Priority Questions

Hospital Beds Data

Billy Kelleher

Question:

1. Deputy Billy Kelleher asked the Minister for Health when the review of bed capacity in the hospital sector will take place; if the review will be independent of the HSE; if those persons conducting the review will be asked to examine Ireland’s public bed capacity in the context of both the position in other OECD countries and the bed-occupancy levels that obtain in those countries; and if he will make a statement on the matter. [38165/16]

I have raised this issue previously, particularly in respect of ensuring that the review will be independent and at one remove from the HSE in order that there can be no accusations of agendas being set, of demands on the State for extra bed capacity or that the HSE would try to cover up failings in the system in terms of the planning problems it may have encountered regarding demands for bed capacity in the coming years.

I thank Deputy Kelleher for tabling this important question on a matter which he has raised on a number of occasions. A Programme for a Partnership Government commits to the undertaking of a national hospital bed capacity review "to establish the number, type and location of beds required into the future recognising the need for a range of beds including critical care, palliative and day case bed stock", with the intention that this would form part of the preparations for the Government's review of the capital plan 2016-2021. This is important work that will enable the determination of future capacity requirements, provide a basis for planning our health and social care services and assist in informing investment decisions over the coming period.

While A Programme for a Partnership Government explicitly commits to a review of hospital bed capacity, I believe this also presents us with an opportunity to consider capacity requirements across the health service generally. We have talked in the House in the past about the shift to primary care and social care, and we have to look at all of the beds within all of the health service. While I appreciate that there are immediate strains within the acute hospital system, I am also conscious that our growing and ageing population is going to drive demand for health and social care services more broadly. The overall population increased by 6.8% over the period 2007 to 2016, while the numbers over the age of 65 increased by nearly 33%. This demographic pattern will continue in the coming years.

A comprehensive review that will assess current capacity and future capacity requirements across primary, social and acute care services will allow us to properly examine and determine how the system, as a whole, can respond to these challenges. My Department has commenced work on an overall model of care which will inform the assessment of future capacity requirements across the different parts of the health sector. This model of care will be informed by international best practice and the work underway has included engagement with experts from the European Observatory on Health Systems and Policies in this regard.

My intention is that the capacity review will be undertaken by my Department rather than the HSE, with suitable external expert inputs as required. Initial work on scoping the project is already under way. I envisage that the review will commence very early in the new year and will be advanced sufficiently to enable it to contribute to next year’s mid-term review of the current capital plan.

We heard evidence from Mr. Tony O'Brien at yesterday's meeting of the Committee on the Future of Healthcare on the future needs of health care provision and the investment requirements. It is quite alarming, taking into account the demographics and the changing nature of how we will provide medical care in the years ahead, that our capacity system could just fall over. It is important that we get it right and that we base it on what we believe will be the challenges and demands on the health service in the years ahead. More importantly, however, we need to take into account that we will need more community care and primary care investment to help ensure the acute hospital system is functioning in the way that is intended, namely, with a focus on acute care.

Overall, for this review to be done right, it has to be at one remove from those who will be making the decisions on funding. My concern is that they would perhaps talk down the demand that will have to be met in order that it would not look like they were raising the bar too high and that the funding would not be put in place as a result. There might then be accusations from this side of the House that this had been done for other reasons. We want the review to be impartial and to have integrity. This will be the bedrock on the capital investment side of health care in the acute hospital system for the next number of years but also in the community care and primary care systems.

I agree with the Deputy about the importance of ensuring that expertise is brought in and that this review will be independent and impartial. While my Department will obviously be scoping the review, we will bring on board external support. It is not in anyone's interest for this not to be absolutely factual because we all need to get serious about the bed needs for our health service right across the spectrum.

In order to ensure that the review is as effective as possible, my Department has been undertaking preliminary work to define both its scope and the broad parameters for assessing capacity. This includes a review of similar types of exercises undertaken internationally. We have already started a number of strands of work defining the scope of the review, the parameters in assessing capacity, benchmarking Ireland against international comparators, the impact of population growth and the ageing population, for which the census 2016 data will be available in March of next year, and the likely changes required in our model of care to most effectively meet future health care requirements. The Department is considering various approaches for undertaking the review. This includes governance and oversight in respect of the role of the HSE and the requirement for external expertise. I will keep the House informed.

