Vol. 726 No. 2
1 Deputy James Reilly asked the Minister for Health and Children the precautions being taken to protect patients from cross infection from swine flu and other hospital infections in view of the number of patients waiting on trolleys in accident and emergency; the additional capacity put in place to deal with the winter increase in hospital admissions; the way she will defend the closure of beds when demand is high; and if she will make a statement on the matter. [1934/11]
2 Deputy Jan O’Sullivan asked the Minister for Health and Children if she carried out any reviews of the effectiveness of the measures she announced in 2006 to address the national crisis in hospital emergency departments; her views on the waiting times for patients in emergency departments in January 2011; her plans to address this problem; and if she will make a statement on the matter. [1839/11]
I propose to take Questions Nos. 1 and 2 together.
The waiting times for patients attending emergency departments in many hospitals during the first week of January were unacceptable and I very much regret the delays that patients experienced. I have discussed plans with the HSE for ensuring that this situation does not recur. The HSE has assured me that it will take all possible steps to improve waiting times in emergency departments, so that all patients are assessed, treated and discharged or admitted without unnecessary delay. The HSE has taken specific steps to cope with the increase in activity that is normally experienced at this time of year. These include opening beds which are normally closed for seasonal reasons.
Other actions taken by hospitals include increasing the number of ward rounds to ensure that any patients who are ready to go home are discharged with support as necessary from community-based services. Hospitals are also ensuring that discharges are carried out early in the morning and over the weekend to make beds available for patients being admitted through the emergency departments. In addition, the HSE is working to have senior clinical decision makers and diagnostic services speedily available for emergency departments. The HSE has also provided for enhanced GP out-of-hours services through the expansion of the GP co-operatives.
The steps I have outlined are taken to address the current short-term difficulties. Improving access to hospital services requires a wider health-care approach. In recognition of this, the HSE has undertaken a number of initiatives in recent years. These include the winter initiative programme, the introduction of the code of practice for integrated discharge planning and actions to reduce the number of delayed discharges, including the introduction of the fair deal. Other innovations undertaken by the HSE include the development of emergency care networks and the acute medicine programme which involves the establishment of acute medical and surgical assessment units, rapid access clinics and minor injury units. The programme seeks to channel patients quickly to the service best suited to their needs and to reduce the usage of emergency department services by those who can be best treated elsewhere. A new acute medical unit was opened at Cork University Hospital last Monday. Other similar units are already in place at Kerry General Hospital and St. Luke's General Hospital in Kilkenny. The HSE service plan for 2011, which I recently approved, commits to the establishment of 12 acute medical units during 2011 with an investment of €8.5 million.
Emergency departments have particular infection control protocols in place for staff to manage patients attending with flu-like illnesses including the H1NI virus to minimise risk to patients and staff. The key to addressing the emergency department challenge is an integrated proactive management by all concerned throughout the system. I have asked the HSE to ensure that minimising waiting times in emergency departments is a key priority in their service to patients.
I wish the Minister a happy new year in her first Question Time of the new year — possibly her last if I hear correctly what is going on outside.
As I raised this issue with you this morning, a Cheann Comhairle, I will now read into the record of the Dáil the question I put and not the question that was issued by the General Office:
To ask the Minister for Health and Children in view of the number of patients waiting on trolleys in accident and emergency, which reached an unprecedented high of 569 in January 2011, the precautions being taken to protect patients from cross infection from swine flu and other hospital infections; the additional capacity put in place to deal with the winter increase in hospital admissions; the way she will defend the closure of beds when demand is high; and if she will make a statement on the matter.
While the Minister has given us her answer, I must point out that in January 2007 the average number of people lying on trolleys was 243. It increased to 286 in January 2008, 346 in January 2009 and 387 in January 2010, and so far this month the average has been 464. Whatever plans the Minister has been putting in place have clearly not worked. Given that we know this increase in demand occurs every year during the winter and we end up with this crisis, surely to God there ought to be a plan to deal with this problem, with an additional ward available in the hospitals most at risk. Why has the Minister not, as I have suggested before, put out to tender to nursing homes for additional beds with associated occupational therapy, physiotherapy, and speech and language therapy? That would help to move out of our hospitals 500 patients who have finished the acute phase of their treatment.
