Dáil Éireann debate -
Tuesday, 18 May 2010

Vol. 709 No. 2

Priority Questions

Accident and Emergency Services

James Reilly

Question:

40 Deputy James Reilly asked the Minister for Health and Children the details of the Health Service Executive plans to close or limit accident and emergency opening hours across the country as a result of cutbacks and doctor shortages; if she will identify each hospital affected by these plans; if she supports this action; if she is concerned about the impact that this will have on patient access to care; the details of the contingency plans that are being prepared for her; the action that she will take regarding the shortage of non consultant hospital doctors; and if she will make a statement on the matter. [20715/10]

Minister for Health and Children (Deputy Mary Harney)

Last year, the HSE dealt with almost 1.2 million emergency department presentations and it expects to do the same again this year. Approximately 70% of people who attended emergency departments were not admitted to hospital; they were treated and discharged. This year, the HSE is planning to increase the number who can be safely discharged home without admission to about 72%. This can be achieved by changing the way services are provided, including by providing quicker access to senior clinical decisions makers.

I am determined to move to a consultant provided, rather than a consultant led, service where consultants work on a team basis. As a result, and following agreement in 2008 on a new consultant contract, I have made it clear to the HSE that it needs to increase the number of consultants and reduce the number of non-consultant hospital doctors, NCHDs, to achieve a more appropriate balance between both groups. I am also determined to support the changes in the NCHD training status and associated medical registration status being introduced by the Medical Council under the Medical Practitioners Act 2007.

I have been advised that there are likely to be difficulties in filling some NCHD posts when doctors begin their next rotation in early July. The indications are that there will be a reduction in the number of applications for certain NCHD posts, especially in posts which are not part of a formal training rotation scheme and in the areas of emergency medicine, anaesthesia and general medicine. However, the extent of any shortfall will only become evident over the coming weeks.

It is because of the expected reductions in applications for NCHD posts, and not because of any budgetary challenges that the HSE is currently examining how best to maintain and improve the quality of services provided to patients attending emergency departments. A range of possible measures are being examined, including some relating to recruitment and training status. Other important measures include reductions in tiered on-call and improved cross-cover arrangements. Instead of cases being referred through successive tiers of doctors, we need to increase the extent to which consultants and other senior clinical decision makers respond to urgent or emergency cases.

As we are serious about patient safety we also have to ensure that acute care is dealt with appropriately.

Deputy James Reilly

The Leas-Cheann Comhairle and I often have disagreements about what is a question and what is an answer.

An Leas-Cheann Comhairle

It is not possible to disagree with the Chair.

Deputy James Reilly

Indeed.

An Leas-Cheann Comhairle

The Chair is always right.

Deputy James Reilly

Indeed. You and the Pope.

An Leas-Cheann Comhairle

No, just the Chair or whoever happens to be in it at the time.

Deputy James Reilly

I put it to the Minister that the question is quite clear. It asks the Minister about her plans to limit accident and emergency services as a result of the cutbacks and shortage of doctors; if she will identify each hospital affected by these plans, which she failed to do; if she supports the action — she failed to say whether she did; if she is concerned about the impact this will have on patient care; and the details of the contingency plans. If she is not in a position to answer verbally today I would like her to submit to me a written answer outlining what hospitals are affected because we are hearing of hospitals all around the country which are being affected.

There have been changes in the visa system which mitigate against non-consultant hospital doctors, who in the past paid a fee and were issued with a visa for two years but are now only being issued with a visa for three months. Can the Minister inform us why that is the case? We are discussing further cutbacks and the European working time directive at a time when the coroner in Kildare is writing to the HSE to highlight the overcrowded nature of our accident and emergency departments after hearing that an 86 year old woman died after a 36 hour wait on a hospital trolley in the accident and emergency department in Naas General Hospital. She was admitted with a suspected hip fracture and uncharacteristic confusion in February 2009. The Minister sent two HSE executives to Galway to help resolve problems with patients in the accident and emergency department there and the HSE plans to close a further 1,100 beds.

How will the Minister achieve what she said she would achieve? I note in her answer she referred to putting in place proper community facilties. They are not there. The fair deal, which was intended to make more space available to people is now being used to close public long-term care facilities and we cannot have it for the private citizens. Does the Minister support these actions?