In view of the fact the Minister has given a commitment that it will be benchmarked against best international practice and that there will be comparisons with standards in other countries, we need to take into account where we believe health care will be going in the years ahead in terms of primary care, community care and feeding into the acute hospital system, as well as, for example, the important area of palliative care. The review needs to be robust and to have integrity.

The point I am making is that people sometimes express a view that the policymakers setting the policy are also the ones who are obligated to fund it, which means there can at times be conflicts of interest. If one sets the policy and then fails to fund it, there might be an incentive to reduce the ambitions in the policy area.

As of July of this year there were 12,733 beds in the health service, 10,579 of them being inpatient beds and 2,154 day beds. There has been a range of reviews, with the most recent bed capacity review carried out by PA Consulting in 2007. It was commissioned by the HSE at the time to carry out an independent review of the acute bed capacity requirements for Ireland until 2020. Interestingly, it said that if we continued with the current model, we would need to increase the bed stock to 19,822, an increase of 70% at the time. It also said that if we shifted care from hospitals to the community, the projected number of acute hospital beds could fall to 8,834, a fall of 25%. Those are not my views or statistics but those of an independent external company. I agree with the Deputy’s point about needing to consider the full spectrum because the more we can do outside the acute setting, the better the impact on the numbers. We need to get this right.

Hospitals Funding

Louise O'Reilly

Question:

2. Deputy Louise O'Reilly asked the Minister for Health the stretch income targets that have been set for each hospital group for 2017; the stretch income targets for each hospital in 2016; the total stretch income targets for 2016 and 2017; the direction that has been given to hospital groups in respect of the generation of private income; the consultation his Department and the HSE have had with each of the hospital groups in relation to the sustainability of the stretch income targets; and if he will make a statement on the matter. [38243/16]

My question refers to the "stretch income targets", not a term I like but one that the Minister and the Department have perhaps chosen. The people in charge of the hospital groups described them as unrealistic in their submission to the Oireachtas Joint Committee on Health. I am interested in knowing where they came from, who directs them, how they are decided and what happens in the event that they are not met.

Hospitals collect income from a number of sources, including charges for public and private patients as provided for in legislation. They also collect income in respect of facilities such as rental of shops, car park charges and other sources.

Setting targets for income collection is a normal part of effective financial planning and management for any organisation. While rates for statutory charges are specified in legislation, there is in practice variation in performance among hospitals in the billing and collecting of charges and in raising other income. This has been commented on by the Comptroller and Auditor General in his Report on the Accounts of the Public Services in 2008, 2009, 2012 and 2014, where the scope for improved billing and collection was highlighted.

In practice, much of the income from private patient charges is recouped directly from private health insurers. In 2014, under the Health (Amendment) Act 2013, the scope of private charges was expanded to include all private patients accommodated in public hospitals and not just those in private or semi-private beds as previously. This was in line with long-standing Government policy to reduce the subsidy to private practice in public hospitals, something the Deputy would probably support. The Health Insurance Authority has identified that payment by private health insurers to public hospitals increased by €144 million between 2014-2015 and 2015-2016.

In 2016 hospitals were set income targets of €50 million or 5% over the normal year-on-year growth associated with increased activity. This recognised the scope for improved performance, particularly in respect of collection. The level set for each hospital group was: RCSI, €5.8 million; Dublin midlands, €7 million; Ireland east €7.9 million; south-south-west, €9.3 million; Saolta, €9.7 million; University of Limerick, €8.5 million; and the children's hospital group, €1.8 million.

Targets for 2017 are under consideration in the context of the approval of the national service plan and subsequent agreement of the operational plans for hospitals. The Department and the HSE engage in consultation with regard to the setting of the national budget for each service area as part of the Estimates process. The setting of budgets for individual hospitals and the hospital groups is completed within the HSE as part of a consultation process between the national directorate and the hospital group chief executive officers, CEOs, and formalised in operational plans for each group.