I also asked about swine flu and cross-infection. On Monday night I was stopped on the road by a taxi driver who told me his wife had been admitted to the Mater Hospital with emphysema and she now has swine flu. I spoke to a doctor at Beaumont Hospital who told me about a younger man with cancer on chemotherapy who was left beside a patient with swine flu, subsequently contracted it and became very unwell. These are real risks for people that are unnecessary if the situation were handled properly. What realistic plans is the Minister putting in place now? Why have the plans she put in place in the past not worked? The lack of junior hospital doctors is putting even more pressure on our hospitals in their ability to deal with the influx of patients into hospitals. How many junior hospital doctor vacancies now exist?
I have no role in phrasing the questions, nor has my office; it is a matter for the General Office. I want to make that clear — in fairness I do not believe the Deputy was suggesting that.
The Minister does not have a role in answering them either.
The Minister without interruption, please.
I will not respond to that provocative comment from Deputy Flanagan.
I will not dispute the figures even though the official figures are different from the figures quoted by the IMMO. Arguing between 400 and 569 is a futile exercise; from my point of view too many people have to wait for an unacceptable period of time in emergency departments. The truth is that there has been virtually constant improvement over the years. For example, last year during January an average of 57 people were waiting and the previous year it was 69. Until we get to the end of January we will not be able to see what the average is for this year. However, those figures are still too high.
The initiatives being taken include the fair deal, which has had a dramatic impact on late discharges. Additional capacity is coming on board; for example St. Joseph's in Deputy Reilly's area will greatly relieve pressure at Beaumont Hospital. Owing to HIQA requirements, that needs to be ramped up gradually and cannot be opened all at once. The opening of the new unit in Cork last Monday has already had an impact on Cork University Hospital. Ultimately, the decision on waits in emergency departments relate to the overall functioning of the hospital. In particular, I am not satisfied with the functioning of six or seven hospitals that constantly have problems, which is why the HSE recently appointed a team to go into those hospitals — in the first instance they are in Beaumont, Limerick and Drogheda. Shortly they will go into Tallaght hospital to work with those hospitals. The team is composed of people from here and from the UK — they successfully completed such an exercise in the UK. It will work with those hospitals on the internal mechanisms that lead to long and unsatisfactory waits for patients in emergency departments.
The HSE had closed more than 400 beds, a seasonal measure taken over Christmas, which is always a quieter time for hospitals. Those beds did not reopen on time this year; I accept they should have opened earlier. If they had opened, we would not have had the problem we had last week. Those beds have now been opened, but for cost reasons the remaining beds cannot and will not be opened. I do not believe it is an issue of simply opening more beds. There is a subsequent question on hospital beds. It is a matter for the appropriate functioning of the hospital — daily discharges with senior clinicians on hand seven days a week. The HSE is putting in place structured clinical cover at the weekends in the hospitals to ensure that the emergency departments do not suffer from the kind of problems we experienced last week.
How long does it take to solve a problem? The Minister stated this was a national emergency in 2006. I would have to dispute the Minister's point, that matters were getting better. There were over 550 patients one day last week, according to the INMO figures, and 442 is the figure for today. If the Minister has been to any of these emergency departments, they are squashed into tiny little spaces in most unsafe conditions.
Would the Minister accept that whatever measures she put in place in 2006 when she stated it was a national crisis have failed? Has she, as I asked in my question, carried out a review of those measures to judge their success and see what has been successful and what has not? She states that the HSE will do this, that and the other now, but this dates back to 2006 on her own admission. We cannot live horse and get grass. There are people lying on trolleys for hours on end who cannot wait until such time as someone somewhere decides to do something.
There are currently, according to the INMO, 1,672 beds closed in the system. Will the Minister give the authorisation to open up some of those beds so that we can get rid of this scandal of people lying on trolleys? The main reason Limerick and Drogheda — two of the hospitals to which the Minister referred — are in trouble is because they are having to cater for people from all over their regions and because she has closed other emergency departments. Let us get real here and let us solve this problem for the people of this country.