Deputy Mary Harney

The Deputy has asked a whole host of questions. A number of issues are affecting the staffing of hospitals. The first is the working time directive, which is now Irish and European law. It is being implemented for patient safety reasons because we do not want overworked doctors attending patients. Under the new Medical Practitioners Act there is a fundamental change in the training of junior hospital doctors which is having an impact.

On the question of visas, I have had good discussions with the Department of Justice, Equality and Law Reform about reverting to a two year visa, and it is agreeable to that. We are currently awaiting a response from the Department of Enterprise, Trade and Innovation and I understand we will have it shortly.

On the wider issue, I had a meeting recently with the HSE. It is examining a number of scenarios. Obviously, it is obliged to commit itself to the 2010 service plan, and that it will do. It states we will reduce admissions from accident and emergency departments to hospital beds by 33,000, which is approximately 2% of the numbers who present at accident and emergency. There are a number of community facilities. As the Deputy probably knows, recently the Mater Hospital opened a facility to deal with minor injuries which has been highly successful. The volumes of patients attending it is in excess of anything which could have been anticipated.

A number of initiatives are under way. The HSE is due to revert to me shortly. I do not have the answer to the question on what accident and emergency departments are closing, which the Deputy would love to get. There is no plan to close any accident and emergency departments on foot of the restrictions which are taking place. There may be restrictions. The same issues are being faced in Northern Ireland and the United Kingdom. This week Northern Ireland announced the closure of two accident and emergency departments for similar reasons. We will not close facilties, rather, we will make sure the facilties which are in place provide safe and appropriate care and those that require emergency care are dealt with in the appropriate place.

Deputy James Reilly

The appropriate place, with 300 people lying on trolleys every single day, is not very satisfactory. Deputy Fergus O'Dowd is from the Louth constituency, in which a new accident and emergency department which is lying idle was built in Our Lady of Lourdes Hospital Drogheda. When will it open? Why has the reduction in services not been outlined? They were not mentioned in the HSE national service plan. We knew the working time directive would be introduced and there would be a shortage of non-consultant hospital doctors. Why has this not been highlighted?

I understand there will now be integrated service areas, rather than what we have had to date, such as the HSE south. There is now talk of having 18 service areas with populations of 225,000 to 250,000. One such area might affect the constituency of the Leas-Cheann Comhairle, Wexford. Others might affect Waterford, Kilkenny, Clonmel, south Tipperary and Carlow. Could the Minister inform the House whether she is in favour of the new initiative? If so, how many will there be and when will they come into being?

Deputy Mary Harney

On Drogheda, the facility is ready. There are issues in terms of recruiting staff and industrial relations. The process will happen this year and money is being provided for that. I do not have the precise opening date for the new facility. I had discussions yesterday with INMO and hope that the current staff could move into the new facility to provide the services which are currently being provided in a facility which is not fit for purpose as we ramp up to get additional staff, in particular paediatric nurses. The process of recruitment will happen this year and the facility will open.

On the integrated service areas, everything we have been trying to do is to integrate services between the hospital and the community. In some regions of the country, such as the west, we spend €2 billion on health and have 27,000 employees. It makes sense that they would work in an integrated fashion. If we are to move staff, which is part of the Croke Park agreement, from the hospital to the community in order that services can be provided there, we need to operate on that basis. If memory serves me correctly, I understand there will be 18 to 24 service areas over the next period of years. It will not happen fast; it will take a considerable amount of time, as the Deputy is aware.

The purpose of an integrated service area is to integrate all the public health services which are happening in a coherent fashion in order that we do not have a situation where the hospital is not encouraged to give somebody something to which he or she is entitled because it will come from its budget and it pushes the problem out into the community where it can be paid for out of another organisation's budget or vice versa. That is the kind of confusion which exists when we do not integrate the services we provide.

Hospital Services

Jan O'Sullivan

Question:

41 Deputy Jan O’Sullivan asked the Minister for Health and Children the advice she will give to hospitals such as Beaumont whose financial allocation is not adequate to address the needs of patients in their catchment area; the way in which patients are to be protected when wards and theatres are closed and accident and emergency departments are overcrowded and understaffed and when there are growing waiting times for outpatient clinics and for elective procedures; if she will intervene to ensure that patient welfare is not compromised; and if she will make a statement on the matter. [20560/10]

Deputy Mary Harney

I have been assured that Beaumont Hospital will meet its service plan targets for 2010. These involve treating the same number of patients this year as last but with less reliance on inpatient stays. In turn this will involve reducing inappropriate hospital admissions, more same day of surgery admissions, more day care cases, earlier discharges and reductions in waiting times for elective surgery. The planned changes announced by Beaumont are designed to allow it deliver its service plan targets while remaining within its budget. For example, the increase in day case activity and the reduction in beds occupied by long-stay patients means the hospital can treat the same number of patients as previously with fewer in-patient beds. Beaumont has also assured my Department that neurosurgery, transplantation and cancer services will not be affected by the changes.

