Priority Questions

HSE National Service Plan

Billy Kelleher

Question:

1. Deputy Billy Kelleher asked the Minister for Health when the Health Service Executive service plan 2014 is to be published; the reason it remained unpublished eight weeks after budget 2014; if there are any substantial changes with regard to the composition of the €666 million savings target set out in budget 2014; and if he will make a statement on the matter. [54386/13]

Caoimhghín Ó Caoláin

Question:

2. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the position regarding the 2014 Health Service Executive service plan. [54128/13]

I seek clarification regarding a notification we received indicating that Questions Nos. 1 and 2 had been grouped.

Priority questions may not be grouped with ordinary questions but may be grouped together.

We did not ask that Questions Nos. 1 and 2 be grouped. We received a notification to that effect.

I have not received any such notification. I am sure the Minister will announce the position when he speaks.

My question was tabled on the assumption that the Health Service Executive service plan would be published this week. I am disappointed that we will not have an opportunity to discuss the plan before the end of the year. The inordinate delay in publishing the plan following the publication of the budget in October is unsatisfactory. Even if one tries to stretch credibility to the nth degree, the difficulty one has with the current HSE service plan is that it is again based on a series of assumptions and premises. When savings were identified in the original back-of-an-envelope estimate for the service plan announced by the Minister in October in the Estimates, it was evident that the Minister was again placing the health service on an unsustainable path in 2014. Officials in the Health Service Executive and the Department of Health have fought a rearguard action in the meantime and the Minister has pretended several times that he stood up to the Minister for Finance with great bravery. How can he expect to deliver health care without cutbacks to services?

To respond to Deputy Ó Caoláin, I will raise the matter at the Committee on Procedure and Privileges this evening. According to Standing Orders, if questions are grouped, only the Deputy who tabled the first question in the group may introduce the subject.

In that case, the questions should be ungrouped. I am as entitled as Deputy Kelleher is to put my question.

I will deal with the issue this evening at a meeting of the Committee on Procedure and Privileges.

What about the questions before us?

I am not allowed to invite the Deputy to introduce his question.

I have sympathy for Deputy Ó Caoláin. His question is as much a priority for him as Deputy Kelleher's question is for him.

If the Minister does not wish to group Questions Nos. 1 and 2, he may answer them separately.

I am more than happy to answer them seriatim.

To respond to Deputy Kelleher's comment on stretching credibility, I thought that was his party's forte. As for his comment about being on an unsustainable path, we have not only sustained the health service in the past 12 months but improved it, as demonstrated by the improvements in inpatient waiting times and the number of people who must endure long waits on trolleys. These figures are still too high and more needs to be done in that regard. I pay tribute again to the men and women who work in our health service on the extraordinary job they have done in the face of reductions of 20% in the budget and 10% in staff.

To respond directly to the question, the Health Service Executive-----

The Minister has 58 seconds left to reply.

-----service plan will be laid before the Oireachtas at 10.15 a.m. In previous years, it was often presented at this time of year or later. The budget was announced earlier this year and while we face a challenging year in 2014 in terms of the finance available to us, we had very good news this morning when the ESRI issued its growth projections for the domestic economy. The country is looking forward with a real sense of hope, having emerged from the bailout. The health service can play its role in that regard.

I reject the assertion that we did not sustain a safe health service last year. Not only did we sustain the service but we made it better in terms of the impact it had on people and the long wait that many had to endure in the past. I again remind Deputy Kelleher that as recently as January 2011 there were 569 people on trolleys. The current figure is below 300 and we have achieved a 34% reduction in the number of people who endure long waits on trolleys.

There has been anything but a sustained improvement in the health service. For example, the number of people waiting for procedures has increased incrementally. The Minister referred to a 34% decrease in the number of people waiting on trolleys, and I accept that is the case, but he overlooks the fact that more than 380,000 are unable to see a consultant in a timely fashion. He informed me at the start of the year that he was not too concerned about this figure, as 380,000 people could be-----

I did not say that. The Deputy should correct the record.

-----dealt with quickly given that more than 200,000 people are seen by consultants every month.

The Deputy should ask a supplementary question.

