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Dáil Éireann debate -
Wednesday, 6 Jul 2011

Vol. 737 No. 4

Leaders’ Questions

Last night the deputy leader of Fine Gael talked at length about his reasons for pushing ahead with the removal of services from Roscommon hospital, and signalled that this will continue with other hospitals. He said he was startled by the quality of treatment at the hospital, although to be startled is an odd reaction given the fact every single one of the issues he mentioned was fully known to him last February.

Fine Gael repeatedly told the people of Roscommon that it had the solution, for example, to the NCHD issue. The only things that have actually changed since then are that the Minister, Deputy Reilly, has taken personal responsibility for the HSE and the Department has underspent its budget by about €40 million. Yesterday we had the remarkable spectacle of the Taoiseach going as far as to deny having made any commitments to smaller hospitals. His problem, of course, is that it only takes about five minutes research to show that making promises to hospitals was a core campaign tactic of Fine Gael in Roscommon and throughout the country during the election, and in the past few years.

For example, the Taoiseach personally gave assurances relating to services in Ennis on 7 February, he gave assurances on services in Nenagh on 4 February, and in Cork on 18 February he said he had a list of hospitals whose services Fine Gael would protect. With regard to Sligo, which we discussed yesterday, he should look at the record of this House, where his name is signed under a motion demanding that services there be protected and retained. As Deputy Feighan said at the launch of Fine Gael's Roscommon campaign: "With us, James Reilly and Enda Kenny, the future of Roscommon hospital will be secure because we are telling the truth".

Instead of the moral outrage——

Could we have a question? You are nearly running out of time. You have ten seconds.

It is good stuff, a Cheann Comhairle. It is worth repeating.

Who created the problem in the first place?

A Deputy

Look at what happened in the past two or three years.

Deputy Martin has ten seconds.

Instead of the moral outrage, when the Taoiseach is asked questions——

What about the promises made in 2007? Promises were made left, right and centre in Waterford. We had them in writing.

Two wrongs do not make a right.

Will Deputy Martin please ask the question?

One would think they were never in charge of the health service.

Will the usual suspects please remain silent?

I never said a word.

Instead of the moral outrage, Taoiseach——

Will you please ask the question? Your time is up.

I am asking the question but I am being heckled repeatedly from the other side.

Ask him about Punch and Judy.

As the leader of the main Opposition party, I am entitled to ask a question and you must allow that to proceed.

Yes, and you have two minutes to do it. You spent the first minute and 50 seconds making a statement.

I am entitled to do so.

Yes, but ask the question.

Hold on a second. Under Standing Orders I am entitled to ask a question on a matter raised.

It says Leaders' Questions here.

Do you want to read out the Standing Order?

Please, go ahead.

No, it is very important that——

Finish the sermon and get on with the question.

It is very important that we understand the Standing Order.

It is also very important that you understand who is in the Chair.

I am being heckled repeatedly and I need to be protected as well.

It is very important that you understand who is in the Chair.

I understand who is in the Chair but I also understand the standing order on Leaders' Questions. It allows me to ask a question on a matter raised.

Please ask it.

I am trying to ask it but I am being repeatedly interrupted by all sides. I am simply saying to the Taoiseach that instead of the moral outrage when he is asked questions about his commitments, can he explain exactly why his straightforward promise to the people of Roscommon has been abandoned?

I find the Deputy's intervention in this pathetic. For somebody who commissioned over 130 reports and acted on none of them, and who came into this House and denied all responsibility for reading his brief about a charge that cost almost €1 billion in respect of taking money back off geriatric patients in long-stay care, his record in this regard is not one to follow.

Come on. Answer the question.

The Taoiseach is ducking the question.

I make no apology for attempting to bring about a situation where patient safety is seen and demonstrated to be of critical and fundamental importance to the Government. I am on record on many radio stations throughout the country as saying the Fine Gael Party, as an Opposition party attempting to get into government, was not going to go down the route of endless promises of restoring places that have been closed down.

There must have been no hospitals at all.

That is our party — Fine Gael.

If the Deputy cares to do some more research, he will find it on record after record in regard to many local hospitals.

(Interruptions).

Will the Deputies give the Taoiseach a chance to reply?