Treating people in more efficient and effective ways like this, with no reduction in access to appropriate services, is obviously the right thing to do given the very difficult financial position facing the Exchequer. However, it is also the right thing for patients. People want to access quality care as quickly as possible and be allowed to go home as soon as possible. There are constant calls inside and outside this House for a more efficient public service, changes in work practices and greater productivity. Despite this, we still hear opposition to such changes, with the focus being put instead on issues like the number of in-patient beds rather than the number of patients being treated and the achievement of best outcomes for patients.

Reforming the way services are provided, reducing costs and maintaining a clear focus on patient safety will allow us to treat people in more effective ways and protect access to appropriate services. I want to make it clear to this House that the implementation by Beaumont Hospital, and other hospitals, of this type of patient-centred reform will have my full support.

Deputy Jan O’Sullivan

I put it to the Minister that on 29 March 2006 she issued a statement declaring accident and emergency departments to be a national emergency. In 2007 she stated that the HSE said no patient should be waiting more than 24 hours in any accident and emergency unit for admission to a ward and by next year the target is to be a maximum of six hours. The HSE also stated its aim is that no accident and emergency unit should have more than ten patients waiting for admission to a ward. She has again given us a beautiful flow of rhetoric. The reality is totally different. How, with 52 fewer beds, will Beaumont achieve the target she has outlined to us? How will other hospitals throughout the country achieve their targets?

The Minister referred to the fair deal and the fact that people will be able to leave hospital more easily. I spoke to a social worker who was working in another large Dublin hospital last week who told me that most of her day is now spent trying to deal with the financial assessments of the fair deal to get elderly patients who are ready to be discharged out of hospital . What is the Minister going to do to ensure that the financial assessment element of the fair deal does not keep people in hospital unnecessarily? I am told that nursing homes will not take them until it is certain they will qualify.

Deputy Mary Harney

As my colleague the Minister of State, Deputy Áine Brady, will address the fair deal scheme, I will only make a brief comment on it. We were dealing with a large volume of applications which came in at the same time because the scheme was only introduced last October. In many cases, court and other legal procedures are involved because we have to deal with people who have diminished mental capacities.

We are receiving a fantastic response on the fair deal scheme. It has freed up 50 beds in Beaumont hospital alone and we are currently awaiting HIQA registration before allowing that hospital to open St. Joseph's, which will provide a further 100 beds. Beaumont has dealt with 1,000 more patients on a day case basis over the first four months of this year than it did during the same period last year. By moving to same day surgery and day case activity, more patients can be treated within available budgets.

Of course accident and emergency provision is not perfect but I can outline data that show year-on-year improvements in the waiting time target of six hours from time of arrival to either being sent home or admitted. Many hospitals meet that target but, unfortunately, approximately six hospitals are not in a position to do so for various reasons and these institutions are now receiving special attention from the HSE at my request.

Deputy Jan O’Sullivan

More than 300 people were accommodated on trolleys on one day last week. That is the average figure for the month of May, when normally the number of people on trolleys is very small. Despite the Minister's claims about what hospitals will be able to achieve, year after year we see the same statistics. We are not seeing improvements in trolley figures. The same difficulties arise in terms of moving people from accident and emergency units to wards, even where they are ready to be transferred. Given the level of cutbacks with which hospitals must contend, does she really believe they will be able to achieve the targets she is setting for them?

Deputy Mary Harney

I believe hospitals can meet the 2010 service plan to which the HSE is committed. I referred specifically to Beaumont, which is a national tertiary referral centre. The financial pressures are enormous and although we have provided some new money for the fair deal scheme, comparing like with like, we have taken an additional €1 billion from the HSE over last year. Approximately €630 million of that comes from staff reductions and the remainder has to come from value-for-money, reductions in drug costs, etc. Notwithstanding these pressures, the activity level at Beaumont was higher over the first four months of this year than in the same period last year.