I say to Deputy O'Sullivan, and mentioned this in response to Deputy Reilly, I will not dispute the figures, except those figures that are not correct. The highest figure at 8 a.m. last week was 414. It suits people to quote an INMO figure one day when it is less favourable and on other occasions to quote a different figure.
I only always quote the INMO figure.
In fairness, Deputy O'Sullivan should quote the official figures.
Second, we will not be opening more beds. We have opened over 400 beds that were closed over the Christmas period for seasonal reasons, which is normal and has been normal for umpteen years.
There have been significant improvements. That is not to say that there have not been occasions when there were blips. We all are aware that there is a swine flu problem. That has led to over 300 people being in hospital over the past period.
Even the Minister's officials state that is not a major factor.
It is a factor. If swine flu patients are taking up over 300 beds and over 70 ICU beds, it is a factor. It is a bigger factor this week than it was last week because we have seen a doubling of swine flu incidents this week over last week. It has been doubling each week for the past number of weeks and there will be a press conference later today to review that.
Among the issues identified by the Comptroller and Auditor General, and everybody else who has looked at this issue, is the need for senior clinicians in the hospital seven days a week, particularly at weekends because there was a high incidence of those who were in hospital on Friday still being there on Monday. That is being put into effect. That is possible, both under the new consultant contract and some other issues to do with the Croke Park agreement which are crucial to staff working differently, particularly as far as diagnostics are concerned. Many patients end up waiting an unacceptable time in the emergency department because they cannot access diagnostics speedily, particularly at night and over the weekends. I look forward to some of the initiatives that have been tabled by the management of the HSE in the context of the Croke Park agreement being agreed in order to address some of those issues.
We need to keep moving. There is limited time.
We will keep moving all right, the Ceann Comhairle need not worry about that.
I want to correct the Minister. The figures that I gave in this House are totally at variance with how she can say matters have improved significantly. The figures come from the INMO site. They may be at variance with those of the HSE which has driven the emergency room consultants to draw their own numbers up as they grew weary of arriving in the morning to be told there were three persons on trolleys in their department when they could clearly see there were still eight, nine or ten waiting for a bed overnight. We have consistently quoted the INMO, the Irish Nurses and Midwives Organisation. I repeat that there were 243 on trolleys in 2007, 286 in 2008, 346 in 2009, 387 in 2010 and 464 in 2011. It has got worse year on year and for the Minister to state otherwise is to go back to the GUBU years of former Taoiseach Charles J. Haughey in the belief that if one states it often enough it is so. I say to the Minister it is not so for those who must suffer those conditions in this country and it has gone on too long.
Let us remember it is Question Time.
I will ask a supplementary question. Why is it not possible to open more beds? Why, when the Minister is paying out €1.1 billion annually in overtime and allowances, can she not take some money away from that through proper organisation — overtime should be an exception — and use it to temporarily open beds? Why has the Minister not brought in generic drugs prescribing and drugs reference pricing, which, the Minister herself admits, could save a couple of hundred million euro but which she has put on the long finger?
Is the Minister saying to this House that the emergency room consultants of this country are talking through their hats when they state they believe the swine flu has very little to do with the significant numbers who are now attending? I am aware that in one hospital, the number admitted up to two weeks ago was only 12.
Since I have come into this House the Minister has muddied the waters. Those who come to accident and emergency looking for an X-ray or some other diagnostic test because they cannot get it in the community——
Deputy Reilly is imparting information.
——do not get admitted, are not waiting on admissions and are not counted as persons lying on trolleys. They are people in for a test and they then leave.
The sad point on which I will finish is that the bulk of the on average 464 patients each day this year are sitting on plastic chairs with IV drips hanging out of them, in distress, with no privacy and exposed to cross-infection. That is the reality. In Beaumont alone, there are only 12 trolleys and yet there were 47 at one stage waiting admission. There were four Buxton chairs, which leaves 31 patients waiting in admission on plastic chairs.
That is the Minister's legacy in health in January 2011 and it saddens me to say it. She has been an utter failure. Her plans have failed at every turn. She has no new plans. She stands here before us today and tells us there has been significant improvement. Tell that to those who get cross-infection and to those with cystic fibrosis who risk the needless additional anxiety.
Deputy Reilly needs to conclude his contribution at this stage.
