Vol. 697 No. 2
32 Deputy James Reilly asked the Minister for Health and Children the hospitals that are cutting back on services ahead of Christmas 2009 to balance the books; the nature of those services; and if she will make a statement on the matter. [45896/09]
Overall clinical activity in our acute hospitals is ahead of target by 3.4% and this pattern is likely to continue until the end of the year. When inpatient and day cases are combined, acute hospitals have treated 33,000 more patients to date in 2009 than during the same period in 2008. Outpatient activity is also 3% ahead of target.
Hospitals must deliver their services within budget and they are working intensively to ensure that they do so in 2009. However, the HSE has indicated hospitals will meet the full level of service promised in the service plan for 2009 and, in a number of cases, that they will exceed this target. Hospitals always scale back elective work towards the end of the year, especially in December. This reflects the preference of most patients not to be in hospital during the holiday period. The traditionally quieter time for elective work also gives hospitals an opportunity for refurbishment of wards, deep-cleaning and maintenance, while not disrupting services to patients. However, emergency and acute services such as the accident and emergency department, critical care, acute surgery, acute medicine, dialysis and obstetrics remain fully operational.
My priority is to ensure that all patients receive a quality service without delay. I am pleased that average waiting times published last week by the National Treatment Purchase Fund show a reduction in the average waiting time to just 2.4 months for all procedures. This contrasts with a situation where patients had to wait for between two and five years in some specialties a number of years ago. The number of acute inpatient beds open at any time will depend on varying circumstances, but the HSE has delivered on the service promised in its service plan for 2009 and average waiting times for elective procedures have fallen demonstrably. Hospitals are managing their budgets and levels of service well in this difficult economic situation.
I hope the Minister is safe from the frog counting exercise, as she seems to have one in her throat. The question was very straightforward; it asked for details on hospitals cutting back services ahead of Christmas to balance the books and the nature of those services. The Minister made a statement on the matter, but she did not tell us the services that will be cut or the hospitals affected.
The National Treatment Purchase Fund, NTPF, figures of 2.4 months are much massaged. At present, to get on the NTPF waiting list in Tallaght, one must be waiting for a year, and to get on an orthopaedic waiting list in Tallaght, one must wait two and half years to see an orthopaedic surgeon. The Minister can massage the figures whatever way she wants but people are not fooled because they know how long they must wait for a service.
Yesterday, when I was in Tallaght, I walked through the accident and emergency unit. Every corridor was full of trolleys. I know that last week in Beaumont Hospital almost 50 people were waiting on trolleys. If the Minister does not mind, I would like her to give us a direct answer on what hospitals and services are being affected.
When Deputy Reilly was in Tallaght yesterday, I do not know whether he met the incoming chief executive officer designate, Professor Conlon. If he did, I am sure Professor Conlon made him aware of his plans, particularly, but not exclusively, with regard to orthopaedics. Tallaght hospital has 11 orthopaedic surgeons, which is a large number by any standard for any hospital. The waiting times to see one of them are unacceptably high and I have discussed this matter with Professor Conlon. I have confidence that he will deal with the issue.
I do not accept what the Deputy stated about the National Treatment Purchase Fund. It has published figures for the first time in recent years and we have verifiable and accurate figures on waiting times which show that only 477 people wait more than 12 months for a procedure. As far as I am concerned, that is 477 too many, but it has reduced and the number was 27,000 at one point. One must acknowledge that there has been major success.
They are massaging the figures.
They are not massaging the figures. They are accurate verifiable figures and I invite the Deputy to meet representatives of the National Treatment Purchase Fund or invite representatives to come before the Oireachtas Joint Committee on Health and Children to discuss the significant progress that has been made. At a meeting with the NTPF last week, I discussed whether a person should remain on a waiting list if he or she refuses an appointment for no good reason. That happens in many instances.
With regard to hospital activity, the key issue is that services are up on the service plan provision for 2009. I agree there are pressure points and major financial pressures, but we cannot give more money to any of the hospitals and they have to live within their budgets. This means hospitals must take whatever steps are necessary to live within that budget.
I accept that hospitals must live within their budgets but I reiterate what I stated. An employee of the Houses was told she would have to be on the waiting list at Tallaght hospital for one year before the NTPF would accept her. That is a fact. Another man, who is 53 and has a painful knee, is awaiting an orthopaedic outpatient appointment but cannot get one for two and a half years. That is another irrefutable fact. I will not go through all of the anecdotes but it is very disconcerting that the Minister——
A question, Deputy.