I am interested specifically in what happens when these targets are not met. When I asked the CEOs of the hospitals, their answer was that they were crossing their fingers in hopes that would not happen. In the event that it does happen, what direction has the Minister given the CEOs on where they should start to cut? Their word, not mine, to describe the stretch income targets was “unrealistic”. These are not just the income targets that have been set, but additional targets. When they have to cut, what direction is the Minister giving them on what is to be cut? At the committee meeting, Liam Woods of the HSE said the cuts would not be in clinical areas. They are already instructed to make all the cuts they can in non-clinical areas. Where is the axe going to fall? What direction has the Department given them on where the cuts are to happen?

It is interesting to talk about cuts when the HSE and the health service has received the largest ever health budget in the history of any budget in this House. It is simply not the case that we are cutting services. We are, however, expecting the hospitals to do a better job of collecting the income that this House legislated for them to collect. These are the views of the Comptroller and Auditor General in four reports in recent years. His office has acknowledged that there is scope to do more. The HSE sets the target for what it expects each hospital group and each individual hospital to collect in income. I have outlined the various different ways a hospital can do that through maintenance charges, long stay charges, car parking, retail, inpatient prescription charge income, canteen receipts and restaurants. These are the targets the HSE works out with the hospital group CEOs which should be met. This year, there was a target of €50 million and €44 million has been met. This shortfall was addressed in the context of the additional €0.5 billion I received for the health service.

Is the Minister saying that if these targets are not met, his Department will come in and meet the shortfall? I do not think he is. That is not realistic and I do not think the hospitals believe it is realistic. I specifically asked the Minister where the cuts will be made because when the unrealistic targets - to use the term these people used - are not met, as they very well might not be, for example, if too few people buy a cup of tea in the canteen, how will the services survive? Is it simply a case of saying it is fine and giving them money when they do not meet the targets or will there be a penalty? If there is a penalty, how will that manifest itself in the event that they simply cannot reach the targets that they, not I, described as unrealistic?

I am not a believer in a financial penalty for a hospital because while it sounds like one is acting like a tough guy, it ends up being a circular flow of money. I am not suggesting the Deputy is saying that, but that is my view. We have allocated additional funding to the health service. The HSE will make sure to put that additional funding to use for patients and improved services. It will take into consideration in that context what targets to set hospitals based on canteens, restaurants, shops and car parks. I am not willing, pardon the pun, to give a hospital pass to managers who cannot hit targets when the constitutional office of the Comptroller and Auditor General has said our hospitals must do better in terms of collecting the income that people in these Houses voted to empower them to collect. We should not be letting people off the hook. These are the targets and people should be trying to meet them. We have additional funding which is now being put to use in the service plan which has been submitted to the Department and which I expect to publish within the next two and a half weeks.

The next question is in the name of Deputy Murphy O’Mahony. She is unavoidably absent this afternoon but the Ceann Comhairle is satisfied that Deputy Kelleher can put the question in her stead.

Disability Support Services Provision

Margaret Murphy O'Mahony

Question:

3. Deputy Margaret Murphy O'Mahony asked the Minister for Health the status of the implementation of the congregated settings report; the number of persons that have left congregated settings to date in 2016; the measures in place to support persons when they leave residential institutions; if his attention has been drawn to the concern among the relations of many of those persons that leave residential institutions that the support levels are insufficient; and if he will make a statement on the matter. [38166/16]

What is the status of the implementation of the congregated settings report, the number of persons that have left congregated settings to date in 2016, and the measures in place to support persons when they leave the residential institutions? Has the Minister’s attention been drawn to the concerns among the relatives of many of those persons who leave those institutions that the support levels are insufficient and will he make a statement on the matter?

