Vol. 717 No. 2
8 Deputy James Reilly asked the Minister for Health and Children the details of the number of non-consultant hospital doctor posts that are vacant; the number of consultant posts that are vacant; what the planned ratio was; what the planned ratio is now, in view of the fact that it is policy to have a consultant delivered service; and if she will make a statement on the matter. [35142/10]
One of the main recommendations of the National Task Force on Medical Staffing in 2003 was to increase the number of consultants and to implement a corresponding decrease in the number of NCHD posts in order to create a consultant-provided service. At the time of publication the consultant to NCHD ratio was 1:2.27. The task force concluded that a team-based consultant-provided service was required to ensure high quality patient care and achieve compliance with the European working time directive. It stated that this would entail a significant increase in consultant numbers.
The move to a consultant-provided service was reflected in the 2008 contract. This provided for consultants to work as part of a team over an extended working day of 8 a.m. to 8 p.m., an increase in the length of the working week and structured weekend work. It is also provided for in the HSE's employment control framework which allows for new hospital consultant posts to be created by the suppression of two non-consultant hospital doctor, NCHD, posts.
As of September 2010, the approved number of consultant posts was 2,410. This represents an increase of 679 posts, or 39%, since the task force reported. The current ratio of hospital consultants to NCHD posts is 1:1.7 compared with 1:2.27 in 2003. For comparison purposes, both ratios exclude interns.
Since 2008, the HSE has created almost 500 new or replacement consultant posts. As of June 2010, approximately 223 contracts had been issued to individuals taking up HSE consultant posts. This reduces potential vacancies to approximately 275, of which 89 consultants are currently being recruited by the Public Appointments Service. While the remaining 186 approved posts are recorded as being vacant, the large majority of these are in HSE-funded agencies, including voluntary hospitals, where the recruitment process has already taken place and the HSE has been asked to establish how many of them have been filled.
Approximately 260 of the 4,638 NCHD posts are vacant, but many of these posts, in particular high priority service positions, are being filled by locums or other short-term contractual arrangements. The moratorium on public sector recruitment is not a factor in these NCHD vacancies.
I thank the Minister for her response. I wonder why interns were excluded for comparative purposes. They are NCHDs and would clearly impact on the ratios considerably.
It is important to point out that emergency pediatric and obstetrics maternity and surgical services across the country are likely to be curtailed as a result of the critical shortage of junior hospital doctors. An anaesthetist consultant in Our Lady of Lourdes Hospital has written a letter to the press outlining the difficulties being faced there with some nine posts in the junior ranks being vacant. This will make the delivery of a service difficult. In the context of events at Navan hospital, this will mean a serious diminution.
Apart from the intern issue, what services will be curtailed or reconfigured due to the forecasted shortages, what action has been taken by the Department and the HSE to fill the vacancies and does the Minister accept that the staffing crisis means hospitals will become increasingly dependent on locums, a matter to which she has alluded? An over-reliance on locums will lead to an increase in adverse incidents as occurred previously, particularly in the north east.
The process of recruiting consultants continues unaffected by the moratorium. The process includes suppressing two non-consultant posts for one consultant post and is working well, as is evident from the ratios. The first report on this matter was the 1994 Tierney report which was to get us there ten years later. We have made good progress since 2003.
The HSE, the Medical Council and others have been engaged in a process of dialogue concerning training posts. Among the initiatives being pursued are the 80 additional specialist training posts in emergency medicine to deal with shortages, 38 posts in general practice and 85 in surgery, together with the relaxing of visa restrictions for the recruitment of individuals from overseas and offers of longer contracts instead of the short-term contracts that were unattractive relative to Northern Ireland or the rest of the UK and put us at a disadvantage. These initiatives will be in operation and the visa changes have been made. I can give the Deputy the details. These and other changes will be in effect from 1 January 2011.
I want to allow Deputy Reilly a further supplementary question.
I will not ask a supplementary question, rather I will repeat the questions I asked that the Minister did not answer. Why were interns excluded and what services will be curtailed or reconfigured due to the forecasted shortages? If she is answering only one question, the most important one is the latter.
