I welcome the Tánaiste and her officials. I invite her to update the committee on her priorities, as Minister for Health and Children, and members may ask questions afterwards.
Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the House or an official by name or in such a way as to make him or her identifiable.
I thank the Chairman. It is a pleasure for me to meet the committee again to talk about the priorities in health care reform. It is useful for the Minister for Health and Children to engage with the committee on several occasions each year. I very much welcome this opportunity to speak to the committee which is not focused on a Bill but on the general health agenda.
My priority and that of the Government is to see through the health reform programme. We have trebled spending on health between 1997 and 2005 but that increased spending does not deliver the results most people expect in the absence of appropriate reforms. Therefore, in future we must match increased investment with reform. As part of that agenda, we passed a Health Act last year which radically changes the way we deliver health services in Ireland. We have moved from a regional delivery structure to a unified structure. The Health Service Executive is a single national body responsible for the delivery of health care. It became fully operational in terms of its mandate in the middle of June this year.
The HSE has just completed recruitment of its key management team and the personnel who will take responsibility for its various aspects. Accountability for funding has moved from the Department of Health and Children to the HSE, a move on which I was very keen. That was recommended as part of the reform process, but those who spend the money must be accountable to the Oireachtas for the manner in which it is spent. It is not possible to achieve good, effective outcomes if one set of individuals accounts for the money and another for the delivery of services.
This was the biggest change in management process ever undertaken here in either the public or private sector. As with any reform, major transitional issues will arise as we seek to turn around a massive organisation. In terms of health care the organisation employs almost 100,000 people directly and if one includes the providers of health care in the voluntary and independent sector, it amounts to many more.
Notwithstanding the transitional difficulties and challenges, the HSE is in good shape as autumn approaches to fulfil the mandate the Oireachtas expects of it in the legislation. During our debate on the Act committee members were interested in several issues, particularly accountability to the Oireachtas, Members of the Dáil and Seanad and this committee and I gave an undertaking to bring forward regulations to that effect. The regulations have been drafted and will soon be in effect.
When the autumn Oireachtas session begins, there will be 45 people in the HSE parliamentary affairs division which will comprise a national central division and regional divisions. The HSE will hold a briefing session in September for Members of the Oireachtas about its parliamentary affairs division and will give each Member details of the individuals responsible for various services in order that Members can engage meaningfully with it. That is important. I have made clear to the acting CEO that to be able to respond rapidly to queries of Members of the Oireachtas on behalf of patients who are constituents will be an important performance indicator for the Health Service Executive.
Second, we want to put in place the regional forum, for which I have approved the regulations. I am required in the Act to consult with the Minister for the Environment, Heritage and Local Government and that consultation is under way. I hope the regulations can be signed into law this month or in August — certainly by autumn of this year.
The third area about which concern was expressed was the complaints procedure. A number of seminars have taken place with various stakeholders, patient groups, service providers and others regarding an appropriate complaints mechanism. When they are being concluded those regulations will be brought into effect.
The major challenge to the delivery of health care is a speedy response to the needs of patients. The acute hospital system, between outpatient appointments, accident and emergency services and inpatient activity, accounts for 2.2 million patients per year. This amounts to considerable activity and it is becoming more complex. The population is aging and there are increasing demands, particularly from those in the older age bracket. The challenges of ensuring we have capacity to meet the needs of our growing population is immense. We must also ensure that when we have capacity in place we use it as efficiently and effectively as possible. That is why during these months, an audit is taking place of ten major hospitals in the first instance.
The purpose of the audit is to establish what the practices are with a view to achieving best practice to resolve difficulties and to make sure the hospitals operate as efficiently and effectively as possible. I want to see our acute hospital system benchmarked against best international practice. Unless we have some baseline data, we will not be able to achieve this. That is under way. In terms of discharge policies, outpatient and inpatient activity, day case activity and so on, it is clear that the skill mix in hospital and other care settings is very much dependent on having good base data and benchmarking against best international practice.
Busy accident and emergency departments remain a challenge, particularly in the Dublin area but not exclusively so, where two main difficulties present. On the north side of the city we have two doctors at night between 6 p.m. and 8 a.m. or 9 a.m. and at weekends to cater for 500,000 people. That is not adequate or satisfactory. We have not been able to resolve the issues with the GPs in the traditional way as we have done in other parts of the country. I have discussed this with Professor Drumm and the head of the primary care division in the HSE, Aidan Browne. Since the traditional route is not producing results, the intention is to go to tender shortly for out of hours services on the north side of Dublin.
Many of those present are familiar with out of hours services in other parts of the country. I recently visited the facility in Carlow which caters for 500,000 patients. It is a fantastic facility and operates very effectively. I see no reason we cannot have a similar facility operating in the Dublin area. That is one of the difficulties that has to be resolved very quickly and since the traditional route has not proved capable of resolving it we have to find alternatives. That process is now under way but until it is resolved it will add to the difficulties in accident and emergency departments.
The second issue adding to difficulties in accident and emergency services is the matter of care of the elderly. The controversy and difficulties in regard to the charges issue has posed problems for the acute hospital system. Currently in the major Dublin hospitals we have over 400 late discharges. Many of these are being assessed for home care packages. It is my and many others' preference to keep as many as possible in a home environment. An innovative home care package has been introduced very much tailored to the needs of the patient rather than a fixed and prescriptive set of rules in which one hopes patients will fit. The individual patient's requirements are examined and a home care package is tailored around his or her needs. It is expensive but appropriate.
The Minister for Social and Family Affairs and I put together a group of officials to examine home care packages for the elderly. The group is due to report to us later this month on all options for care of the elderly. It has been a mismatch with much confusion over the many different factors applying in different places. Home care will be a strong feature of our policy. Several packages have been put in place. There are approximately 500 packages and it is to be hoped that there will be more.
We have acquired some step-down and high dependency beds in the private sector. More than 100 patients have used the step-down facilities which were acquired through a public procurement process and patients are being moved to the high dependency beds. Some younger disabled people fall into the category of late discharges. However, in the main they are elderly people and the provision of appropriate facilities for them is a priority. When it is resolved it will ease the pressures on the acute hospital system.
Various recommendations have been made in the area of bed capacity to achieve the extra 3,000 beds by the end of the decade. Some 900 of these will be in place by the end of the year. Between 400 and 500 are planned as part of the capital programme over the next several years. However, there is still a shortfall. Last week I announced it is intended to provide up to 1,000 of those beds by decanting 1,000 private beds in public hospitals into private facilities on public hospital grounds. Some 2,500 beds of the 12,900 beds in the acute hospital system in public hospitals are private beds. These private beds can be provided through alternative means. It is the quickest and most effective way of providing more public beds for public patients. There is significant interest in this from many hospitals. I have already received a proposal from one hospital which was well-thought out and I know several other hospitals are interested in pursuing this particular matter in this way.
I have seen speculation in the media about the costs of these beds. To provide a public bed costs approximately €500,000. To provide 1,000 beds, therefore, would cost €500 million. Staffing those beds would cost €345 million per year. This is based on the average costs in the acute hospital system. To provide these beds using capital allowances, at the highest level, would cost €220 million if all the investment was done through equity. The cost depends on the tax point of view on the debt-equity ratio. In the guidelines I have sent to the Health Service Executive which were drawn up by Prospectus which has much expertise in this area, the executive is required, before it gives approval to any public hospital to pursue this policy, to assess the private capacity in the area. It is also required to examine the cost to the Exchequer of providing the beds in this way by examining the debt-equity ratio.
Even if all the money was to be invested by way of equity and, therefore, the full capital allowances applied, these beds would cost at most €220 million as opposed to €500 million through the traditional way. It is estimated we need €25 million annually worth of consultants. Obviously when the beds are freed up in the public hospitals, the insurance companies pay the acute hospital system approximately €220 million per annum. Moving these beds would cost the public hospital system approximately €145 million per annum. We are moving to full economic cost for private beds in public hospitals, which every party supports. The insurers pay 60% of the costs of these beds which will cover the costs of decanting the beds. Therefore, there will be no additional cost to the insurers over and above what they will have to pay under the policy adopted by the Government several years ago.
