Vol. 697 No. 2
37 Deputy Kathleen Lynch asked the Minister for Health and Children her plans to change the governance of the Health Service Executive on the retirement of the chief executive officer; and if she will make a statement on the matter. [45548/09]
47 Deputy Róisín Shortall asked the Minister for Health and Children the progress made in the restructuring of the Health Service Executive providing regional structures and interaction between acute services and primary, community and continuing care services; and if she will make a statement on the matter. [45559/09]
I propose to answer Questions Nos. 37 and 47 together. The recruitment of a new chief executive officer is a matter for the board of the HSE, as are the internal governance structures of the organisation. However, I can confirm that certain changes are being introduced in the management structures of the HSE to enable it to better manage and deliver hospital and community services in a more integrated way and to strengthen the role of clinicians in the delivery of services.
In October 2009 the chief executive officer announced that four regional directors of operations were being established. They are accountable and responsible for the delivery of all health and social care services in the existing four geographical areas. In addition, the national hospitals office and the primary, community and continuing care directorate were being replaced by an integrated services directorate with two national directors; one responsible for reconfiguration and the other for performance and financial management.
The HSE is also in the process of appointing care leaders — one each for mental health services, disability services, children and family services and services for older people. The appointees will set out operational plans and delivery targets for their areas of responsibility and will be the key link with the Department and external stakeholders.
A new national director of quality and clinical care, Dr. Barry White, has been appointed. His role is to strengthen clinical leadership, improve clinical performance and ensure care is delivered in a way that maximises quality while minimising expenditure. This will involve the development and implementation of care pathways, protocols and standards for different disease programmes, particularly chronic diseases that have a high impact on the health system. In addition, support functions such as ICT, procurement and estates have been amalgamated into a single directorate. The posts which I have mentioned are being filled from within the existing complement of staff.
The aim of the new management arrangements is to deliver excellent health outcomes for the population by driving the integration of hospital and community services, ensure more efficient use of resources, ensure clear lines of management accountability and support its strategy of shifting the balance of activity towards prevention and community-based care and away from hospital-based care.
On 1 January next, the HSE will have existed for five years. Everyone acknowledges that its layers of administration are top heavy. Will some posts be taken out at that level? When Professor Drumm took up his position, he brought in what has been described as a kitchen cabinet in addition to those already in the health boards. Will the Minister streamline the governance of the HSE?
At the Estimates meeting of the Oireachtas Joint Committee on Health and Children last week, the Minister told us she planned to reduce the numbers working in the HSE by 6,000 by removing 8,000 in some way or another and adding 2,000 for development of services. Now that the talks with the unions have broken down, does the Minister still expect to achieve that reduction and, if so, how? Will there be involuntary redundancies or has she had time to think about how she might achieve this?
In response to the last question, the Minister for Finance will make announcements about public service numbers in the course of his budget speech tomorrow. If the changes in the health service suggested last week, the five over seven, 8 a.m. to 8 p.m. day, redeployment and flexibility can become the norm, as most people seem prepared to accept, they will have a major impact on the capacity to make things happen speedily——
It could have been achieved if the Government had reached an agreement last week.
-----particularly as we seek to integrate community and hospital services in a more orderly fashion than ever before. We want to move staff from providing the service in the hospital to providing it in the community and redeployment within a reasonable geographic radius provides that opportunity. One if not two of Professor Drumm’s advisers have already left the HSE. The contracts of employment of the remaining two will cease when Professor Drumm is no longer chief executive officer from next summer. The board is advertising this week or shortly for a replacement.
The number at directorate or senior management level in the HSE will not change with the new arrangements. There is scope to take people out. There has been a significant interest in early retirement from the public sector, not least the health sector. We had a supplementary budget last week partly because of the increase in those numbers. A large proportion are from the management, administrative or support staff. With the moratorium, those who retire at that level will not be replaced apart from in exceptional circumstances so, for example, one replaces the CEO. Where there is scope for efficiencies, people will not be replaced in what is broadly called the front line services.
The Minister said earlier last year that she would pursue redundancies, yet when she was asked about it at the end of last year, she said it was a matter for the Minister for Finance. Today again, having told us last week that there would be redundancies, she has put it back into the lap of the Minister for Finance. Who will take responsibility for the HSE? What has changed that makes the Minister believe she can achieve redundancies? In the past she has said that the unions were not co-operating and that there was very little uptake. Will the new posts result in increased salaries or will they be the same or lower, given that everybody else is taking a cut?