I thank the Deputy for his very important question. The programme for partnership Government commits to moving people with disabilities out of congregated settings, to facilitate them in living more independently and to be included in their community. Currently, 2,649 people live in congregated settings and the objective is to reduce this figure by one third by 2021 and ultimately, to eliminate all congregated settings. It is anticipated that 97 people will have completed their move to the community during 2016, with a further 63 ready to move early in 2017. A similar additional number of people will be supported to move throughout 2017.

A sub-group under the Transforming Lives programme is developing an implementation plan for moving people from institutions in accordance with the recommendations of the Time to Move on from Congregated Settings report. The needs and wishes of people moving from congregated settings will be prioritised during this process with a model of support based on a person-centred plan.

I wish to emphasise that appropriate plans and resources are being put in place to ensure that people are properly supported as they move out of institutional care. This is very important because a lot of people do not know this. Earlier this year, I announced the provision of €100 million in capital funding between now and 2021 to provide more appropriate homes for people currently living in a number of institutions. Further supports are provided by a service reform fund involving the Department of Health, Atlantic Philanthropies, the HSE and Genio.

Separately, the Department of Housing, Planning, Community and Local Government has provided €10 million under the capital assistance scheme for people transitioning from institutions in 2016, benefiting an estimated further 100 people. A sum of €1 million in ring-fenced funding is also being made available by that Department in 2016 to support people moving from institutions into suitable social housing. This demonstrates the joined up commitment of both Departments to support the decongregation programme.

There is not a Deputy in this House who has not met families and individuals who are being decongregated from institutions. That is a broad policy and it is supported. The difficulty is that when a policy becomes a target-setting exercise, very quickly the individuals get left behind. I would be concerned that the focus on targets the whole time and the pressure on the HSE to achieve the target of moving so many people into a community setting means that we will end up not having person-centred plans. They will become statistically-focused plans. That is something I am beginning to detect in this context.

The chairperson of St. Mary of the Angels Parents and Relatives Association told Kerry County Council recently about the conditions one former care resident is living in since moving out under the HSE's Time to Move on from Congregated Settings policy. These are the words of the chairperson of this organisation:

I saw the outside of the house where one of them is living. There is an eight to ten-foot wooden fence around the back garden. The sides and front of the house are guarded by a six-foot mesh fence and there's a big heavy metal gate. That person is living like a prisoner.

It is an indication that we need to put the supports in place in the community and go back to person-centred plans as opposed to statistically-focused plans.

I say very strongly that, as far as I am concerned in my job as Minister of State with responsibility for the disabled, individuals will never be left behind. My focus is always on the person with the disability. I have heard people's opinions on the row about decongregated settings. I have heard staff and people with a different view to my own. However, I hope the Deputy is not going to tell me that keeping people in institutions in 2016 is the way forward. My objective is to put every single person with a mental and intellectual disability who wants to go, with their permission and with their families' agreement, into smaller community housing with supports in place. The budget of €100 million over the next five years is for that.

I would be very interested to hear about that particular case the Deputy has spoken about. Every single case that I have dealt with over the last six months in which a person has moved from an institution to a community house has had the services in place first. In fact, I was down in Áras Attracta last week. There were young men with intellectual disabilities coming into the office of Ms Suzanne Keenan, the director of services, to ask when they were moving into their new house. The smile and glee on their faces is often not represented, by the way, in this debate. Supports will be in place and if there are any issues or bad practices I will definitely track them down and sort them out.

The Minister of State is quite right and nobody on this side of the House is suggesting that we should abandon the decongregated settings policy that has been in place for a period of time. The issue here is to ensure that there are full assessments carried out on the individuals, that there are supports in place when the individuals move out to the communities and that those supports are committed to and maintained for a long period of time. When families are consistently saying that there is not enough support for the individuals when they move into the community setting, the issue has to be addressed. In the context of the plans that are in place with the HSE in terms of the Time to Move on from Congregated Settings policy, each individual's demands and needs must be assessed and supports put in place in advance of the decongregation. When a target is set and an organisation that does not necessarily have the budget in place all the time is forced to meet it, corners start to be frayed or cut.