Health Insurance Providers

James Reilly

Question:

42 Deputy James Reilly asked the Minister for Health and Children if the VHI fulfilled its legal obligation to achieve solvency by the end of March 2010 deadline set by herself; the number of times she has extended the deadline for VHI to achieve required reserves to date; if the EU Competition Commissioner has contacted her concerning a possible legal action and sanctions if VHI does not meet the requirements of the Financial Regulator regarding appropriate levels of solvency; the potential sanctions against the State from the EU in this regard; and if she will make a statement on the matter. [20716/10]

Deputy Mary Harney

Arising from a derogation under the non-life insurance directives, VHI continues to be exempt from prudential solvency requirements. The Voluntary Health Insurance (Amendment) Act 2008 provided for the VHI to acquire sufficient funding in terms of its capital reserves to enable it to make an application to the Financial Regulator for authorisation. The date originally fixed by that Act was 31 December 2008 but this was subject to the right of the Minister to appoint a later date by order if satisfied that there is good and sufficient reason for so doing. At the time the original date was fixed, the Supreme Court had not yet ruled on the risk equalisation scheme, which it struck down in July 2008. Since then I have extended the date by which the VHI must accrue the necessary reserves on five occasions. The date is now 1 January 2012.

The EU Commission has commenced proceedings against the State in the European Court of Justice regarding the VHI's derogation. The State has forwarded a comprehensive written defence to the court and fully intends to mount a vigorous defence of its action. The matter of sanctions would only arise in the event of an adverse judgment if nothing was done to ameliorate the situation and further proceedings were then brought to seek financial penalties against the State.

The capital position and authorisation of the VHI are only two of many interrelated and complex issues that need to be resolved in order to achieve a stable community rated private health insurance market. I have been examining the broad range of issues involved with my officials, expert advisers and the Health Insurance Authority. The matter has also been considered by the Government on a number of occasions since the Supreme Court judgment. I will make a full statement at the appropriate time on the measures required to support the Government's key policy goal of a community rated health insurance market.

Deputy James Reilly

I ask the Minister to indicate to the House the solvency target for the VHI in monetary and percentage terms and the level of solvency achieved by the company by the end of March 2010. Does she see any inconsistency between the State's treatment of the VHI, in respect of which it once again extended the deadline for solvency, and of Quinn Insurance? An article in The Irish Times cites Seán Murphy, the deputy chief executive of Chambers Ireland, as agreeing that the situation “clearly isn’t fair” and Tom Carney, a partner with Dillon Eustace, as stating:

It emphasises the stark contrast between the State's regulatory approach towards Quinn and that of the VHI. One company is completely and utterly exempted from solvency arrangements, while, on the other hand, another company is in permanent administration — and both companies are pursuing the same market.

Perhaps the Minister can inform the House how many times she has extended the deadline.

Deputy Mary Harney

I introduced the legislation on the deadline but that was prior to the Supreme Court's decision to strike down risk equalisation. I want to point out some facts. We are discussing the reserves ratio. The VHI has 82% of the over 60s market and 92% of the over 90s market. I strongly favour community rated health insurance because it allows older and sicker people to afford insurance on the same basis as younger customers. If we are to retain that system, it will require intergenerational support. The scheme which was introduced when the market was opened up to competition on foot of an EU requirement was, unfortunately, struck down by the Supreme Court in 2008. That changed everything and, in the interim, we have introduced tax relief at source.

I remain determined to bring before the Government shortly a comprehensive set of measures not only in respect of the capital requirements of the VHI but also on a sustainable financial model for the company. If one company has an unfair risk burden, we clearly will not have a market that is capable of being fair in all circumstances. We need a new risk equalisation scheme in Ireland and in the meantime we have provided for a scheme of tax relief at source which has been approved by the EU as a temporary measure. We also need to sort out the VHI's capital requirements and the three companies' respective market ratios. The ratios vary considerably at present but I would like to see a healthier market where at least three players have similar shares.

Notwithstanding the financial pressures we currently face, it is encouraging that only 1.6% of people have dropped out of health insurance. This is because we keep insurance costs affordable, particularly for older and sicker people.

