Dáil Éireann debate -
Wednesday, 21 Apr 2010

Vol. 707 No. 1

Other Questions.

Defence Forces Medical Services.

John Deasy

Question:

54 Deputy John Deasy asked the Minister for Defence the number of recommendations of the Defence Forces Medical Services Review that remain unimplemented; the number of recommendations in the process of implementation but not yet fully implemented; the number of recommendations yet to begin the process of implementation; the number of recommendations that have been fully implemented; the specific timeframe in which the recommendations will be implemented; and if he will make a statement on the matter. [15669/10]

Ciaran Lynch

Question:

88 Deputy Ciarán Lynch asked the Minister for Defence the position regarding the establishment of the new centralised medical corps for the Defence Forces. [15615/10]

Deputy Tony Killeen

I propose to take Questions Nos. 54 and 88 together.

The PA report assessed the current arrangements for the provision of medical services and proposed a model for future delivery of those services. The consultants recommended a programme of major change. The high level recommendations include a centralised command structure for the Medical Corps and the creation of a medical services management and administrative function. This structure will provide strategic planning, resource allocation and overall responsibility for the management and delivery of the medical service and for the development of medical officer-led care teams, together with a refocusing of medical staff on appropriate clinical tasks. The structure and systems recommended have been designed to meet the demands and needs of the modern Defence Forces at home and overseas and provide medical officers with a fulfilling and rewarding career. The implementation schedule follows the recommendations made by PA. Many of the recommendations made in the PA report are of a high level strategic nature.

The governance structure proposed in the report for the delivery of change in this area has been put in place. A dedicated programme group with civilian and military representatives is co-ordinating a range of projects. Progress has been made on implementation of the PA recommendations including, alignment of Defence Forces and medical corps strategies, redesign of the medical care model in the Defence Forces, a centralised command structure, informed service provision through strategic and operational demand and capacity planning and the making available of accurate and timely health and business information. Also included are a performance-based approach to managing demand and ensuring efficient use of resources and support to sustaining and developing the medical service within the PDF.

As recommended, working groups have been set up to progress the various projects identified. These continue to meet regularly and all have submitted reports. The steering group has considered all of these reports. While none of the seven recommendations from the PA report has been completely implemented, the programme of implementation is progressing. In particular, the steering group has approved the high level organisation for the unit, which now includes a line officer at the rank of colonel commanding the medical corps. It has also authorised the immediate introduction of an annual medical for all Defence Forces personnel and directed, following the findings and recommendations of the future medical information system working group, that all medical corps personnel will use the personnel management system medical module. Formal links have been established with the Medical Council, the Health Services Executive, the Royal College of Surgeons in Ireland and other relevant bodies to explore external training for doctors in the Defence Forces medical services.

Final reports from a number of the working groups including those on the future medical information system, organisation and establishment, training and education, and financial arrangements and outsourcing are due to be delivered by 30 April 2010. The clinical review working group is not due to submit its final report until 30 September this year with monthly reports to be submitted in the interim. It is only following completion of this phase that full implementation of the recommendations can be achieved.

It is expected there will be substantial progress before the end of the year in implementing recommendations. Some issues will be resolved quickly while others will require significant consideration and will, for example, require negotiation with the representative associations.

Deputy Jimmy Deenihan

The first question I asked the Minister's predecessor back in October 2007 was about establishing a review of the medical corps in the Defences Forces, to which the then Minister responded. The consultancy group was taken on in 2008 and reported last year. It is very important that the report is implemented and I have concerns about the speed of implementation. The PWC report of the late 1990s suggested there was an establishment requirement of 46 medical doctors for the Defence Forces. I understand that at present the number is 23, some of whom are non-nationals. Will the Minister confirm the number?

Due to the nature of their work, the health and fitness of our Defence Forces is paramount. More than any other occupation, they are exposed to physical challenges and stresses that people in other occupations would not fully comprehend. This is why a proper well resourced medical corps is paramount. We are failing badly in many respects with regard to providing that support to the Defence Forces. The report stated quite clearly that current demand for medical assessments is not met. It also stated that the medical corps delivered 7,222 medical assessments in 2007 against a requirement estimated at more than 18,716. This is grossly inadequate.