The primary care strategy envisages spending €1 billion on primary care centres nationwide over several years. It is difficult to see how we could make that money available using the traditional method. There are a number of innovative projects, including one in Killarney where all the GPs have come together and put forward an innovative proposal, of which I am supportive. The Department is making advances with that group and others regarding the provision of primary care facilities at local level. Clearly, a growing number of our health requirements must be met at primary care level. For example, one of the big challenges facing health ministries worldwide is managing chronic illness in the community, whether it be diabetes, heart disease of whatever else. This is best suited to be done at primary care level.
We will soon open negotiations on the GMS contract with the IMO which I look forward to being completed as quickly as possible. In the meantime, the outstanding issues regarding Sustaining Progress have been resolved and the doctor-only medical cards which I announced last autumn are now being issued. In addition to issuing the cards we have changed the manner in which people's means will be calculated. Instead of the traditional way of looking at one's gross income, whereby one had to pay the first €26 per week towards one's mortgage or rent, €23 towards one's transport to work and so on, we will allow all reasonable expenses for mortgage or rent, child care and travel to work. In effect that means we are taking into account a person's net income, a much fairer way to allocate both the traditional medical card and the new doctor-only card.
The legislation to deal with illegal nursing home charges went through the Oireachtas and charges have been back in place since 14 July. Regarding waiting time for procedures, we established the national treatment purchase fund a number of years ago and to date it has treated more than 30,000 patients mainly in the private health care system in Ireland. We have some difficulties in getting referrals to the national treatment purchase fund and instead of waiting lists for procedures, we are moving to a patient register. That will be in place in some parts of the country later this year. In effect, the patient will get a card telling him or her that after three months waiting, he or she can contact the national treatment purchase fund and have the treatment provided. The fund will also have the patient data and will be able to write directly to the patient to outline the treatment it can offer in the patient's circumstances. This is a way of empowering patients.
I have also asked the national treatment purchase fund to look at outpatient waiting lists on a pilot basis as there are considerable delays in many key areas where there is a shortage of consultants. The national treatment purchase fund is looking at 5,000 patients on a pilot project basis and will report to me later this year. Essentially, the fund relates to surgical or procedure-based medicine, which is a new area for it, but I asked the members to do some pilot work in this area to see if there is a role for the fund in clearing waiting lists there also.
As everyone knows, the Government agreed in 2000 to establish an inquiry into organ retention. Unfortunately, the report was not ready for publication by 31 March last, the deadline given. The Government has appointed Dr. Deirdre Madden, a lawyer and scientist, to take forward the work, and she has agreed to report by 21 December. I met her recently and she is determined to meet that deadline. That is important because this inquiry in Northern Ireland and Britain was done in an 18-month timeframe. The inquiry to date has cost about €21 million, a considerable amount of money.
A major priority for all of us is the issue of disability. As everyone knows, we have moved to multi-annual funding, an appropriate way for the disability sector to be able to make plans with regard to its services. Funding is now guaranteed for five year periods hence, which is important.
I know people will ask me many questions about different matters and I will be delighted to answer them. The issues of hospital cleanliness, hygiene, MRSA and so on are a priority for me and for the HSE. Currently a hygiene audit of every hospital is being conducted. Like the other audit of practice and procedure, it is being done with a view to establishing the situation in each place. The results will be published, not to name and shame, but the public has a right to know the hygiene standards in various hospitals. The idea is to work with individual hospitals to bring them up to an acceptable standard. It is a fact that hospitals are not places where any of us should be unless we have to be there. However, we must ensure they operate to the highest possible standard.
I see that in our neighbouring jurisdiction the Prime Minister, in the course of the recent election, set a target of halving the rate of MRSA in Britain by 2009. Some might say that is not very ambitious, but it indicates how difficult it is to achieve. In addition to basic hygiene and operation to high standards, there are other important issues such as bed occupancy and isolation rooms. In the ideal hospital, everyone would have a single room. I recently met microbiologists who said that in future everyone would be in a single room, the only real way that one can maximise infection control and minimise the possibility of people contracting infections. We are a long way from that in Ireland and across Europe.
We know the cost implications of moving in that direction. Within the resources we have and the current hospital structure, we must ensure we operate to the highest possible standard. I am especially anxious, as is Pat McLoughlin of the National Hospitals Office, to ensure a senior clinician in every hospital will have responsibility for infection control and hygiene and that it is not a matter for the cleaning staff or someone from the HSE. A clinician should have overall responsibility for the area. I understand from other countries' experience that one achieves the best performance that way.
It is a privilege to appear before the committee and I am sure there are many areas about which members would like to ask with which I have not dealt. I would be delighted to take whatever questions they have.
I thank the Tánaiste for honouring her commitment of some months ago to appear regularly before the committee. It is obvious to me and every member that she has been a very busy Minister for Health and Children since her appointment. I am particularly pleased to see there is an air of confidence regarding the health service. I am also pleased to hear her mention Oireachtas scrutiny, that we will now have the facility of meeting the HSE, and that a department has been assigned in that area. I am also happy to hear her refer to MRSA. The committee has invited the HSE and people representing MRSA victims to attend in October, when we intend going through the issues. I was especially delighted to hear the Tánaiste's announcement last week regarding 1,000 beds in the private sector. I am glad to hear her fill out the figures quite clearly, since there had been some concern about that in the preceding days. I congratulate her on that bold initiative, since the service is in good hands.
I will begin by inviting questions from members. The first to indicate was Deputy McManus.
I welcome the Minister. If I leave early, no discourtesy is intended, since I have a long-standing commitment.
I wish to raise certain issues, since I do not think the Tánaiste really described the reality of patients' experience or that of ourselves trying to represent them. There is now a virtual blackout on information. There is no means of ensuring the normal accountability that any civilised society would expect regarding the health service. The impression one gets regarding the HSE is of a serious bureaucratic mess, whereby the old structures have been overlaid with the new one. On top of that we now have the change management team of Professor Drumm. Morale in the system is very low, over which I would not skirt if I were Minister.
I have raised this issue before. We need more doctors, an issue highlighted by the recent report. It will not be possible to meet the population's needs without educating many more doctors. I would like the Minister to refer to what she is doing regarding medical education. If we do not lay down the foundations now, we are going nowhere.
I also want to ask the Minister about the practicalities of a major hospital such as the Mater Misericordiae which has stated it has a €20 million shortfall in funding for this year. The board has stated it will not be able to maintain existing services, or at least services that were maintained into this year because of the shortfall. Mr. Kevin Kelly told a committee of this House that there was a shortfall of almost €200 million in terms of funding for the HSE. When I raised this with the Minister, she expressed surprise. She did not seem to know about it. The Mater is now experiencing the fall-out of that cutback in funding. I ask the Minister to explain to the committee how she envisages that a hospital of such importance will deal with this.
On the 3,000 beds issue which, as the Minister said, was not a recommendation but rather a commitment, that commitment was made by the Government in the health strategy and to the people that capital moneys would be made available for this purpose. We now know that just over 400 acute beds have been provided and that there is to be a new venture that involves handing the job of providing 1,000 beds to the private sector. Some 3,000 beds was the target assessed by the Minister's Department. Will she explain why they are no longer needed? Perhaps she will explain too how she feels about the private health operators saying that the Minister has given them the answer to their prayers. Clearly, they see the facility of providing 1,000 beds in effect as a cash cow. This is enormously lucrative and very attractive to investors. It is difficult for anybody to comprehend how we have that response from the investor, yet the Minister maintains we will get better value for money than by the State investing in a public service, as required.
I want to make a point about community services and care of the elderly, on which the Minister has placed some emphasis. Is she aware that there are serious difficulties in this regard? It is difficult to know the position because I have sought information repeatedly and have not been given it. From the information I received from the Department and the HSE, it appears there are cutbacks in hours in the home help service. The money has increased — rightly so — but the hours have been cut back significantly in many locations, for example, in Kildare. There is now a disjuncture between the home care package system the Tánaiste introduced which is supposed to enable people to be discharged from hospital and the care normally provided under the community care service. In some cases I have heard from medical professionals that people are literally being advised to go into hospital in order that they can avail of the home care package. There is a problem in terms of overall support for community care if the resources are not meeting the need and freeing up the beds in the acute hospital sector.