Let me say this about Roscommon. I know Roscommon hospital exceptionally well, I have been there on many occasions, I know many of the people who work there and many of the constituents from County Roscommon have come to me and have come to protest outside my office.

They are not happy.

I want to make it clear that what is involved here is changing a situation whereby patient safety becomes paramount. The fact is that the Health Information and Quality Authority has expressed serious safety reservations about the situation that exists in a number of small hospitals where there is not the range of medical capacity to deal with all of the situations that arise. That is not the fault of any individual working in the hospital. It is just a fact of life that the situation that exists in a number of small hospitals is not the way we would like it to be. HIQA expressed concern in this regard about a number of hospitals, including Roscommon, and the consultants in the region have also expressed fears in respect of safety.

Unlike the thread the Deputy is trying to spin here, there is no intention to close down Roscommon hospital — that is the first point. The second point is that, as has been clarified in the debate here with the Minister for Health, there will be an urgent care centre, run by non-consultant hospital doctors in Roscommon hospital and operating from 8 a.m. until 8 p.m.

It is a band-aid station.

The GP service has gathered together to form a co-operative which will provide a call-in centre based in the outpatient department of the hospital and this will operate from 6 p.m. until 9 a.m. The GPs will also provide their own roster for Saturdays and weekends, as heretofore. The vast majority of the treatments that have been provided in Roscommon hospital to good effect over the years will continue.

From a medical safety perspective, the Minister has pointed out that people suffering from deep trauma, heart attack or stroke have a better chance of survival if they are brought to a high volume centre like Galway. He has confirmed that Roscommon will have four ambulances, with two based in Roscommon town and backed up by a rapid response vehicle with a team of trained paramedics and the advantage of a medical assessment unit. This is in the interest of patient safety. I am aware of the concerns, fears and anxieties that people have but I assure the Deputy that what I am describing is going to happen.

I will quote the statement from the Taoiseach's party to the people of Roscommon: "I would like to confirm that Fine Gael undertakes, in accordance with the Fine Gael policy on local hospitals, to retain the emergency, surgical, medical and other health services at Roscommon hospital which are present on the formation of the 31st Dáil". That is what he said a short while ago. He knew everything that he has outlined in the Dáil in terms of patient safety and non-consultant hospital doctors, NCHD. In the debate held last October, Deputy Reilly made it clear he had the solutions to the NCHD issue and that by eliminating waste in the HSE, and so on, he would solve all the problems and resolve the issues in terms of protecting services in local hospitals.

Could we hear the Deputy's supplementary question?

Punch and Judy.

The Taoiseach always lets politics get in the way of facts in terms of the €1 billion reported——

Could we have the supplementary question please?

——but if he took time to read the independent report he would find that what he has asserted is absolute nonsense.

Living on a prayer, that is how Fianna Fáil left us.

Substantial investments have been made in Roscommon hospital over the years.

Will the Deputy put his supplementary question?

I will put it now. Yesterday the Taoiseach made an incredible statement to the House when I asked him about keeping report cards on Ministers. He said we should not take his words at face value and it was only a metaphor.

The Deputy is over time.

Can he be straight this morning by telling us whether the country should take the same approach when it thinks back to the long list of specific commitments and promises he and his party made while they sought power? They were only metaphors.

The damage was already done to the economy.

Fianna Fáil is a metaphor for disaster.

The Taoiseach has one minute to reply.

That is equally pathetic. What I said on other matters in this House, in respect of which my word can be taken as coming true and through, is that we are going to hold a number of referendums, which Fianna Fáil failed to organise when it was in Government, on accountability and responsibility.

Stick to the question.

They are not metaphors; they are facts. We will have one about confidentiality and one about the consequences of Abbeylara. We have made a number of additional decisions which we said we would make.

What are the consequences for Roscommon?

The Government is also getting rid of 20 Deputies.

If Deputy Martin wants to go down the road of having report cards, he should stick with that. If that is his limit for the moment, he should stay with it. He is doing well. We have a bigger picture to sort out, namely, the challenge that faces our country.

Will the Taoiseach answer my question?

He stated that the Minister, Deputy Reilly, had the answers to the non-consultant hospital doctor problem. This week the Minister made an amendment to the Act to provide a facility for temporary registration in order to allow greater access for non-consultant hospital doctors to work in this country, an issue which Deputy Martin and his Government failed to address for ten years.