A key recommendation of the report was for the immediate creation of one centralised medical command structure. It is now six months later and one would think it should have been possible for that to have been put in place immediately. Will the Minister respond on the inadequacy of what is available at present? Will he give us more direction and a timeframe for the implementation of the recommendations made by the PA consultant group? Will he be more specific with regard to the centralised medical command structure because it strikes me that it will be the structure which will drive reform?

Deputy Tony Killeen

I will take the final point first. I agree with Deputy Deenihan that the single medical command structure with a line officer at colonel level will have a positive bearing on the quality of service provided. As I stated in my reply, it is already being done with regard to the appointment of the line officer. Deputy Deenihan also made the point that some of the recommendations could be implemented more speedily. It is important to bear in mind that there are a number of review groups, some of which reported recently and others which will not report until the end of the month. Without knowing the detail of the work it is doing, it seems the report of the clinical review working group, which is due in September, will have a considerable bearing on the direction, notwithstanding the fact that it is making interim monthly reports.

Last week, I visited the Galway office of the Department and the barracks. I got a very good close-up view of the work undertaken there in support of the medical services for military personnel. I was very impressed with the manner in which it is organised. With regard to some of these changes, it is also important that there will be elements on which the representative organisations will have views. I have had the opportunity to meet two of them and I will meet them while I am in the job. It is important that we take on board any concerns or recommendations they may have.

I will have to come back to the Deputy with information on the numbers of personnel in specialisation. I know some are non-nationals but that is the case across all of our health services and I do think anything negative could be taken from it.

Deputy Brian O’Shea

In answer to a question tabled on 24 February, the then Minister of State at the Department of Defence, Deputy Pat Carey, told us it was planned that the new centralised medical corps would be established prior to the end of the year. In his response today, the Minister was not as definitive as that with regard to when the corps will be established. It seems the date is moving back. In essence, many processes are under consideration at present and some have been put in place to some degree. Is there any improvement, even at this stage, in the provision of medical services within the Defence Forces? Realistically, when does the Minister consider that we will see major and worthwhile improvements to a situation described in the not too distant past as being a shambles?

Deputy Tony Killeen

The agreement reached at steering group level is an important development. It is very hard to ascribe a timeframe in a situation such as this where a steering group and various sub-groups are reporting. However, the fact that it has approved a high-level organisation unit to include a line officer at the level of colonel is very important because it is central to delivering on many other concerns. The introduction of an annual medical for all Defence Forces personnel must be welcomed because one would have thought this was the case already. With regard to a peer review group and access to best practice, the links being established with the HSE, the Royal College of Surgeons in Ireland and other bodies must be a positive move. However, I understand the frustration, if that is the right term, of Deputy O'Shea about the fact that many recommendations which appear to be required in common sense seem to take a bit longer to implement than one would hope. I will try to encourage as much progress as quickly as possible in this regard.

Defence Forces Strength.

Paul Connaughton

Question:

55 Deputy Paul Connaughton asked the Minister for Defence the outcome of the review with the military authorities into structures and posts required to meet the operational requirements of the Defence Forces in view of the decision to maintain a complement of 10,000 personnel, which was due to be completed in March 2010; if the Department of Finance has sanctioned the outcome as produced by the review; the timescale for the implementation of the review; the nature of cost implications from the review and its implementations; and if he will make a statement on the matter. [15658/10]

Deputy Tony Killeen

Within the available resources, the Government is committed to maintaining the strength of the Permanent Defence Force at a level of 10,000 all ranks, for which Government approval has been secured in the context of budget 2010. This reflects the reductions in personnel recommended in the report of the special group on public service numbers and expenditure programmes.

I am advised by the military authorities that the strength of the Permanent Defence Force as at 31 March 2010, the latest date for which figures are available, was 9,877 and I have already provided the details of those figures.