I welcome the Tánaiste. I appreciate her attendance at these meetings, having experienced a different approach in this regard at various times.
The difficulty we experience is that despite massive increases in investment we are not getting value for money. We often wonder where the money goes. Last week there were media reports about the personal payroll and related system, PARS, which has cost over €100 million, we understand, since 1999. It is alleged that the costs of the project have grown massively and that a common PARS across the entire health service is far from being achieved.
Can the Tánaiste inform us of the situation? What briefing on this project did she receive when she arrived in the Department? Is she satisfied that her predecessor in the Department exercised sufficient control over the project? The capital fund is coming out of subhead C.3 of the Department's Vote. Is the Tánaiste satisfied that the project is yielding value for money in light of the substantial sums already paid to consultants?
The Tánaiste recently signed regulations reintroducing nursing home charges. However, €75 million has been lost to the former health boards between December 2004 and June 2005. What arrangements have been made to make up that loss to health services? There are serious implications for services if that money is not made up. In 2004, there was a drop of almost 2 million hours in the level of home help delivered. In 2003, there were 8.8 million hours of home help. The budget for 2004 allowed for 8.9 million hours but the outcome was 6.9 million hours. The Tánaiste informs us that the same level of home help hours will be delivered in 2005 as was delivered in 2004, but that effectively means a drop of 2 million hours on the 2003 figures. This is a very important low level service because it allows people to stay at home rather than be admitted to a hospital or a nursing home. It gives the elderly a decent standard of living.
A total of €15 million is being spent this year on the promotion of health services. Where is this money being spent? How much of the money is going to the development in the Central Mental Hospital and its transfer to the new prison site? In our view, €15 million is derisory.
In May each year I ask about the allocation by the Department of Health and Children towards suicide prevention. I usually obtain the response to this question in four days. This year, I was told that it was now the responsibility of the Health Service Executive and it was asked to provide the information. I was surprised that the Department did not have that information to pass on directly. By the time the Dáil adjourned for the summer at the end of June, I had not yet received that information and I raised the issue with the Minister of State, Deputy Seán Power, who assured me that he would do his best to obtain the information as soon as possible and I do not doubt him. On 1 July I asked the Minister of State, Deputy Tim O'Malley, for the figures. I still have not got them, even though I asked the original question on 10 May. Why is it the case that I could get the information previously in four days, yet this year I have not got it in three months?
There has been no blackout on information but it is an entirely new organisation. We did not have a national organisation such as the HSE previously and there were transitional issues. However, I am more than satisfied with the arrangements now in place. Mr. Killian McGrane is the director of corporate affairs and has worked extraordinarily hard on this project. The 45-person team effectively supports Members of the Oireachtas and will provide a very good service. If it is found to be deficient, it will certainly be improved upon. It is a key performance indicator for the HSE to be able to respond rapidly to the queries of Members of the Oireachtas.
Deputy McManus made a valid point.
Are the 45 positions new posts?
No, these will not be new positions. Some 45 people from the existing system will be dedicated to servicing the needs of Members of the Oireachtas in answering queries and dealing with parliamentary questions and related matters.
How many are there at present?
There are ten people in place.
I could not obtain that figure from the Department within three months, yet the Minister could tell me within four days.
The main issue is that we know there will be 45 people.
I am optimistic that there will be a remarkable improvement in the HSE by the autumn. It has planned a briefing session in September and the committee will receive documentation containing details relating to the different individuals responsible in order that members may contact them directly. The format of the former health boards meant that people had their contacts and knew where to go for information. Under the new system, however, people are obviously not to be found in the same locations. I am conscious of the issue.
It does not matter to us who answers parliamentary questions as long as we get the truth within a certain timeframe.
I have given the HSE a timeframe for answering parliamentary questions which will be honoured in the autumn.
Regarding the issue of morale, this is an organisation undergoing change. As individuals, we are always frightened of change but we know that when we embrace it, great progress is made. An organisation involved in the process of change in terms of the scale envisaged for the HSE will obviously cause pressure points for individuals. A strong feature of Professor Drumm's role is to provide leadership for the organisation and motivate people involved in the agenda of change. He will, I hope, appear before the committee in the autumn. He takes up his post in three weeks' time and strongly intends to put huge effort into the issue of staff morale and support in respect of the changes taking place. The most effective way of delivering in any organisation is to bring people along with you.
I agree with Deputy McManus in that we need to develop our own doctors. Of the 900 medics graduating this year from Irish medical schools, only 300 are from Ireland or the European Union. The other 600 are from outside the Union and considerable shortages are emerging. We intend to recruit more students into our medical schools in the next academic year but it will be seven years — perhaps a decade, if GP training is taken into account — before we see the benefits. Long-term planning is certainly required in this regard.
The Fottrell report has yet to come to hand, although I read about it in the newspapers. It will recommend graduate entry, of which I am a strong supporter. Many are not in a position at the age of 17 or 18 to decide whether they want to be doctors. They might come to that decision when they are 21 or 22 years old and they should have the option of entering medical school as graduates. This has proved successful in other countries and will, I hope, give us further options. However, it must be funded between my Department and the Department of Education and Science. In recent years we have invested much money in nursing education and we now have 13 nursing schools. Some 1,650 nurses are in training and €60 million of capital is being spent this year on nursing education. We have, therefore, done a significant amount with regard to nursing education and must apply to same vigour to doctor education and other key medical areas.
Regarding the figure of 3,000 beds, 800 are in place and I wish to dispel a myth regarding people, including certain professionals, who are happy to use different definitions. The 3,000 beds include day beds and the places in which people are treated. They are not all overnight beds, 800 of which are in place. A further 450 to 500 beds are planned as part of the capital framework programme between now and 2009.
By the end of this year, we will have a further 200 to 250 beds in place and are heading towards 1,500 or 1,600 beds. The issue is how to get from 1,500 or 1,600 beds to 3,000 beds. A total of 1,000 will be provided in the manner I have suggested. No one can justify keeping private some beds in our public hospitals when we have a shortage of beds for public patients. If the private system can supply those beds, it should do so. One issue that made it more difficult for independent private providers in the past was the fact that private beds in public hospitals were heavily subsidised by taxpayers. Consequently, it was difficult for private providers to compete. However, I note that 40% of the open heart surgery currently carried out in this State is performed in two private hospitals, the Blackrock Clinic and the Mater Private Hospital, Dublin. Hence, the private system can perform to high standards. We must have clear plans in this regard.
I do not come to this 1,000 bed plan to provide more private beds, but from the perspective of getting more public beds. From my perspective, based in Hawkins House, I cannot see any way that Deputies McManus and Twomey, should they become Ministers for Health and Children in the foreseeable future, or I would be able to get the sum of €1.5 billion. The same is true for Deputy Neville, or Deputy O'Connor for that matter.
The Tánaiste should not get me into trouble.
The €1.5 billion capital required to build 1,000——
Why did the Tánaiste tell the people that she would? It was in the capital programme that was published.
This is how I will do it.
The Tánaiste undertook to do this when she stood for election. This is exactly what she promised the people she would do.
No. I undertook and continue to undertake to provide 1,000 of these beds in addition to the 1,500 beds which are currently either in place or being planned. For example, I envisage that the new Mater Hospital will have at least 100 extra beds. There is no point building a new hospital without providing extra capacity. However, I will provide 1,000 beds in this manner. The outcome and results should matter, rather than the mechanism by which they are achieved. We will do it by decanting private beds from the public system. Everyone knows the advantages of keeping doctors on-site. Many projects have been hanging around for several years waiting for approval along these lines and we will see much action quickly.
I wish to clarify a point regarding home helps. In 2003, 8.8 million hours of home help were provided and the figure for 2004 was 8.9 million hours. I heard Deputy Twomey use the figure of 6.9 million hours on the radio the other morning. The figure of 6.9 million hours refers to home help provided for the elderly. However, the overall figure includes the home help provided for other categories, including the disability sector or young people. Sometimes, there are young families in particularly difficult circumstances such as a mother on her own with three or four children. She might be obliged to have serious surgery and a home help goes to help her. There will be as many home help hours provided this year as there were last year. I hope there will be even more provided next year. Deputy Twomey is not comparing like with like, but is comparing apples with oranges. He took the figure of 6.9 million hours for the elderly and compared it with the global figure for the previous years. That is where the difficulty arose. To be fair, there was confusion as the service plan produced by the HSE simply included the figure for the elderly.
