Vol. 704 No. 1
45 Deputy James Reilly asked the Minister for Health and Children her views on the fact that vulnerable patients with psychiatric or intellectual disabilities continue to be housed in archaic institutions in which they fail to receive adequate care and treatment; and if she will make a statement on the matter. [10865/10]
Our current model of mental health care is largely institution-based, and 15 Victorian and older asylums are still in use. However, A Vision for Change, the report of the expert group on mental health policy, provides a framework for action to develop a modern, high-quality mental health service over a seven to ten year period and recommends that the remaining psychiatric hospitals should close and that patients should be relocated to more appropriate community-based settings.
The mental health capital programme will provide the infrastructure necessary for the patient-centred, flexible community-based service envisioned in A Vision for Change and will facilitate closure of the remaining hospitals. In this regard, budget 2010 provided for a multi-annual programme of capital investment to be funded from the proceeds of the sale of lands. In 2010, the HSE will dispose of surplus assets and reinvest an initial sum of €50 million in developing the new mental health infrastructure. Projects which will be progressed in 2010 include the development of an acute unit at Beaumont to replace the acute unit at St. Ita's, Portrane; the construction of a community nursing unit in Clonmel which will enable St. Luke's Hospital to close later this year; and the construction of a community nursing unit in Mullingar to facilitate the closure of St. Loman's Hospital. Approximately 300 patients with an intellectual disability are placed in psychiatric hospitals. Their needs, which relate to their disability rather than a mental health concern, will be addressed by the HSE in the context of the closure of the hospitals.
In addition to those inappropriately placed in psychiatric hospitals, it is estimated that approximately 4,000 people with disabilities reside in institutions or congregated settings. This includes a cohort of approximately 460 patients with an intellectual disability who are accommodated in specialised units which were formerly designated as psychiatric hospitals. Their needs will be addressed in the context of the review of congregated settings which is nearing completion. Congregated settings are defined as living arrangements where ten or more people share a single living unit or where the living arrangements are campus-based. The review will inform policy development on services for people with disabilities and specify a framework to guide the transfer of identified individuals from congregated settings to the community.
In 2004, planning permission was sought and granted for a new psychiatric unit at Beaumont and, as far as I know, it was put out to tender in 2005. However, nothing happened thereafter, funding having been withdrawn or evaporated. The new collocated private hospital at Beaumont, which has yet to have a sod turned, a brick put in place or a bed delivered, is impinging on that site and the psychiatric unit must move elsewhere. Today, we are told again by the Minister of State that it is in the pipeline. We have been waiting for 20 or 25 years and it is just not good enough.
A question to the Minister of State.
Will the Minister of State provide a definite timeline for this unit?
Why do children continue to be admitted to adult centres? In 2009, 155 children were admitted to adult centres. Suicide rates have increased and 1,200 seriously ill patients continue to be admitted to inappropriate institutions. Will the Minister of State provide a list of assets sold to date and the revenue raised for same; a list of assets due to be sold and the estimated revenue that will be raised for same; the timescale for investment; and the details of where the 1,200 patients will be placed? With regard to those with intellectual disabilities, our mental health services were described by the inspector as crumbling institutions unfit for human habitation with residents wandering around aimlessly, cramped dormitories, the presence of dirt, the stench of urine, poor sanitation, broken furniture and the absence of constructive daily activities.
In 2010, the HSE will dispose of surplus assets and reinvest the initial sum of €50 million. The HSE has already identified properties and has already received €15 million. It is in the process of selling other lands which will realise €50 million this year. The mental health capital programme will provide a range of facilities throughout the entire spectrum of mental health care facilities, including acute psychiatric units, day hospitals, community nursing units and high-support hostels, which will provide the infrastructure necessary to enable its modernisation into a patient-centred flexible community-based mental health service. The acute unit at Beaumont is prioritised as one of the projects to be funded in 2010. Acute admissions will be moved from St. Ita's to a new unit at Beaumont.