The problem is that there has been an alarming increase in the number of people waiting for consultants as those seeking to see consultants face inordinate delays. The Minister speaks of sustainable health services. He should acknowledge that inherent problems remain in the health services.

The real problem is that the Deputy does not recognise the truth and engages in fantasy. I never said any of the words he uttered.

The Minister said the figure was not a big deal.

The Deputy should allow me to finish. We discovered that 380,000 people were on the waiting list. This is an issue that the Fianna Fáil Party in government ignored because it did not want to count the number waiting or tell people the truth. We were up-front in stating how many people were waiting.

I stated it was an awesome figure but that it had to be put in context because 200,000 outpatients were seen every month. We will deal with this matter in the same way as we dealt with that relating to inpatient waiting times, namely, by catering for those who have been waiting longest first. There are no longer 386,000 on the list. Since we first discovered this issue in March and counted and validated the numbers involved, there has been a huge reduction. We will be dealing with that issue in the context of a later question. I intend to deal with the service plan now.

The year ahead will be challenging. I am pleased that we were able to obtain some extra money during the course of the consideration of the validation process relating to some of the figures involved. This will reduce the need to examine the medical card issue. Frankly, I did not believe that was possible. I reassure Deputies that a figure of €23 million, not €133 million, will be sought on the probity side. This will allow people who are possession of medical cards to rest assured that those who are entitled to them will remain so entitled, that there will be no change to the eligibility criteria during the coming year and that the normal probity measures will be used when validating medical cards-----

The Minister must conclude. I will allow him to come back in.

-----to ensure people have not left the country or moved on and that doctors are not being paid for services they are not delivering. I wish to make an important point.

No, the Minister cannot do so. We are over time. I will allow him to come back in.

I accept that, but this is a critical point.

I know it is, but the Minister can contribute again. There is a limit of one minute on these contributions.

As is the case each year, we are starting off by denying the reality. The Estimates relating to the two most recent budgets presented to this House were wholly unsustainable from the day they were published. I knew that, as did the Minister and everyone else. Obviously, however, those who operate the system were wandering around in a world of fantasy and pretence.

Perhaps the Deputy might ask a supplementary question.

In the aftermath of drilling down, the Minister has accepted that €130 million in savings could not have been achieved on the probity side in the absence of the wholesale withdrawal of medical cards from swathes of vulnerable people. Now he is clapping himself on the back for reducing that figure. Either way, he must accept that from the beginning of 2014 he will be implementing cuts which will have a detrimental impact on front-line services and that a Supplementary Estimate will have to be introduced as some point. He is aware of that fact, even before 2014 begins.

Clocks were installed in the Chamber to allow Members to see how much time they had for their contributions.

We had this discussion at a meeting of the select committee. The Deputy would like the world to believe that during his party's time in government no Supplementary Estimates were introduced in the area of health. Fianna Fáil-led Governments more than quadrupled the health budget between 1997 and 2009, but in 2010 the then Minister for Health and Children brought forward a whopping Supplementary Estimate of €595 million. The Deputy refers to Members on this side of the House engaging in fantasies. However, he has no sense of reality at all. What he is good at is the old Charlie Haughey trick, that "If I say it often enough, it becomes so." That is not reality.

It is reminiscent of Pol Pot. History begins now.

Exactly. The reality is that we are facing a very challenging year. The economy is recovering, but we must continue to consider ways in which we can operate more efficiently. I again congratulate the people who work in the health service on the great job they are doing and acknowledge that waiting times have been reduced. Hundreds of thousands of people had been awaiting inpatient treatment for longer than one year when I entered office. By the end of the year, it is hoped no one will be obliged to wait longer than eight months for such treatment. We will deal with this matter again later.

Will the Minister accept that it is absolutely objectionable-----

Will the Deputy introduce question No. 2? It is a separate question.

I am dealing with question No. 2. Will the Minister accept that it is most unacceptable that Opposition spokespersons are dependent on purposeful leaks through the media in order to obtain some sense of the detail contained in the national service plan? I presume that detail will be formally announced later this morning. We do not have access to the relevant information. Such information should have been shared immediately on sign-off, particularly in view of the fact that it was leaked to the media yesterday in order that it might appear on the front pages of the newspapers this morning. We most certainly should have been made aware of the detail of what was contained in the plan. Does the Minister accept that to be the case and that the detail of the HSE's national service plan should have been announced in this Chamber?