The very service the Taoiseach said he would keep is closing.

Deputy Martin is good at pointing the finger.

Year after year, the same problem arose in January and July and he did nothing about it.

We dealt with them.

They were dealt with.

We are over time.

The Minister has the Government's authority to deal with the problem in so far as non-consultant hospital doctors are concerned and that situation will improve on the next roster because of the changes he has introduced.

Who is he codding?

The Deputy has not commented, as others have, on the facilities now being introduced in respect of patient safety in Roscommon.

The service is closing.

I am sure he will agree that the medical evidence is incontrovertible in so far as mortality rates are concerned.

He knew all about that for the past couple of years but it did not stop him putting down motions in this House.

Fianna Fáil had 14 years.

I am sure the Deputy wants every patient to have the best chance of survival, whether from heart attack, stroke or deep trauma.

The Taoiseach made a commitment knowing all that.

The facilities being put there are in the interest of patient safety and the vast majority of treatments carried out in Roscommon hospital will continue as heretofore with an enhanced and improved situation.

Knowing all of that, he made the commitment.

What about Fianna Fáil's own promises?

There will be additional facilities in terms of the new ambulance crew and the rapid response vehicle backed up by the trained paramedic team. Believe reality.

Deputy Naughten says the promise should not have been made.

Has Deputy Martin inhaled something? I thought the headshops were shut.

We are now five minutes over time on this question. I am not going to tolerate this. If I call people to finish, they should finish. We are five minutes over and we are supposed to allow seven minutes for a question. I also ask Deputies to cut out the heckling so we can hear what is being said.

I am sure the people of Roscommon are uplifted and edified by the rí rá taking place in this Chamber over a deadly serious issue. I understand the Taoiseach's frustration at Fianna Fáil, which closed accident and emergency departments in Monaghan, Dundalk, Ennis and Nenagh.

You guys certainly filled them.

The Taoiseach is doing exactly the same thing.

Is this Deputy Adams's question? Is he speaking on health?

I do not understand why the Ceann Comhairle interrupted me.

I apologise. I thought he was commenting on the previous question.

I am allowed to comment on anything I wish.

That is what I was sent here to do.

The Deputy will do so through the rules of this Chair.

Of course. The Labour Party stated: "The Labour Party is 100 per cent behind Roscommon Hospital".

Deputy Dooley was quiet for long enough.

I stood by it.

The statement continues: "the Labour Party under Eamon Gilmore will not tolerate and will reverse any cuts to services if the HSE attempts to implement them between now and the election". The local Fine Gael candidates and Deputies, as well as the present Minister for Health, gave cast iron guarantees. The Taoiseach stated that GPs in the region will provide an out-of-hours service to replace the accident and emergency unit but tá sé ráite ag na dochtúirí seo go gcuirfear saol daoine i mbaol má leanann an Rialtas ar aghaidh leis an dúnadh seo. GPs advise that people's lives will be put at risk if the Government goes ahead with this closure.

On a point of order——

There are no points of order on questions. The Deputy should resume his seat.

I am appealing to Fine Gael and the Labour Party——

I ask that the script Deputy Adams is using be circulated.

The Deputy should resume his seat.

I am appealing to Fine Gael and Labour Party Members to support the Private Members' motion proposed by Sinn Féin and make a stand——

Please put the question.

——on behalf of our communities. I urge the Taoiseach to give clear notice that the Government will reverse the decision.

Will the Deputy put the question?

I am also appealing to people to join today's protest against this outrageous decision.

What about all the cuts in the North?

Of all the U-turns the Taoiseach has performed since he came into office, this is the most brazen.

What about the U-turns Sinn Féin has done in the North?

It is a different song now.

Deputy Buttimer, every single day I have to address you. Will you please remain silent?

It is impossible for him to do that.

It is not a joke.

A full debate is being held arising from Sinn Féin's motion on small hospitals, including Roscommon. Deputy Adams is aware that Roscommon hospital has had difficulties in respect of recruiting non-consultant hospital doctors and has for quite some time relied heavily on agency staff. The hospital does not have anaesthetic cover on a 24-seven basis and an emergency department consultant is only available on site one day per week. This is not satisfactory and arising from these and other issues the HIQA report expressed serious concerns about the safety of patients. This was not because of the qualities of individual doctors but due to a lack of range of medical personnel. It is for that reason only that these changes are being made; to provide 24 hour cover in respect of the urgent care centre, to provide improved ambulance and transport facilities, backup paramedic personnel, facilities for access to a medical assessment unit, and transfers for patients suffering from heart attacks, deep trauma, stroke and so on. The changes being made are based on a requirement, a necessity and a responsibility to provide the best opportunity for patients in those categories to have the best level of treatment and the best opportunity to survive deep trauma, a heart attack or a stroke.