There are still 23 men and 23 women sharing open wards with a block of three toilets, one shower and one bathroom. This is a disgrace in modern Ireland. Why has the 60-bedded unit at St. Ita's sat idle for the past seven months while intellectually disabled people live with paint peeling off the walls and the dirty conditions I described?
What percentage of child and adult community mental health teams are not fully staffed? The Minister of State should have that information.
The Minister of State, Deputy John Moloney, was quite clear as to where he wants to go with A Vision for Change and he has three main items on his agenda: the appointment of an assistant national director with sole responsibility for mental health; to get the capital ringfenced; and to protect the human resources, which are affected by the moratorium. Deputy Reilly was present when the Minister of State indicated that he is working with the Minister for Finance to develop a mechanism whereby the human resources in certain mental health services can be supported and reconfigured where vacancies arise elsewhere and in the overall employment control framework of the HSE.
What is the percentage of child and adult community mental health teams that are not fully staffed? The Minister of State should have that information.
That is the same issue.
How many? Name them.
Perhaps the Minister of State will revert to the Deputy.
The answer is that I do not know.
A Vision for Change was published in 2005. It is a disgrace.
46 Deputy Jan O’Sullivan asked the Minister for Health and Children her views on a report issued by the Department of the Taoiseach under the auspices of the organisational review programme (details supplied); her plans to review and refocus the work of her Department; and if she will make a statement on the matter. [10661/10]
At the request of the Department of Health and Children, a review of the Department was carried out last year under the organisational review programme, ORP. The report of this review was received approximately four weeks ago and the Department is now preparing an action plan which will set out its response to the ORP conclusions. The report and action plan will be published in due course along with similar reports and action plans for other Government offices and Departments, following submission to the Government.
The ORP is a public service modernisation initiative under the auspices of the Department of the Taoiseach. It involves assessing the capacity of individual Departments and major Government offices to meet their challenges over the coming years. It is essentially a management tool which can be used by Departments to help them improve their performance.
While it would be inappropriate to comment on the report in advance of its consideration by Government and publication, the Department has already made it clear that it welcomes this report and is satisfied that it provides a timely and helpful review. The report acknowledges the Department's strengths and achievements including, in particular, the ability and commitment of its staff in dealing with a difficult agenda.
It also identifies areas which require improvement, including the need to clarify its roles and responsibilities particularly vis-à-vis the HSE; manage delivery by its agencies through stronger goal setting, output and outcome measurement and performance management; define its customers and stakeholders more clearly and align itself to serving these appropriately; and improve its human resource capacities.
I am confident the Department will respond effectively to the ORP report and will use it as intended, to build on its undoubted strengths and to further improve its performance in these changing and challenging times.
I note the Minister stated she cannot comment because it has not been published. Is the account published in The Irish Times on Thursday, 18 February accurate? It depicts a lamentable account of mismanagement and disorganisation in the Department, which indicates that some people have too much to do and other people do not have anything to do. It suggests that there should be more of a focus on the main stakeholder, namely, the patient. Will the Minister comment on that? Why has it taken so long to reorganise the Department given that the Health Service Executive has been in existence for five years? Presumably that should have been enough time to reorganise the Department. Given that the functions, in essence, have been passed on to the Health Service Executive, does the Minister consider that 436 core staff are required in the Department? Why do staff spend so much time on Oireachtas business especially as most of our questions are passed on to the Health Service Executive?
The number of staff in the Department has reduced by 25% since the Health Service Executive was established. The Department was never an operational Department. In the health board era it was never involved in operational issues. A myth has arisen in this regard. The Accounting Officer role has changed. The chief executive officer of the Health Service Executive who spends the money is accountable to the Oireachtas for the expenditure of that money. That is an appropriate management tool and although it has been criticised in some quarters it has been very much praised in another. It is not acceptable that a Secretary General of a Department who is not responsible for the expenditure of money and operational issues should have remained the Accounting Officer.