The Minister for Finance is responsible for the public service. That is factually correct. Of course we can reduce numbers within the HSE and I have said before, including last week, that the intention is to reduce the number by 8,000 but recruit back 2,000, making a net reduction of 6,000. We want to recruit consultants, specialist nurses and health care therapists and other specialists that we require in the service. A voluntary redundancy scheme for the public service was announced in last year's budget. We did not implement it in the health sector because it cannot be applied without redeployment. It would not be possible, for example, to have a large number leave from one hospital without being able to redeploy people from another. At present, it is not possible to redeploy from one part of a hospital to another. Any voluntary redundancy scheme must be accompanied by a redeployment scheme; otherwise, we would not achieve the savings envisaged and the voluntary redundancy scheme could be quite expensive. The people who have retired are those who were close to retirement age. That is why the number was higher this year.
The Minister for Finance will enunciate pay policy in his budget speech tomorrow. Any pay reductions that apply to Ministers, politicians and public servants will apply to posts within the HSE and the wider public service.
Does the Minister agree it is very disappointing that the talks broke down, particularly in respect of the health service because of the likelihood of achieving agreement on redeployment, flexibility and an 8 a.m. to 8 p.m. working day? Following the breakdown of the talks, will it not be very difficult for the Minister to achieve what she wants to achieve with regard to streamlining the HSE? Is it correct to say that only 16% of those who opted for early retirement were in the administrative or management grades?
That would be a higher proportion. One must include support staff too.
It is a great disappointment because we were discussing last week everything that had been sought for the past five years and which is central to the transformation of our health service, including a longer working day, a five over seven working week, different rostering and particularly redeployment. These are all central if we are to move from hospital-based services to community and primary care and to have the appropriate staff ratios and so on. I hope we will be able to resume that agenda very quickly. When everybody has had an opportunity to reflect and perhaps have a break because there were a lot of all night meetings over the past few weeks——
A change is as good as a break.
There is small chance of that happening.
I hope we can return to that agenda very early in the new year. I am delighted to have the Deputies' support for that agenda. That applies to other aspects of the public service.
The Minister will find it very hard to do that.
I believe public servants are in favour of change and they know the kind of change that is necessary. I believe they are willing to respond.
38 Deputy Jan O’Sullivan asked the Minister for Health and Children the recommendations she will propose in order to protect the rights of children; and if she will make a statement on the matter. [45534/09]
69 Deputy Jack Wall asked the Minister for Health and Children the action she will take in response to the Murphy report on the Dublin Archdiocese; and if she will make a statement on the matter. [45533/09]
I will be responding in the context of the reports of the Dublin Archdiocese Commission of Investigation and the Oireachtas Joint Committee on the Constitutional Amendment on Children.
The report of the Dublin Archdiocese Commission of Investigation documents the litany of abuses perpetrated by clergy operating under the aegis of the Dublin Archdiocese. The HSE is finalising its audits of other dioceses. The purpose of the audits is to ensure that the HSE is fully aware of all cases of clerical child sex abuse known to the church, including the whereabouts of any alleged perpetrators. Pending receipt of a report from the HSE on the results of these audits, the Government has reserved its position on the option of further diocesan investigations, along the lines of the Murphy commission.
While the commission's report does not include specific recommendations on the rights of children, it is important, in light of the report, to establish whether any further actions are required to strengthen child protection policies and practices generally.
The Joint Committee on the Constitutional Amendment on Children, which was established in November 2007, has produced two interim reports to date. One deals with the exchange of so called soft information and the other with a proposal to give legal authority to create offences of absolute or strict liability in respect of sexual offences against, or in connection with, children. The joint committee is now concentrating on family law issues arising in respect of proposed changes to the Constitution dealing with, among other things, the rights of children. A draft final report is currently being considered by the committee and its deadline for reporting back to the Oireachtas is 16 December 2009. The report will be submitted to Government for its consideration. In the meantime, my office, in co-operation with the Department of Justice, Equality and Law Reform, has started work on preparing heads of a Bill to deal with the issue of soft information.
A revised edition of the Children First guidelines will be published shortly by my office and will be promulgated throughout the public service. Standardised processes for dealing with cases of child welfare and protection will be introduced by the HSE, along with a national child care information system. This will help ensure that all information relating to an individual case is readily available to HSE professionals and that all contacts can be traced.
I am committed to making whatever changes are necessary in legislation, policy or practice to provide the best possible protection for children.
