Vol. 737 No. 2
6 Deputy Pat Deering asked the Minister for Health his views regarding the Health Service Executive paying a substantial amount of rent for a premises in County Carlow, intended to provide facilities that are already available in the nearby Sacred Heart, District, and St. Dymphna’s Hospitals, in view of the fact that the rented premises are not currently in use; and if he will make a statement on the matter. [17860/11]
I presume that the premises referred to is located at Shamrock Plaza, Carlow. If so, then there appears to be considerable confusion with regard to the use of the premises and the services to be provided. The facilities at the nearby Sacred Heart District Hospital and St Dympna's Hospital are not suitable for the provision of primary care services.
The new primary care centre for Carlow town is to be accommodated at Shamrock Plaza. The development of primary care teams and primary care centres is a priority under the programme for Government. The first floor is already occupied by three GP practices and HSE staff will occupy the second floor. Both floors have lift access. Together, these floors will accommodate the Carlow town primary care centre and when the HSE staff move in, the primary care team will be located there. Other businesses, including a bank, a software company and pharmacy are accommodated in the building. There is residential accommodation on the upper floors. There is underground car parking beneath the building and an estimated 1,000 car parking spaces in the vicinity, including a multi-storey car-park. Up to 43 HSE staff will provide a range of health services, including public health nursing, occupational therapy, physiotherapy services, speech and language therapy, psychology services, dietary and nutrition advice, home help services and general support staff facilities. There are additional rooms to accommodate outreach hospital consultant clinics and other visiting specialists. At maximum capacity, up to 40 clients can receive services at a single point in time. The fit-out has been completed and equipping is virtually completed. The accommodation will be ready for occupation by HSE staff shortly.
The rent paid for any HSE occupied primary care centre accommodation cannot exceed that approved by the HSE board for that specific location. The annual rent for this centre is €320,000 a year, for an area of just less than 20,000 square feet. This rent is less than the rent approved by the HSE board for a premises of this size. Rent payments, which are payable in advance, have just commenced.
I thank the Minister for his response, although I would dispute some of the facts in it. Over the past 18 months, the two words "Shamrock Plaza" have become dirty words in Carlow town. This building is seen as a pay-off for developers who built it in the so-called Celtic tiger years. The building is totally inaccessible. There are a number of car parking spaces, but as far as I understand these are limited to the staff working in the building and are being paid for by the HSE. Once again this is an example of a totally unaccountable HSE, a monster created by the former Fianna Fáil Government of which Deputy Kelleher was a member. At a rent of €1,000 per day, I question the value for money.
Can the Minister confirm the length of the contract entered into for this building? The rumour is that it is for 20 years. At €1,000 per day or €320,000 per year, the cost works out at €7 million over a 20-year period. That is a significant amount of money. We could do a lot more work with it. We could build a facility. What contracts are in place and will they be reviewed over the next period of time?
I apologise because I do not have an answer to the Deputy's question. I hear his concerns, particularly with regard to accessibility to the site. I will not comment on the other contention at this time, but I will check out the duration of the contract. I will also ask for a report on accessibility to the site and its appropriateness and will check what other sites might be available in the town. It is not the intention of the Government to preside over waste or excessive costs for accommodation, particularly when, as I know, the HSE has many sites rented which are now surplus to requirement. In fairness to the lead man in the HSE in this area, he is seeking to rationalise the situation. For example, now that the Department of Children and Youth Affairs has been set up, the Department of Health will have extra space in Hawkins House which we hope to make available to other agencies so they can give up their leases around the city. We are seeking value for money. If this is a case of waste, I will revert to the Deputy.
The real issue at the heart of this matter has not been referred to. I refer to the requirement for a public private partnership contract. The HSE in Carlow has adequate accommodation for its needs. As the Deputy said, €1,000 per day is being flushed away through the arrangement in question. I have raised this directly in the House and was the first to do so through a parliamentary question last December. The response received from the then Minister made it very clear she was not in a position to roll away from the public private partnership requirement. I welcome the fact that the current Minister is willing to recognise the madness of the circumstances that obtain and to consider reconfiguring the use of existing HSE accommodation. He should take the required steps to address the real problem at the kernel of this issue.
Carlow Town Council has asked that the Comptroller and Auditor General take a direct interest in this matter. Could the Minister check whether the Comptroller and Auditor General is carrying out an investigation into this matter both in Carlow and elsewhere around the country?
We must move on to Question No. 7 in the name of Deputy Colreavy. Six minutes are allowed.
Very briefly——
Can I make one point clear? Two minutes are allowed for the Minister in which to reply. Four minutes are allowed for supplementary questions with a maximum of one minute per person, including the Minister. This amounts to six minutes in total. Other Deputies are waiting for their questions to be answered. I intend to stick to the limit of six minutes.
I will check.