The now approved strength of the Permanent Defence Force at 10,000 represents a reduction of 500 over the previous approved strength. Officials from the Department are continuing to engage with the military authorities on a review of structures and posts required to meet the operational requirements of the Defence Forces in light of the Government decision to maintain a complement of 10,000 personnel. This review is expected to be completed before the end of next month. Following on from this review, discussions will commence with the Department of Finance to agree an overall structure for the Defence Forces, which is sustainable within a figure of 10,000 serving personnel in the Permanent Defence Force.

Since the review is not yet completed it is not possible to comment on the nature of cost implications resulting from it and its implementation. I am glad to say that while these are challenging times, the Defence Forces have risen to the challenge and are organised, equipped and staffed in a manner which will ensure that they can continue to deliver the services required of them by Government. I am advised that at this time the Defence Forces retain the capacity to undertake the tasks laid down by Government both at home and overseas.

Deputy Jimmy Deenihan

How many ranks remain unfilled at the moment? How many officers are acting up? Would he agree with me that if ranks remain unfilled it affects the entire operational capacity of the Defence Forces and could affect their day-to-day running? Some feedback I am getting indicates that if the promotions fail to take place in the near future it will add to frustration and lead to a drain from the forces. With the numbers reduced to 10,000 it is reasonable to expect that all posts within that structure should be filled as soon as possible when it is agreed. How will the moratorium affect promotions in the Defence Forces and the filling of vacancies? Will that not be considered when the new structures are agreed? Will the moratorium affect promotions where vacancies already exist and where people have been more or less informed that they will be placed in certain positions? How will the moratorium affect that? When will these vacancies be filled? Will the moratorium affect the filling of these vacancies or promotions?

We have a new Minister for Defence. When can we expect him to announce a new Chief of Staff?

Deputy Tony Killeen

I do not have information on the final question at this point. However, I will inform the Deputies as soon as that information becomes available.

To the best of my recollection there are approximately 100 people in acting-up posts and perhaps approximately 50 promotions to address parity, operational and command requirements. If that is incorrect I will come back to the Deputy in that regard. As I explained in the original reply, there are ongoing discussions with the Department of Finance on the implications of the issues the Deputy raised on people acting up at various levels and the filling of command positions at various levels, which need to be addressed in the context of the operational capacity of the Defence Forces in any event. That is progressing and I would hope the matter would be addressed in the very near future.

Deputy Brian O’Shea

This is a fundamental question. Obviously with a review of structures against a background of a reduction of 500 in personnel complement it means that some posts will be suppressed or not filled, which will have an impact on promotions. Will the completion of the review have a bearing on the date for the announcement of recruitment into the armed forces generally? While we are considering the structures at a higher level, obviously there are adjustments at a lower level. Until all that is clear, is there a possibility that this will unduly delay the recruitment process?

Deputy Tony Killeen

I expect the review will be completed by the end of May, which is not a very long time away. An overall structure then needs to be agreed with the Department of Finance. The Deputy is correct that that could have implications for the kind of recruitment that would be undertaken. If that were to be a long drawn out process I would be unhappy if the impact were to delay ordinary recruitment, particularly if as we go along, as I am finding already, there are areas where recruitment is becoming quite urgent and needs to be addressed. In an ideal world I would like to do the two in parallel or close together, but that may not be possible. The recruitment imperative might drive that as the priority.

Irish Red Cross Society.

Michael Noonan

Question:

56 Deputy Michael Noonan asked the Minister for Defence his plans to nominate a new chairperson for the Irish Red Cross; and if he will make a statement on the matter. [15704/10]

John O'Mahony

Question:

67 Deputy John O’Mahony asked the Minister for Defence his views on whether there should be an independent investigation into the governance and management of the Irish Red Cross in view of the recent negative publicity surrounding the organisation; and if he will make a statement on the matter. [15709/10]

Tom Sheahan

Question:

70 Deputy Tom Sheahan asked the Minister for Defence his views on the recent internal governance review of the Irish Red Cross; his further views on whether this review goes far enough in terms of addressing concerns relating to the governance and management of that organisation; the outcome of recent discussions between officers of his Department and the Irish Red Cross; and if he will make a statement on the matter. [15716/10]