The obvious question is how can the Minister tell us that patients are not being affected detrimentally when this is the reality.
I invite the Deputy to read the OECD publication today which shows the significant improvements we have made in Ireland in health, life expectancy and cancer treatment. It is an independent analysis which shows that, over the past decade, life expectancy has increased faster in Ireland than in any other EU country. Some of the cases the Deputy discussed had already been brought to my attention, which is why I discussed the matter with Professor Conlon. It is not acceptable when there are 11 orthopaedic surgeons in one hospital that someone must wait two and a half years for an outpatient appointment. It is not acceptable to me, to Professor Conlon or to the board of the hospital and the matter will be dealt with.
33 Deputy Jan O’Sullivan asked the Minister for Health and Children her views on the reported advertising of a private clinic offering oncology services in Sligo while the public cancer services in Sligo are being moved to Galway due to the size of the population in the north west; and if she will make a statement on the matter. [45808/09]
The Deputy may be referring to recent media reports regarding an application before Sligo County Council to rezone land which would permit a planning application to be made in respect of a private health facility. The reports state that such a facility may provide certain medical services, including oncology. It is not clear whether the facility will ever be established but I want to make it clear that I have no intention of encouraging or supporting the provision of any services which cannot meet the required standards of safety and care.
I am aware that a number of private health facilities have advertised various oncology services which they provide. I contacted hospitals in the independent sector in 2007 urging them to take steps to ensure that their breast cancer services complied with the national standards for symptomatic breast disease. I also brought the standards to the attention of private health insurance providers and the chief medical officer wrote to health insurers and the independent hospital sector again in October this year reminding them of their responsibilities in this regard.
We have been preparing to work on legislative proposals for a mandatory licensing system to cover both public and private health care providers, based on explicit standards to be set by the Health Information and Quality Authority. I intend to bring these proposals to Government next year. This will ensure that all services, whether publicly or privately provided, meet the same high quality care standards for all patients.
Under this national strategy for cancer control, the HSE has designated eight specialist cancer centres, each serving a minimum population of 500,000. University Hospital Galway is the designated centre for Sligo. Breast cancer diagnostic and surgical services were transferred from Sligo General Hospital to University Hospital Galway in August, but medical oncology services and outpatient radiation oncology clinics continue to be provided in Sligo. Other than non-melanoma skin cancer and a limited volume of bowel cancer cases, the vast majority of other curative cancer surgeries have never been undertaken at Sligo and are routinely referred to one of the eight designated cancer centres.
Irrespective of media reports regarding the possible development of other services, I believe that the concentration of breast cancer services into eight designated specialist centres is the only way to achieve the best results for our patients. The application of national standards, and ultimately the mandatory licensing of public and private facilities, will provide the best way forward.
Does the Minister think it is ironic, inadequate and possibly dangerous for private patients that private facilities are not regulated? Does the Minister know how many private facilities in Ireland provide cancer services of any type, particularly in the context of the cancer control programme and the need for critical mass, triple assessment and multi-disciplinary teams? How long will it take to introduce the legislation required? The Minister mentioned next year but the private sector can do what it likes in the provision of health services without HIQA having any control whatsoever. Does the Minister believe there is an urgent need to ensure that all patients have properly regulated health services?
As the Deputy is aware, patient safety is a priority for me and that is why I established the patient safety commission. All the reform taking place in acute hospitals is with a view to their meeting minimum standards for licensing in 2012 and 2013. As I stated previously here and at committee meetings, if we had the legislation and pressed the green button in the morning, many of the services currently provided would not meet minimum standards and, therefore, are not licensable. This is why there is such a momentum behind the reconfiguration of acute hospital services in particular.
With regard to the provision of cancer services, the Blackrock Clinic in Dublin and Barringtons Hospital in Limerick have stopped providing surgery for breast cancer. In the case of Barringtons Hospital, that was at my request. The health insurance providers are taking this matter seriously and if they honour the symptomatic breast disease standards, I do not foresee anybody being foolish enough to put their money into a private facility of the type suggested in Sligo. That is my honest opinion. I do not believe that anyone would do so. Other private facilities such as St. Vincent's Hospital and the Mater Hospital in Dublin are co-located private facilities and have the volumes required under the symptomatic breast disease standards. The only other facility that I am aware provides breast cancer surgery is the Beacon Hospital in Dublin.
Does the Minister for Health and Children have an obligation to ensure that facilities which do not comply with the basic minimum standards are not available to the public? This is specifically with regard to cancer; I accept a broader issue arises.