7 Deputy Michael Colreavy asked the Minister for Health if he will ensure the continuation of all services at Sligo and Roscommon hospitals in view of the non-consultant hospital doctor shortage; and if he will make a statement on the matter. [17903/11]
26 Deputy Luke ‘Ming’ Flanagan asked the Minister for Health his views on the downgrading of the services provided at Roscommon hospital. [17856/11]
I propose to take Questions Nos. 7 and 26 together.
As Minister for Health, I will not stand over unsafe practice in any setting nor will I allow patients lives to be put at risk. However, it is not my policy to close small hospitals or to diminish them in any way. My priority is to ensure safe, high-quality care for patients, provided in the most appropriate location.
The circumstances in Roscommon Hospital are a cause for serious concern. It is clear that the acceptance of acutely ill patients in Roscommon as at present cannot continue and we need to find a safe solution for patients without delay. The hospital has had significant problems recruiting NCHDs, to which I referred, and relies heavily on agency staff.
Last week, I met a group from Roscommon which is concerned about the future of the hospital. I asked senior clinicians from the HSE to attend that meeting. I also asked the CEO of the Health Information and Quality Authority, Dr. Tracey Cooper, to attend to outline the authority's concerns about the hospital.
The HSE has been working with local clinicians to finalise a plan to provide a satisfactory and safe level of service in the hospital. I have asked the HSE to submit the plan to me by the end of this week.
The Government is strongly committed to developing the role of smaller hospitals in Ireland, including Roscommon Hospital, so that they will play a key part in the services provided to local communities. Local hospitals can and should be a vibrant element of local services, providing treatment and care at the appropriate level of complexity.
I assure the House that services will continue to be provided at Roscommon Hospital, as part of the Galway University Hospital group. The nature of the services will change but the hospital will always have a key role. In particular, I expect to see an increased level of less-complex activity at the hospital for the benefit of the whole local community.
With regard to Sligo General Hospital, I have confirmed it will continue to provide vital services. I am monitoring closely the NCHD vacancies around the country. As of now, the HSE has not expressed specific concerns regarding the NCHD situation in Sligo.
We must be honest and straight. What is currently available at Roscommon hospital is not safe. I referred to fractures and orthopaedic surgeons. There is no surgeon or cardiac staff to insert a stent. There is no vascular surgeon or team to deal with multiple trauma.
I want to see a vibrant 24-hour service available, through an urgent care centre, to the people who attend Roscommon hospital. This centre should be staffed and the care should be delivered by doctors. Hospital doctors should deliver the care from 8 p.m. to 8 a.m. We are in talks with the local general practitioners to provide coverage from 8 p.m. to 8 a.m. If one sprained one's ankle, one would go to the care centre to have an X-ray. However, if one's ankle were broken in two places, one would need to go to Galway. If one caught one's hand in the lawnmower and cut one's finger, one would go to the centre to get sutured but if one's hand were mangled one would clearly go to Galway. The service was to be supplemented by an additional ambulance so there would be four ambulances covering Roscommon during the day and three at night. I can guarantee that. There will be extra paramedics available with a car to provide cover if all the ambulances are out of Roscommon at any given time.
These are services that I can control and which I will deliver. I do not control the NCHDs at present because I do not know the numbers, but when they become available I commit to their inclusion. People will have an urgent care centre and a safe service. The abiding message I want to send from this House today is that I want to replace that which is not safe with something that is safe.
Go raibh maith agat.
Is Deputy Ó Caoláin speaking on behalf of Deputy Colreavy?
Yes, of course.
I did not know that.
I do not see him here anyway so I presume I am speaking on his behalf.
Deputy Luke Flanagan is present and he has tabled a question also.
The Ceann Comhairle is only getting used to his role and should not be distracted from what we have just heard. I have just heard the Minister state Roscommon hospital is to become the home of an out-of-hours GP service from 8 p.m. to 8 a.m. There is no other way to describe this; it is simply unacceptable. The Minister and his party colleagues gave firm commitments to the people of Roscommon prior to the general election which have been restated line after line——
Could we have a question?
——this week in one of the two local newspapers, the Roscommon People. We are all familiar with the commitments that have been made by Fine Gael and the Labour Party——
This is Question Time. Could the Deputy ask a question, please?
I have a question to ask.
The Deputy should ask it. A minute has elapsed and the Deputy's time is nearly up.
My question is simple — will the Minister accept that what he is proposing for Roscommon General Hospital represents a significant downgrading of the services the people of Roscommon have treasured over many years and rightly expected to be reaffirmed, protected and guaranteed on the election of the new Government? Does he accept that what he now proposes represents a significant diminution of those services that will have serious consequences? May I say, as a representative——
The Deputy is way over time.
——of the people of Cavan and Monaghan that it most certainly reflects the same template that was introduced at the hospital in Monaghan, which template will ultimately lead to a further domino effect bringing about a loss of critical services? The people of Roscommon should not tolerate it under any circumstances.