Is the figure for the disability sector included in the HSE service plan?
We have figures. Only yesterday, I met Aidan Browne, the head of the primary, community and continuing care, PCCC, division of the HSE. As many hours of home help will be provided this year as last year. If I have my way, I hope to secure more hours of home help next year, which brings me to the home care package. The home help system is fantastic.
The Tánaiste stated she had a meeting yesterday.
I can get the figures for the Deputy, but do not have them to hand. They are no fewer than the 8.9 million hours provided last year. Last year's figure came to 8.9 million hours while the previous year's figure was 8.8 million hours. The 2005 figure includes 6.9 million hours to the elderly as well as a couple of million hours provided for people in the disability sector and others. The money has been provided.
As far as home help and home care packages are concerned, the home help system was introduced as a way of supplementing good neighbourliness and has now become a formalised support method. In general, it is provided between the hours of 9 a.m.to 5 p.m., five days a week, although there are exceptions. However, the care people require is not limited to those hours. Obviously, the home care package concept must run in conjunction with home help. Home help forms part of the home care package. It must be much more flexible and less prescriptive and capable of dealing with people late at night, overnight and at the weekends, if required. If a disabled or elderly person is not capable of cooking meals, dressing himself or herself or putting himself or herself to bed, our home help and home care package must be able to facilitate support to do these things in the home. That is the idea behind home packages.
As we move forward, the two supports will become part of the same package. There will be different requirements for different people. Above all, I want flexibility. I do not want a system that is excessively prescriptive, as often occurs in other areas besides health care. If one brings in rules, suddenly one will meet circumstances that do not comply with them and a person will end up in an acute hospital bed at a cost of over €1,000 a week, which makes no sense.
Home care packages average approximately €350 per week. I met an individual whose family received a home care package for their mother. The individual said the home care package was wonderful compared to what she had previously received. That is the direction in which we are moving. Obviously, it is expensive and, therefore, we must move forward having assessed the particular requirements.
Deputy Neville asked about the power system and the technology introduced in 1999. I understand there are discussions going on between the Comptroller and Auditor General and my Department concerning this issue. I am not in a position to say it is inappropriate. I am concerned by the matter and if we got it wrong, we must put our hands up and say so. We spent €120 million on this technology. If it cannot do the job it was intended to do, we must come clean and admit it. I am not in a position to do this. I am awaiting a further briefing. I have been briefed by my Secretary General who is involved in discussions regarding this issue and we are trying to get our heads around it. I will revert to the committee and Deputy Neville when I have more information. I cannot condemn it today because I do not have a complete set of information to allow me to do so.
Could the Tánaiste repeat what she said as I did not catch it?
Deputy Neville mentioned a piece of technology which I think is called PPARS — Personnel, Payroll and Related Systems. I think this package was acquired by the health system in 1999. I understand it cost in the region of €120 million and that there were consultants to the project. I think that there are discussions taking place with the Comptroller and Auditor General. I have had a preliminary briefing from the Secretary General of my Department who is having further briefings.
Was the Tánaiste briefed on this when she became Minister for Health and Children?
I was not briefed. I think the first I heard of it was towards the end of last week. My philosophy is that if we got the wrong technology and it is not doing the job properly — I understand somebody received a cheque that he or she should not have received — there is something wrong. Perhaps it explains where the money has gone. I cannot give a definitive answer on the matter today but I assure Deputy Neville that the Secretary General of my Department is active on the case and due to report to me on it.
Regarding the figure of €15 million and the Central Mental Hospital, I visited the hospital yesterday.
The €15 million is for the development of the entire health service.
I am aware of that. I saw the new facility at the Central Mental Hospital that will take in more patients — I think it may be 14 but I am not certain. The hospital is about to commission the new facility which has been completed. The Central Mental Hospital is not a facility of which any of us could be proud. It is appalling and worse than my worst nightmares. I visited the hospital privately as I thought it was appropriate to do so. There was a very high standard of care and I was very impressed by those I met there. However, the hospital is not an appropriate place in which citizens should reside. I visited Nelson Mandela's prison cell in Robben Island, South Africa and it was no worse than what I saw yesterday, which is a shocking thing to say. That is why building a new facility must be a priority. There is no doubt about this and the faster we can do it, the better.
Regarding the issue of suicide, we will publish the suicide strategy in the autumn. I compliment Deputy Neville on the work he has done. He has been the pioneer in the Oireachtas on this issue. The people I meet around the country who have an interest in this matter mention the Deputy frequently and, as Minister for Health and Children, I pay tribute to him. I had recent discussions with my counterpart in Northern Ireland, Mr. Sean Woodward, and he is interested in doing something on an all-island basis. Suicide is not unique to us.
My association works with him in Northern Ireland.
I know that.
We thank the Tánaiste for her recent visit.
He had some very good ideas which we hope to pursue. Unfortunately, we will never be able to fully prevent suicide but we can do much more to reach out to those who are vulnerable and to ensure support systems are in place. This is what the new strategy will be concerned with. The shortfall will be made up. I gave a commitment to the Dáil that there would not be a reduction in services. Since the charges were reintroduced on 14 July, the shortfall will be made up.
Some €75 million will be provided.
Something in that order, yes.
I welcome the Tánaiste. It is important that we have these meetings and it is welcome she acknowledges this. I applaud her announcement on HSE accountability, which is important. As someone who served on a health board from 1994 and was chairman of the South Western Area Health Board, I understand the issue. The Tánaiste should understand that we, as Oireachtas Members, have certain concerns in this regard. There are challenges as far as our relationship with the HSE is concerned. One of the gaps in accountability is that we do not have the opportunities we had with the old boards to have "hands on" contact with management teams or to do something. The Tánaiste mentioned her visit to the Central Mental Hospital and I concur with what she said. The health board always made regular committee visits to that institution and others.
A number of times, I raised with the Tánaiste the need to examine local representation on different boards such as hospital boards. Every hospital board would be the same but my experience in Tallaght is that the gap in public representation on the board in question is something that does not give it a local perspective. I have no complaints about people on hospital boards, especially the Tallaght Hospital board. However, there is a need for a local perspective, which local public representatives would fill. There is also a need to examine the prospect of having local meetings with HSE executives. For example, local authorities do so due to the abolition of the dual mandate. The HSE must do likewise.
I will not be too parochial but I find issue with the development of primary care services in my constituency. As the Tánaiste knows, a burned out Shell station has posed as the health centre in Millbrook Lawns in Tallaght for several years. As a local Deputy resident in Tallaght, I am very frustrated about this issue and I would welcome a more positive response from the HSE on the matter.
The Tánaiste rightly referred to the importance of these meetings. The joint committee provides a good forum for different organisations to address us, for example. We had a particularly important meeting on rheumatology services in September 2004, which is the subject of correspondence from the Tánaiste before us today. The organisation in question pointed out to the committee the challenges it faced and the need to develop services. I am supportive of what it is trying to achieve in this regard because it is vital that the organisation competes with other more important interests in the health services, as people would see them.
I welcome the appointment in regard to the Tallaght matter but a consultant is already in place in St. James's Hospital. Listening to the presentation in September obviously referred to in the correspondence, we got a clear sense that there is a need to develop the services and to ensure that rheumatology is given proper resources to provide these services. This is a matter I have pursued in the Dáil since. In light of this correspondence, will the Tánaiste give her attention to the matter?
I wish to refer briefly to Tallaght which the Tánaiste knows as well as I do. She shares my pride in Tallaght Hospital which is seven years old. It is important that we support the development of services in Tallaght. Tallaght Hospital does not just cater for the third largest population centre in the country, namely, Tallaght. Its catchment area stretches to Kildare, Wicklow and Carnew. Therefore, it is a very important institution which provides a tremendous service for the wider community.