The Minister has confirmed that €133 million, not €113 million-----

The Deputy can come back in when the Minister has replied.

-----and, therefore, that-----

The 30 seconds allocated is for Deputies to introduce their questions rather than to make speeches.

The HSE's national service plan will be placed before the Oireachtas, as required, at 10.15 a.m.

After it was leaked to the newspapers and "Morning Ireland".

The plan took quite some time to prepare on foot of the challenges we faced. However, we have managed to address many of the main issues of concern. This does not mean that we are going to have an easy year. In fact, it is going to be a very difficult year, but we will continue to work hard to implement the plan. I reiterate that I do not wish services to be cut; rather, I wish to see the cost of services being reduced. That is what the Government is about.

In the context of question No. 2, the service plan is comprehensive. I am prepared to offer those in opposition a briefing on it by the HSE. Obviously, the HSE will be briefing its own staff on it today.

As regards the plan, we have done as good a job as possible in protecting existing services and developing new ones. I look forward to implementing the plan which is heavy on reform during the course of the coming year. We are using the good offices of the HSE to bring forward many of the reforms on an administrative basis in order that the legislative process will have an opportunity to catch up. In addition, we will be in a position to learn from the administrative side about some of the fine tuning which may be necessary in the context of the legislation we will ultimately introduce.

The director general of the HSE, Mr. Tony O'Brien, has calculated that 225,000 medical cards equates to €44 million in cuts under the so-called probity heading. If one extrapolates from this on the basis that the Minister had adhered to the €133 million cut, some 675,000 medical cards would be taken back in 2014. The reality is that on the basis of the director general's calculation and the figure of €23 million, there will be a reduction of between 112,000 and 115,000 medical cards next year. What I am saying is based on figures contained in the director general's letter to the Minister. How can the Minister state what is being done is a success? The people involved are already suffering. I am aware of this as a result of individual cases on which I have made representations. The Minister cannot take any comfort from the fact that there is going to be untold suffering, of which evidence is already emerging, in this area. Regardless of what the eventual figure might be, what are the prospects for the people involved in 2014? What can he say that will offer them any comfort as they face the loss of their medical cards in the coming year?

I do not know whether there is something wrong with the air filtration system in the House. Again, a Deputy opposite is stating I referred to something as being a success. I never used that word; rather, I stated it was going to be a very challenging and difficult year. I never described anything as a success.

The word was on the tip of the Minister's tongue.

If, in the context of the substantive question posed by Deputy Caoimghín Ó Caoláin, one averages out the cost of a medical card at €1,000 and if one is purely going to remove medical cards on that basis, it might not be unreasonable to assume that 113,000, 115,000 or 133,000 medical cards might be taken back. Of course, there will be many other factors involved when the implementation process takes place. As I have stated elsewhere, I know what probity means and I am aware that it does not involve changes to policy or eligibility.

Probity means ensuring that those who are entitled to medical cards have them and that those who are not entitled or are no longer entitled to them do not have them. It also means ensuring that the fees claimed by doctors, pharmacists and dentists are appropriate, right and proper.

I expressed concern at the outset about the possibility of achieving that level of saving with just a probity measure, and I made it very clear that there would not be a policy change. I can stand here and, with absolute certainty, reassure people who have medical cards, which is nearly 2 million people, that they have nothing to worry about.

The Minister is over time.

The normal probity measures will continue in terms of regular checks. If we did not do that, we would be held to account for it in the Committee of Public Accounts.

Does the Minister not accept that it is unacceptable that the opposition spokespersons on health will not have the opportunity to address the detail of the national service plan until after its introduction and implementation from 1 January next? The plan is for the calendar year of 2014.

With regard to provision for the roll-out of the bilateral cochlear implant programme, speculation in the media this morning cites a figure of just over €3 million. Is that not on the low side, given the possible cost of introducing the bilateral programme? How many young people will be seen in the course of 2014, given that the window for young people who are challenged by hearing loss is limited as time passes? There is provision of approximately €500,000 in respect of narcolepsy and the victims of Pandemrix. What services will that provide?