I ask Members to respect the Chair. The Deputy exceeded the time allowed. A minute is allowed per supplementary question. There are other Deputies in the Chamber. The Minister has a minute to reply to Deputy Ó Caoláin's supplementary question.
I reject the Deputy's contention that there is a diminution of services. I have just explained to him that what is currently available is not safe. It is not safe as adjudicated by the clinicians in the hospital, who will no longer stand over the circumstances that obtain.
They should make the service better rather than do away with it.
The Deputy should allow the Minister to reply.
I can come to that in a moment. I refer to the position on safety as adjudicated by HIQA and clinicians in my Department. I am seeking to make the location safe and to ensure there is a 24-hour service. It will be an enhanced service from a general practitioner's point of view because one will now be able to have X-rays at night, which was not the case heretofore. The service will be enhanced because people will now know exactly what they are getting. People will not turn up at the hospital having heart attacks in the false belief that they will be looked after in a comprehensive fashion.
Let me quote some statistics for the Deputy.
The Minister has exceeded his time.
Thirty patients per day pass through the accident and emergency department. Fewer than one per day is transferred to Galway. Some 25%——
If one has a heart attack after 8 p.m. in Roscommon, one should not go to the local hospital.
The Minister is over time. I call Deputy Luke Flanagan.
When I first heard the Minister was getting into politics, I was overjoyed.
Please ask a question. The Deputy is using up his time.
Fair enough. Did the Minister know this place was not safe when he made a promise in a letter and confirmed that Fine Gael undertook in accordance with its policy on local hospitals to retain the emergency, surgical, medical and other health services at Roscommon hospital which were present on the formation of the 31st Dáil and upgrade such services where feasible? Did he know at the time the accident and emergency services at the hospital were not safe, as he claims they are now? If he did, why did he make that promise?
The first paragraph of the letter which Deputy Flanagan quoted is correct. The second paragraph states in the event of the accident and emergency unit being downgraded we are committed to reinstating a 24-7 service where feasible. Let us have accuracy on the record of the Dáil.
You always throw in the——
The question is a straight one. Was I aware? No, I was not. The Mallow report had not been published. The Ennis report suggested a review needed to be done but no such review was done, so I was not aware. I must preside over what is safe. Apart from being a Minister, I am a doctor, and I will not preside over what is not safe. I will not ignore expert advice from colleagues in the hospital and in HIQA; I cannot do so and it would be absolutely irresponsible of me to do so.
I am seeking a solution and I am saying to the people of Roscommon today that the solution I see is the one I have outlined, but it is contingent on me getting NCHDs which I may not be able to do.
It is not the one the Minister offered in February.
I did not interrupt Deputy Ó Caoláin.
We know what was on offer in February; we now know what we are faced with——
I ask the Minister to please not respond to——
——and if Deputy Ó Caoláin can predict the future with absolute certainty, then fair play to him.
The Minister is over time.
I want to make one important point. People have spoken about the golden hour. This is a concept from the 1970s and 1980s which has been superseded by much information, many reports and peer review journals which show one is better off, even if one is more than an hour away——
Sorry Minister, you are over time.
——going to a high-volume centre. One's chances of survival increase by 25% — one in four. Let us do what is safe. Let us be honest.
Please respect the Chair. You are over time.
I apologise.
In light of what the Minister has just said on the golden hour, will he have an independent evaluation done on this? Contrary evidence exists on the golden hour.
Will the Minister ensure the HIQA terms of reference are amended to deal with the issue of travel times? The single biggest issue for the people of County Roscommon is the fact that Galway University Hospital is in excess of an hour and a half away from them. This is the specific concern they have which is not being addressed.
I will call on local Deputies only as there is not enough time.
I have indicated for a long time.
Surely there is nothing in Standing Orders about local Deputies.
Will the Minister elaborate on the letter regarding the safety of Roscommon hospital?
Does he have any control over HIQA? It seems to be determining what happens in our hospitals and health system throughout the country? As politicians, we give commitments on safety. We also make commitments prior to elections and I ask the Minister what role he has to play in response to HIQA.
I have not been taking up the Ceann Comhairle's time by raising matters under Standing Order 32.
I appreciate that but the time is up.
The Minister mentioned that acute surgery services in some small rural hospitals would not be retained. Last year, 41,000 emergency cases went through Portlaoise hospital. The Minister mentioned 475 NCHD posts were to be filled, 221 of which have been. Portlaoise hospital has four in place already——
We are not discussing Portlaoise.
——with two more are on standby. Last Friday, I sought a meeting with the Minister on behalf of Deputies——
Sorry Deputy, this is Question Time.
I am asking a question.
Please resume your seat.
I am asking the Minister whether he will contact the HSE management——
No, he cannot.
