Dáil Éireann debate -
Wednesday, 21 Sep 2011

Vol. 741 No. 1

Hospital Services

Deputy Michael McNamara

I thank the Ceann Comhairle for providing me with an opportunity to address the House on the issue of health care at Raheen Hospital, County Clare. I regret that the Health Service Executive remains a bureaucracy which is completely out of control and utterly unaccountable to democratically elected representatives at all levels. I greatly commend the Minister for Health for his moves earlier this year to have the entire board of the HSE resign and then appoint a new board. However, this signal clearly has not permeated down to the HSE representatives in the mid-west region, as borne out by recent developments in County Clare and particularly in Raheen hospital.

On Saturday, 10 September, staff at Raheen hospital were informed by e-mail that the number of respite beds would be reduced from 28 to 23. There was no discussion in advance and no inquiries about the impact this might have on care. Furthermore, they were informed that this would take effect from the following Monday morning. Patients who thought they would have a bed on Monday morning learned on Monday morning that this was not the case. This is completely unacceptable. As somebody who lives near Raheen hospital, I was aware there were difficulties there because the staff had outlined these to me. I made numerous inquiries to the HSE about what was happening but I got no information. This is not about me; it displays a contempt for the people who voted for me and for those who voted for Deputies Carey, Dooley and Breen in Clare, because they also made inquiries and similarly received no information, as did local councillors, yet the HSE persists in the circus of organising meetings and bringing in all the elected representatives to their lovely boardroom in Limerick where they ply us with generalities but give us no specific information.

The HSE was set up by the previous Government and it has ballooned into a bureaucracy. It now falls upon this Government to deal with it, and I urge the Minister to do so. Furthermore, the HSE was set up to provide health care led by professionals rather than by politicians. This is simply not the case. Professionals are not being listened to in the HSE. Instead, it is being run by bureaucrats who display nothing but contempt for this House, the people who sit in it and local government.

This is borne out by what has happened to psychiatric services in Clare. I am greatly encouraged by the comments of the Minister of State, Deputy Lynch, at the weekend that money would hopefully be ring-fenced for psychiatric services, because the 200 psychiatric nurses who were working in County Clare three years ago have now been reduced to less than 150. There are now rumours that psychiatric units in Tipperary, particularly in Clonmel hospital, are due to close and that all north Tipperary patients will be sent to Ennis. Initially, staff in Ennis were informed they would receive 14 new nursing posts to cope with the demand; now they are expected to receive only five. The psychiatric day care centre in my town was closed on 26 August. It had been manned five days a week up to May 2011 and two days a week since then. Some of the patients who attended that day care centre were not even informed that it was to close. That is simply unacceptable in 2011. Some of those psychiatric patients showed up on the Monday morning at the day care centre to find it closed. A little bit of communication with elected representatives, or with the population, would go a long way.

Minister of State at the Department of Health (Deputy Kathleen Lynch)

I agree with the Deputy on the issue of psychiatric services. To discontinue a service without informing the people who rely on it is not right and should not happen. I hope it will not happen under the new regime we are trying to establish. The days when psychiatric services were part and parcel of the overall Vote and budget for acute hospitals are coming to an end. I hope we will be able to disentangle the funding and establish a far more robust system of psychiatric services. I am aware there is major resistance to the closing of particular units — I am not talking about day centres — but we must move from the bedside to the fireside. People with mental health issues must be treated in the community in a humane and respectful fashion. They should not turn up at centres to find them closed. I agree with the Deputy in that regard.

The Deputy asked about Raheen hospital. The Government is committed to supporting people to live with dignity and independence in their own homes and communities for as long as possible. Where this not feasible, the health service supports access to high quality long-term residential care where this is appropriate. We continue to develop and improve health services in all regions of the country to meet this objective and to ensure quality and patient safety.

The HSE has sole operational responsibility for the delivery of health and social services, including those at facilities such as Raheen Community Nursing Unit in County Clare. The community nursing unit is located in a rural area in south-east Clare. The unit has a total capacity of 28 beds. It can accommodate 14 long-term residents, with 12 places allocated as short-term care or assessment beds and two places dedicated to palliative care.