As I stated on previous occasions, I can only do so when we have a legislative way of doing so and we cannot do that in advance of having licensing, authorisation or accreditation. Some of the misdiagnoses that have come to public attention occurred in both the public and private sectors, in services that are organised around extremely small volumes of patients and where the critical mass of specialist doctors, etc., does not exist. Discussing matters with the independent hospitals and advising insurers to follow the guidelines is the most appropriate way to ensure we meet the patient safety standards.
The Deputy's question relates to something that may never happen.
It is already happening at other facilities.
The question relates to Sligo and I presume it arose on foot of Fintan O'Toole's article in respect of a meeting of Sligo County Council. It is my view that people would be extremely foolish to invest resources in a facility which could not deal with the volume of patients required to qualify for licensing and to meet the relevant standards.
34 Deputy James Reilly asked the Minister for Health and Children the number of contracts or leases that have been signed by the Health Service Executive with general practitioners in respect of primary care centres; the location of these centres; and if she will make a statement on the matter. [45897/09]
The HSE sought expressions of interest in December 2007 and July 2008 for the provision of primary care centres for primary care teams. Negotiations with interested parties proceeded in respect of 163 locations. Letters of intent have issued in respect of approximately 80 of these locations. Of those 80 locations, one centre has opened in Letterkenny, seven centres are due to open by the end of January 2010 at Kinnegad, Moate, Gorey, Waterford City, Carlow, Callan and Trim, respectively, and a further 37 are scheduled to open during 2010. These 80 locations will provide accommodation for 105 primary care teams and approximately 350 general practitioners will provide services from them.
The terms and conditions of the leasing arrangement stipulate that the HSE will sign a lease with a landlord only when GP involvement in providing services from the primary care teams accommodated in a centre has been agreed. The HSE has indicated that negotiations may not be completed in all of the chosen locations due to planning issues, withdrawal of developers or banking or market conditions. The HSE is also continuing to develop primary care centres through its Exchequer funded capital programme, with seven such centres opened in 2009 at Irishtown, Mark's Lane and Dundrum in Dublin, Strokestown in County Roscommon, Inis Mór and Clonbur in County Galway and Westbury in County Clare.
We know the Minister has a large number of plans and that some of Professor Drumm's bonus was apparently based on having teams in place. For the most part, these teams are virtual in nature. In other words, they do not really exist. A letter of intent is just that and it has no legal status or standing. My question is very straightforward and seeks to discover the number of contracts that have been signed this year. On each occasion we inquire about this matter we are informed that there are 90 centres. Mr. Brian Gilroy of the HSE is on record as stating that there are 90 centres, some of which have two teams and some of which have three. The fact is, however, that there are not 90 centres. I would be grateful if the Minister would indicate the number of centres in respect of which contracts were signed in the past 11 months.
The significance of primary care teams has nothing to do with buildings or new facilities, even though there are many of both. These teams involve health care professionals working differently together around patients. As stated previously, I recently met a health care nurse who has reduced, by half of one working day a week, the amount of time she spends seeking to make contact with colleagues dealing with the same patients as her.
By September last, 165 teams were operational. By the end of the year there will be some 210 teams in operation. The Deputy's question relates to contracts in respect of new facilities and I informed him that negotiations with interested parties proceeded in respect of 163 locations. These negotiations are at various stages.
I just want to know the number in respect of which contracts have been signed. We have been negotiating for years. The primary care strategy has been in place since 2001.
No, we have not been negotiating——
How many contracts have been signed?
The Deputy should allow the Minister to answer.
I wish she would answer.
There are some people who are not happy with the terms that have been put to them. These individuals have come to see me and they have probably also visited the Deputy. Some arrangements have not been concluded but I am not in a position to inform the Deputy with regard to the different stages at which they stand. I informed him that 80 centres will open next year and that 350 doctors will be involved in the teams located at these centres. I believe the purpose of the Deputy's question was——
The purpose of my question is to elicit information on the number of contracts that have been signed.
The Deputy should not ignore the Chair. Neither should he address the House while sitting down.
I will ask my question again. How many contracts have been signed? I do not want to know how many we aspire to sign, nor am I interested in the difficulties we face. I merely wish to discover the number of contracts that have been signed in the past 11 months.
Perhaps the Deputy does not understand the law.
No, I do understand it.
Letters of intent have issued in respect of 80 different centres. That is a considerable number.
Not a contract has been signed.
Many contracts have been signed.
Letters of intent were signed two, three or four years ago.