In Louth and Monaghan, the hospitals are suffering death by a thousand cuts. If services are removed and if the proper appointments are not made at the appropriate times, then a hospital can become unsafe. The responsibility of a government is to make a hospital safe. A mark of any society is that citizens — we are citizens, not subjects — have the right of access to wrap-around health care. The Taoiseach used the phrase "small hospital". Who defines that term? If a citizen is ill, he or she should have access to first-class primary health services. This is a small State. We have half the population of London. The Taoiseach is governing the USA.

Can I have your question, please?

Part of the major problem is that money which should be going into these hospitals is going elsewhere. Today, the Government is going to give €10 million to unguaranteed senior bondholders who are not part of the banking guarantee. Why does the Taoiseach not reverse that? He can reverse all his other judgments. Why does he not keep to the promises he made on this issue in the election and put the money into front-line public services as opposed to toxic banks?

That is why the changes are being made to improve patient safety. We are a small country and a small State with a population less than half the city of London. Our philosophy is that we should have health services available to people at the lowest unit cost and as close to them as possible. This means that we cannot have everything at every crossroads. In this case, the changes are being brought about for the people of Roscommon who attend Roscommon hospital. They will still have access to the vast majority of the types of treatments that they have always had, except in the outlined cases where small numbers will have an opportunity for better treatment due to the range of medical personnel in a bigger hospital. It is for that reason that extra transport facilities, extra trained paramedic staff and a rapid response vehicle are being made available. That applies from this weekend.

I understand that GPs have agreed to base their drop-in centre in the outpatient department of Roscommon hospital. That facility will be available to the people as it always was, and the GPs will continue their roster at weekends as they have done heretofore. The service in the urgent care centre in the hospital will be provided by the non-consultant hospital doctors for the people of Roscommon on a daily basis, as they would expect. In the interests of those who suffer from serious attacks, the facility and best opportunity for them will be provided elsewhere.

It is a case of anxiety and concern. I know many of the people involved. It is not an easy situation to say we must change this, but it is in the better interests of the patient and the services being provided. As the Minister for Health proceeds to change the structures, the problems associated with bigger hospitals, including Galway, will also be dealt with. His setting up of the special delivery unit will begin to deal with the backlog of waiting lists, with consequent problems for everyone when there are patients lying on trolleys and so on.

This is not an isolated issue. This is a leviathan structure that did not deliver what it was supposed to deliver and which has to change direction, its structure and the way it does its business. That is not an easy task for the Minister, but that is what the Government will do in the interests of patients and the quality of services provided.

How many more accident and emergency departments are being closed down?

I call on Deputy Ross.

Thank you. A few weeks ago, the Government launched its jobs initiative in a great fanfare of triumph and publicity. A few days ago, the US Chamber of Commerce announced that there were 2,000 jobs vacant in the multinational sector here, especially in the areas of science, mathematics and technology. It seems a strange reflection on Government policy that there are 440,000 unemployed people here crying out for jobs, yet there are 2,000 vacancies which cannot be filled. What are the job-creating quangos up to? Why were they not ready for this problem which has now arisen?

In particular, what has happened to FÁS, the €1 billion per annum bloated quango which is supposed to be in charge of training and employment in Ireland? Why is there so little information about FÁS? I made the mistake of looking for the FÁS annual report in the Library last night, but I could only get the annual report for 2009. I made inquiries about this issue this morning. In blatant breach of its statutory requirement, FÁS has not been able to produce its accounts on time by 30 June of this year. This quango has been surrounded by controversy and scandal for a long time. To find that it cannot produce its accounts begs the question as to what is going on in this training agency. Is it still in the same sort of chaos that it was before?

Thank you, Deputy.

I am just coming to the question. If this happened in public companies, they would be struck off after four months. Apparently, FÁS can act with impunity. It does not produce its accounts on time and there is no prospect of it doing so.