Services to patients will not be curtailed and are constantly being reconfigured. There will be a question later on Navan Hospital and I shall deal with the matter then in line with recommendations on patient safety and so on. Regarding interns, the issue is to have a comparative figure that compares like for like, comparing our position when the manpower study reported with where we are now. That was the intent of the question. The shortages that arose on 1 July are being dealt with through dialogue between the Medical Council, the HSE and the training bodies. In the longer term the initiatives, including central recruitment and so on, for those who come from outside the country will offer two-year contracts rather than a six-month contract. This will make Ireland more attractive and will deal with the pressure points. Most of the vacancies at consultant and non-consultant hospital doctor level are being filled by temporary locums and although I hear what the Deputy has to say, there is much more vigilance in this area now than might have been the case previously.
9 Deputy Jan O’Sullivan asked the Minister for Health and Children if discussions are on-going between her Department and the Health Service Executive to change the compensation on termination clauses in contracts for the building of co-located private hospitals on the grounds of public hospitals; if these discussions have concluded and if changes are being made; if so, if she will detail these changes; if she proposes to go ahead with the projects; and if she will make a statement on the matter. [34958/10]
The renewed programme for Government reaffirms the Government's commitment to the hospital co-location programme. Preferred bidders have been selected for six co-location projects, including those at Beaumont, Cork University, Limerick Regional and St. James's hospitals. The Beacon Medical Group was awarded the Beaumont, Cork and Limerick projects. Synchrony Healthcare was successful in the case of the St James's project. Project agreements have been signed and planning permission has been granted for these four projects.
The co-location programme is a complex public procurement process. A core principle underlying the co-location initiative is that the private sector should bear all normal business risks. 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, must deal with the changed funding environment.
The HSE has been considering proposals put forward by the Beacon Medical Group to advance the projects. For reasons of commercial confidentiality I am not in a position to comment on the elements of these proposals or the specific issue raised in the Deputy's question at this time. I recently met representatives of the Beacon Medical Group at their request and was briefed on progress on the banking issues and other factors they consider to have a bearing on this matter.
Does the Minister still plan to go ahead with these projects, especially in view of the fact that her own expert working group under Ms Frances Ruane stated, on page 51 of its report, there is a surplus of private hospital space and a shortage of public hospital space? Why is the Minister proceeding with this project despite the fact there is officially a surplus of private hospital space? God knows, we need all the tax we can get to fund vital public services in the years ahead and obviously tax will be forgone if these projects go ahead.
I read a report in the Irish Medical Times of 20 August which stated specifically that the Beacon Medical Group has submitted a proposed contract amendment, essentially to have a way out clause in order that the risk to the private company involved in the case would be less than that contained in the original plan. Will the Minister assure Members there will not be a change to the original proposals? At this stage does the Minister accept we do not need any more private hospital beds and that what we need is funding for the public hospital service?
That may be correct in regard to stand-alone private facilities but the reality is that almost 50% of elective admissions, including those in the Deputy's local hospital, are for private patients. The impetus behind this plan came from a letter from six consultants in the Deputy's hospital who were the first people to write to me on this idea.
That does not mean it is right.
Hold on. They are highly respected and I believe the Deputy, too, would respect them. The reason they proposed this was to free up the private beds which are designated in our public hospitals for public patients. That remains the plan. The sad reality is that we do not have additional resources to invest in our public hospital programme, regardless of whether I or anyone else is in charge.
The Deputy is adopting an ideological approach to this but it is the most cost-effective way——
It is the Minister's ideological approach.
——of providing additional capacity because too many public beds are used by private patients who could be dealt with in private sector facilities. These facilities must be made available to all patients of the hospital and profit may arise — in the case of the hospital in Limerick about 25%. There can be no breach of the tender or of the project agreement entered into with any of the promoters, nor any breach of competition law, which does not arise.
I put it to the Minister that one reason we do not have enough acute beds in the public service is that almost 1,000 of them have been closed. No number of private hospital beds will address that issue. It is not that we do not physically have beds in acute public hospitals, rather that we do not have the resources to staff them. Is it not true that if the Minister gives tax breaks to private developers to build co-located or apartheid-style hospitals in the grounds of public hospitals she will, in effect, be giving taxpayers' money to these hospitals which will not be available to provide public services?
In Waterford Regional Hospital there are 80 private beds paid for by taxpayers which are accessible only to private patients. I do not have the figure for Limerick but it is similar. A large proportion of private beds in our public hospitals are paid for by taxpayers, as are the staff concerned, but these are available to one group of patients only. I do not find that acceptable.