Tallaght Hospital has identified a need for an acute medical unit. This is compatible with what the Tánaiste is trying to achieve in respect of accident and emergency services. The Tallaght Hospital board and management team has identified the need for this 38-bed unit which would cost €3 million to build and equip. It would make a significant contribution to dealing with the challenges of accident and emergency. As the Tánaiste is aware, planning permission has been granted but the HSE allocation amounts to half the figure required. I am sensitive about being parochial but the needs of Tallaght are as important as those of any other part of the country. This is a great hospital and I appeal to the Tánaiste to request that the HSE consider this case in a special way. Public money would be well spent, the unit would be tremendous and it would make a huge contribution to addressing the accident and emergency crisis, particularly in the Tallaght region. I ask that this be examined in a special way as the unit could be provided and this would make a tremendous contribution.
I am impressed by what the Tánaiste seeks to achieve. She has had 303 good days in the Department and I wish her continued success.
I also welcome the Tánaiste. It is many years since anything was added to the long-term illness scheme. This is particularly relevant in light of a presentation made last year by the Post Polio Support Group with which every member of the committee was impressed. This is a small, diminishing group of people who have enormous needs. This is a sad situation and we all undertook to support them in their bid to be considered under the long-term illness scheme. I ask the Tánaiste to examine this. Given that it is many years since additions were made to it, what is the future of the long-term illness scheme?
The Tánaiste is enjoying her job. There is a tremendous sense of morale and it was great to hear the positive aspects and the detail of matters we read about in newspapers. The one challenge facing the Tánaiste is the timescale because, as a politician, she is sensitive to the next election. To what extent is that a burden in following through with her plans? If I may be parochial, I met a woman in Glasthule who is delighted that the Tánaiste is the Minister for Health and Children but is worried about the next election. The Tánaiste is described as the only woman who could do the job.
Recently we had a meeting with the person who runs the healthcare and social services in the OECD. He provided us with insight into medical records and the role IT plays in this area. To what extent is IT a priority for the HSE? Much is to be gained and money, time and effort can be saved if one invests in an IT service.
Last week the committee heard a presentation from the Rape Crisis Network, dealing with violence against women in particular. All committee members were impressed by it and the Chairman suggested forming a subgroup which could work across the committees. We heard about the issue from a health perspective but there are also judicial issues involved and these will be considered by the Oireachtas Joint Committee on Justice, Equality, Defence and Women's Rights. Educational issues are also prevalent. We heard that a little more investment would have a significant effect, particularly with regard to children. When violence against women occurs children suffer as a result. We also undertook to make a plea for the rape crisis network, particularly the umbrella group on violence against women, and to petition the Tánaiste and Minister for Health and Children to examine prioritising this area.
I welcome the Tánaiste and Minister for Health and Children. I will start with the appointment and establishment of the representational fora. When that is complete, it should in the main address most of the complaints mechanism of which the Tánaiste spoke. The absence of an appropriate conduit from the caree to the provider of services, as is the case since the abolition of the boards, contributes considerably to the level of complaints. Will those representational fora have the right to visit institutions, not only public institutions but any institution which receives public moneys? They should have a right to carry out such visits and ensure the general public, on whose behalf they act, gets appropriate care.
The Tánaiste spoke of the audit of ten major hospitals. Will she provide us with more information on it?
With regard to care of the elderly, the Tánaiste stated late discharge causes problems for acute hospitals. People are not discharged as soon as they might be due to the fact that appropriate step-down facilities are not available. What models of elderly care have been studied? A number are available, not only in this country but also across the water. If they have not been examined to date, it might be a good idea to do so.
I am pleased to hear entitlement to the card-only scheme will be determined by net income, not gross income. That is a great step forward. It is interesting to note that since the hiatus arose with regard to the illegality of hospital charges, some of the funding traditionally deducted for extra patient comfort has not been paid over and has been pocketed by relatives. I spoke about this before and do so again. I welcome the return of the charges since 14 July. At least the people in those institutions will again get a fair crack of the whip.
With regard to MRSA, the Tánaiste spoke about conducting a hygiene audit and isolation, which is de facto barrier nursing. When I underwent training, the disposal of excreta was always a nursing duty. Is that still the case? As everybody knows excreta is a major source of infection. General cleaning and the appropriate manner of such cleaning may have been undertaken by people who did not do it in the correct way. That contributed to the spread of MRSA. Will the Tánaiste liaise with An Bord Altranais to establish what is the procedure adopted of late?
The increase of incidence of type two diabetes is a cause for serious concern. It affects an increasing number of adults and for the first time also affects children. That is borne out by the report on obesity recently considered. Does the Tánaiste have any proposals to introduce a screening process to establish how this increasing scourge can be stemmed?
What proposals does the Tánaiste have to address the situation pertaining to men's health? The increase in prostate cancer is a concern. As I go about my daily business, I increasingly meet people who have had to have a prostatectomy and not always for the best medical reasons.
I have more than a passing interest in the area of psychiatric services and have always been of the view that hospitals have a role to play in the provision of such services. Hospitals were constructed to treat people and help them to return to the community as soon as possible. Therefore, if the number of hospital beds in the psychiatric service is going down, that is a good thing. However, the community service, while superior to hospital treatment, is more costly. There has been a tendency, under successive Governments, to reduce the amount of capital expenditure on psychiatric services. I ask the Tánaiste to examine this issue because there is evidence that the aforementioned scenario is the reality.
I agree with the Tánaiste's expression of appreciation to Deputy Neville for his work on the issue of suicide. It is an issue I have dealt with for a great many years. We should be examining practices that have been successful in other countries and funding them adequately.
I compliment the sub-committee on orthodontics for the report it has produced. We have a problem regarding training of orthodontists. Information has been forwarded to the Tánaiste regarding the fact that there are training facilities available in Great Britain if funding is provided. Does the Tánaiste have any proposals regarding training for orthodontists?
Does the Tánaiste have any proposals regarding the fast-tracking of capital projects? Such projects seem to go on forever and there must be a better way to bring them to a more speedy conclusion.
Like other members, I welcome the Tánaiste to this meeting. When she mentioned an audit, was she specifically referring to case-mix and analysis? In Sligo General Hospital, for example, a dedicated unit has been involved in this work for the last two or three years.
I welcome the initiative involving the establishment of private hospitals on public hospital grounds. Is it envisaged that such private hospitals would be fully self-contained or would they mainly provide accommodation, minor surgery and the like? I have always been intrigued by the fact that while the provision of operating theatres is hugely expensive, they tend to be used only between the hours of 8 a.m. and 6 p.m., Monday to Friday. Apart from on-call theatres, the remainder tend to lie idle outside the core hours I mentioned. Perhaps new private hospital facilities could buy time in the unused theatres, out-of-hours and at weekends.
I welcome the fact that the Tánaiste is examining the issue of graduate entry to medical schools. I am aware that there are some innovative proposals on her desk including one involving the regional hospitals working in association with third level institutions, as well as some cross-Border initiatives. I ask that she examines those proposals sympathetically.
An issue has been brought to my attention in recent days relating to people who suffer from a disability who have been moved out into accommodation in the community. They pay a certain amount towards their care but in the last week a number have been notified of substantial increases in charges. In one case, the increase was over 100%. I have not had a chance to fully investigate this matter but I wonder if the decision to increase charges was made by the HSE or by the local health authorities.
It was confirmed this week that there are still over 200 people on trolleys in our hospitals. I have tried to assist constituents in gaining admittance to the Mater hospital for coronary care, but there are only 12 beds available nationally. Even Beaumont hospital has major problems in treating people with head injuries, etc. The National Rehabilitation Hospital in Dún Laoghaire has a three to six-month waiting listing for entry.
In light of the terrorist attacks on London two weeks ago, in Turkey this week and previously in Bali, is there an emergency plan here for a similar situation? Does the country have the capability to cope on a medical front with such an atrocity? I hope such an event will never happen but nobody can ever surely know that it will not. In looking at the current scenario within the health services I am not encouraged. I believe the country does not have the capability to deal with a terrorist attack. Can the Tánaiste indicate the plan that is in place, not even in the event of a terrorist attack, but in the case of a major disaster? Could the health services in the Shannon and Dublin regions cope, as these places could be prone to such an event?