The huge change in the Department was acknowledged in the report. Unfortunately, the report was leaked. I say that because the staff in the Department were entitled to hear from management on the outcome of the report before they read it in a newspaper but someone chose to leak the report and we have to deal with that. The role of the Department has changed immensely. For example, until recently the medical team in the Department led by the chief medical officer had an advisory role; now the chief medical officer heads up a division of the Department and has management responsibility for patient safety. That is the division dealing, for example, with the upcoming licensing and accreditation of health facilities. The role has changed enormously. The report is full of praise for the Department in many respects, including the cancer policy, the cardiovascular strategy and the fair deal.
Deputy O'Sullivan inquired whether there are too many staff. Most Oireachtas Members who have an interest in this area were exposed to the team of three people who were involved not just in putting together the fair deal legislation but in discussing it with all stakeholders and other Departments. We are usually accused of not being accountable to the Oireachtas but we are one of the most productive Departments in terms of producing legislation. Last year four major Bills were produced and 12 Bills are in preparation. The Department deals with more than 5,000 parliamentary questions and 500 Adjournment debates. It is an extremely busy Department.
The head of the Department in this case is the Minister and the Ministers of State. The management team is led by the Secretary General. We are fortunate to have one of the most dynamic public servants of his generation. It is a matter for him and his management team to address the issue if it is the case that some people do not have enough to do and others at the lower levels have too much to do. That is not an acceptable position from management's perspective and the Secretary General and his team intend to deal with that.
I acknowledge the work of the staff who are dealing with a fair deal. They have been particularly helpful in that regard. I do not wish there to be any doubt on that.
What we read in the newspaper indicated much chaos with some people having too much to do and others having nothing to do. Has the Minister commenced the reorganisation of the Department since that report was received?
I question whether many of the decisions being made by the Health Service Executive are implementation or policy decisions in so far as in times of budgetary constraints, deciding where the budget goes can in effect be a policy decision. What input does the Minister have on bed closures and on the various other decisions that impact on patients that are currently made by the Health Service Executive?
Traditionally, the Department over-concentrated on inputs. As is clear from the report, the role of the Department is focused on outcomes, results and measuring performance. The report draws attention to the need for the Department to have a different skill-set such as economic analysis and analytical skills in general. I share that view. The service plan has to be approved by the Minister. I agree that there is a fine line in many respects between policy and its implementation. The cancer control framework was a policy initiative of mine which was endorsed by the Government and implemented by the Health Service Executive. The Department has to be praised for that policy initiative. We need to see the Department involved in more of that.
Significant reorganisation has taken place. It is acknowledged that the Department and the Health Service Executive are on a journey in terms of how services are provided. Initially there is always a lot of nervousness about change but the working relationship between the Department and the Health Service Executive has improved immensely. I want to see that continue. I would be happy to arrange for Deputies to meet and engage with the management team. Members would see that they are made up of hard-working, committed, energetic civil servants who take that task seriously.
47 Deputy James Reilly asked the Minister for Health and Children the number of acute hospital beds closed nationally; the reason those beds are closed; the details of her plans to close an additional 1,100 hospital beds in 2010; the location of those beds; her views on the impact that will have on patient services; and if she will make a statement on the matter. [10866/10]
The most recent information on bed closures in the acute hospital system refers to the week ended 17 January 2010. At that time, 689 inpatient beds and 37 day beds were closed for reasons of cost-containment, infection control, refurbishment and seasonal closure of facilities.
While public debate tends to focus on bed numbers, it is much more meaningful to measure the number of patients treated. In 2009, the combined number of inpatient and day case discharges was 3% greater than the equivalent figure in 2008, despite the difficult situation in regard to resources.
The preparation of the Health Service Executive's 2010 national service plan, which I approved on 5 February, maintains the focus on increased efficiency and targets broadly the same level of overall hospital activity as in 2009. This involves a shift from inpatient to day cases, a reduction in emergency admissions and a further increase in day cases.
While there is no proposal in the service plan to close a specific number of beds, the reduction in inpatient treatments will mean that less capacity will be required in this area during 2010. The exact number of beds available at any one time will fluctuate depending on such factors as planned activity levels, maintenance and refurbishment requirements and staff leave arrangements. Beds may be also closed from time to time to control expenditure, given the need for every hospital to operate within its allocated budget for the year.