Not all such projects are looking for tax breaks and it is a myth to suggest they are. The Deputy's party favours the tax breaks for primary care facilities, as recommended by the all-party committee on health, so it is not the case that every——
That is a different issue.
Those tax breaks, too, will only be available to certain people. If the tax system can deliver in health or any other area a benefit for our citizens that is greater than the benefit which can be achieved otherwise, we must have an open mind about it.
We have too many private beds.
10 Deputy James Reilly asked the Minister for Health and Children the basis of the Health Service Executive decision to cease surgery, particularly elective surgery, at Navan Hospital, County Meath; the clinical reasons behind this decision; the details of the HSE review into this matter; and if she will make a statement on the matter. [35141/10]
In its role as patient advocate for high quality, safe, surgical care and practice, the Royal College of Surgeons of Ireland supported the decision of the HSE's director of quality and clinical control, Dr. White, to cease emergency acute surgical services at Our Lady's Hospital in Navan with effect from 1 September. Earlier this year, the HSE north east identified two general surgery cases with poor clinical outcomes. It later identified four laparoscopic surgery cases where outcomes were also poor. The HSE has asked the RCSI to nominate two senior clinicians to review the two general surgery cases. The precise format of this review will be finalised shortly and the review will be concluded as soon as possible.
The HSE has appointed a review team of three senior surgeons with appropriate experience and standing to undertake a review of the four laparoscopic cases. This review is expected to take approximately two months. Four reviews have been conducted into the department of surgery in Navan since 2005. The HSE has accepted all the recommendations of these reviews and is committed to their ongoing implementation. All decisions regarding the location of services will be taken with patient safety as the priority. Minor elective surgery and endoscopy will remain in Navan. The hospital continues to be the regional centre for elective orthopaedic surgery.
I thank the Minister for her reply. I will point out a number of issues. The Minister mentioned two cases, one of which involved the mother of a general practitioner who asked that his mother's case be removed because he has no issue concerning the manner of treatment given.
The surgery facilities at Navan have been cancelled for elective surgery too. Some 1,800 surgeries are performed there every year. At a professional level I am aware there is no capacity within Dublin and the north east, including Cavan, Drogheda, Beaumont, Blanchardstown and the Mater hospitals, to take on those 1,800 cases. Patients of mine have had to wait four days on trolleys and have had their operations cancelled as a consequence of the downflow from the other end of the north east. The patients in Navan will not be accommodated within the system and waiting lists will grow. People are being deprived of the rightful service they now have. Where are they supposed to go? There was a preliminary investigation by the RCSI. When will there be a full investigation? Will the Minister explain to the House why elective surgery has been cancelled at that centre when the RCSI did not allude to elective surgery?
The question relates to emergencies. There are six cases involved and one surgeon was put on temporary leave while being subject to investigation. As to emergency surgery, there was one such procedure in every 24 hours and the decision was made to move that to a safe environment. There are reviews pending which involve the Royal College of Surgeons.
Regarding elective surgery, financial pressure points exist in that hospital and in other regions of the country, as the Deputy is well aware. We shall be debating that tonight, and I do not believe that hospital is mentioned. However, there are pressures and the HSE has to live within its budget. Deputy Reilly is the deputy leader of his party and I understand is committed to fiscal rectitude.
I thank the Minister for orientating me.
I believe that at the very minimum he would expect units of the HSE in every part of the country to live within the budgets allocated for the year.
At least the Minister clarified one thing for the people of the north-east. It is all about money and not patient safety. As the Minister well knows, the reason we are not mentioning Navan hospital in tonight's motion is that any question in regard to it would probably be disallowed if it influenced the motion. To get back to the real question, the Minister has acknowledged that it is a matter of money, not quality of care in regard to elective surgery. She also mentioned that a consultant was placed on administrative leave. That consultant has since been cleared and is off that leave, so I do not get any sense from her of any real patient safety issue as regards her decision, through the HSE, to close Navan hospital. Having mentioned earlier the shortage of anaesthetists at Drogheda, it is difficult to see how the greater area can cope. Clearly, we are going to see a deterioration in patient services in the north-east.
To cite the advice of the Royal College of Surgeons in Ireland in regard to this matter, it is to the effect that we cease all emergency surgery, all emergency surgery admissions, examine patients in the emergency department and transfer any patient needing a surgical admission — this accounts for four admissions a day, approximately two of which would require a surgical procedure — and so on.
We know all that.
Allow the Minister to reply. She may well reach the point the Deputy wants.