Several contracts have been signed. I informed the Deputy that 80 centres will open next year. Is he of the view that contracts were not signed in respect of these?
The Minister refused to answer the question. That is fine. The answer is approximately four or five contracts were signed.
35 Deputy Dan Neville asked the Minister for Health and Children if she is satisfied with the inpatient services for children and young adults; her views on whether it is unacceptable that 247 children were admitted to adults centres in 2008; if the dedicated 80 beds in child and adolescent units will be delivered in 2010; and if she will make a statement on the matter. [45898/09]
The development of child and adolescent mental health services is a priority for me and the Government. Inpatient capacity has doubled since 2007. Two new child and adolescent units opened in 2009, at St. Vincent's Hospital, Fairview, and St. Stephen's Hospital, Cork. This brings total inpatient capacity to 30. Some time ago I appeared on "Prime Time" and outlined this point when asked about the Government's policy on child and adolescent beds. I have not been invited back since to provide information on our commitment in this regard.
Two 20-bed units are currently under construction at Bessboro, Cork, and Merlin Park, Galway. I am advised that these beds will be commissioned in 2010. The HSE mental health capital programme, which will be funded from the proceeds of the sales of the old psychiatric hospitals, will be also finalised shortly. This will provide for further beds in the child and adolescent mental health service, in line with the recommendations in A Vision for Change. The number currently available is 50, while A Vision for Change recommends 100. The Government is intent on selling the assets to which I refer to ensure this area will be prioritised and targeted.
I recognise the undesirability of admitting children to units providing care and treatment to adults. In the absence of an alternatives, however, I must accept that such admissions are sometimes necessary in the best interests of the child. The Mental Health Commission has issued a code of practice relating to the admission of children under the Mental Health Act 2001 which outlines the arrangements and facilities that should be put in place to ensure the protection and safety of such children. The commission recently issued an addendum to this code of practice which seeks to ensure that by 1 December 2011, no child under 18 years will be admitted to an adult psychiatric unit. I am of the view that this commitment will be honoured.
I thank the Minister of State for his reply. Do I infer from his remarks that it was completely inappropriate to place 247 children in adult psychiatric units? The psychiatric profession has expressed concerns in respect of this matter for some time. I welcome the fact that the Minister of State made a commitment with regard to this matter. His predecessors in the Department made commitments in respect of four areas that were identified in A Vision for Change. One of those areas is Limerick, to which the Minister of State did not refer in his reply. The mid-west is in urgent need of facilities similar to those provided in Cork, Galway and Dublin. Will the Minister of State comment on the information emanating from Temple Street Children's University Hospital to the effect that children as young as five years of age are attempting suicide and engaging in self-harm?
A fortnight ago I came before the Joint Committee on Health and Children and indicated that the Government would honour its commitment on the child and adolescent units that will contain 100 beds in all. I also indicated on that day that I would return to the committee in February with clear and decisive commitments in respect of this matter. I am not ignoring arguments to the effect that Limerick should be included in this regard. I asked the committee for its indulgence until February on this matter.
The Deputy will recognise that there has been a significant increase in the number of child and adolescent beds. I accept, however, that this increase is not enough. Neither I nor the Minister for Health and Children have ever pretended that half the required number is adequate. The commitment to 100 beds remains in place. The target in this regard was set when A Vision for Change first appeared and it is now being brought forward.
I cannot comment specifically on reports that children as young as five years of age have attempted suicide. The priority in the mental health area always has been the provision of early intervention. That will be proven over the next few weeks and we will return to the matter in February. The commitment was to ensure adequate child and adolescent mental health beds. I appreciate the work of Deputy Neville and the Department will have proposals in February for dealing with mental health in the best way, with the added aim of ensuring that we reduce the number of suicides, specifically those of children and adolescents.
The McCarthy report recommended that €50 million be removed from mental health services. Does the Minister of State have views on this? From some of his statements, it seems that he does not accept this. Can he confirm this is correct?
Like Deputy Neville, I do not want to make a menu of the McCarthy report. We cannot pick and choose. I am satisfied with the commitment of the Minister, Deputy Harney, to mental health. The McCarthy report made recommendations but I prefer to see the outcome of the budget before I comment on that.
36 Deputy Denis Naughten asked the Minister for Health and Children the number of separated migrant children who have disappeared from Health Service Executive accommodation in each of the years 2007, 2008 and to date in 2009; and if she will make a statement on the matter. [45899/09]
The HSE has provided the following information on the number of separated children or unaccompanied minors seeking asylum who have gone missing from the care of the HSE since 2007. In 2007, 32 separated children went missing from the care of the HSE, in 2008 22 went missing, and up to October 2009 45 young people went missing from the care of the HSE.