I would try to keep it short if I could get answers to questions that were based in reality, not in cloud cuckoo land fantasy.
As Minister for Health and Children, I do not like having to say this. Deputy Reilly is a doctor and he should think carefully about the kind of things he says, both here and outside, because a number of his colleagues have spoken to me about the scaremongering in which he engages.
Nothing I ever said has not been repeated by the Minister's document.
The Deputy should listen.
Second, I do not misinform the House or tell lies in this House. Deputy Reilly is a relatively new Deputy. He should be careful about making allegations of that kind.
I will cite the Minister three incidents and I will send them in writing to her and the Ceann Comhairle.
Can Deputy Reilly listen? The information I have put on the record in this House is the information that is available to me and given to me by my officials in good faith.
Massaged by the HSE.
If mistakes are made they are corrected.
Notwithstanding the fact that there has been an extra 100,000 people visiting emergency departments over the past five years, even in that context, there have been significant improvements. All of the research, both in Ireland and elsewhere, on emergency departments is that quick access to diagnostics and key clinical decision makers are the two most important ingredients in ensuring speedy access through the emergency department.
The reforms that we have been putting in place are leading to significant improvements, and most of those reforms have been opposed by Deputy Reilly because every vested interested is represented by him, as health spokesperson for his party.
Including the patients.
The total market for generic drugs in Ireland is €300 million. Unless we got the drugs for free, we could not get more than €300 million. If they gave us all the drugs for free, we would get €300 million. Deputy Reilly constantly states, when the information is at his disposal, that we would save hundreds of millions of euro by simply introducing reference pricing. We are introducing the legislation this year and it will save an extra €7 million this year. I have taken a couple of hundred million euro in costs out of the drugs bill and Deputy Reilly has opposed it. He would not even stand up to the pharmacists when we were reducing costs in the way they were remunerated. I will not take any lecture from Deputy Reilly about drugs because he opposed all of the changes we made.
Including the prescription charge, which I do still.
Deputy O'Sullivan on a brief supplementary. We need to move on.
I think I am entitled to half of the time for these two questions.
Yes. We do the best we can for Deputy O'Sullivan.
I want to ask a simple question of the Minister. Why will she not sanction the opening of more beds in order to relieve this pressure and take those poor patients out of their misery when they are lying on trolleys?
First, we do not have the money to do so. Second, it is not the only way of dealing with the problems that arise in the emergency department.
It is the only quick way.
The other ways are not working.
They are. In a moment, I will give data on beds. With fewer beds there are more than 1 million more people being treated in our hospitals. The solution is not more of the same and pouring more money into doing things the way they have always been done. There must be change through innovation like the acute medicine programme, which I know Deputies opposite have been briefed on and which is to be introduced in some of our hospitals. As some hospitals are not performing to the standard expected, we have brought in teams to help them. It is being done in the UK. The teams that were involved in the UK are here to help our hospitals.
That is fine but why are new beds being opened?
They are not being staffed. As the Deputy knows, it is not about the physical bed.
Absolutely. What is the point in having them?
3 Deputy Charles Flanagan asked the Minister for Health and Children the nature of her discussions with senior executives of the Health Service Executive on the matter of deaths of children in care; and if she will make a statement on the matter. [1935/11]
I meet monthly with senior officials from the HSE to discuss a range of child protection issues, including deaths of children in care. Last March, I established an independent review group on child deaths, which is reviewing the deaths of children over the period of 1 January 2000 to 30 April 2010 who were in care within the meaning of the Child Care Act 1991 at the time of death; in receipt of after care within the meaning of section 45 of the Child Care Act 1991 at the time of death; or known to the child protection services within the meaning of the HIQA guidance to the HSE of 20 January 2010 at the time of death. The review group has indicated that it expects to report to me early next month.
As set out in the Ryan report implementation plan, HIQA has developed guidance for the HSE for the review of serious incidents, including deaths of children in care. The HSE has established a panel, chaired by an independent expert, Dr. Helen Buckley of Trinity College, Dublin, to carry out such reviews.