To conclude, it is really unacceptable that the Minister is circulating this plan at 10.15 this morning. We should have had the plan at 10.15 p.m. last night, at the latest, to prepare for detailed questions to the Minister.

Thank you, Deputy.

As for the Minister's claim of success, he should read the newspapers. He does not have to say it when his spin doctors are suggesting that this was a victory for the Minister over the Labour Party-----

This is Question Time, Deputy.

-----with that party claiming, in turn, that it was a victory over the Minister. The Minister should look to his colleagues beside him who are quoted in the newspapers this morning.

From now on I will strictly adhere to the rules. It is unfair to other Deputies if somebody takes up all the time. We have spent 22 minutes on two questions, and we are supposed to spend six minutes on each question. The Minister has two minutes to answer and there is one minute for a supplementary question by a Member after the reply. That is the rule. Otherwise, it is unfair to other Deputies whose questions are not reached. The Minister has one minute to respond.

With regard to the last point raised by the Deputy, who manages to work himself up into a great state of indignation, both parties are very concerned about any distress being caused to medical card holders regarding uncertainty about their cards, and both parties were eager to address this. I sought the validation process, as the line Minister, because I am closest to it and understood that there would be real difficulty in achieving the type of saving that was apportioned. Following a validation and examination by the Department of the Taoiseach and the Department of Public Expenditure and Reform, with my colleague, Deputy Howlin, we concluded that this would not achieve the types of saving mentioned, so we have approached it from a different point of view. There is no question of victory of one over the other. This Government is here to serve the people. It is not about trying to score points.

We will move to Question No. 3 from Deputy Maureen O'Sullivan.

What about the bilateral cochlear implant programme? Is the Minister in a position to answer that?

No, he is not. Deputy Maureen O'Sullivan has been called.

Substance Misuse

Maureen O'Sullivan

Question:

3. Deputy Maureen O'Sullivan asked the Minister for Health the rationale behind having those in addiction put into mental health services as opposed to general health services; the resources that are being considered for persons who will be impacted by the possible reduction of tablets when related new legislation is implemented, as there are concerns among front-line workers of increased risks to those currently misusing tablets; and if he will make a statement on the matter. [54126/13]

This question is about addiction and substance misuse and abuse and the general health issues in that area, as opposed to the mental health issues. In particular, I refer to the forthcoming legislation on the tablet issue, which is very welcome, and the planning implications for those who are currently abusing tablets.

I take it the Deputy is referring to persons who have drug addiction problems. Persons who have such difficulties, whether due to misuse of prescribed medicines or the use of illicit drugs, can access treatment through their GP or their local drug addiction service. In accordance with "A Vision for Change", the national mental health policy, the mental health services are responsible for providing services to persons who have both substance abuse and mental health problems. Mental health services are available on referral from a GP or through emergency departments.

Medicines which have a high potential for misuse are controlled under the Misuse of Drugs Acts. A person who has a controlled drug in his possession for the purpose of sale or supply is guilty of an offence. My Department is finalising major amendments to the misuse of drugs regulations. The proposals include stricter prescribing and dispensing controls on certain prescription drugs which are being traded illicitly, including benzodiazepines and Z-drugs, as well as creating the offence of unauthorised possession of such drugs. Due to the complexity of the draft regulations, it has been necessary to have two rounds of consultations with stakeholders and interested parties. Arising from the latest consultation process, the draft regulations are being reviewed. When this review is completed, the Government's approval will be sought to notify the draft regulations to the European Commission and member states under the technical standards directive.

It is intended that the draft regulations will be so notified before the end of the first quarter of 2014. The EU notification period may take up to three months to complete. Following its completion, the Government's approval will be sought to the relevant statutory instruments. The Deputy referred to the need for additional treatment services for persons who may be affected by the proposed regulations. I understand her point and it is something I will attend to and keep under review.