Would the Taoiseach consider calling in the board and the chief executive of the so-called reformed FÁS — it shows no signs of renewal — asking them why they cannot produce and will not produce accounts and annual reports according to their statutory obligations? This produces great unease. Will he ask them what plans they have, as the leading training agency, to fill the identified gap of 2,000 jobs in the multinational sector?

The Deputy has raised an issue that pertains to other countries as well as Ireland. There is a shortage of skills in many countries. With things moving so rapidly in the area of the Internet, robotics, nanotechnology, genetics and so on, the next decade will require a new range of skills sets and training for young people.

I met Mr. Schmidt of Google last week when he was here. He pointed out that the company is exceptionally happy with the facilities made available to it, and the opportunity that Ireland has presented for the company to do business. He pointed out the shortage of particular skills. The Minister for Education and Skills was with me when we met Mr. Schmidt. This requires an adjustment in the curriculum dealing with mathematics, engineering, physics and so on. That is not something which can happen overnight but it is something of which the Minister is fully cognisant.

The question of FÁS will be decided on by Government, if not next week, then the week after. It is being reformed. I take Deputy Ross's point about the opportunity for the chief executive and chief personnel to be called in and I expect they will appear before the appropriate Oireachtas committee, whether education and skills or social protection. Deputies, like Deputy Ross, will have the opportunity to have face-to-face discussions on the projections and proposals on the revamped and reformed structure which was FÁS and on which the Deputy had a particular and direct hit some years ago. Deputy Ross's point is perfectly valid.

From speaking to chief executives and senior officers in companies like Hewlett Packard, Intel, Dell and so on, I know they recognise the scale of evolution and change required in all these sectors. Flexibility in our education system is required to deal with that. The Minister for Education and Skills, Deputy Quinn, is very conscious of that. I hope that as a small country we can meet that flexibility and demand.

Looking at what has happened with mathematics over the years, it appears some companies look for some elements from the mathematics curriculum when looking for young people here while others with a different skills set are very happy with what they have got. However, it is an issue which needs to be addressed. I hope that when the new entity is formed, Deputy Ross will have the opportunity to speak directly to the chief executive at the Oireachtas committees.

I thank the Taoiseach for his reply. The question really is, why was the need for these particular skills sets not anticipated because we now have a serious situation?

The Deputy should ask the guys in front of him.

I would blame those guys too. The Minister should not worry. However, it is a question which only one person can answer. If it wanted to blame those guys, I am sure the Government would not be averse to doing so.

Is there any penalty or stricture or can anything be done when these quangos, these semi-State or State agencies, decide to ride roughshod over these rules and say they will not or cannot produce accounts on time? What can be done to enforce this rule? Often it is honoured more in the breach than in the actuality. FÁS did not produce its accounts until November last year. Now it does not give a hoot and it is again not producing them. One would have to ask the question whether it is up to its old tricks or whether it is just being negligent.

That is a valid question. I will ask the Minister for Education and Skills to provide the answer as to why FÁS has not been in a position to produce its end of year report by June. Deputy Ross is right that it should be in a position to do so. The Minister for Education and Skills will come back with the reasons. The Minister and the Minister of State, Deputy Cannon, met the chief executive officer and the board of FÁS on this issue.

Deputy Ross will be aware that 3,000 places in third level have been offered through the Springboard jobs initiative. The jobs initiative will provide 16,000 places for training. The point was made by the chairman of the board dealing with the jobs initiative and the new internship programme that invariably when businesses in these areas take on young qualified people, even on internships, they find that after a six month period, the young person decides to start a business of his or her own or he or she proves so efficient that the firm hires them full time.

As Deputy Ross knows, what is happening in the laboratories and research units throughout the world is, in many cases, bringing to light new innovations which have not or could not have been thought of because perhaps they were discovered by different sorts of research. When given the opportunity to be exposed to that range of challenge, our young people invariably measure up. I saw this recently at the highest level in some of the major software and multinational companies in the country. It is a case of attempting to be on the next wave which will come. It is happening in terms of robotics, nanotechnology, software, genetics and so on where these changes will be made. Deputy Ross's question is perfectly valid. Flexibility and adaptability are required to give our young people the opportunity to measure up to the challenge from wherever it comes.

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