Will the Minister of State outline to the House when and in what way he specifically conveyed the views of the Irish public to the HSE on the matter of the totally unacceptable culture of secrecy, lack of transparency, complete absence of accountability and the scandal that has been and continues to be deaths of children while in care? The Minister of State indicated that he established the review group but is he satisfied that the review group has received all the appropriate papers from the HSE? Is he concerned at the reports that in spite of legislation rushed through this House because of the legislative weakness in the HSE structure, the review group only received some vital information by way of a consignment of files some weeks ago? Those files were sought earlier in the year.
Will the Minister of State outline to the House the number of children who have died in care during the period under review by the group? These figures appear to be unavailable and seem to change, again giving rise to well-grounded feelings on the part of people involved that there continues to be a culture of secrecy and a total lack of transparency and accountability in the provision of these figures and such vital information.
This is an extremely sensitive and important area; I do not use those words carelessly. It is important because——
I asked the question because it is important. That is a given.
The Deputy might listen to the answer.
I agree with Deputy Flanagan. The point is this is the way in which members of the public see our child protection services. Child protection cases are not reported in newspapers because of privacy associated with section 31 of the Child Care Act. The only way we can see it is in this type of reporting, so it is extremely important it is done correctly. As we saw in the tragic circumstances surrounding what is commonly known as the Roscommon case, the High Court took great care in ensuring the manner of its publication struck the right balance between the public interest, which Deputy Flanagan says he represents, and the importance balancing right of the families to their privacy and the continuing care often associated with families which must deal with the tragedy after the event.
Striking the right balance is at the core of the issue. It is easy to feed into the narrative of secrecy a lack of transparency and an attempt to conceal information when the truth is that we are striving to strike the right balance. That is why we set up the independent review group and the group chaired by Dr. Helen Buckley. This is so that in future there would be a very clear standard for reporting in this area and members of the public can have confidence that the HSE is not inspired by a desire to conceal information but rather to get that information into the public domain in a way that strikes the balance I have referred to and which the High Court took such great care in trying to achieve.
In terms of numbers, the HSE has transferred documentation and the review group hopes to have examination of these files completed, with a report by next month. To date, 185 files have been transferred and another 11 are in the process of being handed over following a further trawl of case files. There is a continuing process which I would not describe as a case where there is a reluctance to act. Clearly everybody wants to comply with the law as it applies to the transfer of these very sensitive case files to allow the review group to complete its work.
The Minister of State and the Ceann Comhairle will forgive me if I exhibit a sense of frustration at the Minister of State's comments. He refused to accept my invitation to confirm to the HSE that he had conveyed the abhorrence of the public to the scandalous litany of failures in the child protection services. I thought he might confirm at least that he conveyed the displeasure of the people but he chose not to.
Having regard to his comments on the review group, there will be another opportunity to discuss the matter. I dispute the Minister of State's comments. Leaving aside the review group, how many child deaths have taken place in care since March 2010 or when the review group was set up?
I will clarify how I conveyed to the HSE the abhorrence spoken of by the Deputy. I initiated the policy of meeting HSE representatives on a monthly basis to deal with child protection issues. We have ensured that 200 additional social workers are in place to alleviate the case load that social workers had in the child protection area; we achieved that target, on which I was rightly questioned throughout the year.
It is not as simple as that. It is a different question and the Minister of State should answer the question he was asked.
There is a new national director with specific responsibility for children and families. My point is that the Deputy should not take my word for it but look at our record on child protection. We hired social workers when a moratorium was in place and there was virtually no other recruitment in the public service. That proves the commitment from the Government and me to ensuring child protection services are improved. We have confirmed the appointment of a new national director with specific responsibility for children and families, reporting for the first time to the chief executive of the HSE. That will centralise and mainstream child protection in the HSE for the first time.
I answered a question on the figures of deaths in care since March 2010 but I do not have the figures to hand. I will provide them to the Deputy as soon as possible.
The Minister of State has confirmed a total disconnection between his office and the HSE.