It is a matter of great concern to the Government, the HSE and the Garda Síochána that a number of separated children go missing after they enter the State. Separated children going missing from care is not a phenomenon unique to Ireland. In many cases children go missing very soon after arriving in the country. The suspicion is that many of these children may have planned this with persons unknown prior to entering the country. This may be done with the objective of reuniting with their families, who have already arrived in the State, or with the intention of relocating to other European countries where their families are located.
The HSE has developed a strong working relationship with the Garda National Immigration Bureau with regard to missing children. A joint national protocol is in place between the HSE and Garda Síochána for all children who go missing from care. The protocol seeks to maximise inter-agency co-operation, to reduce the incidence of children going missing from care placements and to return missing children to safety as soon as possible.
The implementation plan for the 2009 report of the Commission to Inquire into Child Abuse contains a commitment that separated children will be accommodated in mainstream care instead of hostels by December 2010. This move from hostel accommodation to residential and foster care should help to ensure that fewer children go missing. The HSE has begun the process of phasing out the hostel arrangements. Three hostels were closed recently, leaving four to be closed in 2010. The introduction of the Criminal Law (Human Trafficking) Act 2008, together with the work been undertaken by the anti-human trafficking unit in the Department of Justice, Equality and Law Reform should help to ensure that the numbers going missing are reduced significantly and that these young people are cared for in a safe and secure environment.
I thank the Minister of State for his reply. How many children have gone missing from foster care?
I questioned the Minister of State on this matter last February and he said the issue had attracted a high level of concentration from the Government and that while there has been a fall-off in the number of children disappearing in 2008, he was not going to become complacent about it. If that is the case, how did we lose five children every single month for the first nine months of this year? Is it not the case that we have lost twice as many children in the first nine months of this year as the whole of last year?
In February, the Minister of State told us that 24-hour care was being provided to these children. I draw attention to the report of the Ombudsman for Children, which pointed out that security guards provide care after 6 p.m. The Ombudsman for Children stated that one of the children she dealt with in the report disappeared and did not make it onto the missing children website. If that is the case, how is the Garda protocol operating when the child working directly with the Ombudsman for Children has evaporated?
It is an issue of serious concern that the figure has increased in 2009 after a very low figure in 2008. For this reason we have included it in our implementation plan arising from the Ryan report. In order to prevent this from happening we need to bring children seeking asylum into a position of equality with children in residential or foster care so that they are provided with the same services and the accommodation is properly registered and inspected. This has not been the case until now. Next year we hope to phase out the four hostels that remain providing services to children. Through that level of equality, we can ensure that children coming to the attention of State agencies are dealt with at the earliest stages. Children go missing very soon after coming to the attention of State agencies. If they are in inappropriate accommodation one can be sure that inappropriate service will be provided.
In February the Minister of State clapped himself on the back because the number had reduced last year. He took credit in the House for that fact that only 22 children had gone missing. Two in five children placed in care this year have disappeared from accommodation. Will the Minister of State take responsibility for that?
Only two of the three residential centre inspection reports were made available to me. Will the third report be made available? The Minister of State referred to proper accommodation being made available. Does the Minister of State consider it acceptable that the HSE has a proposal to put new accommodation alongside existing asylum centres? These have been seen as a focal point for traffickers. Is it acceptable to locate them so close to asylum centres when this will make it easier for traffickers to access them?
I completely reject the assertion that I clapped myself on the back earlier this year.
Does the Minister of State want me to cite the quotation?
The Minister of State should be allowed to reply.
I was only a Minister of State at the Department of Health and Children for half of the previous year. I fail to see how I could be credited with positive development that occurred in the previous year. The more serious issue raised by Deputy Naughten is the location of appropriate accommodation for children separated or seeking asylum. The anti-human trafficking unit in the Department of Justice, Equality and Law Reform has a working group dealing with human trafficking, with representatives from the Garda Síochána, the HSE and NGOs. I have committed to ensuring that the closing of hostels is accompanied by a forum representing the HSE, the Garda Síochána and the NGOs. This process can draw on the knowledge of stakeholders and the experience of anyone who has something positive to contribute so the transition from inadequate accommodation to the fulfilment of the commitment to close hostels by the end of 2010 is done with the best interests of children at heart.
Will the third report be made available?
I will provide the report to Deputy Naughten.