——today and ask it not to pull acute surgery services from Portlaoise hospital due to the fact that he is——
Did the Deputy hear me? The next time I ask him to resume his seat I ask him to please do so. We are discussing Roscommon and Sligo, not Portlaoise. I ask the Minister to reply to the questions about them.
Will Deputies please refer to Standing Orders and learn how to put a question? Time periods of two minutes and four minutes are allowed for replies. Time is up for this question.
Important issues have been raised.
They may be important but I must stick by the time limits.
I accept that.
Other Deputies are waiting for questions to be answered.
Am I allowed answer the two queries?
Yes, very quickly — you have one second.
I cannot do it in one second, sorry.
Do the best you can.
I will certainly ask HIQA to look at its terms of reference with regard to travel time. This is perfectly reasonable. I have no issue whatsoever with getting independent verification on the golden hour because plenty of information exists and it has been superseded. The figures are quite clear, with 25% better survival rates through going to a high-volume centre even if one must travel an hour and a half.
Deputy Feighan asked me to elaborate on the letter. I do not have the letter so I cannot do so. However, with regard to control over HIQA, I wish to make an important point and I ask the Ceann Comhairle to allow me to do so. HIQA is the regulator of our health service. It would be inappropriate, improper and very unwise of me to interfere with it. Everyone in this House knows, and to the cost of the country, what happened when — I believe — a regulator was last interfered with, and this was the Financial Regulator.
He was not. Nobody interfered with the regulator.
He did not regulate at all.
Where are your resignations boys? You promised them. There have been no resignations like you promised. You would not be here now if you had told the truth.
Maybe if we had interfered with the last regulator we might not be where we are.
Does the Minister have evidence? A very serious allegation has been made by a senior Minister that the previous regulator was interfered with.
Please resume your seat. I am not responsible for the answers given.
An allegation was made across the House that the previous——
Please resume your seat.
8 Deputy Catherine Murphy asked the Minister for Health his plans for the development of a career path for doctors who have finished their training; the timeframe to which he is working; and if he will make a statement on the matter. [17862/11]
There is already a structured pathway in place for persons who have been awarded a basic medical qualification following completion of a course of study in one of the medical schools.
The first year of postgraduate medical training, the intern year, is undertaken in a teaching university hospital following which doctors can apply to commence training in the area of medicine in which they hope to specialise. They do this by either entering a basic specialist training programme and then a higher specialist training programme in the clinical specialties, public health, occupational health, microbiology, radiology and pathology or by entering a general practice training programme.
Basic specialist training, which generally takes two years to complete, involves working in a series of senior house officer posts in supervised clinical settings, which include structured training opportunities. Upon successful completion of their basic specialist training, doctors are eligible to apply for higher specialist training. However, as these posts are very competitive many doctors work as registrars, under the supervision of a consultant, for a year or two before progressing to higher specialist training.
Higher specialist training, at specialist registrar level, takes four to seven years and is overseen by the relevant postgraduate training body. It involves rotating through a number of supervised training posts across the breadth of the relevant specialty, undertaking in-house and external training activities and sitting a number of postgraduate training body membership examinations in that specialty.
Doctors who have successfully completed their higher specialist training are entitled to registration in the specialist division of the register of medical practitioners and are eligible to apply for a consultant post in their specialty.
Doctors who wish to become general practitioners must complete a GP training programme following completion of the intern year. This consists of two years at senior house officer level in supervised clinical posts, followed by two years at GP registrar level in a GP training practice. Formal training opportunities are provided throughout and trainees must sit the general practice membership examination.
I have asked my Department to consider the scope for the creation of a new hospital specialist grade which would make for a more appropriate and sustainable model of service provision. While consideration is at an early stage, it is envisaged that this would be a non-training post filled by doctors who have completed specialist training.
Additional information not given on the floor of the House.
In addition, I am setting up a group to carry out an immediate review of career structures and paths for non-consultant hospital doctor, NCHD, posts. This group, which will include the Department, the training colleges and other key stakeholders, will examine issues such as designation of training posts, career structures for NCHD service posts and working hours and conditions and is aiming to complete its work by the autumn. We will endeavour to match undergraduate numbers to consultants and GP numbers required and provide a clear career path.
On a point of order, the Minister made——
Please resume your seat.
——a very serious allegation——
The Minister did not make any allegation against an individual——
He made a very serious allegation across the floor of the House.
Please resume your seat.
The Minister——-
If you do not resume your seat I will ask you to leave. Please resume your seat.
The Minister should withdraw or substantiate that allegation.
The Minister did not make an allegation against any individual.
Is the Minister quite clear in stating that the previous regulator was interfered with in some way?
If the Deputy does not resume his seat he will leave the House. Does he want me to name him?
That is absolutely——
Leave the House please.
I believe the financial regulator was interfered with and everybody in the House knows it.
Deputy Feighan, do you mind?
Substantiate it so.
By whom?
This is Question Time. I ask Deputy Kelleher to leave the House.
That was a good maiden speech.