Thomas P. Broughan

Question:

87 Deputy Thomas P. Broughan asked the Minister for Defence the discussions that have taken place between his officials and the Irish Red Cross regarding the recent internal governance review of the Irish Red Cross; and the action he proposes to take arising from these discussions. [15607/10]

Thomas P. Broughan

Question:

96 Deputy Thomas P. Broughan asked the Minister for Defence his plans to nominate a new chairperson for the Irish Red Cross. [15606/10]

Deputy Tony Killeen

I propose to take Questions Nos. 56, 67, 70, 87, and 96 together.

The Irish Red Cross Society is an autonomous body, established by the Irish Red Cross Society Order 1939 pursuant to the Red Cross Act 1938. The society is an independent charitable organisation with full powers to manage and administer its affairs through its governing body, the central council. Membership of the central council is by way of appointment by the Government or by election in accordance with the rules of the society.

In accordance with Article 9 of the Irish Red Cross Society Order 1939, the chairman of the Irish Red Cross Society shall be a member of the central council and shall be nominated by the president of the society. The Red Cross Act 1944 provides that the President of Ireland shall by virtue of her office be president of the society. I am following up on the good work of my predecessor in ascertaining a suitable candidate to be proposed by Government to the President, for appointment to the post of chairman of the society. In the interim, the vice chair of the society acts in lieu of the chair.

The society has been subject to some adverse publicity in recent times but this fact does not fully reflect the true standing of the society and its international governing body in the eyes of the public. It is important for the morale of its volunteers that the society's unique position be properly recognised and that change, as appropriate, be effected.

As independence from Government is one of the fundamental principles under which the Red Cross conducts its business, it would be inappropriate for me to comment on the question of an independent investigation into the governance and management of the Irish Red Cross Society. National societies, while auxiliaries in the humanitarian services of their Government and subject to the laws of their respective countries, must always maintain their autonomy so that they may be able at all times to act in accordance with the principles of the International Red Cross movement. I am anxious to ensure that all my dealings with the society continue to be conducted in accordance with the society's basic principle of independence from Government.

The working group, which was established by the society to propose changes in governance, forwarded its findings and recommendations to the Minister for Defence in January 2010. Officials in the Department have commenced dialogue on the contents of the report with officials in the Departments of the Taoiseach and Foreign Affairs, and the Irish Red Cross Society. When the consultative process is concluded, I will bring before Government any statutory changes deemed necessary.

Deputy Jimmy Deenihan

Obviously there have been ongoing problems with the Irish Red Cross Society for a number of years and it is important that the Minister addresses the matter. Whereas he wants to keep at arm's length from the organisation, the laws passed by this House give him the authority to get involved. This issue has been festering. I met the acting secretary general and the chairman of the Irish Red Cross Society some time ago. Like Deputy O'Shea I have been receiving letters from members of the Irish Red Cross Society. A recent blog on Saturday, 17 April again reflected that rumours of serious industrial relations unrest at the society intensify. Matters seem to be getting worse and not better in the Irish Red Cross Society. While I am not taking any sides, those issues need to be addressed because the Red Cross is a very important and closely knit organisation. The wrong message is going out to people throughout the world as regards what is happening in Ireland. When we see people with the reputation of Mr. David Andrews and the highly regarded civil servant Mr. John Roycroft resign before their time, this obviously raises questions.

That blog laid out a challenge to the Minister, in regard to whose role it states:

If, however, the Minister does not indicate in the near future his intentions, it can only be assumed that he plans to follow the example of his predecessor and put his head firmly and deeply in the sand. The former Minister for Defence, Willie O'Dea, not only refused to do anything to address the problems in an organisation his Department contributes nearly €1 million to annually, he actually exacerbated them by reappointing members to the Red Cross board who were there for years beforehand.

This is to lay down a challenge to the Minister. Given that he is contributing €1 million from his budget and by statute he is entitled to become involved in the governance of the Irish Red Cross, he should act.