The HSE in the mid-west had spent €20 million more than its allocated budget at the end of June 2011. One of the measures implemented to deal with this issue is a reduction in the use of agency staff and overtime across all health and hospital facilities and services in the mid-west. This has had an impact on the number of residents that can be safely accommodated. Consequently, the HSE has reduced the number of beds in Limerick, County Clare and north Tipperary by 65. The reductions, mainly in short-stay beds, are as follows: 15 beds at St. Camillus Hospital, Limerick; 17 beds at St. Ita's Hospital, Newcastlewest; 22 beds at the Community Hospital of the Assumption, Thurles; six beds at Dean Maxwell Home, Roscrea; and five beds at Raheen CNU. It must be noted that 23 of these beds are currently vacant. A reduction of nine beds had originally been envisaged in County Clare; however, through a successful redeployment of nursing staff, this figure was reduced to five beds at Raheen. The reduction will be managed with minimum disruption to residents. I accept the Deputy's point about the planning that goes into respite and long-stay beds. Clearly, this is a cause of major disruption.

The Deputies will appreciate that all developments must be addressed in the light of current economic and budgetary pressures. Any decisions taken by the HSE must have regard to this and to the current moratorium on the recruitment of nursing and non-nursing staff.

Additional information not given on the floor of the House.

The HSE has been asked to make a rigorous examination of how existing funding might be reallocated to ensure maximum service provision. In particular, we need to ensure that the highest standard of care will continue to be provided to all residents in a safe and secure environment. The employment control framework gives effect to Government priorities on employment policy in the public sector and provides that there will be a net reduction in employment of approximately 1,500 annually to 2014. The framework is designed to maintain tight control on the cost of providing public services while at the same time allowing the service flexibility to manage staffing resources so as to protect front-line services as far as possible. The framework also provides for adaptation to changing service needs. It allows for some growth in certain grades and posts which are exempt from the moratorium on recruitment in order to deliver on key priority services. These exemptions include certain therapy grades, medical consultants and a limited number of nursing posts. The Croke Park agreement also allows the HSE to redeploy staff based on service need. In July 2011, the HSE introduced a recruitment pause to assist it in addressing its serious budgetary overrun. Notwithstanding this pause, exceptions are still being made where this is deemed necessary to address critical service risks.

The Department of Health is currently reviewing the provision of public residential care in the light of the need to meet national standards and regulations, local demographic pressures and the differential between public and private provision. The review will serve as a platform for discussion and will inform the development of an overall strategy on how the HSE should continue to provide this service in future in view of current budgetary and other pressures. The review must be also seen in the light of the wider health reform programme to which the Government is committed and the position of social care services in a future health service. I should make it clear, however, that, the HSE must maintain appropriate staffing levels to meet the needs of residents. Providing high quality and safe care will have to remain at the heart of any considerations.

Deputy Michael McNamara

I am somewhat encouraged to hear that it had been envisaged that the number of beds in County Clare would be reduced by nine and that this was changed to five. However, I am reliably informed by the professional nursing staff at Raheen hospital that they are now a couple of nurses short of the number required to deal safely with the 23 beds that remain, yet other health facilities in County Clare remain over-staffed, and the HSE, in its infinite bureaucracy, does not seem to be able to move nurses from one hospital to another. The problem of a lack of information is not confined to Raheen. The Friends of Ennistymon Hospital group has €500,000 ready to invest in the hospital, but Senator Conway, a former Fine Gael councillor, has been unable to obtain information from the HSE about its long-term plans for the hospital. We have exactly what we want on a political level — public private partnership — but people who are willing to put their money where their mouths are and invest in local care are being stymied by a secretive bureaucracy. The only information I received about Raheen hospital was a message on my voicemail to say that a press release would be going out that night but the contents could not be shared with me. I cannot think of a greater example of contempt — not for me, but for the people who vote for me or bother to vote at all.

I call upon the Minister of State to address this issue. I for one have lost confidence in the ability of the HSE to manage our hospitals. I note the programme for Government provides that the ownership and management of hospitals will be transferred to boards whose members are selected from among local people with an interest in and genuine commitment to the area. It seems the bureaucrats of the HSE do not have a commitment to anything other than pushing pens. If I sound frustrated, it is because I am. This is not something I suffer from alone; it is shared by all Deputies from County Clare and, I suspect, the great majority of Deputies in the House. I urge the Minister of State, therefore, to move ahead as speedily as possible with the transfer of the running of hospitals from the HSE to boards, as provided for in the programme for Government.