There is no doubt there have been changes in the drugs scene. For many years drug abuse equalled heroin abuse, before it moved on to cocaine abuse. Then there were the head-shop products, and recently we have seen an influx of snow blow and high-strength cannabis. Beneath all of that there is increasing use of tablets, both licit and illicit. The national drug-related deaths index showed that the generic group of benzodiazepine drugs are those most commonly found in polysubstance poisoning deaths. In the course of the consultations, front-line workers expressed their concern that when the legislation is introduced, welcome as it is, there will be a need to consider treatment services for those who are caught up in that tablet scene. That is the point of my question. There is quite a long lead-in to the legislation, and the European Commission also must express its view on it. It would be useful to commence planning for the services that will be provided for that group.

The additional time that has been afforded to me in the consultation process will certainly be used to address some of the issues the Deputy raised. She is correct that some of the people involved, including project workers, have expressed certain concerns to me. While they support the changes and the new regulations I intend to introduce, there are ancillary issues which they wish to have addressed. I understand their point and I will continue to meet and engage with them.

In addition, the Deputy will be aware that next January we will set up a new consultative process across the system for bolstering the national drugs strategy. Previously, we had certain processes that worked well. They had to be reviewed, and we have done that. A new national co-ordinating committee will be set up in January and on 16 January I will host a conference to which all of the interested parties will be invited, including project workers, national drugs task forces and people involved nationally and locally. That will be an important focus for us. The issue the Deputy raises, which she has raised previously in the House, will certainly be addressed at that meeting, as well as the issue of alcohol in the context of that forum.

When people have alcohol problems it is seen as a general health problem. There are people with mental health issues who take up substance misuse, which exacerbates the mental health problem. There are also people who take up substance misuse and that develops into mental health problems for some, while for others it does not. I have been involved in a particular area, which includes those who are active in addiction who have suicidal ideation. It is the Oasis Deora Counselling Centre, and I am on the board. It is the only centre that will counsel those who are active in addiction and have a mental health issue or suicidal ideation. It is very difficult and extremely challenging counselling, but I have no doubt that it has prevented some people from going further with suicidal ideation. The funding for that organisation is minuscule compared with the funding for other organisations involved in suicide prevention. That centre is the only one that will counsel people who are active in addiction and will provide crisis counselling at the point at which people need it.

I value the Deputy's insights in that regard and I take her point about funding. We are doing everything we can to ensure there is adequate funding across the board, both through the HSE addiction services and also in the form of the funds for which I, as Minister of State, have responsibility.

I agree with the Deputy's point regarding the interaction between mental health services and drug treatment services. We will have an opportunity to address those issues early in the new year.

Mental Health Services Provision

Billy Kelleher

Question:

4. Deputy Billy Kelleher asked the Minister for Health the way in which community mental health services will be developed in 2014; the new funding being provided for same; the number of new posts this will support; and if he will make a statement on the matter. [54387/13]

The Minister of State, Deputy Kathleen Lynch, spoke about mental health services recently in the Seanad. There is no doubt that this area has been the Cinderella of the health system for many years. There is a commitment to A Vision for Change, but what is needed now is the financial commitment to implement it. While the Minister of State has made valiant efforts, she is not receiving a great deal of support from some of her colleagues in this area. We must have clarity as to how many people will be recruited in 2014 and 2015 to make up the shortfall left by previous years of underfunding.

I have never found there to be a lack of support for my endeavours from any of my colleagues, including Opposition Members.

The Minister of State threatened to resign at one point.

The current economic environment presents a significant challenge for the health system generally in delivering services. However, mental health is being treated as a priority in so far as possible and I am pleased that a further substantial ring-fenced allocation will be provided next year. The announcement in budget 2014 of €20 million for mental health is in line with a commitment in the programme for Government to accelerate the pace of change to develop a modern, patient-centred and recovery-orientated mental health service. Despite serious resource pressures overall, funding of €90 million has been made available since 2012 up to the end 2014 that is specifically earmarked for mental health and suicide prevention.

This funding will enable the Health Service Executive to continue to develop and modernise mental health services in line with the recommendations in A Vision for Change and allow for the recruitment of between 250 and 280 additional staff to enhance adult community mental health teams, child and adolescent mental health teams, and specialist mental health teams, including in the area of elder psychiatry. The recruitment process for these new posts will commence in the first quarter of 2014, with all posts targeted to be in place by the fourth quarter

The HSE's national service plan for 2014, which has been submitted to the Minister for Health, outlines the types and volume of health and personal services to be provided in 2014 within the overall level of funding provided. I expect the plan to be published today.

