeltacht Affairs has sole responsibility. I am sure the Deputy will accept that the causes of social isolation can be varied and include poverty, unemployment, disability, illness, educational difficulties and substance abuse, to mention but a few. Accordingly, many Departments and agencies, including the HSE, the Garda, the Department of Education and Science and local authorities have responsibilities that touch directly or indirectly on this matter. In addition, there are numerous voluntary and community agencies with specific or broader remits that are available to those who experience social isolation for one reason or another.

The remit of the Department of Communications, Energy and Natural Resources includes support for communities, irrespective of location or socio-economic development. However, its programmes, individually and collectively, focus on communities, particularly those that are vulnerable, disadvantaged or under threat. The key principle underlying these activities is the provision of support that enables communities to identify and address problems in their areas. In order to be effective in this work, the Department seeks to provide a co-ordinated approach not only across the range of measures for which it has direct responsibility, but also with other Departments and State agencies.

The Department operates a wide range of measures, programmes and schemes which support disadvantaged communities. These include the local development social inclusion programme, LDSIP, the community development programme, CDP and the RAPID programme. Some of the programmes operated by the Department of Community, Rural and Gaeltacht Affairs may also indirectly impact on issues relating to social isolation. I refer, for example, to the community services programme and the programme of grants for locally-based community and voluntary organisations.

The Department of Communications, Energy and Natural Resources also provides general support to the voluntary sector and supports volunteering. In the time available, it is not possible to give a comprehensive description of all these programmes. However, I will provide a brief outline of the LDSIP and the CDP.

The LDSIP aims to counter disadvantage and promote equality and social and economic inclusion through the provision of funding and support to urban partnerships and integrated companies. The LDSIP comprises measures that are designed to counter disadvantage and it specifically promotes equality and social and economic inclusion. The programme is implemented by 37 integrated local development companies and 16 urban partnerships. These are not-for-profit organisations which target the areas of greatest need throughout the country in order to provide an area-based response to long-term unemployment and promote social inclusion across three sub-measures, namely, services for the unemployed, community development and community-based youth initiatives.

Under the LDSIP, the companies work with specific groups in Irish society including people with disabilities, migrant workers and their families, lone parents, farming smallholders, members of the Traveller community, the elderly and youths at risk, all of whom experience specific forms of marginalisation and, in some cases, social isolation. The companies tackle issues of social exclusion and work with a cross-section of State agencies and local bodies in their respective areas.

The CDP provides financial assistance to some 180 community development projects in recognised disadvantaged areas nationwide, in both urban and rural settings. It also provides support for self-help work to specific target groups that experience disadvantage, for example, lone parents, members of the Traveller community, people with disabilities and elderly individuals living in isolation. The programme is designed to reduce social exclusion by targeting support at disadvantaged and socially excluded communities in order to improve their capacity to benefit from social and economic development.

These programmes and those operated by the Department Community, Rural and Gaeltacht Affairs provide real remedies for those experiencing social isolation. However, this is not to say that we are complacent, particularly in the context of the challenges we face with regard to the public finances. The LDSIP and the CDP are being redesigned in order that we can be sure they provide real value for money and actually provide measurable improvements in the lives of the communities they are designed to serve.

An Ceann Comhairle

Deputy Chris Andrews will be obliged to send a postcard to the LDSIP from the post office to which he refers.

The Dáil adjourned at 10.40 p.m. until 10.30 a.m. on Thursday, 18 June 2009.

Dáil Éireann debate - Wednesday, 17 Jun 2009