Deputy Kathleen Lynch

The frustration is very obvious. The movement of the organisation to a board type structure and the running of different community-based units and smaller hospitals may ensure budgets are adhered to and priorities are dealt with at that level. However, shortage of staff in one area and an excess in others will not be dealt with by boards. That is clearly a matter which must be managed centrally. That is what the Croke Park agreement is about. We see this not only in County Clare but in many areas of the country. We see a disproportionate number of staff in certain allocated areas and must get down to dealing with that task.

In the psychiatric area we will lose even more staff nurses from the system but one hopes that in the future a different skill set will give us the type of service we want. I thank the Deputy.

Army Barracks

Deputy Robert Troy

I thank the Ceann Comhairle for selecting this item for topical debate today. It is the most topical and talked about issue in my constituency since senior Army personnel visited Columb Barracks on Monday and dropped a bombshell with the news that our barracks is to close in early December. I was surprised that my constituency colleague, Deputy James Bannon, yesterday withdrew his parliamentary questions to the Minister for Defence, Deputy Alan Shatter. Might this indicate the barracks is indeed to close in December? Was the Deputy embarrassed by the reply of the Minister?

This is not my first time to raise the issue. I raised it directly with the Minister on 24 May, at which stage I was accused of scaremongering by members of the Government parties. At the time I invited the Minister to visit the Army barracks to see the facilities at first hand and the good work Army personnel are carrying out. That invitation stands, to the Minister of State, Deputy Paul Kehoe, and to the Minister, Deputy Alan Shatter. The previous three Ministers for Defence, the former Deputy, Tony Killeen, and Deputies Willie O'Dea and Brendan Smith, visited the barracks and gave commitments regarding its future.

The people of Mullingar are anxious and worried and want the Government to be upfront and honest with them. Last night Rebecca O'Callaghan started a Facebook campaign to keep Columb Barracks open. Within one hour more than 1,000 people had signed it and today in excess of 2,000 had joined. If the Minister of State looks at the page he will see clearly the level of feelings expressed.

The Army barracks can trace its history back almost 200 years when it was purchased by the British War Department. Today it is the home of the fourth field artillery regiment and also acts as a headquarters of the Reserve Defence Force and the 54th regiment. The driving range is used by members of An Garda Síochána. Columb Barracks is the last remaining artillery barracks in Ireland and, given its location in the geographical centre of the country, is of strategic importance. It acts as a staging post for all our overseas and UN-based operations. More than 200 serving personnel are based in the barracks along with more than 20 highly skilled civilian staff. Currently a large number of personnel from the barracks are representing their country in Lebanon. It is bad to think that when these men and women are doing their work abroad, this Government is threatening to close their home.

These men and women continue to display the fine tradition of overseas peacekeeping work. We are very proud of our Army personnel, from both Columb Barracks, Mullingar and Custume Barracks, Athlone. There are also two active groups in Mullingar which represent retired soldiers and are doing great community work. Many serving members of the Defence Forces are heavily involved within the community. Only recently they organised a sponsored climb of Croagh Patrick for Living Links, in which I took part.

The income generated from pay, pensions and ancillary purchases is worth in the region of €8 million to the local economy. To close this barracks, with the withdrawal of this level of revenue from the local economy, would be devastating to many families and to small businesses and their staff who are fighting a hard battle to stay afloat with no support from this Government. This is not an issue for the EU-IMF as there is no financial gain to be made in closing this barracks, a point well articulated by my constituency colleague and Cabinet member, the Minister of State, Deputy Willie Penrose, in The Irish Times today and in local media, the Westmeath Topic and Midlands Radio 3. Army personnel will be paid relocation fees and there will be capital costs to extend further barracks to accommodate additional personnel. We will be unable to sell the barracks so any possible gain would be outweighed.