Go outside the House and say it.
Deflecting from Roscommon, that is all you are doing.
Step outside the House and say it if you have something to say.
Of course I will.
We are elected to this House.
Some of them would not have been if they told the truth before the election.
Deputies, you are in a parliament. Please behave as if you are in a parliament.
It was you and the likes of you who got us into this mess.
I did not interfere with any regulator.
I thank the Minister for his reply.
Deputy Cowen should be ashamed of himself.
I was not here, mate.
I have listened to——
I am a Deputy. How dare Deputy Cowen address me in that manner.
I ask Deputy Keating to remain quiet also.
——the Minister speaks about money following the patient.
How dare he.
I ask Deputy Keating to be quiet, please.
For that to take place, there must be a sufficient number of consultants.
I am leaving the Chamber in disgust at Deputy Cowen's comment.
I tabled the question because this topic will continue to crop up until an adequate structure is put in place. The inadequacy of the structure is clear from the continuing shortages we hear about in particular disciplines. Does the Minister believe the number of consultants is sufficient and the career path for medics is adequate to enable them to reach a point at which they are appointed consultants?
The Minister highlighted a number of issues related to Roscommon hospital. This week, I spoke to a person who is seeking admission to one of the large teaching hospitals. When I spoke to someone in the hospital in question I was informed that admissions, including serious cases, are being repeatedly rescheduled. When a resource is inadequate nationwide it has a knock-on effect. It is not a question of how quickly one can travel from one hospital to another. If the career path is not adequate and there are too few consultants, a logjam develops in the large hospitals and no one passes through the system.
The Minister has one minute to reply.
I accept everything the Deputy said. I did not reach the end of my reply owing to time restrictions. I will not bother with the script and instead tell the Deputy what is the position. I am pleased that as a result of the terrible dark cloud of the shortage of non-consultant hospital doctors, the Medical Council and colleges have come forward and co-operated in an effort to have the issue resolved. Arising out of this, I have spoken to their representatives about creating a forum. I want to report by the autumn on how we will address manpower issues from the day a person starts as a medical student to the day he or she retires as a specialist or general practitioner. We need to create clear career paths and treat people with dignity. We should create a specialist position. At present, one in four of those who complete their specialist registrar training become consultants because jobs are available for them, while three out of four become deskilled and start to go backwards or leave the country because jobs are not available for them.
People have referred to indenture. It costs nearly €1 million to get someone to specialist registrar level at the end of training. For this reason, I want to create a new post of specialist who will be clinically autonomous, will only report to the clinical director and will ultimately become a full consultant. We should acknowledge that he or she has the clinical acumen, training and experience to work as an autonomous clinician. This will provide a clear career path and address much of the shortage being experienced in our hospitals.
Before we move on to Question No. 9——
Is there an opportunity to ask a brief supplementary question?
No, we are out of time. I stress again that, in accordance with Standing Orders presented to me, during ordinary questions the Minister has two minutes to reply and four minutes are available for supplementary questions, one minute for the person asking the question and one minute for the Minister to reply. In other words, four minutes are available for two supplementary questions and two replies. That is the position under Standing Orders. We have exceeded the time available on every single question.
Is there not a provision for other Deputies to——
I ask Deputy Ó Caoláin to resume his seat for a moment, please. I am trying to get through Question Time and there are Deputies who have questions on the Order Paper.
Perhaps the Ceann Comhairle should have Question Time on the plinth.
Deputy Ó Caoláin may ask his party's Whip to propose changes at the Committee on Procedure and Privileges in order that Question Time can be dealt with in a different manner. I must deal with Question Time as provided for in Standing Orders. The Minister has two minutes to answer a question and four minutes are available for supplementary questions. That is the position as laid out before me. The replies supplied to Ministers are much too long and are over-running the two minutes available. As a result, I am required to interrupt.
The Ceann Comhairle exercised a little leniency earlier. Perhaps he could continue that pattern.
If I allow eight or ten minutes for one question, other Deputies will not have their questions answered. The matter is that simple. I ask the Minister to reply to Question No. 9.
With due respect, I am trying to give comprehensive answers but I will expedite them. I respect what the Ceann Comhairle said and will speak more quickly if somewhat less distinctly.
I must make the House aware of the position.