I recently met a woman whose husband acquired MRSA. After his discharge from hospital, the woman looked after him at home, with the aid of home help. In looking after the patient, the home help personnel initially took away his waste, such as bandages obviously contaminated with MRSA, in their cars. This was stopped because the personnel needed a licence to carry out such a practice. The woman was told that she had to keep the contaminated waste on her own premises, causing even more problems. Is the Tánaiste aware of the problems facing relatives and people looking after patients at home who have the MRSA superbug, and the problems of disposing of the waste from such patients? This is a massive problem and conflicting advice appears to be coming from the HSE on the issue.
I wish to ask the Tánaiste about the nursing home inspectorate. We were horrified by the recent "Prime Time" programme which showed abuse of patients in a particular nursing home. The Minister of State, Deputy Seán Power, promised at the time to publish a list of 33 nursing homes which received adverse reports from the nursing home inspectors. When will this information be received, as it has not yet been made public? We were also told that the report on the Peter McKenna case would be published at the end of June this year. This has not happened. What are the Department's plans for the nursing home inspectorate? It appears farcical that a nursing home should receive advance notice that it is to be inspected.
The audit for MRSA is so well flagged in advance that the report will be worthless. With every hospital to be inspected being very active in addressing the problem, a true picture will not be evident. Moreover, the audit is taking place in the summer, when hospitals are less crowded and the weather is far better. As this will also distort the picture, I am not sure how much value can be placed on the ensuing report.
Has the issue of appointing full-time cleaners to hospitals, instead of contract cleaners, been examined? Contract cleaners come in perhaps twice a day at fixed hours. This adds to problems. The issue of an isolation room has been touched on by the Tánaiste and I am glad she agrees that it is a major step forward. There is a severe lack in this area.
On 17 June 2005, the secretariat to the Committee of Public Accounts received a letter from Derek Mulligan, private secretary to the Secretary General of the Department of Social Welfare. The letter dealt with the appointment of agents to act on a person's behalf when receiving social welfare payments. In the letter, it is stated that the administrator of the service is normally appointed as an agent. In this case, a special social welfare payment scheme is being discussed. However, this has implications in terms of nursing home charges. On reading the letter, one could assume that the former CEOs of the old health boards were, in effect, agents on behalf of people and were taking social welfare payments from them. This has implications for the issue of liability and making CEOs liable for the illegal gathering of money from people.
I am not sure if the Tánaiste is aware of this letter, but some concern has been expressed by some former CEOs of the old health boards that it indicates they are possibly personally liable for the illegal gathering of money from patients in nursing homes. It raises the issue of corporate versus personal liability. This should be examined because accountability is important in this area.
A variety of questions were asked and I will do my best to reply to them. Deputy O'Connor asked the first set of questions. Tallaght is a national issue and not only a parochial issue.
It is a major national issue.
The Deputy mentioned the burnt out Shell station at Millbrook Lawns, Tallaght, and the lack of GP services in Fettercairn which has a population of 6,500. That is not satisfactory and it is one of the reasons accident and emergency departments are busier than they might be, particularly in comparison to similar population areas in the United Kingdom. Ireland has as many acute hospital beds as the United Kingdom proportionately, even though 17% of its population is over 65 while 11% of ours is over 65. While calls are made for the provision of more beds, it must be ensured we use the available capacity efficiently. That is often forgotten in the rush to sanction more beds.
With regard to acute medical assessment units, there is a Rolls Royce version and the version we require. We must be realistic regarding what is required. The HSE's hospitals office is engaged in a scoping exercise to ascertain what is the requirement in individual hospitals. The intention is to establish acute medical assessment units in Tallaght and Beaumont hospitals. That is part and parcel of the accident and emergency package I made available this year.
I agree with the Deputy's comments on rheumatology. Ireland has 1,960 consultants but we should have 3,600. More consultants are needed as well as fewer non-consultant hospital doctors, as we move to a consultant-led service, particularly if services are to be provided in the regions, of which I am a strong fan. Many patients travel to hospitals in Dublin, Cork and, to a lesser extent, Galway, who could be dealt with in their own region if sufficient consultants were in place. For example, we do not even have a plastic surgeon in the mid-west. A service cannot be provided if nobody is available and not much of a service can be provided by only one consultant. Serious shortages are experienced in the areas of rheumatology and neurology. I refer to the upcoming negotiations on the consultants' contract. New consultants must be employed on a contract more appropriate to 2005, which provides for increased flexibility and places a greater emphasis on research, education and public duty. A range of different options must be put in place. I look forward to those talks which will begin in October and conclude by the end by the year. This contract is urgent for patients and if we want a consultant-led service. That is when the best outcomes are achieved.
Deputy O'Malley mentioned the long-term illness card which is a limited form of the medical card. I have extended the criteria governing medical cards rather than giving every category of patient something. The long-term illness card is allocated on the basis of particular illnesses. It is expensive and, therefore, medical cards are being provided to these patients on the basis of means. However, there is scope within the medical card scheme to grant a card on the basis of hardship. If, for example, diabetes runs in a family, the family can be granted a medical card, notwithstanding its means. Last year, 70,000 medical cards were granted on the basis of hardship. The medical card is more beneficial than the long-term illness card because the latter provides only for medication while the former provides for doctor visits as well, which is important.
Reference was made to the move from a net income as opposed to a gross income for the purposes of the new doctor-only card. This applies also to the traditional card. The net income will apply to both cards, which is fairer, easier to understand and much easier to administer.
Deputy O'Malley also asked about the next election. If I were just worried about the next election, I probably would not be here in the first place. While it is two years away, it is not part of my focus. Much can be done in a week but much more can be done in two years. The aim and determination is that in two years there will be major changes in the delivery of health care in Ireland.
I must be honest in regard to the Rape Crisis Network. I have met those involved but I have not yet been able to assist with their funding requirement. I hope to have discussions with my colleague, the Minister for Justice, Equality and Law Reform and especially the Minister of State, Deputy Fahey, who has responsibility and a keen interest in this area.
On representational fora, the idea is that there will be four regional fora which will meet a number of times a year. While these are to a large extent consultative, I will not be too prescriptive as to what they cannot do. On the other hand, I do not want people to duplicate the work of others. I have an open mind on what they might or might not do. The idea is that public representatives will be consulted and involved in the delivery of health care. While this is the purpose of the fora, I must discuss the matter with the Minister for the Environment, Heritage and Local Government.
On cancer screening programmes, Senator Glynn referred to men's health, with which I agree. The jury is out on screening for prostate cancer. The only two areas in which cancer screening has proved to be successful globally — I am sure this will change — is breast cancer and cervical cancer.
I have made a decision on rolling out BreastCheck to the whole country by 2007. Cervical screening takes place in the mid-west region only. This will be an important item on the agenda for talks with the IMO because much of that screening can be done at GP level for medical card patients. I have spoken on a number of occasions to my medical experts in the Department about screening for prostate cancer. Sometimes I often feel that men's health is ignored in the debate. I raised the issue with my medical experts on a number of occasions and the jury is out internationally on whether screening programmes are appropriate at present in this area.
On psychiatric services, the spend over the period 2006-09 is €900 million, which includes €600 million on revenue and €300 million on capital for disability, including mental health. This is the multi-annual expenditure to which the Government has agreed.
Deputy Devins has asked if the hospitals will be self-contained. I want them to be flexible in regard to the needs in the area. I do not want to be too prescriptive. I envisage that the public system will buy services from the hospitals and vice versa. For example, laboratory services might be sold to a private provider. The Deputy gave the example of the operating theatre. I do not want to re-invent the wheel. The whole purpose of having the services on campus is to have them integrated with the public hospitals, so that one will work for the benefit of the other and it is a win-win situation, particularly for public patients.
I want to see flexibility which may well be the case in the area of sharing theatres. I am a great fan of using as much as possible the available facilities, including scanners. I recently visited the PET scanner in the Blackrock Clinic which cost €2.5 million. Some 70% of patients currently receiving this treatment are public patients. If we buy that kind of equipment, whether for public or private hospitals, the diagnostic facilities must be used as extensively as possible. Having private operators on the ground brings great flexibility to that debate. I hope that will be the case.
The Deputy referred to using hospitals such as Sligo as teaching hospitals. If we are to increase the number of students we must increase the number of teaching facilities. Teaching must be factored into consultants' contracts more, since it is almost an add-on after they do everything else, and that is not a satisfactory way to train and teach our doctors. All that is certainly very much part of the equation.