I give Deputy Billy Kelleher a final commitment that every single person involved in the planned movement from congregated settings into the wider community will be monitored by the people who work in that sector and by my own office. I give the commitment that we will put the services in place where these people are moving to. We will ensure that that is happening. As I said before, I visited some of those places recently. I saw examples of very good practice. I saw examples of the staff changing its own mindset in that they had worked in an institution for 20 years and were now working in a smaller community house with better facilities. They saw the change in the individuals, particularly those with intellectual disabilities. They saw the change of mindset, the change in health and the change in happiness. It is very beneficial. Of course, I agree with Deputy Kelleher that the supports have to be there. People cannot just be left in the community without the supports because that has been a failed policy of the past. That is something that I have to prioritise.

UN Convention on the Rights of Persons with Disabilities

Gino Kenny

Question:

4. Deputy Gino Kenny asked the Minister for Health the preparations he is making across his Department to ensure rights will be vindicated for the persons with disabilities in the care of the health service and under his area of responsibility in view of the imminence of the Government's commitment to ratifying the UN Convention on the Rights of Persons with Disabilities; and if he will make a statement on the matter. [38167/16]

I ask the Minister for Health the preparations he is making across his Department to ensure rights will be vindicated for the persons with disabilities in the care of the health service and under his area of responsibility in view of the imminence of the Government's commitment to ratifying the UN Convention on the Rights of Persons with Disabilities; and if he will make a statement on the matter.

I thank Deputy Kenny for raising this very important question. As the Deputy will be aware, responsibility for the ratification of the UN Convention on the Rights of Persons with Disabilities rests with my colleague, the Minister for Justice and Equality.

The Department of Health is currently framing legislative provisions to satisfy the requirements of Article 14 of the UN Convention, which provides that State parties shall ensure that persons with disabilities, on an equal basis with others, enjoy the right to liberty and security of person, are not deprived of their liberty unlawfully or arbitrarily and that the existence of a disability shall in no case justify a deprivation of liberty. These legislative provisions will form part of the Department of Justice and Equality’s equality/disability (miscellaneous provisions) Bill. While the Department of Justice and Equality has overall responsibility for the related Assisted Decision-Making (Capacity) Act 2015, my Department continues to assist regarding the establishment of the decision support service under that Act.

Once the legislative framework is in place, my Department will work closely with the HSE to ensure its full implementation. The HSE has begun to implement the Assisted Decision-Making (Capacity) Act 2015, establishing a national assisted decision-making steering group to develop a programmatic response to the legislation to ensure effective compliance and implementation. It has also commenced impact assessments across HSE community health organisation areas, including engagement with HSE disability service providers and non-statutory service providers to gather real life case studies so that people’s lived experience can be included within the guidance and the training.

I wish to point something out to the Minister of State. I am sure he is aware of it because he has a good track record on it. Ireland has been pretty poor on equality for people with disabilities. Currently, 156 countries have ratified the UN Convention on the Rights of Persons with Disabilities. Ireland signed it almost nine years ago but never came good on it. Even Ireland's UN representative wrote to the UN in April 2012 promising to ratify the convention.

The people listening to this debate want to know when this will come into effect because the Disability Act is flagrantly breached all the time. People with disabilities are being left behind. The convention must be signed and ratified to ensure equality for people with disabilities.

I share the Deputy's position on the UN convention. I agree that we must ratify it and I am working towards that at the moment. In fact, I have just left a meeting with officials from my Department and the Department of Justice and Equality at which we discussed the legislative position and some of the blockages in the system. On the broader point, I fully support the ratification of the convention and I am working very hard to do that.