4 Deputy Caoimhghín Ó Caoláin asked the Minister for Health and Children her plans to introduce a supplementary redress scheme for the surviving women victims, and surviving next of kin of deceased victims, of Michael Neary, in Our Lady of Lourdes Hospital in Drogheda, County Louth who were not covered by the redress scheme established and who have for long been campaigning for proper recognition. [1842/11]
The Lourdes hospital redress scheme was established following an inquiry into peripartum hysterectomy at Our Lady of Lourdes Hospital, Drogheda. The inquiry was chaired by Judge Maureen Harding Clark. Judge Clark was requested by the Government to advise on an appropriate scheme of redress arising from the findings of the report. Having received her advice, the Government approved the establishment of a non-statutory ex gratia scheme of redress in 2007 and appointed Judge Clark as its chairperson.
The Lourdes hospital redress board has now concluded its work and all awards determined have been notified to successful applicants. The total cost of the scheme was €20.6 million. I was asked to consider an extension of the scope of the scheme to include additional former patients of Mr. Neary outside of the terms of the scheme. I gave due consideration to the request and consulted Judge Clark in the matter, who advised against an extension. Acting on this advice, I decided against an extension of the scheme and this was publicly communicated in November 2008.
The Government believes that the Lourdes hospital redress scheme addressed the matter in a sensitive and timely fashion. It was always the Government's intention that the women who qualified for the scheme would receive adequate compensation and that has been achieved in a fair and reasonable manner.
I have been a member of an all-party Oireachtas group which, for a considerable period, has been pressing the Minister by every means open to it to acknowledge and provide compensation for the unfortunate women in question. The group is made up of representatives of the Fianna Fáil Party, Fine Gael Party, Labour Party, Sinn Féin and the Green Party across the entire north-east region and Dublin North.
The pain and anguish of the women concerned has been compounded by the Minister's persistent refusal to recognise properly their loss and suffering. Only 35 cases are excluded under the terms of the Lourdes hospital redress scheme. This very small cohort of tragic women includes one woman who was three days past her 40th birthday when her procedure was performed having been deferred by one week. Why were women aged over 40 years excluded under the terms of the redress scheme? I ask the Minister not to trundle out once more Judge Maureen Harding Clark's recommendations or advice because that is exactly what they were — recommendations and advice. The Minister has the power to respond appropriately to the cases in question.
I acknowledge, uniquely in my experience as a Deputy of almost 14 years, the cohesion and commitment to work together of all the Deputies and Senators who have been a constituent part of the all-party Oireachtas patient support group. I have no doubt that the points I am putting——
The Deputy must ask a question.
——also carry their imprimatur.
It has been reported that the Minister, in the company of representatives of Patient Focus, indicated to some of the excluded women that they would be catered for, and the Minister has not denied that she made such a statement, including at an engagement that we had with her at one point over this long and protracted lobby. I ask the Minister to respond positively and appeal to her to establish a supplementary Lourdes hospital redress scheme. The number of women involved is small, as would be the size of any compensation fund. Right and justice demand, however, that this be done.
I understand the Deputy's wish and those of his colleagues in the constituencies in question. Unfortunately, however, as a Minister, I have wider responsibilities, as has the Government. The inquiry chaired by Judge Maureen Harding Clark and the report she produced were well received by the patients concerned and their representative organisation. The judge continues to be held in very high esteem.
Following the inquiry, when I recommended to the Government the establishment of an ex gratia compensation scheme, I believed it appropriate to ask Judge Harding Clark to determine the terms of the scheme because she had more information than anyone else and enjoyed credibility, authority and the support of the relevant organisation. I am not seeking to pass the buck to the judge. However, given her experience as chairperson of the inquiry and on the basis of her recommendations, I asked her what should be the parameters of the redress scheme. She recommended that redress be given to any patient who had an unplanned obstetric hysterectomy which, in the opinion of a consultant obstetrician, was medically unwarranted and any woman who had an unplanned bilateral oophorectomy which, in the opinion of a consultant obstetrician, was medically unwarranted.
When the issue arose of extending the scheme to others, I consulted Judge Harding Clark and she strongly recommended against doing so. I recall her saying to me that when one establishes a compensation scheme of this nature, in other words, one which did not cover all of the patients of the doctor in question — the inquiry was not held into all his patients — there will always be hard cases. She also drew my attention to several hard cases and we asked the State Claims Agency to deal with them. I believe the agency has done this.