Someone mentioned orthodontic training. We are examining dentistry and orthodontics. I have someone working on this and hope that by the autumn of this year we will have made some decisions in that regard.
Senator Browne asked about the emergency plan. Of course, there is one. I recently attended a gathering that included the person in charge of dealing with SARS when it broke out in Hong Kong and someone in one of the big hospitals in Manhattan on 11 September 2001. They came here to talk to our emergency team.
I am very optimistic regarding our emergency plans. On a small scale they were put into operation after the recent terrible bus accident in County Meath. The manner in which the hospital system coped was quite remarkable. I was very proud and visited each hospital to thank the staff. In Our Lady of Lourdes Hospital in Drogheda, they were able almost immediately to discharge 27 patients as soon as they heard about the accident, getting their beds ready and calling in staff. The hospital system certainly responded very well. The other wonderful thing was the co-operation with the Northern Ireland Ambulance Service. Our ambulance service in that region was engaged with dealing with the accident and the Northern Ireland authorities came in to take over the regular ambulances. That worked extremely well.
A great deal of work has gone into emergency planning everywhere in Ireland. As I said, we had two visitors whom I was delighted to meet. They came to emergency planning from two different perspectives — an outbreak of SARS and terrorism. We learned a great deal from them and they were impressed by the plans we had in place. However, unfortunately — I say this reluctantly — one can never know whether they work until the tragedy or disaster comes and I hope we never have one. However, I am quite confident that, if one is really seriously ill in Ireland and has an emergency, our system will work well. Where it falls far short of what we are entitled to expect is with routine matters.
I do not know the answer regarding MRSA and home waits and will have to get someone to talk to Senator Browne about the matter. It is a very good question and I simply do not know what correct practice is in that regard. The Senator's question has given me food for thought.
Regarding Leas Cross and Peter McKenna, the report was produced on 6 July and sent to St. Michael's House and any affected parties, including I presume the family of the later Peter McKenna. They were given time to respond and I understand those responses are now with Martin Hynes who drafted the report. I believe his final report is imminent and we intend to publish it.
I do not know about the 33 nursing homes and will ask the HSE about the matter. It was to publish the information. We will follow up on the matter for the Senator. Regarding the letter read by the Senator, perhaps he might make it available to Mr. Smyth. The same applies to Deputy Devins regarding the person whose charges went up 100%. When we were introducing the charges, we were conscious we might be bringing in some people who had perhaps never paid a charge. When one writes regulations, it is hard to get everything right, since we are talking about over 20,000 people. Perhaps the members might bring the circumstances to the attention of Mr. Smyth who is in charge of the area. The same applies regarding the letter and I assure the member that they will be dealt with.
On the social services inspectorate, we will have the legislation ready later this year. The Minister of State, Deputy Power, is working on it. I am optimistic that we will have an appropriate inspectorate for our nursing homes.
Regarding full-time cleaners, I will not micro-manage hospitals from Hawkins House, since that is the hospital managers' job. However, whether the cleaners are on contract or full-time, there is no excuse for places not being cleaned, since we are paying appropriate rates for all those services. The fact they are contract cleaners does not mean they should not have an appropriate level of service in hospitals, whatever that may be.
Is there anything I have neglected to deal with?
Yes, two questions, namely, the increased incidence of type II diabetes and the fast-tracking of capital programmes.
I will take the capital programmes first. The many stages of capital programmes in health, education and other areas of government add years to the timescales involved. It takes eight years from the time of its announcement for a new hospital to admit a patient. For example, the Minister for Finance, Deputy Cowen, when he was Minister for Health and Children, decided in 1999 that radiotherapy should be provided in Galway. The first patient was treated in March this year. That project was smaller than building a new hospital.
This is unsatisfactory and sometimes it is done to prolong the process because there are so many projects under way at one time. We waste a great deal of money on consultants, of whom there are a large number, and many plans. I wish to discuss this with the new chief executive officer of the HSE because we are developing more public private partnership activity.
We need to examine how to make things happen from the capital perspective. There were several layers involved in the past. For example, the hospital, the health board and the Department each had a team. These people are all highly qualified and there is merit in the Senator's comments but while I do not have the answer, it is an issue we need to address.
Diabetes entails hereditary factors, obesity-related issues and lifestyle. One of the major challenges for health care systems globally is managing chronic illness because in the past people died from these illnesses much earlier than they do now. As they continue to live, it is important that they have a high quality of life. Managing those illnesses in the community rather than having people in the acute hospital system is a challenge.
It is an area of concern for primary care in the HSE and I have held some preliminary discussions on that topic. It may be possible to use the facilities used out of hours during the day. These are excellent facilities but they are used only at night. Perhaps during the day they could be centres for managing chronic illness and we could invest more in preventive health care. The Minister of State, Deputy Seán Power, has many ideas on this topic and it might be good for the committee to invite him to discuss preventative strategies.
The Tánaiste this week announced 1,000 extra hospital beds. I realise this will not happen quickly because she must renegotiate the consultants' contract.
The number of acute beds per head of population is the same in the United Kingdom as it is here. We are moving to the point where the Tánaiste will give up to €20 million in taxation to bring these 1,000 beds into the private system. Would it not be more appropriate for the Government to spend its money on moving patients unsuitable for long-term beds into proper long-term care facilities rather than proceeding with its current approach?
It is known in the Dublin hospitals that there are between 400 and 500 patients who would be better placed in either long-term care or step-down facilities. If all those patients were taken out of the acute hospitals and allowance was made for the number of patients on trolleys, there would be 400 empty beds in the Dublin hospitals. For example, in Tralee and Letterkenny there is no problem regarding patients inappropriately held in acute hospital beds because they have good community facilities for nursing home care and also step-down facilities. If we dealt with this aspect of the acute hospital sector in Dublin alone, there would be empty beds here.
The 1,000 beds to which the Tánaiste refers, which will cost €220 million, causing an increase in VHI membership fees over time, will be allocated to Dublin. I presume St. James's, Tallaght and Beaumont hospitals are three of the public hospitals that will want to build private hospitals on the other side of their car parks. This was regarded as bad policy 20 years ago. What has changed in the meantime? The consultants' contract would need to be renegotiated to make this work properly. While the Tánaiste claims that she is adding 1,000 private beds to the system, I believed 1,000 beds were actually coming out of the public hospital system. I would have thought this required renegotiations with the consultants as they have a right to 20% of public beds for their private practices in public hospitals. I disagree with the Tánaiste on that point and I want to hear her explanation in respect of it.
The Tánaiste claims that revenue lost to public hospitals will amount to €145 million out of a total of €220 million. This means that for 40% of the private beds to be transferred, the hospitals will lose some 66% of the revenue they receive. This is a high cost to them and to private health insurance subscribers. Private medical procedures will be moved out of public hospitals. It will not be the private patients with chronic or complicated medical problems who will be affected. In some respects, this is what cherry-picking is all about. While I have no major problem with this, it must be made clear that the hospital part of private medicine is being moved out of public hospitals, without renegotiating the consultants' contract.
It was claimed in the Tánaiste's press release that this was not compensation for the consultants. It does not appear as compensation but as a windfall for the consultants because they will be able to earn more in private practices on the grounds of public hospitals. Much of the debate centres on this being bad for the overall delivery of health care. It is argued that consultants may discover it is easier to make money from private rather than public practice. I want a debate on whether we should separate private medicine from the public system. The idea of tagging private medicine to the public system means that taxpayers and private health insurance subscribers lose out. Those who pay for private health insurance — half the population — are also taxpayers. They are also paying the highest per capita rates in Europe to maintain a public health system. Gross inefficiencies must exist in the health system. This scheme will tag a new form of private service to an inefficient public service.
The Tánaiste may refer to the national treatment purchase fund to justify this. However, the fund only has a budget of €60 million out of the total health budget of €12 billion. One cannot super-size the example of the national treatment purchase fund, expecting it to work perfectly for the rest of the health care system. The fund does not even give breakdowns of operation costs or what it does. Although it is now looking after waiting lists, it does not matter if 27,000 people or 24,000 people are on waiting lists. What is of concern is the length of time people must wait to see consultants or, when their general practitioners write letters of referral, to have their operations carried out. In the south east, the waiting lists for dermatology, ear and throat and orthopaedic treatment are two, three and four years, respectively. I am sure it is a great bonus to those people affected that, having waited four and a half years just to get that far, they can go on the national treatment purchase fund after six months.