I strongly disagree with the Deputy's second point because since this Government came into office, we have improved the investment in disability services. I secured an additional €31 million within a matter of weeks of becoming Minister of State. We are now investing more in disability services and there was an increase in funding in the recent budget. The Minister for Health and I have worked very closely on this. We have spent the past few weeks working very hard on the HSE service plan for 2017. We are trying to develop services. It is all very well to talk about the rights of people with intellectual and physical disabilities but we must also ensure they have access to services. While work is ongoing in terms of the ratification of the UN convention, I want to invest in and improve the services. We all accept that services for people with disabilities have been devastated over the past seven or eight years and we are now trying to rebuild them. We are starting that process and I would love the Deputy's support in that regard. People will be coming along over the next few months, trying to steal money from the services. We must focus on services. We gave a commitment prior to the general election to allocate funds 2:1 in favour of services over tax cuts. We must uphold that commitment and we need support to do so.

That is all well and good but will the Minister of State not put a timeframe on it? This has been dragging on for years. The Government signed the UN convention nine years ago. Why has it not been ratified and put into effect? We must send a strong signal to people with disabilities that this will be done within a matter of months. If this is allowed to go on and on, the convention will never be ratified. Will the Minister of State give a commitment to ratify the convention within six months or even earlier? If he commits to ratifying it within the next three to six months, people will believe that the Government is serious about this issue.

I assure Deputy Kenny that I would happily sign the convention tomorrow morning if I had the opportunity. However, the necessary legislation must be in place and certain issues must be resolved before I can do so. As the Deputy knows, I set myself the objective of ratifying the convention by the end of 2016. I knew there were blockages to that and I am now getting the feeling that I might not meet my target. That said, it might be possible to meet it only a number of weeks later. It will be done shortly. There are blockages within the legislative process and problems which must be resolved, which is why I have not signed it yet. I hope to see it done as quickly as possible - in a matter of weeks, in fact.

Will it be done after the Christmas recess?

Absolutely. Well, hopefully. I would come back tomorrow and do it if it were possible.

I will sign it too.

Hospital Investigations

Catherine Connolly

Question:

5. Deputy Catherine Connolly asked the Minister for Health the status of the audit into spinal surgeries performed on 198 persons between January 2013 and November 2014 in University Hospital Galway; when the audit commenced; when it was completed; when the findings will be published; and if he will make a statement on the matter. [38242/16]

As the Minister is aware, the most serious issues have arisen concerning a substantial number of patients who underwent spinal surgery. Inappropriate procedures were carried out, and in one case the death of a patient was hastened. In addition, unnecessary and dreadful pain was caused. We learned of this through patients - I learned of it from the family of one patient - and through the press. It is entirely unacceptable to learn of this in such a manner. Will the Minister tell us about the audit and specifically when it commenced, the outcome and why it was delayed?

I thank Deputy Connolly for raising this very serious and important issue. I understand that following concerns over four spinal surgery cases detected through the quality and safety systems in University Hospital Galway in 2014, an audit of care provided by one consultant orthopaedic surgeon was undertaken. An external review of the four cases was then commissioned. On receipt of that report in November 2014, the Saolta University Healthcare Group initiated a wider audit of the operative practice of the surgeon which was carried out by two independent orthopaedic surgeons.

Sorry to interrupt but I did not catch the date. I ask the Minister to repeat it.

November 2014 was when the external review was reported. The Saolta group then initiated a wider audit of the practice of the surgeon which was carried out by two independent orthopaedic surgeons. The consultant involved ceased performing spinal surgery immediately. I am further advised that the consultant orthopaedic surgeon in question resigned his post in February 2015 and is no longer working in Ireland.

A total of 198 patient charts were audited and in 151 cases, no concerns were expressed with regard to patient care. Some concerns were raised in respect of 43 cases but the auditors did not consider that serious harm had resulted. The audit raised serious concerns about resulting harm to the original four patients.

The HSE has advised me that patients were contacted in early November and a patient helpline has been established. In addition, follow-up patient care is being provided by the spinal service at University Hospital Galway.

University Hospital Galway and the Saolta University Healthcare Group have expressed their regret regarding any distress this process may have caused to patients or their families. The HSE has provided assurance regarding the safety of the spinal services currently in place for patients in Galway. I would like to stress the importance of supporting the needs of the patients and protecting patient confidentiality during this time. That said, all of those patients whose charts were audited were contacted directly by the Saolta group on foot of legal advice.