Has the Minister of State an idea when he might be ready to propose a referendum in regard to the rights of the child? The Murphy report contained a suggestion that the HSE may not have strong enough powers in regard to child sexual abuse outside of the family. Will the Minister of State comment on whether there is a need for further legislation in this regard?
The Ryan report suggested that there was a need for an extra 270 social workers specifically in the area of child protection. There is also information that more than 6,000 children at risk are not assigned to a social worker at present. In addition, the Adoption Bill will require more social workers. What action is the Government taking in regard to the shortage of social workers?
With regard to the referendum, the committee has until the end of next week to provide its consensus on wording to improve the position of children in the Constitution. A decision on a date of a referendum will follow consideration of that report by the Government.
HSE powers under section 3 of the Child Care Act are very clear in terms of abuse that might occur within a family. Both the Ferns report and the Murphy commission report raised a doubt as to whether the HSE had powers in terms of extra-familial abuse, as the Deputy stated. The Attorney General at the time of the Ferns report confirmed that the HSE powers under section 3 did contemplate extra-familial abuse. Nonetheless, as the Murphy commission has raised it again, we will again clarify the point with the Attorney General.
The question of the 270 social workers is a key part of the implementation plan. There already have been appointments in 2009 and I am confident we will be able to meet the target. The Deputy stated that 6,000 children do not have a social worker, which underlines the need, which is not disputed. Where a reference is made to the HSE, all children are triaged and dealt with in terms of priority.
The Adoption Bill contemplates the idea of accredited agencies that would carry out assessments in regard to suitability for adoption. Because that can be done, it should free up social workers who are currently occupied with the issue of assessments.
While I welcome the freer availability of social workers, I do not believe it goes far enough and we need more appointed.
My main point is simple and it concerns an issue broader than that of health. There are four Ministers across the Chamber. Surely they realise the absolute necessity that the Garda would investigate all dioceses to check for the situation that pertains in the Archdiocese of Dublin. We know well it is not limited to Dublin, nor was it limited to Ferns. All dioceses need to be investigated by the Garda. It is not a matter of focusing on the children, although, of course, that is important. The perpetrators who inflicted this pain on the victims have to be brought to book, and the victims must be given the right of redress and the right to confront their predators.
First, the perpetrators are brought to book through the criminal justice system, not through commissions of inquiry. Commissions of inquiry are supposed to try to find out what went wrong in the past, who was responsible and——
I asked for a Garda inquiry.
A Garda inquiry concerns criminal justice. The Deputy asked whether all dioceses should be referred to the commission, if I am clear on his question. The Deputy must remember the Dublin commission looked at only a sample of cases, so it was not an effort to try to bring perpetrators to book. Rather, it was an exercise to try to find out what went wrong, who was responsible and what we can learn for the future.
There is a limit in regard to including all of the dioceses in the commission of inquiry because we have learned so much through both the Ryan and Murphy reports, and we will learn more from the Cloyne report. We have to remember there are also 140 congregations. It has taken us a year to examine Cloyne thus far, and it may take us a little longer. If we go through all of the dioceses and all of the congregations, for which some people are now calling, I doubt we will add much to our body of knowledge in regard to where we went wrong in the past. We have learned much. However, the Government, of course, reserves its position in regard to the HSE audits and what they will uncover about these dioceses.
I am anxious to get more information on the social work issue. Will the Minister explain how many extra social workers have been appointed this year? At what stage does he expect to have appointed the extra 270 social workers that were recommended in the Ryan report?
On the issue raised by Deputy Reilly and the specific matter of possible criminal investigations, what is the Minister of State's role, given his responsibility for children? Does he have a responsibility in regard to that element or is this purely a matter for the DPP and the Garda?
On the second issue, it is a matter for the DPP and the Garda and I do not have a role in that regard.
With regard to the social workers, while there have been 100 appointments this year, some of these are temporary staff who have been made permanent and some staff have taken retirement, so the net additional position is approximately 50. Therefore, there is a further number to be gained and it is my ambition to achieve that by the end of next year. However, resources obviously will be an issue and those matters will have to be resolved in terms of the ongoing Estimates and discussions with the Department of Finance.
Members will recall the Monageer case, which involved a murder-suicide in Wexford in which two young children unfortunately died. One of the key recommendations of the Monageer report was that a full-time, 24-7 crisis intervention service would be available. It is available on a part-time basis at present. Will the Minister of State revisit the question of full-time service? His statement at the time was that the €12 million it would cost to save those lives was not available.