The problem here is the language being used and the way in which the figures are being massaged. There has been underfunding in the past two years; that is a fact. The Minister, Deputy James Reilly, stole the allocation for mental health, taking it into the big black hole of his Estimates.

The Deputy is spouting fantasies.

Commitments were given that there would be an accelerated recruitment process and the necessary staff would be in place, that is, whole-time equivalents dealing with people in vulnerable positions. That has not happened. The Minister of State is playing catch-up from a position of absolute underfunding in recent years.

That is precisely right.

I wonder why we are in that position.

It was the Minister who robbed €35 million from the mental health budget.

I remind Deputy Kelleher that this is Question Time. Does he have a question?

It was the Minister who took that money. We have had enough of hearing the same old nonsense on this issue.

The Deputy must put his question.

Will the Minister agree that he is engaged in absolute nonsense? The fact is that the mental health budget was used for reasons other than those identified. The moneys were supposed to be ring-fenced for a recruitment process for mental health services, but that did not happen.

It should have been done years ago.

The Minister of State to respond, although I am not sure what is the question.

It would appear that undue influence is being brought to bear on Deputy Kelleher on this issue, and it is very recent.

It might be also long lasting.

The 890 posts that were provided to develop our mental health services in 2012 and 2013 are indisputable facts. Those people are in their posts. The Deputy will know that I take a very clear view of the world. These people's salaries have to be paid, and they are salaries commensurate with the professionalism of those staff and the very specific jobs they are doing. How does the Deputy suppose their salaries are being paid?

There are particular areas where we have a difficulty in recruiting people. As I said, we will recruit an additional 250 to 280 staff in 2014. In my first year in office we recruited 414 staff, of whom 96% are in post. There is a difficulty in filling the remainder simply because qualified persons are not available, but we continue the process. The Deputy's problem is that he is reluctant to allow the facts to get in the way of the story.

It is important to look at what the Minister of State inherited in terms of the number of people working in mental health services and where we are at in this regard at the end of 2013. By any credible stretch of the imagination, the bottom line is that there are far fewer people working in the area of mental health than there were before. That is a fact. Taking credit for recruiting people is untenable when the large numbers who have left mean there are actually now fewer people dealing with the area of mental health. That has come about because there was no aggressive recruitment process in 2011 and 2012. The Minister of State is now attempting to make up for the shortfall.

The Deputy is wrong and so is his adviser.

That is what is happening.

Does the Deputy have a question?

My question is whether the Minister of the State will again threaten to resign in light of the failure to secure the full complement of staff necessary to implement the commitments given in the programme for Government and A Vision for Change.

I will deal with the last fantasy first. I never threatened to resign and I never would; that is not what I do. I have a job to do and I intend to do it, despite the fact there is so much opposition to the implementation of A Vision for Change. I have found in the past two years that everybody is in favour of that plan until it is happening in their area, when suddenly it is the wrong way to go and the wrong thing to do.

We are putting in place a modern system. It will not be the same system as we had before because we need a different skill mix. Nurses will be needed, but we also need physiotherapists, occupational therapists, speech therapists and a range of other people with the types of skill mixes we did not have in the past. I if I were Deputy Kelleher I would hang my head in shame. A Vision for Change was published in 2006, but the first serious move to implement it was in 2011.

Deputies

Hear, hear.

Health Services Staff Remuneration

Caoimhghín Ó Caoláin

Question:

5. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he will establish a timeframed independent inquiry into the practice of top-up payments to senior executives at section 38 entities; the steps he has taken to impress on all such bodies that these payments must cease with immediate effect; if recoupment is being pursued; and if he will make a statement on the matter. [54127/13]

The recent focus on salary top-ups was not just about the irregular practices at the Central Remedial Clinic. The Health Service Executive and the Department themselves have, in some cases, approved top-ups of a very substantial nature. Does the Minister agree that a timeframed independent inquiry into such practices at all section 38 entities is now required?