Deputy James Reilly

I contend that the reason 53% of the people in this country take out private health insurance is because they do not have any faith in the public system to deliver in a timely fashion. I do not wish to do a disservice to the late and very brave Susie Long but people do not want to find themselves in her situation. Otherwise, how could one explain the decision? Our hospitals are supposed to provide a system of free secondary health care but this a virtual system. It is not available to our citizens, who as a result, wait months and years for outpatient appointments.

As the Minister failed to answer, I remind her that this is the sixth time that she extended the deadline.

Deputy Mary Harney

I said "five" in my reply.

Deputy James Reilly

She has admitted that the market is not fair. Given that the VHI's shortfall is estimated at over €200 million, might it indeed face the same fate as Quinn Insurance? I do not believe we have a fair market and that is why we do not have more players.

Deputy Mary Harney

We will not have a fair market if some participants have to carry the burden of older and sicker people. That is a fact. There are other unfair aspects to the market. I want to see a market that is fair to all the players. Deputy Reilly's party favours providing private health insurance to everybody but that is also based on a risk equalisation model.

Deputy James Reilly

One that works, as opposed to the one the Minister introduced.

Deputy Mary Harney

No. First——

An Leas-Cheann Comhairle

The Minister should be allowed to make her reply.

Deputy Mary Harney

Deputy Reilly seems to think we will have a market where no one will pay more than they pay at the moment and everyone will get unlimited hospitalisation, treatment and diagnostics.

Deputy James Reilly

There is no such thing as unlimited anything.

Deputy Mary Harney

I would like to see Deputy Reilly's plan worked out. I have not seen it yet.

Deputy James Reilly

The only thing that is unlimited is the Minister's promises.

An Leas-Cheann Comhairle

Deputy Reilly, please.

Deputy Mary Harney

That is a thoroughly non-objective judgment.

Hospitals Building Programme

James Reilly

Question:

43 Deputy James Reilly asked the Minister for Health and Children if building work has commenced at any of the eight co-location sites regarding her plan to fast track 1,000 public beds through the co-location plan; if finance has been secured for any of the sites; her views on whether her co-location plan will become a reality; and if she will make a statement on the matter. [20717/10]

Deputy Mary Harney

The renewed programme for government re-affirms the Government's commitment to the current co-location programme. Preferred bidders have been selected for six co-location projects at Beaumont Hospital, Cork University Hospital, Limerick Regional Hospital, St. James's Hospital, Sligo Hospital and Waterford Regional Hospital. Project agreements have been signed for the projects in Beaumont, Cork, Limerick and St James's. Planning permission has been granted for the first three of these projects. Planning permission has been granted by the local authority for the St James's project but this has recently been appealed to An Bord Pleanála. Two other projects are at earlier stages of the procurement process.

The co-location programme is a complex public procurement process. It is a matter for each successful bidder to arrange its finance under the terms of the relevant project agreement. The co-location initiative, like other major projects, has to deal with the changed funding environment. The HSE is continuing to work with the successful bidders to provide whatever assistance it can to help them advance the projects.

Deputy James Reilly

I thank the Minister. It is timely that we should discuss the matter because, as my colleague, Deputy Jan O'Sullivan mentioned a few weeks ago, we are heading towards the fifth anniversary of the announcement of the plan, which was to fast track the 1,000 public beds. Not a single brick has been laid, a sod turned or a bed delivered. Will the Minister confirm whether finance has been secured for the projects and when construction will begin? Will she remind the House of the total cost to the State of tax reliefs for co-located hospitals, should they go ahead? The banking and finance situation has not been resolved. We have been waiting five years. As I indicated, this is yet another of those great promises on which there has been a failure to deliver. It would be as well for the Minister to put her hands up and advise us that she will find some other way of putting beds into the system because if this is a fast-track approach, God help Ireland.

Deputy Mary Harney

A number of issues arise. I am aware Deputy Reilly is opposed to co-location but that view is not shared by all his party colleagues, as some of them have spoken to me about it.

Deputy James Reilly

When they are elected they can express an opinion.

Deputy Mary Harney

We have had a credit crunch and it is difficult to get access to private finance for many projects. People are working extremely hard to advance the projects. There is great enthusiasm for them in various parts of the country to provide not just extra capacity by way of acute hospital beds but to allow acute hospitals to be able to reconfigure within themselves to have more private rooms and more infection control rooms. There is no other plan, nor are any resources available for major capital investment in public hospitals. That is a fact. This remains the only plan for major investment in major, acute public hospitals for the foreseeable future. Bankers and project promoters are working closely together. I hope we will be in a position to see the advancement of some of the projects shortly.