Meeting the agreed efficiency targets will require increased access to the specialist skills and senior clinical decision-making available in medical assessment units, to diagnostics and to other ambulatory care services. The HSE will also focus on minimising length of stay, with a particular focus on reducing the current variation across different hospitals for similar procedures. It will also work to increase same day of surgery admission and to protect inpatient beds for elective surgery to reduce waiting times.
By reforming the manner in which services are provided, I am confident the HSE can deliver the volumes of service provided for in the plan, while at the same time continuing to improve service quality and patient outcomes.
Despite what Professor Drumm has to say, I fail to see how one can possibly reduce emergency admissions by 33,000. I have spoken to accident and emergency consultants the length and breadth of this country and they are not admitting any patients that are not emergencies and that in medical terms need admission. In Galway, one of the dedicated centres for cancer care, they have reached a record level of an average of 18 patients overnighting on trolleys every single night this year to the end of February. Yesterday, according to the Irish Nurses and Midwives Organisation, 368 people were lying on trolleys. We learnt of a man who died in an accident and emergency department having waited there for seven hours.
A reduction of 54,000 inpatient procedures will be compensated for by an increase of 10,000 outpatient procedures. The maths does not add up. Professor Drumm has confirmed that 1,100 more beds will be closed. How is the Minister going to achieve that? Will she give us a breakdown of where the beds will be closed and what hospitals will be affected?
I wish to explain something to the Deputy because it makes a difference. Many procedures can be done on a day case basis that are currently done on an inpatient basis. I will outline some data. For example, 37% of hernia repairs happen on a day case basis. It varies from Tallaght where 84% of them happen on a day case basis to Mayo where only 16% happen on a day case basis. The length of stay in Mayo is on average three days. In the case of varicose vein procedures, 56% are done on a day case basis, varying from 99% at St. Columcille's Hospital, Loughlinstown, County Dublin, to 57% at Mercy Hospital, Cork. For cataracts, the day case rate varies from 90% in the Mater, Waterford, Sligo and Letterkenny hospitals to 42% in St. Vincent's Hospital. In the case of hip replacements, it goes from seven days in Croom to 18 days in Waterford.
If all facilities could operate to the level of best practice within the country, that in itself would have enormous potential to decrease dependence on inpatient activity. Dr. Barry White has been appointed clinical affairs director of the Health Service Executive and is now appointing clinical leads, particularly in area of chronic illness, to devise and work with clinicians on care pathways. For example, as part of that process, the intention is to ring-fence surgical beds for surgeons so that they are not obliged to have patients admitted one or two days in advance in order to ensure a bed is available. These reforms will generate much increased activity in 2010.
With all due respect, it is necessary to observe that the Minister has been in office for four years and the Health Service Executive in existence longer. The purpose of the reorganisation of the management of health services was to bring about a uniformity in the delivery of care. We can only look to the Minister herself in assessing the failure to address the issue she has just raised, namely, the lack of uniformity of approach, where particular procedures can be done on an outpatient basis in some hospitals but require inpatient admittance in others. No attempt has been made to resolve this problem.
The Minister has not answered the core question, which is a simple arithmetic question. How does one tally a reduction in inpatient procedures of 50,000 with an increase of 10,000 in outpatient procedures? Will the Minister explain how the apparent net deficit of 40,000 will be overcome and how it will not result in longer waiting times and increased pain and worry for patients?
The Deputy, if he is being fair, must acknowledge the substantial progress that has been made in the delivery of health services, particularly in regard to day case activity which has virtually doubled since 2000. In regard to the service plan, the main element of the change is that 33,000 fewer people will be admitted to hospital in the first place. Those people will either receive hospital-in-the-home services or be provided with diagnostic access without requiring hospital admission. As Professor Drumm has pointed out, a large proportion of those who go into hospital are there for less than 48 hours; in some cases it is less than 24 hours. It is well established that many of these people do not need to be hospitalised but are admitted in order to access diagnostics and so on. Those types of services will be provided in an alternative way.
That is not true.
It has been confirmed by the bed utilisation study and so on.
It is ludicrous to conclude that a patient admitted for 48 hours with acute cardiac failure and discharged after 48 hours did not need to be admitted in the first place.