As Deputy Ó Caoláin will be aware, one lady took a judicial review because she was not compensated under the redress scheme. The case was struck out by the High Court. I must be honest with the Deputy because I am not in a position to re-open the redress scheme or establish a supplementary scheme. It may well be that others may wish to do so in future but I do not believe it would not be appropriate for me to recommend such a step to the Government. Even if I did believe it appropriate to make such a recommendation, I do not believe that, in the current circumstances and given the other two groups from the region in question which also have grievances against individuals from the hospital concerned, the Government would re-open the redress scheme and extend it beyond the scope recommended by Judge Harding Clark.
Deputy Ó Caoláin may ask a brief supplementary question. I remind him, however, that we are over time on priority questions.
There are five constituencies in the area in which the 35 excluded women, at least those of them who have survived, reside. The Minister, in her response, exposes the weakness in her position. One cannot give to somebody who is not democratically accountable and does not have ministerial responsibility the right to make the final determination as to what is appropriate in a particular situation. Whereas the Minister invited recommendations and advice, the ultimate responsibility in determining what is the appropriate response rests with the Minister.
The Minister cited two particular groups Judge Maureen Harding Clark recommended for inclusion under the terms of the redress scheme. The judge also recommended those who had reached the age of 40 years, a group which I specifically and deliberately referred to in my earlier contribution. How can the Minister, as an officeholder but also — if I may — as a woman, explain the decision to reject this recommendation? Will she explain the idea that women who had passed their 40th birthday were in some way less hurt than women who had not reached 40 years of age? Among the 35 cases excluded from the scheme is a woman who had her procedure deferred by one week immediately before her 40th birthday and had it performed three days after her birthday.
With all respect, whatever responsibilities will rest on those who will take up government after the upcoming general election, surely the Minister recognises that one of the last actions, in all justice and fairness, that she should take is to proceed as she has indicated she is not of mind to do, namely, by recommending to government, however late in the day, that a supplementary redress scheme be introduced.
We welcomed the money allocated for the first scheme and correctly covered many of the cases which came under it. I understand this money was not fully drawn down. There is a question that the additionality in this particular instance is so small that it is not beyond either the Minister's gift or duty to make such a recommendation and do justice and right by the women concerned. I conclude again with that appeal.
Unfortunately, I am not in a position to accede to the Deputy's appeal, notwithstanding the passion with which he makes it. When the Government decided, on foot of the report of Judge Maureen Harding Clark, to have an ex gratia compensation scheme — the term “redress scheme” is more appropriate because it is not possible to compensate those concerned with money for the traumatic impacts on their lives — we asked the judge to recommend the terms of the scheme. We made this decision because we believed she had the expertise to make recommendations. I accept, however, that I made the final decision in conjunction with the Government. I am not trying to pass the buck to the judge who simply gave advice.
When a plea was made to extend the terms of the initial scheme, I sought and secured Judge Harding Clark's advice and spent some time discussing the matter with her. She took a strong view that the scheme should not be extended for a number of reasons. While the Government did not have an obligation to introduce a redress scheme, on the basis that the women in question could not vindicate their rights through the courts for a number of reasons, we believed it was right to establish a redress scheme.
When one opens up a redress scheme of this kind, one will always find some people are unhappy because they find the redress insufficient or the cut-off point — age in this case — is unreasonable. We felt there were a number of hard cases outside the scheme and we asked the State Claims Agency to deal with them. I believe the agency has dealt with them.
Not with these cases.
I accept they did not deal with the 35 cases. One of those 35 cases is the woman who recently took the judicial review, which was denied. I know the name of the woman but not her circumstances. She felt the redress scheme should have dealt with her but it was denied by the courts. For a host of reasons, I am not in a position to reopen this scheme or to establish a supplementary scheme.
5 Deputy Denis Naughten asked the Minister for Health and Children her plans for the provision of acute emergency services at Roscommon County Hospital; and if she will make a statement on the matter. [1841/11]
Roscommon County Hospital provides an important range of elective and emergency services and treats cases on both an inpatient and a day case basis. Like a number of other hospitals, Roscommon County Hospital has experienced difficulties in recruiting non-consultant hospital doctors during the normal six monthly rotation in January 2011. This is not a staff moratorium or financial issue; smaller non-training hospitals like Roscommon County Hospital are finding it increasingly difficult to attract the number of non-consultant doctors required to maintain all services as structured at present.