Deputy James Reilly

Five years later, there is no real prospect of that happening. I disagree fundamentally with the Minister's point that no other funding is available. There is gross wastage within the Health Service Executive and the health budget. If the funding was directed appropriately and managed properly the funding would be available. I remind the Minister that she promised the House previously that she would add beds to the system, instead of which we have lost beds.

The Minister referred to 33,000 fewer emergency admissions. Can she explain to the House how in the name of God she is going to reduce 33,000 emergency admissions in the health service this year? Is the Minister saying consultants in emergency medicine are admitting people needlessly? I do not think they nor any other doctor in the country would accept that.

Deputy Mary Harney

Deputy Reilly represents every second vested interest that opposes any change in the health system proposed in this House. I already replied to a question on Beaumont Hospital. An extra 1,000 day-case patients were treated there in the first quarter of this year compared with last year. Reductions will be achieved by hospitals doing things differently, such as bringing in people on the same day for surgery. Approximately 3% of admissions from accident and emergency units are for diagnostics. It is a case of doing all of those things. We should not get obsessed about the number of beds. It is about the money following not just the patient but the patient's best health. That does not always mean that the patients should be in a hospital — far from it — it means the patient getting access to the appropriate treatment he or she needs wherever he or she requires it. Often that is in a community non-hospital environment.

Deputy James Reilly

Patients are not getting treated because the Minister is closing other facilities and burdening the major hospitals which cannot cope.

Child Care Services

Alan Shatter

Question:

44 Deputy Alan Shatter asked the Minister for Health and Children her views on the recent report of the Ombudsman for Children based on an investigation on the implementation of Children First: National Guidelines for the Protection and Welfare of Children; if she will detail the actions that she has taken to protect children at risk; her future plans in this regard; and if she will make a statement on the matter. [20559/10]

Minister of State at the Department of Health and Children (Deputy Barry Andrews)

I welcome the publication last week of the ombudsman's report on Children First. The report identifies many of the implementation difficulties highlighted in previous reviews of the Children First guidelines. It acknowledges that planned and substantial steps were taken to implement the guidelines but also that efforts to drive forward implementation were not always sustained and were not sufficient at particular times. The investigation found that insufficient efforts were made by the HSE to drive forward implementation of the guidelines and identified the failure of the former health boards to resolve problems arising with Children First, including variable implementation. The report is also critical of the degree of inter-agency oversight and the role of the Office of the Minister for Children and Youth Affairs in this regard. The adverse findings focus in particular on the period 2003 to 2007.

The Children First guidelines have now been revised and take into account the findings of previous reviews and some comments put forward by the ombudsman. The newly revised guidelines will be supported by a detailed and comprehensive implementation framework which will apply across all sectors. This framework will include emphasis on robust implementation assurance systems including inspection and audits. I will be bringing proposals to Government shortly in this regard.

Successive Ministers have taken a series of initiatives since the publication of Children First in 1999 to improve the quality of children's lives and to protect children at risk. The legislative and policy framework has been significantly strengthened through the passage of major pieces of legislation, such as the Children Act 2001, the Ombudsman for Children Act 2002, the Child Care (Amendment) Act 2007, and the continuing passage of new legislation through the Oireachtas including the Adoption Bill 2009 and the Child Care (Amendment) Bill 2009. Key policy initiatives include the agenda for children's services, the Government's implementation plan following the Ryan report, the Irish Youth Justice service strategy, the youth homelessness strategy, and the report of the working group on foster care.

Major developments have also taken place at service level including the establishment and expansion of the Social Services Inspectorate under HIQA; the development of national standards for children in the care of the State; the continued development of special care units for vulnerable children, expansion of the Garda vetting services; the establishment of the children's services committees; the creation of a new management position in the HSE at senior management level with responsibility for child and family social services; the development of standardised service delivery and business processes within the HSE; the development of a knowledge management strategy for child welfare and protection services; and the development of a sustainable and cost-effective solution for the provision of out-of-hours services for gardaí who remove children under section 12 of the Child Care Act 1991. The Government is committed to building on the existing legislative and policy framework and to taking any additional actions deemed necessary to ensure greater protection for children at risk.