9 Deputy Micheál Martin asked the Minister for Health following comments that no decision has been taken to withdraw ambulance transport services in the north west and that these facilities will remain, the discussions he has had with the his officials to ensure that these sort of briefings will cease. [17677/11]
31 Deputy Micheál Martin asked the Minister for Health if he still stands by the fact that no decision has been taken to withdraw ambulance transport services in the north west and that these facilities will remain. [17676/11]
40 Deputy Michael Moynihan asked the Minister for Health when he was first informed of the Health Service Executive’s intention to cease funding for ambulance transport services in respect of cancer and dialysis patients at Mayo General and Roscommon County Hospitals; and if he will make a statement on the matter. [17885/11]
49 Deputy Pádraig Mac Lochlainn asked the Minister for Health if he will ensure that ambulance transport services for seriously ill patients will be continued in all regions; and if he will make a statement on the matter. [17900/11]
50 Deputy Pearse Doherty asked the Minister for Health if the Health Service Executive ambulance transport service provided for dialysis and cancer patients in the west region will be continued; and if he will make a statement on the matter. [17899/11]
52 Deputy Dara Calleary asked the Minister for Health if he will confirm a statement made by the Taoiseach in Dáil Éireann last week that no decision has been taken on the removal of ambulance transport services for cancer and dialysis patients in the north west. [17884/11]
60 Deputy Billy Kelleher asked the Minister for Health if cuts to ambulance transport services for cancer and dialysis patients in the north west are to proceed from the 1 July 2011; and the meetings he has held with the Health Service Executive West and other interested parties to address this matter in the past week. [17877/11]
I propose to take Questions Nos. 9, 31, 40, 49, 50, 52 and 60 together.
It is not my wish to reduce the level of any service, including patient transport. However the country is facing an unprecedented economic and financial crisis. This is an inescapable reality. The HSE must live within its budget and must prioritise its services accordingly. We must examine the way services are being delivered, make sure they are safe, prioritise services that will meet clear clinical needs and reallocate resources accordingly.
The national ambulance service provides pre-hospital emergency care and emergency and some non-emergency patient transport. Clearly the priority is emergency care, including transporting sick patients between hospitals. The HSE also provides non-urgent care using either ambulances or taxis. Non-emergency transport comprises inter-hospital transfers, patient transport from home to health facility and from health facility to home. It includes both HSE and private transport providers. There must be a clear national approach to non-emergency transport. This is a key point.
This type of expenditure from public moneys must be able to stand up to scrutiny in the new economic reality. There must be a consistent approach across the country instead of the differing practices in place now. Scarce resources for emergency transport cannot continue to be expended on non-emergency transport without clear criteria in place based on clinical need. Supported by my Department and HIQA, the national ambulance service is working to improve the management and integration of its services. This includes the development of standard national criteria on non-emergency patient transport which will be announced shortly. There are a number of systems of support in place for cancer patients who have to travel for treatment and these arrangements will continue on the same basis as previously.
The national ambulance service has undergone significant change to ensure quality, safety and value for money. In line with other clinical areas, this process is ongoing as clinical needs and standards develop. These developments are in the best interests of patients and are a key part of the Government's work to ensure high quality emergency care.
Does Deputy Cowen wish to speak in place of Deputy Martin?
I am certain Deputy Martin will be pleased that I was present to take the opportunity to speak.
This threatened cut was first revealed by me, interestingly, when we obtained a copy of a letter sent by the Health Service Executive ambulance management to hospitals in the west region stating that from 1 July transport services for people requiring dialysis and cancer care supports and services would be stopped. This concerned the whole west region, from the Cork-Kerry border all the way to Inishowen in County Donegal. This threat has caused serious concern. We were told subsequently that it would not be implemented and we are now told there is a review. I ask the Minister to elaborate on what review is in train. Will he have the final say in the matter?
The Minister has indicated his disposition towards HIQA, which must operate with certain terms and conditions applying to its remit. It is important to remind him of his public statement that he will take back responsibility for the health service and is not abrogating his responsibility, as the previous Minister did, in relation to the Health Service Executive. I welcome that statement and encourage him in that respect. If that is the case, does he agree with the view expressed by the director of operations for HSE west, Mr. John Hennessy, when he referred to——
Deputies may not quote on Question Time.
With respect, I am not quoting. Mr. Hennessy referred to the indiscriminate transport arrangements which applied heretofore. Does the Minister agree with him? There is no such thing as indiscriminate transport arrangements for people in need of dialysis and cancer care. The definition of the word "indiscriminate"——
Thank you, Deputy. I ask you to respect the Chair.
——is "making no distinctions". I hope there will be no distinctions made regarding the transport needs of people requiring dialysis and cancer care across the west in future.
Thank you, Deputy.
You are welcome, a Cheann Comhairle.
I do not appreciate your remarks.
Will the Minister please clarify his intent in that regard?
I ask the Minister to give a brief response.
With respect, I indicated first. My constituency is in the north west.
Deputy Pringle please.
So is Donegal South-West.
Hurry, Deputy, we are running out of time. Question Time finishes at 4.45 p.m.
Donegal South-West is also in the north west. It is my information that this issue arose from the separation of the ambulance and hospital services that took place within the HSE. It is an indication of the dysfunctional way the HSE works. The separation of budgets between community care and hospital care causes all this friction and huge distress for patients throughout the country. It is vital that these issues do not arise again and I ask the Minister to ensure they do not. The distress it causes for very ill dialysis and cancer patients is unacceptable. Patients are entitled to transport and it should be provided regardless of empire building or empire protection within the ambulance service and the hospital service.