I have initiated this process arising from the Health Information and Quality Authority report into practices at Tallaght hospital. I requested that the Health Service Executive conduct an internal audit of all section 38 funding recipients. As a result of this audit, as has been reported extensively, a considerable number of funding recipients have been found to be in breach of Government pay policy with regard to the remuneration of senior staff. I have requested urgent action to ensure every agency is fully compliant with Government pay policy.

The HSE has a team of senior managers following up with individual agencies. The director general of the HSE met with the chairpersons and chief executive officers of all section 38 organisations last Thursday. That meeting focused on the requirement of the board of each agency to strengthen governance standards. Also agreed was a new requirement to furnish the HSE with a compliance statement from the current financial year and for each year thereafter. This statement will have to be approved by the board of each agency on an annual basis, signed by the chairman and another director on behalf of the board, and submitted to the HSE together with the organisation's annual audited accounts. This annual compliance statement will be required in addition to the annual service agreement between the agency and the HSE.

Further and separate meetings are being held by senior HSE managers with all of the disability organisations and hospitals concerned this week to ensure that a clear plan to achieve full compliance with health sector pay policy is developed with each agency.

The question of recoupment will be dealt with on a case-by-case basis. As indicated, the HSE is urgently meeting individual agencies and it is important that due process is followed. I have no plans to establish an independent inquiry into the practice of top-up payments to senior executives at agencies funded under section 38 of the Health Act 2004.

Time will show that an independent inquiry was required because one of the first things that has to be established or re-established here is public trust and confidence, which has been seriously dented. I believe the issues involved are more than just the top-ups themselves, although they are the most vexatious. We have also seen exposed the unusual arrangements in regard to pensions and other issues. However, if we do not know the questions, it is very difficult to get to the core of what is involved. An independent inquiry will establish a number of irregular practices and, hopefully, contribute to their eradication.

In the context of all of this, and of the efforts the Minister has just outlined to us, has he ensured that patients of these entities are not to be further penalised by further Government funding cuts in the HSE service plan to be announced later this morning?

It is important to point out the HSE has been investigating this issue and it is the body which revealed what we now know. There are further revelations that will become apparent when it is finished its investigation. The investigation will not be a finite thing that suddenly stops and that is the end of the matter. As I have already said, new arrangements are being put in place to ensure people remain compliant. The HSE is taking this very seriously. It has 17 senior management staff involved in pursuing these organisations to ensure public pay policy is in place. Equally, as we know, people who give charitable donations want to be assured that those donations will be used for the purposes for which they made them. To do otherwise is to betray public trust in the most shocking way.

While the Minister is leaving it to an evaluation on an individual basis, I believe he should signal in the strongest possible terms that recoupment is indeed a target of the exercise. I believe the funds should be restored to their intended target area, which is the services to the patients involved. Again, I am very concerned that it is the HSE on which we are depending in this instance given the top-up arrangements within the HSE put a question mark as to its suitability in this regard. I understand that it can certainly do the initial work but an independent inquiry is, I believe, the way to go.

In the spirit of the day that is in it and the times we are living in, does the Minister agree with me that the most important people in all of this are the patients who avail of the vital services provided by section 38 bodies across our health services? Will he join with me, as I am sure he and all colleagues in the Chamber will, in a public appeal to citizens to maintain their strong support for all charitable organisations which are providing most important services to our people, services that simply would not be there but for the generosity of the Irish people? They cannot afford to take the hit that is currently being recorded. I ask everyone to be of one voice on that.

As the Deputy will know, I have already made that appeal very publicly on the airwaves and television screens of the nation. The Irish people have always been very generous, I suppose because of a deep and dark past and the experience we had two centuries ago. Even in hard times, they were never found wanting in giving to others who were less fortunate than themselves. I certainly appeal to the generosity of people and ask them not to be put off by these recent events. These matters will be resolved. The last people we want to suffer are those for whom the charitable donations were made in the first instance. I know, having spoken to them, that many of the organisations have suffered a reduction in contributions so I would ask people to think again and perhaps to give as they have before.

In regard to the whole area of an independent inquiry, I believe that is not necessary at this juncture. However, I would never rule out such a thing in the future if it became necessary as a result of the investigations being carried out by the HSE.