Deputy Alan Shatter

Does the Minister of State not regard it as slightly odd, both in this House and in a statement he issued on the publication of the ombudsman's report, to welcome the publication of a report which makes two findings of maladministration or unsound administration against the Department in the area of child protection and nine findings of maladministration or unsound administration against the HSE with regard to implementation of the Children First guidelines? Can the Minister of State explain, in the context of the first finding of unsound administration against his Department why, despite all the public statements made, for almost eight years little was done that mattered to ensure the uniform application of the Children First guidelines across the country?

In respect of the second finding of unsound administration, can the Minister of State explain why he, the Minister, Deputy Harney, who is sitting beside him, and his predecessors as Ministers for children, either concealed and-or did nothing about an ongoing dispute involving the IMPACT trade union, originally the health boards in 2002 all the way up to today's date with the Health Service Executive, in which IMPACT directed social workers in various local health offices across the eastern region not to apply various parts of the Children First guidelines, to the detriment of children? Why was that kept secret? Why had there been no intervention of any description to resolve that dispute to ensure children are properly protected?

Deputy Barry Andrews

I welcomed the report in the first instance because it is a good report which gives a good summary of the way in which efforts have been made to implement the Children First guidelines uniformly throughout the State. I would not expect the Deputy to refer to the positive progress identified by the ombudsman, particularly in reference to the Office of the Minister for Children and Youth Affairs. She observed that planned steps had been taken to implement the Children First guidelines and that those steps were substantial. She further remarked that it was clear "considerable efforts" were made to implement the guidelines, particularly in the earlier years following its publication, and that the multitude of reviews point to the policy priority accorded their implementation by the Government. She acknowledges that since 2008 considerable progress has been made in trying to tackle what is described as "differential compliance". I adverted to some of those developments in my reply.

An Leas-Cheann Comhairle

I wish to allow time for another supplementary question.

Deputy Barry Andrews

I am eager to tackle the Deputy's two specific questions on administration. The second one is——

An Leas-Cheann Comhairle

Time is almost up for this question, so I propose to allow a further supplementary question.

Deputy Alan Shatter

I would certainly like to hear the Minister of State's response to the two questions raised. Is he not ashamed of a report — which he describes as a good report — that documents total incompetence by the Health Service Executive and the Department in ensuring the application across the State of the Children First guidelines? Is he not ashamed that the lessons that were supposed to have been learned from the tragic deaths of Tracey Fay and David Foley clearly were not learned? Moreover, last weekend the remains of another young man, Daniel McAnaspie, were found. I drew his case to the attention of the House last February, when the Minister of State criticised me for naming him and for expressing concern about his circumstances——

Deputy Barry Andrews

I expressed no such criticism of the Deputy.

Deputy Alan Shatter

Is the Minister of State not ashamed that a failure of the Health Service Executive to provide proper care to this young man has contributed to his tragic death? Can he tell this House truthfully that everything possible has been done by the Government to ensure the application of the Children First guidelines since 1999? Will he acknowledge that his party in government has failed to a scandalous and abysmal degree to protect children? Will he indicate to the House that there will be an independent inquiry into the tragic death of Daniel McAnaspie and give an assurance that those appointed to it are not selected by the Health Service Executive?

Deputy Barry Andrews

I absolutely reject the Deputy's unfair claims. The Government committed €15 million to this area in the last budget at a time of retrenchment in almost every other Department and within the Department of Health and Children itself.

Deputy Alan Shatter

This is 2010. The guidelines introduced in 1999 have not yet been implemented.

Deputy Barry Andrews

That funding will be applied to the recruitment of 200 additional social workers. Any fair analysis of this situation will show that I am absolutely committed to the delivery of improved compliance with the Children First guidelines. That is central to the taskforce on the standardisation of business processes. It is central to our commitment in the last budget to the roll-out of additional social workers and to the entire framework for the implementation plan following the Ryan report. The Children First guidelines are in and of themselves robust. We must not only ensure compliance on a statutory footing with those guidelines but also ensure the capacity to audit the various sectors with responsibility for their delivery.

In regard to the case of Daniel McAnaspie, I join with everybody in the House in expressing our deepest regret to his family on the tragedy that has befallen them. I understand the Deputy intends to raise this matter on the Adjournment. We will provide further details of our response at that time.

Deputy Alan Shatter

Are the Minister of State and his colleagues not ashamed at the number of children who have died in the past ten years because of a failure to implement the Children First guidelines?

An Leas-Cheann Comhairle

That concludes Priority Questions.