To correct Deputy Ó Caoláin, the letter went from somebody down the ranks of the HSE and it did not say the service was stopped. It said, and the Deputy's party leader read it out to the House, that it was expended.
There is quite a distinction there, all right.
There certainly is.
He was talking about the budget at that point.
When money is expended that does not mean the service stops.
It did. The letter also said it did.
It did not.
He talked about the budget being expended.
The proof of the pudding is in the eating.
It is in the letter.
The transport has not stopped. People who need transport for dialysis and cancer services get it.
The intent was there. I will send the Minister a copy of the letter.
I wish to point out, notwithstanding the interruptions, that there has been huge inconsistency in the transport arrangements across this island. I must concur with Deputy Pringle's comments. There is a lack of uniformity, although the HSE was supposed to result in uniformity of approach and of care for 4.4 million people, or 4.2 million as it was at the time. There are totally different criteria in the west of Ireland from those on the east coast. While people are entitled in the west, they are not entitled in the east.
We must make a decision on the basis of having so little money. We can argue why that is the case but that is the reality we face. Are we going to meet expectation or are we going to meet need? My view is that we will do damned well to meet need and need is what we should focus on — the needs of those who require this transport and who do not have their own transport because they do not have the income or means. It is a fact that there are many people in the west who currently have their own transport and drive to get dialysis. Furthermore, we are not just discussing dialysis and cancer patients in this context but a range of services that are used to bring people to health facilities. We need clear guidelines and criteria that are fair and transparent. I do not believe that has been the case in HSE west and there is an acknowledgement of that on its part. That is what this review is about.
Is the Minister saying that if one has a car, one can drive oneself there?
I am saying that if one has the means——
Is that what the Minister is saying to people in need of cancer care support?
The Deputy can put whatever misinterpretation he wishes on it——
No, it is what the Minister is saying.
——but he clearly heard what I said.
If one has one's own car, one can make one's own way.
Only if one is able.
I wish Deputies would learn to have some respect in the House, particularly those who have been Members for a long time.
10 Deputy Niall Collins asked the Minister for Health if he will provide a list of the hospital emergency departments around the country that will not have enough non-consultant hospital doctors from the 11 July 2011; and if he will make a statement on the matter. [17878/11]
32 Deputy Sandra McLellan asked the Minister for Health if he will ensure the continuation of all services at Mallow and Bantry hospitals, County Cork, in view of the non-consultant hospital doctor shortage; and if he will make a statement on the matter. [17901/11]
33 Deputy Dara Calleary asked the Minister for Health if he will provide on update on the review of small hospitals; when he expects this review to be published; and the reason this review was not included in the programme for Government. [17882/11]
34 Deputy Clare Daly asked the Minister for Health his plans for the emergency services across the country in view of recent reports that questioned the future of full accident and emergency services in many smaller hospitals. [17871/11]
37 Deputy Brian Stanley asked the Minister for Health if he will ensure the continuation of all services at Portlaoise Hospital, County Laois, in view of the non-consultant hospital doctor shortage; and if he will make a statement on the matter. [17902/11]
39 Deputy Denis Naughten asked the Minister for Health the current status of his review of the Health Service Executive reconfiguration process for acute hospitals; and if he will make a statement on the matter. [17866/11]
43 Deputy Thomas Pringle asked the Minister for Health if he plans to close 24 hour accident and emergency departments across the country; the measures will put in place to ensure access to emergency services for citizens; and if he will make a statement on the matter. [17867/11]
59 Deputy Niall Collins asked the Minister for Health the small hospitals that will face the temporary cessation of certain services in 2011; and the services that will be affected. [17881/11]
62 Deputy Richard Boyd Barrett asked the Minister for Health his plans to shut the 24 hour accident and emergency department at St Colmcille’s Hospital, Loughlinstown, Dublin; and if so, the measures he will put in place to ensure the health and lives of residents in Dublin South East and Wicklow; and if he will make a statement on the matter. [17873/11]
I propose to take Questions Nos. 10, 32 to 34, inclusive, 37, 39, 43, 59 and 62 together.
I am committed to ensuring that acute hospital services at national, regional and local level are provided in a clinically appropriate and efficient manner. In particular I wish to ensure that as many services as possible can be provided safely in smaller, local hospitals. I have also made it clear that patient safety must be the overriding priority. I want patients to be treated at the lowest level of complexity that is safe, timely, efficient and as near to home as possible.
The configuration of services is constantly reviewed and from time to time rearranged to improve access and quality of service and minimise risk to patients. This programme of realignment of services has received recent impetus from HIQA on the need to implement the recommendations from the Ennis and Mallow reports. The reports deal in particular with the type of services that can safely be provided in smaller hospitals and the structures required for good governance and accountability. The HSE must ensure that this happens and I will be monitoring the situation closely in conjunction with HIQA.