I wish to be clear that while an out-of-hours service was the key recommendation, the conclusion of the report was that it would not have saved those lives. We have to be clear about the context in which this recommendation was made. Nevertheless, as a result of that, in June 2009, the HSE with the Garda began operating a protocol for a place of safety under section 12 of the Child Care Act, whereby a child who in previous times would have spent a night in a Garda station would now be placed with a fostering service until social work services were available. This is working very well from the point of view of the Garda, the HSE and those children who have been referred to it.
It is interesting to note the volume of children coming into this place of safety service is very low, which makes us wonder whether a full-scale out-of-hours service is necessary. In any case, under the implementation plan, we have committed to doing two pilot areas, which will begin in 2010, in order to have an out-of-hours service outside of Dublin. Those recommendations will be acted on.
39 Deputy Richard Bruton asked the Minister for Health and Children her plans to rationalise laboratory services here; when this process of rationalisation will commence; the estimated amount of money that will be saved from this rationalisation; and if she will make a statement on the matter. [45580/09]
Approximately 77 million laboratory tests are undertaken annually across 44 public hospitals. At present, the annual cost of this service is approximately €470 million. The workload comprises both urgent and non-urgent tests, and a significant proportion of the activity originates in the primary care setting.
An external review of laboratory services was conducted for the HSE by Teamwork Management Services in 2007. The review highlighted limitations in the current organisation of laboratories which impact on quality, turnaround time and cost. In light of the review, the HSE announced plans earlier this year to modernise laboratory services and to introduce significant efficiencies in the configuration and operation of these services. The HSE has already had significant engagement with stakeholders in progressing this initiative. Groups such as the faculty of pathology and the Medical Laboratory Scientists Association will have an ongoing input into the process.
As part of this initiative, the HSE has recently commenced discussions with the National Development Finance Agency about the capital financing of a small number of dedicated "cold" laboratories to process the large volumes of routine patient tests currently undertaken in hospital laboratories. This will include a robust analysis of the cold laboratory business model from a value for money perspective.
Everyone supports the rationalisation of laboratory services. The Minister used the words "cold" and "hot" to define routine versus emergency. The issue is that there are plans to allow for international tendering so, once again, a company like Quest Diagnostics can take over laboratory services in this country and we end up with hundreds of medical laboratory scientists' jobs gone. They have already seen the cervical screening activity removed.
Invitation by letter has reduced the number of people attending for smears from 28,000 in August to 18,000 in September, as was anticipated, despite the denials on the other side of the table. Could the Minister tell us if she intends to tender this work outside the country and how many jobs will be lost? Does she believe this is a sensible use of Irish taxpayers' money in terms of retaining Irish jobs and a particular skill?
The main issue is quality and cost. The Deputy knows from the report that our turn-around time is bad, our quality is poor and our cost is enormous. Clearly, from any perspective, that is not satisfactory. The intention is to go to tender and there has been discussion with stakeholders. One would hope that the public service would be successful in that tender but clearly it must compete on the basis of quality, turn-around time and cost. That must be the future because if we waste €200 million on this service that could be used in areas where we have deficiencies, be that in the child protection area or the many other areas where there are deficiencies, no one could defend that. Quest Diagnostics is in discussions about a public facility in Ireland with a view to putting facilities in place.
On the cervical screening, there was huge take up, there were 250,000 smears taken last year, with the number up this year. It is appropriate that we do it by way of letter so there are proper systems for recall. Given we only started cervical screening in September 2008, it has been highly successful and we want to see it develop further during 2010.
I understand the issue of the cold labs and the farming out of the work, possibly abroad, although I share Deputy Reilly's concern about the loss of jobs. One of the problems when Quest Diagnostics got the contract for cervical cancer screening was that many of the Irish laboratories had been neglected in terms of building up what they needed to be able to carry out the tests.
Can the Minister clarify if some of the cytology screening will be done in Ireland now that the two year contract has run out and is being renewed?
Quest Diagnostics has announced its intention to establish a facility in Ireland and it is in active discussions with a public facility here. The issue is one of quality, turn-around time and cost. It is not appropriate, as everyone accepts, including the professional representatives and the College of Pathology, that there are 44 centres in Ireland. There cannot be a quality-driven, quick turn-around, cost effective laboratory service in that scenario. Everyone has signed up for rationalisation of that.
The challenge for the public sector is to be able to compete with others, and I believe it has the capacity to do that in a tender. The HSE is in active discussions with the national finance agency about a public private partnership model for the provision of this service which we hope to advance during 2010.
Written Answers follow Adjournment Debate.