I said that "many" of those admitted for less than 48 hours do not require hospitalisation.
48 Deputy Jan O’Sullivan asked the Minister for Health and Children the plans that are in place to ensure patients and their families are protected and will have access to the information they need in the context of the planned escalation of industrial action in the health services commencing this week; and if she will make a statement on the matter. [10662/10]
The Health Service Executive received notice on 22 February from the trade union IMPACT of its intention to intensify its members' industrial action with effect from Monday, 1 March. The HSE was informed that, in addition to their existing actions, IMPACT members would refuse to take on work in regard to any vacancy, not just those vacancies that have arisen since the general industrial action commenced on 25 January 2010; refuse to participate in all work relating to the HSE's reconfiguration programme; refuse to deal with all political representations, including parliamentary questions and freedom of information requests; and refuse to answer telephones, including mobile telephones, for specified periods of time, to be advised by the union, with little advance notice to management. This will apply unless a specific derogation for emergency cover has been agreed with the union.
Clearly, health service employers are very concerned about the potential impact of this intensification of the industrial action on services and patient safety. I share this concern. I assure the Deputy that the situation is being monitored on a daily basis by the HSE and my Department. It is a matter of great regret to me to see patients and the public inconvenienced in this way. There is no doubt that following a period of rapid increases in funding, health services are now facing the challenge of managing within much tighter resource constraints. There is scope within our health system, by reforming how services are delivered, to achieve more through greater efficiency and concentrating on services that contribute most to people's health and well-being. There is an onus on all concerned — Government, management, trade unions and employees — to find a way of engaging in the reforms that are needed to deliver better services to patients.
If the Government had not pulled out of talks with health service unions before the budget, we would be well on our way to achieving the types of reforms we all want to see in the health service. The information provided by the Minister at the start of her reply was given to me by the Minister of State, Deputy Áine Brady, who kindly responded to my matter on the Adjournment last Thursday. Has the Minister had any reports on the effects of the action in the health service? Has she met with representatives of any union besides IMPACT? SIPTU, for example, also has a large number of workers in the health service. Has the Minister been informed of any ongoing actions and what information does she have from her meeting with IMPACT as to what is likely to happen in the coming weeks?
To clarify, I have not met with any of the unions. The industrial relations activity that is under way is part of a broader campaign across the public sector the response to which is being led and managed by the Minister for Finance and the Taoiseach. To clarify another point, the Government did not pull out of talks with the unions. Unfortunately, we failed to reach agreement within those talks, and I am eager to see them resume as quickly as possible. In every dispute between Government and its employees or the employees of others, it is incumbent upon us to find a resolution. From the perspective of the health service, and patient safety in particular, I would like to see a resumption of the talks as soon as possible.
In areas where it was anticipated that there could be a negative impact on patient safety, where management has engaged at local level with the relevant unions that threat has not materialised. Radiotherapy services in Cork are an example of that. To the best of my knowledge I do not have information that would suggest there have been any adverse effects on any patient services, except that there is a difficulty in giving information to those who require it, including Members of the Oireachtas. It is difficult to operate and manage an organisation as large as the health service without appropriate information on a daily and weekly basis.
In regard to information to the Oireachtas, is it not the Minister's responsibility to ensure parliamentary questions are answered irrespective of actions by trade unions?
Yes, but I must be able to access the information in order to respond accurately to Members. Neither I nor my colleagues have all the information in our heads. In recent weeks, and in preparation for today in particular, we pulled out all the stops to obtain information. In the current unusual situation even very senior people are involved in the industrial action. In order to provide up-to-date information to the Oireachtas, data must be obtained on a real-time basis. It was not possible to do that in the case of many of the questions we are discussing today, but we have done our best. What we are experiencing is not different from what is happening in other Departments.
49 Deputy Alan Shatter asked the Minister for Health and Children when the report relating to the abuse of children (details supplied) and the failure of our child protection services to intervene appropriately and promptly to protect the welfare of the children will be published; the action taken following the publication of the report into the death of Kelly Fitzgerald in 1996 to attempt to ensure the failures of the Western Health Board documented in that report did not recur. [10663/10]
I am informed by the Health Service Executive that it expects to publish the report of the independent inquiry into the Roscommon abuse case in the coming weeks.