It was on the basis of that advice and the number of reports that have been conducted into these procedures that the decision was made. With regard to elective procedures there and elsewhere, hospitals have to live within the budgets allocated to them, and that includes Navan Hospital.
The Minister says that to live within the budget they must cancel the entire service. That is not funny for the people who must use that service.
I believe I have dealt with the issue. The Deputy is raising two separate issues. One is the matter of safety and the transfer of acute surgery from Navan to Drogheda hospitals.
Which we all accept.
I am delighted to hear the Deputy does, since he opposed it when it was announced.
We did not, but we opposed the cancellation of elective surgery. The Minister should get her facts right.
References should be made through the Chair. This is a priority question. Other Members should not be encouraged to enter into the debate.
I do not want to provoke the Deputy, but it was not cancelled in August when he was speaking on this matter, because I have some of his quotes here.
It was cancelled on 31 August.
Navan hospital in the north-east, Galway University Hospital and every other hospital and region in the country have to live with the budget allocation for health services for 2010. It constitutes 12% of national income, which is very high by comparison with other countries. I do not have additional money, and neither does the Exchequer, to allocate to any hospital that falls short in its budget in terms of elective or other procedures.
11 Deputy Charles Flanagan asked the Minister for Health and Children when a national director for child care services will be appointed; and the role and functions of the director [34957/10]
In the course of discussions with the HSE in June 2010, I raised the need for the appointment of an individual at national director level who has a proven track record to lead the reform of children and family services. I envisaged that this appointment would be for a limited period of approximately two years. Following those discussions, I briefed my Cabinet colleagues on the initiative and drew the parallel between the role that Professor Tom Keane played very successfully in cancer care and the new role that I envisage in respect of children and family services. The HSE has been very receptive to the proposal and is committed to sourcing and appointing a person who would have the authority to deliver on the wide and ambitious reform programme in this area.
The creation of this new position is a reflection of the priority which I and the HSE attach to improving children and family services. Specifically, the post has been established to lead organisational and cultural change in children and family services in the HSE. The post holder will lead structural, information and managerial changes in the delivery of a clear service model that focuses on best outcomes for families and children. The post holder will set standards to ensure services are fit for purpose, provide a safe and high quality child protection service and are consistent with statutory obligations.
The recruitment process for the new national director of children and family services is well underway. The HSE hope to be in a position to make an announcement regarding the appointment shortly. It is envisaged that the appointee will report directly to the chief executive of the HSE and to the board.
What does the Minister of State mean by "shortly"? Very little progress has been made on this matter since his announcement in June this year. I remind him that in what was one of the most euphemistic statements of the year, he adverted to clear defects within the child care system. I should have thought that this might have acted as an alarm bell in the Minister of State's office, to ensure that this appointment was made as a matter of urgency.
I ask him again what he means by "shortly". He should by now be in a position to put a timeframe on it. Will he expand on the role and function of such an appointee, and will he confirm that it is to be someone from overseas?
That is correct. I spoke about this at the joint committee meeting when I said that I hoped the appointee would be in place before Christmas, so that "shortly" could be within the next few weeks. Clearly, the person appointed will have to serve notice, assuming he or she is employed somewhere else. I have referred to deficiencies and clear defects and this is not a euphemism. Rather, it is an honest appraisal of the situation in which we find ourselves as regards children and family services. We have a much more open and transparent system of appraisal of our services, particularly through HIQA, the Ombudsman for Children, and the Children Acts Advisory Board. We therefore have a much better idea of what is going on from time to time. It is unfortunate that it has taken so long to get a grip on the situation.
With regard to the role the appointee will have, it is important he or she reports directly to the chief executive of the HSE as this would elevate the position of children to the one it should rightly hold within the HSE, namely, mainstream and not peripheral. From time to time that label has been attached to children and family services within the HSE, and I do not believe that is unreasonable.
Unless and until such an appointee reports directly to the Minister of State's office, the defects in the child care system will continue. Will the Minister of State confirm that this initiative arises directly from the PA Consultants' report? I remind him of that report's recommendations which pointed clearly to confusion and lack of consistency in terms of how child care services are being run in this country. The report specifically adverted to a serious lack of transparency, an absence of accountability and any form of responsibility within the system. Unless and until the new international child care director is prepared to act within specific timeframes on the PA Consultants' report, this initiative will not be what is required in the circumstances.