Enough money has been spent on consultancy fees in examining the Irish Red Cross. We know there is a problem. What is needed as soon as possible is new legislation and the setting up of a new structure for the governance of the Irish Red Cross, as well as the definition of the composition of the Government body and the central executive, which is too big and unwieldy at present.

Will the Minister give a commitment that it is his intention to bring legislation before the House? We will give him every possible help with it in order to reform the Irish Red Cross and ensure that the current problems are addressed. When does the Minister intend to appoint a new chairman, which is important? I know the Minister will act prudently in the appointment of that person and will appoint somebody with an international reputation with vast experience not only in this country in the context of providing Irish Red Cross services, but also internationally. Such people are available.

Deputy Tony Killeen

In his early sentences, Deputy Deenihan outlined the difficulty, namely, how to address a problem while at the same time staying at arm's length and remaining within the provisions of the law, which is a somewhat tricky assignment. I would be very concerned if the view were the one that has been expressed to him, namely, that matters are getting worse, which would be most unwelcome.

My understanding is that there is no provision in the establishment order for me, as Minister, to intervene directly in the day-to-day running of the organisation. There is perhaps a grey area in that regard and Deputy Deenihan has suggested there may be a requirement for legislative change. This is an issue I have not considered but, in view of what the Deputy has said, I will consider it.

Deputy Jimmy Deenihan

The Department gave €1 million.

Deputy Tony Killeen

That is a substantial consideration in the current economic climate. I presume the quote read out by the Deputy is a personal view of a person whom I do not know——

Deputy Jimmy Deenihan

Absolutely. It is from a blog.

Deputy Tony Killeen

——and with whom I would strongly disagree. I have had an opportunity to examine the record of the previous Minister, Deputy Willie O'Dea, in this regard. Frankly, I do not believe I could have done any better, considering the issues he was trying to address and the constraints he was forced to operate within.

Deputy Jimmy Deenihan

The Minister will have to do better.

Deputy Tony Killeen

With regard to the question of the chair, it was not a matter that had been abandoned. Considerable work had been done by Deputy O'Dea in many areas regarding this issue, and I will not go back to the start but will benefit from that work.

On all sides of the House, we agree that the International Red Cross and, by extension, the Irish Red Cross has a particularly positive standing and has enormous potential which it has realised almost all of the time, notwithstanding the difficulties it has faced. In so far as we can facilitate or help to ensure that this continues to be the case, it is incumbent on all of us, particularly on myself, as Minister, to try to get to that point.

Deputy Brian O’Shea

There is a basic issue in this regard. The fact the State has any major role in terms of the Irish Red Cross relates to the fact the relevant statutory instruments come from the period just before the Second World War, when there was the threat of invasion, bombing and mass casualties. My view is that the role of the State should be reduced. However, in the context of what the Minister has to deal with, where he can make a positive input into the future of the organisation is in regard to governance as per the legislation which he may or may not feel is appropriate.

I realise this is all new to the Minister and that he has inherited this issue. I absolutely share his view that the Irish Red Cross is a very important organisation and there needs to be an end to all of the current adverse publicity. I ask that the Minister would consider the idea of the organisation being much more independent of Government, that he would consider a modern governance structure and, most of all, that the issue be dealt with rapidly so this very important national organisation, which has done a great deal of good, can get on with its primary work, serve the community and be involved in important projects abroad. This would ensure a period of negativity is brought to an end.

Deputy Tony Killeen

I welcome the comments by Deputies O'Shea and Deenihan and agree with both in many respects. Ultimately, the logic of what Deputy O'Shea said in regard to State involvement cannot be argued against. That is a direction that may or may not be possible within the legal parameters that are currently in place under that Act, which, as the Deputy says, dates from a particular era and reflects that fact. Notwithstanding this, the need for a modern governance structure is probably a matter of considerable urgency and how that can be achieved is an issue on which we will have future engagement. I welcome the support of the Deputies and also the goodwill in society, which is reflected in both Houses, towards the International Red Cross and the Irish Red Cross.

Written Answers follow Adjournment Debate.