I have asked when the audit began, when it concluded and whether it will be published. The Minister has spoken about protecting the patients but the system was and is being protected here. I ask again, when did the audit actually commence? Who carried out the external review in the first instance? Was that separate from the review carried out by the two external doctors? When was it completed and will it be published?

This is the most serious issue that has arisen in Galway city since the case of Savita Halappanavar. We are learning nothing, it seems to me. I am loath to criticise the public system because I am the greatest advocate of the public system. The Minister is nodding in agreement. I raise this as a matter of public importance. A statement should have been made by the Minister and the HSE, proactively, if they wished to reassure people, with all of the facts given. We should not be reliant on press statements and should not have to drag information out.

I fully accept Deputy Connolly's bona fides on the matter but I am sure she accepts mine as well. My primary concern is and will always be - as long as I hold this office - for the individual patients, their confidentiality, safety and sensitivity with regard to their own cases. They have a right to have their confidential patient information absolutely protected.

Let me put some more information on the record. I am more than willing to make all of the information I have available. As I said, there were concerns about four spinal surgery cases identified as part of the internal quality management systems in place within the Saolta University Healthcare Group. An independent audit of the spinal surgical practice of a consultant orthopaedic surgeon at University Hospital Galway was completed between 1 January 2013 and 14 November 2014. The four cases were notified and reviewed in the period March to July 2014 - those people were notified - whereupon an external review was commissioned. When Saolta received the report of the external review in November 2014, it then decided to initiate a wider audit and the surgeon involved was directed to cease performing spinal surgery immediately.

A communications process was commenced on 7 November this year to notify each patient whose chart was audited, even where there was no concern raised at all. Of importance is that Mr. Frank Dowling, external spinal and orthopaedic consultant, will provide a clinical review of the identified patients through specific scheduled clinics this month, December 2016. If patients require any ongoing spinal care or follow-up, this will be provided by the spinal service at University Hospital Galway.

First, I would like a comprehensive written reply. Second, the figures the Minister has given are accurate but the timespan is not. The audit was conducted between January 2013, as the Minister said, and November 2014. We are now in December 2016. Patients and families were only contacted in November of this year. There was no contact before that. I know that, intimately and personally. The spinal surgery carried out in the case of which I am aware was inappropriate, hastened the death of the patient and caused absolutely unimaginable pain.

It is unacceptable in the 21st century for a system to seek to protect itself, particularly if we are to learn anything and engender confidence in a public health system. I am asking the Minister to take a hands-on approach and to come back to me and explain how it could possibly take until November 2016 to communicate the relevant information. When will the general findings of the audit be published? What have we learned from it? What has been put in place? When we talk about quality assurance, we are talking about a small number of people who finally complained and whose actions led to concerns being expressed. In the particular case I highlight, no complaints were made and no quality assurance system picked it up. In that case, where death was hastened, unimaginable pain was caused and incorrect procedure was not picked up by any quality assurance system or on foot of any complaints.

I have given both the Deputy and the Minister latitude.

I am very happy to share with Deputy Connolly the information I have available to me because this is a very serious matter and it is difficult, going back and forth, to put all the information on the record. However, I am endeavouring to do so. It is important to assure the public that an audit of the surgeon's non-spinal orthopaedic work was also carried out and that no concerns were raised. The Irish Medical Council has been made aware of the audit and the relevant information has been forwarded to it. A key finding from the audit was the need for structured multidisciplinary input into the decision-making about surgery and review of cases. The consultant orthopaedic surgeon resigned from his permanent post at University Hospital Galway in February 2015 and is no longer working in this country. The HSE advises that this doctor's only periods of practising in Ireland were when he undertook his internship in basic surgical training in the Saolta Group and following his appointment as a consultant orthopaedic surgeon with special interest in spinal surgery, at Galway University Hospital on 21 January 2013.

I assure the public that this review has been carried out extensively and that it was audited by independent external consultant orthopaedic surgeons. I will, however, make available to Deputy Connolly the information I have in my possession.