The appointee will have a reporting structure within the HSE, pursuant to the Health Acts. However, I have provided for monthly meetings with the assistant national director in the HSE with responsibility for children and families, and his appointment was pursuant to the PA Consultants' recommendation in September 2009. That has worked out very well and I believe we need to enhance this further. That is why we took the initiative in regard to the appointment we are discussing today. PA Consultants recommended this, and it will be delivered. We are making substantial progress, and I hope to make an announcement shortly.
12 Deputy James Reilly asked the Minister for Health and Children if she will reverse the Health Service Executive dental policy decision which advises dentists not to fill cavities in children’s teeth, in view of the fact that it puts children’s health at risk; and if she will make a statement on the matter. [35143/10]
The HSE has not issued a national directive to dentists working in the public dental service that they are not to fill cavities in children's teeth.
The Deputy may be referring to a clinical policy in Sligo-Leitrim for the past 15 years not to fill milk teeth unless there was clear evidence of an associated health benefit. In response to media reports in August, the principal dental surgeon for the area said that this policy is evidence-based. He stated:
The policy in Sligo-Leitrim focuses on dealing with the causes of the decay and working towards reducing the risk of tooth decay in baby teeth. It also prioritises treatment of permanent teeth. Any baby teeth which are causing pain or which may consequently cause problems for adult teeth are of course treated as required.
The HSE has recently appointed a new oral health lead, Dr. Dympna Kavanagh, to ensure that the delivery of oral health services is in line with national policies and best practice.
I should like to put on the record of the House the fact that I am informed that Navan hospital is not over budget, in response to my last question that was dealt with by the Minister.
In regard to this issue, the Minister will forgive me if I read out a section of a report from the Dental Protection Ireland. Dental Protection Ireland, DPL, the specialist risk management group, has raised concerns about a memo from a HSE senior dental manager sent to dentists working in community clinics indicating that the agency's policy is that dentists are instructed not to provide routine fillings for deciduous, or baby, teeth. The expert advice sought by DPL contradicted the HSE's policy rationale, citing a recent study based on a sample of nearly 7,000 five-year-old children in Scotland, the findings of which did not support a policy of non-intervention for primary teeth. The expert advice stated that dental caries left untreated are likely to progress to a stage which causes pain and suffering for children and said a general policy of non-intervention was "wrong and unjustifiable".
Other claims offered as policy rationale by the HSE were similarly disputed by the expert advice, which concluded that the main issue that had driven the policy was the lack of resources, which was mentioned by the senior dental manager in the memo. Damningly, the expert said that there was no evidence in the dental literature to support this approach and that it would expose children to serious risk of pain and discomfort, and — even worse — abscesses, sepsis and hospitalisation.
Please, Deputy, we must have questions. This is Question Time.
Does the Minister accept this opinion, which comes from an internationally respected body with no conflicts of interest in terms of costings? Is this yet another policy born out of a desire to save money rather than saving children from pain and distress?
This is not a directive or policy of the HSE but a policy that has been pursued for the past 15 years by Dr. Joe Mullen, the principal dental surgeon for Sligo-Leitrim. I will not dispute what he believes is best practice because I am not a dentist, and I understand the Deputy is not either.
The Minister listens to experts; I listen to experts.
With regard to evidence from research, a project is under way in the UK to examine the benefits of providing baby tooth fillings and also to examine other methods of restoration and assess the best outcomes. I understand the results will not be available for at least five years.
I will ask the Minister a simple question. Does she accept the literature that is available in the dental world in the moment, or will she depend, as she so often does, on information to come in the future when dictating policy that affects the welfare of our children?
The dental policy that applies was initiated by the Deputy's party colleague when he was Minister for Health. A new dental policy will be published later this year. The HSE has just appointed a clinical lead in this area, and we will see dental services being given greater priority. However, the issue raised by the Deputy is a practice that takes place in only one region of the country.
Would the Minister not accept, then, that this person is out of kilter with the rest of the HSE, and does she not think it appropriate for her to seek advice from the remaining dental practitioners within the HSE about whether it is safe to continue this practice?
The person concerned is a principal dental surgeon and, as the Deputy knows, clinical independence operates in such areas. That is the policy pursued by that particular dentist, and it would be a matter for the chief dental officer, if he felt the policy was inappropriate, to intervene in the situation. It is certainly not a matter for me.
That concludes Priority Questions. We will now move on to Other Questions.