I know that the Minister of State, Deputy Penrose, will raise this issue at Cabinet as he has always been supportive of the barracks. I hope the Minister of State, Deputy Kehoe, will listen to him and to what the people of Mullingar have to say. I finish with the words of Deputy Penrose, spoken before he became a Minister of State. In May 2009 he stated "We will not allow the barracks to close in any term, whether short, medium or long."

Minister of State at the Department of Defence (Deputy Paul Kehoe)

I can confirm to Deputy Troy that as of now no decision has been made by the Government in regard to the future of Columb Barracks, Mullingar, or any other military installation in the country. However various commissions, reports and studies dating back to the 1990s identified barrack closures as a fundamental requirement towards improving military effectiveness and efficiency. Since then there have been a number of consolidation programmes which have seen the number of barracks occupied by the Permanent Defence Force reduced from 34 to 23.

Notwithstanding the progress made to date, the dispersal of Defence Forces personnel over an extended number of locations continues to be a major impediment to essential collective training and to releasing personnel for operational duties. As is the case with all Departments, the Department of Defence has been actively reviewing all areas of expenditure for which it is responsible to ensure the maximum benefit in the public interest from the use of its resources. This is a key element in the context of the comprehensive review of expenditure in which the Government is engaged. My Department has submitted its report as part of that process. This report sets out in clear terms the options available to Government with regard to defence funding. The outcome of the comprehensive review of expenditure will determine the future resource envelope available for defence.

I wish to ensure that all decisions made and resources utilised are focused on maximising the capabilities of the Defence Forces and ensuring their continued operational excellence. I am also anxious to ensure, in so far as is possible, that the Government is not compelled by fiscal and budgetary constraints to effect any substantial reduction in the current number of personnel in the Defence Forces. In the circumstances, I cannot give any specific commitment that there will not be further programmes of barracks consolidation.

Deputy Robert Troy

It is absolute waffle to state that, as of now, the Government cannot give any commitment. Where is the openness, honesty and transparency the Government promised the people? The people of Mullingar have been out of their minds with worry for the past two nights. Senior Army personnel visited this barracks on Monday and told people it would be closing in December. Who is fooling whom? We want and need answers.

The Minister of State noted that his Department has submitted its report as part of the process. Is Columb Barracks, Mullingar, included in the report? The Minister of State must be honest with the people and let them know where they stand. He should not hide behind the phrase "as of now". We do not want that. We want to know exactly what is happening. People's livelihoods are at stake here. People who are settled and living in Mullingar do not know where to send their children but must think about relocating and what the future holds for them. Let us be honest. The Minister of State must come up front and tell the truth.

Deputy Paul Kehoe

I thank Deputy Troy. As I outlined in my reply, I sit at the Cabinet table. I can confirm that the Cabinet has not made a decision——

Deputy Robert Troy

As of now.

Deputy Paul Kehoe

——on this or any other issue relating to the Defence Forces. It is great that members of senior management have visited Columb Barracks in Mullingar. It is their job to do so. I do not doubt that senior personnel within the Defence Forces visit the barracks on a regular basis because they have a responsibility to do so in other to observe what is happening there. They do not inform those at the barracks on a regular basis that it is going to be closed. Those responsible for making decisions in respect of matters such as this are the Minister for Defence and the Government. The Deputy's efforts to pre-empt a decision which has been neither discussed nor made by the Cabinet amount to scaremongering.

Deputy Robert Troy

I did not pre-empt anything. I asked the Minister of State to come clean and be honest.

Deputy Paul Kehoe

As is the case with all other Departments, a review of expenditure is taking place in the Department of Defence. This matter has not come before the Cabinet. When a decision is made in respect of this or any other issue relating to the Defence Forces, I have no doubt the Deputy will be made aware of it and that information on why certain choices were made will be provided. I assure him that, as matters stand, a decision has not been made in respect of the closure of any barracks in the country.

Deputy Robert Troy

When will it be made?

Deputy Paul Kehoe

The Deputy will be given plenty of notice prior to a decision being made.

Deputy Robert Troy

The people of Mullingar want to know now.

Deputy Paul Kehoe

Attempts should not be made to pre-empt Cabinet decisions. If the Deputy speaks to senior members of his party who served in government, I am sure they will provide him with information on what happens at Cabinet and on how decisions are made.