The report into the death of Kelly Fitzgerald, published in 1995, contained in excess of 40 recommendations. Those recommendations were presented to the then Western Health Board and adopted in full by it. Several of the report's recommendations required consideration at national level, including: the need for amendment of the Constitution to include a statement of the constitutional rights of children; the need for the establishment at a national level of a system for the setting and monitoring of child protection standards to promote examples of good practice and to inquire into serious failures of practice; and the need to introduce a system of mandatory reporting.
Issues relevant to the rights of the child have been considered by the Joint Committee on the Constitutional Amendment on Children which recently published its third and final report. That report will now be considered by Government. Issues relating to national guidelines for the protection and welfare of children and the conduct of reviews into serious incidents are addressed in the Government's implementation plan in response to the recommendation of the Ryan commission. The issue of mandatory reporting was previously considered. International evidence suggests that mandatory reporting can overload existing child protection systems with high volumes of reports, often resulting in no commensurate increase in substantiated cases. The concern, therefore, is that child protection resources would be diverted into an extensive administrative system with no guarantee of increased protection for children.
A number of the additional recommendations in the report highlighted the need for significantly improved and standardised business processes to ensure consistency in service delivery. In this regard the HSE recently has completed a national project designed to standardise the child welfare and protection business processes across all regions. The process of implementation is now being commenced.
The report into the death of Kelly Fitzgerald stated:
we do not believe it is possible to guarantee that children will not be abused but we believe that Health Boards, as child protection agencies, must aim to ensure that all children at risk are accurately identified and that intervention is effective in reducing the level of risk to a child or removing it altogether.
This remains a principal focus of the Government and its agencies as it seeks to strengthen the existing child welfare and protection system.
I thank the Minister of State for his reply. As he is aware, the first part of the question relates to the barbaric abuse, both physical and sexual, perpetrated on children in County Roscommon, which resulted in the mother of children being convicted in the courts in January 2009. The father involved was convicted only recently and sentencing is due on Friday. Originally, it was promised that the report into the Roscommon tragedy would be published in July. My understanding is that its publication has been delayed for understandable reasons pending completion of the criminal prosecution. When the Minister of State stated the report will be published in a matter of weeks, what precisely is meant by that? Does he know whether the report essentially is complete? Does it merely await publication following sentencing, which is expected this Friday? Are there other issues the Minister of State anticipates will arise with regard to the publication of the report? It is clear, based on what already is known, that this report will depict yet another appalling failure by the Western Health Board in respect of this family to provide children with the protection to which they are entitled. I note it is the same health board that was criticised in the Kelly Fitzgerald report. Is it known whether the report in full will be published? Does the Minister of State know whether the report, as prepared, includes an audit of the extent to which, in the years that followed the publication of the Kelly Fitzgerald report, the Western Health Board failed to implement the recommendations contained therein? Will publication of the report require prior permission from either the mother or the father of the children who were the victims of abuse in Roscommon?
I understand the report is substantially complete and that the issue of publication is related to the criminal prosecution and the sentencing which, as the Deputy observed, is due next Friday. Obviously, I have not seen it and cannot comment on what issues might arise in respect of publication. However, I assure the House that the inquiry is being chaired by a person in whom everyone in this House who is familiar with children's rights issues will have great confidence, namely, Norah Gibbons, and I have no doubt but that every effort will be made to ensure that the report is published. Members will be aware that it frequently arises that one must balance the rights of individuals to their good name and to privacy for families in particular, against the great public interest in knowing how such tragedies came to pass and to learn from them accordingly. As for publication, the inquiry will be published through the HSE, which will give all due consideration to the manner of its publication thereafter.