The HSE has assured me that, in the light of these difficulties, it will employ all possible measures to address the staffing issues, including continued recruitment efforts and the use of nursing and other supports from Merlin Park University Hospital and Portiuncula Hospital, to maintain the 24-hour emergency service provided at Roscommon County Hospital.
The HSE is in the process of devising a reorganisation programme for hospital services in Galway and Roscommon. This will be informed by the HSE report on the national acute medicine programme, which was published in December. As a first step, in 2010 a clinical director was appointed to manage Galway University Hospital, Merlin Park University Hospital, Portiuncula Hospital and Roscommon County Hospital as one integrated service, to provide additional support to the hospitals concerned and to ensure that care is delivered on a safe and sustainable basis.
A reorganisation project group has been established to develop a plan for services in Roscommon and Galway. Following consultations with key stakeholders including clinicians, senior managers and directors of nursing across the three hospitals, a reorganisation plan will be developed by the group. A clinical lead will be identified in the coming weeks and a project manager will be appointed to co-ordinate and drive planning and implementation. It is expected that an agreed detailed plan will be available in the course of 2011.
I thank the Minister for her response. I ask the Minister to clarify why every other appointment to Roscommon is done on a joint basis of a hospital group of Roscommon, Galway University Hospital and Portiuncula, yet in regard to non-consultant hospital doctors, it is specific to the hospital in Roscommon. This situation could be addressed overnight and reduce the 22% deficit of non-consultant hospital doctors to 3%.
There is a specific crisis in respect of theatre nurses in Roscommon. If two theatre nurses are appointed, we can deal with the colonoscopy backlog in Galway University Hospital. Theatre nurses are critical health staff and their absence is jeopardising the 24-hour service. In light of the commitment given by the Minister in respect of the 24-7 service, will she ensure non-consultant hospital doctors are appointed on the basis of a group of hospitals and will she make two theatre nurse appointments to ensure the services continue?
The HSE is changing the manner in which non-consultant hospital doctors are appointed. This week, I met with Dr. White and others on this point. It is becoming difficult in an environment where there is a global shortage to get non-consultant hospital doctors for smaller, non-training hospitals. The most effective way of overcoming the difficulty is to have smaller hospitals combined with larger hospitals. This is already happening in regard to some of the midlands hospitals and St. James's Hospital. It should also happen in regard to Galway University Hospital. I will pursue the matter.
I am aware there is a shortage of nurses in Roscommon. I have spoken to the HSE about the quantum of nurses in the region to ensure Roscommon can function. I do not want to see a hospital with a deficit because of a particular problem in regard to nurses. We have a high ratio of nurses. Every time I say this, Mr. Doran talks to me about it. We have a high proportion of nurses in the Irish health care system, notwithstanding the moratorium and retirements. The comparison with Canada in The Irish Times supplement shows we are substantially ahead of Canada in the number of nurses working in our health care system. We have a sufficient number of nurses in the region to assign nurses to Roscommon County Hospital. I will endeavour to ensure that happens.
I thank the Minister for her commitment on these two specific issues. I ask the Minister to assure the House about rumours in Roscommon to the effect that the hospital will be removed from the 24-7 on-call service. In light of the lack of an out of hours GP service, the grossly inadequate ambulance service and the fact that the HSE has publicly committed to addressing both of those issues before considering a reduction in services, can the Minister give a commitment that it will happen?
I understand Deputy Naughten was speaking with Dr. O'Keeffe, who manages the three hospitals, this week and he is familiar with the arrangements. This week, I had a meeting at HSE on this point and others, including emergency units, and I am assured that 24-7 services will continue. I cannot guarantee it will continue forever but I can guarantee the best endeavours are being used as we speak to ensure we maintain services for the region. The future for Roscommon County Hospital, Galway University Hospital and Portiuncula is to work together as a single hospital, albeit on three sites. There is no doubt in my mind on this point in terms of staffing, recruitment of required expertise, the financial perspective and the perspective of patients. Many patients from Roscommon still go to Galway and procedures could be supplied in the local hospital if the three hospitals worked as one. There are a number of benefits when three hospitals work as one and that is the future.