Additional information not given on the floor of the House
The HSE has now put an implementation team in place to ensure that the recommendations of both the Ennis and Mallow reports are implemented in a speedy, systematic and consistent manner and I have asked for regular progress reports on this important initiative.
This Government is strongly committed to developing the role of smaller hospitals in Ireland so that they play a key part in the services provided to local communities. Patients should only have to travel to the larger hospitals for more complex services. The HIQA reports are entirely in keeping with this approach. I can assure the public that no hospitals will close, regardless of the difficult economic situation we find ourselves in. However, ongoing reform of the system will require some changes in how care is delivered in some locations across our health system.
I am very conscious of concerns about some hospitals in advance of the next rotation of non-consultant hospital doctors, NCHDs. The shortage of suitable NCHDs is an issue worldwide. In this context I am working with the HSE and other stakeholders to ensure the filling of as many as possible of some 475 NCHD posts which are due to be filled from 11 July 2011. The HSE conducted an extensive recruitment drive in India and Pakistan in recent months and succeeded in identifying 439 potential candidates for NCHD positions in Ireland. I have held meetings involving my Department, the Medical Council, medical training bodies and the HSE with a view to identifying measures to facilitate the appointment of suitably qualified doctors from abroad. Drafting of a Bill to amend the Medical Practitioners Act 2007, to enable the Medical Council to register doctors in supervised posts for a defined period, is at an advanced stage.
I can assure the Deputies that the necessary steps are being taken to ensure the ongoing safe delivery of service in hospitals and in emergency departments in particular. I am advised that while significant staffing problems remain at both SHO and registrar level in emergency medicine, it is anticipated that increasing the number of staff available to general surgery and general medicine will assist in the delivery and support of emergency department services. In this context, the HSE is focusing on addressing particular emergency department staffing issues in Our Lady of Lourdes Hospital, Drogheda, the Mid-Western Regional Hospital, Limerick, the Midlands Regional Hospitals at Mullingar, Tullamore and Portlaoise and Naas General Hospital.
Notwithstanding this and other initiatives, it is unlikely that all NCHD vacancies can be filled by 11 July. Hospital management is working with clinical directors in a planned way to devise contingency arrangements which can be implemented, if required, to ensure that any resulting impact on services is minimised and that safe delivery of hospital services is assured. Whatever happens I will not stand over unsafe care. Guarding against unsafe care must be the overriding principle driving all the actions taken in terms of clinical service provision and any changes required in that regard.
In respect of the downgrading of hospitals, there is huge anxiety about small and large rural hospitals. What defines a small rural hospital? My local hospital in Portlaoise treated 41,000 emergency cases, so I ask the Minister not to count it as one. Will the Minister contact the HSE today and ask it not to pull acute surgery services in such hospitals throughout the country until the recruitment process has been completed?
The Minister said earlier that of the 60 or 70 who had got visas for placements——
I had indicated, a Cheann Comhairle.
We are dealing with Question No. 10.
That is what the Minister replied to. I have indicated three or four times now.
May I continue?
Deputy Niall Collins put down this question and Deputy Cowen is here representing him.
I am entitled to ask a supplementary question.
That is not the issue, a Cheann Comhairle.
It is the issue. Nobody is automatically entitled to ask a supplementary question other than the Deputy who put down the question.
It is at your discretion, a Cheann Comhairle.
That is correct. Deputy Cowen should proceed.
The Minister said the first demand would be in the busier hospitals and that he is allocating them to the most pressing need. The Minister therefore has a list of those that are most pressing with regard to the 221 that have been filled and the 60 that are coming. Can the Minister tell us what is at the bottom of the list? What hospitals will not get their quota if they are not there before 11 July? The Minister also said contingency plans would be put in place. What contingency plan will there be for them? Can the Minister place on the public record or on a website or can he inform the relevant authorities what contingency systems will be in place? What can the public expect on 11 July?
The answer to both questions is that there are a number of contingency plans contingent on the amount of NCHDs we have. I cannot say what they are until I know what that figure is. I am reliably informed that I will have a better idea at 4 p.m. tomorrow but I will have an even better one towards the end of next week. I realise people like to know what is happening in advance but I do not know and nobody can know because we do not know how many people will land here. We can only judge by the success we have had to date and see how many more people will apply for visas next week and book an aircraft to come here. I believe the vast majority of the 424 who have been identified as suitable and who arrive will remain here and will be found to be suitable. I am not as convinced about the 65 people who have applied to sit the old examination because they have not been screened and I have no idea what the pass rate will be.
I accept that this causes anxiety for people, particularly in the smaller hospitals. The rationale behind the need of bigger regional hospitals having to be addressed is that hospitals such as those in Limerick and Letterkenny must serve huge populations and other hospitals. They must be a priority.
Written Answers follow Adjournment Debate.