Will the Minister of State confirm that in the context of this report's publication, the primary issue must be the best interests of children, to ensure that we learn from what went wrong, to ensure that whatever action that possibly can be taken is taken to prevent a recurrence of the failures of this health board, which now is known to have failed children abysmally twice? In addition, will the Minister of State confirm that it is unacceptable to suggest that parents who have substantially failed their children or who have abused their children physically or sexually should be entitled to a veto on the publication of reports in the public interest to ensure the existence of a proper functioning child care system? Does the Minister of State agree it is a false analogy to suggest that some form of confidentiality would entitle parents who have failed their own children to exercise a veto over the full publication of reports into the failure of our social services to provide children with the protection to which they are entitled?
Deputy Shatter obviously is trying to refer to the publication he effected this morning.
I am referring specifically to this publication.
He clearly is drawing an analogy with what he did this morning. It was most unfortunate and irresponsible to do so in the circumstances in which it was done. Had Deputy Shatter asked either the HSE or me, I would have been able to assure him that every step was being taken to try to effect that publication, having regard to balancing the rights to which I referred earlier.
The Minister of State had that report for 12 months. He is hiding behind the unwillingness of the HSE——
It is unfortunate that he should try to draw on that issue. However, if he insists on so doing——
Deputy Shatter, allow the Minister of State to reply.
——and its incapacity to communicate with a mother who had failed her children.
Deputy Shatter, please. The Deputy should not shout down people in the House.
With due respect, the Minister of State was giving opinions rather than facts.
The Minister headed into an issue——
First——
On a point of information——
There is no such thing as a point of information, as a Deputy of such experience is aware.
On a point of order, I specifically raised these issues only in the context of the Roscommon case that is the subject matter of this question. The Minister of State has now strayed into an entirely different case and has made an accusation that I am entitled to address.
Allow the Chair to determine. It is not a matter of addressing it now. The Minister of State is entitled to make his response and I had intended to call the Deputy again. However, my point is that everyone should be heard in this Chamber and should not be shouted down.
With respect, Deputy Shatter is trying to ask everyone in this House and everyone who is watching this debate to suspend reality and to ignore what happened this morning. To state there is no analogy between what he is talking about now and what occurred this morning is simply a fantasy of his own making.
The Minister of State should not be contentious in his reply.
I apologise if I am being unnecessarily contentious but it is important to re-emphasise that difficulties always arise in respect of the publication of this type of report. It is crucial for public confidence in our child welfare and protection service that they are published. It is for this reason that the Government has ensured that HIQA will provide the HSE with guidance in the matter of serious incidents and deaths in care and that a panel will be established to effect proper and timely investigations and publication of reports.
While we have gone over time, I had stated that I would allow Deputy Shatter ask a brief supplementary question that no doubt will be carefully constructed.
I appreciate that. Is the Minister of State seriously suggesting, in the context of the issue he now has raised, that it was in the best interests of children generally in this State or in the interests of a functioning child care and protection service, that an eight-year old report should languish unpublished in his Department and on the shelves of the HSE for 12 months? It was a damning indictment of the complete failure of our child care services to provide for the protection of a child. Does the Minister of State seriously suggest that a mother who failed that child and who was reported in that report to have physically assaulted the child at the age of seven to the extent that two of the child's front teeth were removed, is entitled to exercise a veto in the public interest over the publication of that report? I will conclude by suggesting to the Minister of State that the public interest is that there should be transparency and accountability in our child care services to the maximum extent to ensure they truly protect children.
The Deputy should not issue such challenges.
Covering up reports of this nature only suits the HSE or the health boards who are failing children or parents who have abused children.
Hear, hear.
From the moment of my appointment, it became clear to me that child welfare and protection would have to be a priority in the discharge of my functions and this continues to be the case. One key element in the restoration of public trust in that part of our health service is to ensure that reports like these are published. To suggest, as has been suggested on the floor of this Chamber today, that there is a mentality of cover-up or a failure to try to effect transparency, is most inaccurate and unfair to people who work extremely hard in the interests of children. I will continue to try to effect the changes the Government announced following the Ryan report and the implementation plan arising from it.
However, the Government has not published any of these reports.
It is difficult to publish such reports. While no attempt is made to cover them up, it simply is a matter of trying to balance rights.