These are the weaknesses in the health system I want to see addressed. We must have a more open debate on what will happen to the 1,000 new beds coming into the system. In the long term, they could cost large amounts for the taxpayer and the person paying for private health insurance. On an individual basis, we pay the highest for health care but no action has been taken to reform this. I would have thought the Tánaiste, having previously served in the Department of Enterprise, Trade and Employment, would have looked for a more competitive approach and a separation of both roles.
One gets a very competitive rate from the Beacon Clinic for treating renal dialysis patients because it is a stand-alone hospital and must show its costs for each procedure. It is fine for the Tánaiste to say the Department is currently getting only 60% of the costs of an acute bed in the public hospital from the private health insurers, but how can she know this? To the best of my knowledge, we do not know the cost of acute beds in our public hospitals. We do not have the IT facilities or the analysis of what each bed costs in our public hospitals, or if we do, it is very difficult to get such information, apart from the fact that different rates are charged to private insurance companies. That is the only information we currently have. We should have more clarity in order that people will know what they are getting into. This is a policy change which could affect the health services in five or ten years' time. We could find that it is costing us a fortune and make another U-turn in five to ten years' time simply because we did not look into the issue as closely as we now should.
Though the Government has published a strategy on primary health care, it is an area which it has greatly neglected. There has been little or no investment in primary health care. The only thing I have heard from the Tánaiste on the subject which is any way realistic is her statement that the Department must bring in foreign GPs to run our GP services. She is finally acknowledging the manpower crisis in general practice. Because in four years we have not moved ahead regarding graduate entry medical school, we have allowed more places in our universities to be taken up by foreign graduates as we need the money for our third level institutions.
We are now reaching a stage where up to 40% of GPs could retire within the next ten years. Some of them want to retire sooner because they find the current burden too much. This issue cropped up in the Tánaiste's consultation with the IMO. The IMO committee may not have said as much to the Tánaiste, but the feedback I get from GPs is that they already feel their workload is becoming a little burdensome. They are not so sure that if the Tánaiste continues down the road she is taking that things will work out.
What serious plans does the Tánaiste have for correcting the manpower problem in general practice? What does she mean when she says she will bring in foreign doctors? We have large numbers of South African doctors working in this country. Most of them do the red-eye shift, from midnight to 8 a.m. in our GP out-of-hours co-ops. However, those doctors are not recognised in this country if they wish to apply for a GMS listing or to register as working permanently here in the public health care system. Individual doctors from South Africa have been in discussion with the Department of Health and Children and they have received nothing to indicate a positive approach by the Department in this regard.
I am not sure this recruitment plan to deal with the manpower crisis is a good idea — though it might be cheap — because general practice prides itself on being a holistic service in which doctors understand their communities and the people. In the same way as an Irish doctor would have difficulty with cultural issues in eastern Europe or India, for example, the doctors being brought in by the Tánaiste to run primary care will run into similar difficulties of understanding the communities with which they work.
The Tánaiste also needs to be clearer on her plans for primary care because we have heard nothing positive on the matter from the Government in the past four years since the primary care strategy was published. We still have fewer than ten primary care centres out of a total of 600 promised.
We need to be more realistic regarding waiting lists. Some Dublin hospitals find it very difficult to even do elective work. Though much of the focus is currently on the crisis in accident and emergency units and the numbers of patients on trolleys, many of the public hospitals have difficulty in carrying out significant elective work. Nothing innovative has come from the Department in terms of dealing with that issue.
Mention was made earlier about an arrangement with the new private hospitals whereby their theatre space could be used to carry out operations when the public hospitals are busy. In reality, theatres in many of the public hospitals are not working at all because the post-operative beds are already occupied by people admitted the previous night to accident and emergency units.
A significant number of consultants and nurses are not working. It is called a long breakfast. I am sure the Tánaiste will hear about it if she goes looking for it.
Regarding MRSA, we would be lucky to have a report on the issue in this country by 2009, even though the United Kingdom aims to halve the occurrence by then. We have made no serious attempts. When this issue was first raised, I asked the Tánaiste who was responsible for cleanliness and hygiene in hospitals. It is ridiculous having an audit. The feedback I am getting from hospitals is that the only good thing about it is that for some strange reason cleaning activity is up 100% in the month of July. It can only be due to the fact that they know they will be audited. The Tánaiste should formulate a longer term plan. She does not need another report. We have more than enough reports on the health service. We must ask who is responsible for cleaning in each hospital on each ward and on each floor.
The Tánaiste is getting the same reports as I am. Patients have said the state of public toilet facilities on wards in some hospitals, not to mind accident and emergency departments, is a disgrace. It has been said these toilets are only being cleaned once a day and as a result the level of hygiene deteriorates during the day unless patients' families go to the trouble of cleaning them themselves. That is a Third World attitude to hospital cleanliness. There is no need for fancy audits and reports; it is just a case of making somebody responsible. If a ward sister says a toilet or kitchen is filthy, somebody should be responsible for doing the job. That is all it takes to solve the problem.
Another proposal I put to the Tánaiste which she made little of was that a flying squad should visit hospitals unannounced because that is what would make things work, not the giving of three or four days notice — or two months notice in this case — to people that they will be checked. One might say it would make no difference if somebody were to turn up to check the level of hygiene and take swab tests around hospitals unless they were going to clean them, but people can be embarrassed into having a level of respect and responsibility for what their job entails. That is the line we should take on this matter; we should not be commissioning more reports.
Regarding the illegal nursing home charges and the refunds that will be made to patients, there appears to be an inordinate delay. I do not know if that is just a stalling tactic. Who will be responsible for it when all this money goes back to patients in nursing homes? I am not certain what amount of funds were held by the former health boards and public nursing homes on behalf of patients but it could mushroom to €500 million in the next two years. Has the Tánaiste examined the matter or at other ways of dealing with this money? If significant amounts of money are involved we would need far tighter accountancy and far greater transparency once it is transferred to the accounts of patients. Not all the money will be going to the estates of deceased patients; much of it will go to people who are still alive.
I do not agree with the Tánaiste's views on screening. This could be a significant aspect of the health service in the future. The problem with screening worldwide is that it is not given due consideration. Primary care is a far more preventive type of service than the acute hospital sector. Significant resources have been invested in the acute hospital sector. We have poured millions of euro of taxpayers' money into the acute hospital sector in the past seven or eight years but we have barely made any investment in primary care apart from pay awards which in any case went to all public servants. We have done nothing in terms of infrastructure or investment that would improve primary care.
As someone who works as a general practitioner, I have seen this change in the past ten years. Doctors are no longer carrying out minor surgical procedures; it is all being done in outpatient departments in hospitals, which is far more costly to the taxpayer in the long term. Blood tests are no longer being carried out in general practice. GPs cannot get funding to carry out warfarin testing on their patients, even though many of these patients are elderly and immobile, yet millions of euro are being given to hospitals to set up dedicated clinics just to deal with warfarin blood testing.
This illustrates the ethos at departmental level and perhaps also at Government level. The focus is on the acute hospital sector, the most expensive part of the service. The Minister does not appear to put any great emphasis on the more preventative approach of primary care. I can see why she dismisses screening so easily, because in some respects she does not know what is happening in primary care.
I would like the Minister's comments on the EU working time directive. There are two more years before the directive is fully implemented in Ireland. What are the hopes of that being achieved within the stipulated deadline?
The fluoride issue should also be reviewed by the Minister. I am aware that her Department has a report on fluoridation. She might say it is comprehensive. This subject crops up regularly in the media, but I have difficulty in understanding why none of the local authorities in Northern Ireland and in most of Europe put fluoride in their public water systems, yet we continue to do so. We are not so different from Northern Ireland or the rest of Europe as regards oral hygiene and the manner in which people care for their teeth to be able to justify this practice.
The Tánaiste should take a more in-depth approach to the issue and, perhaps, ask the report's authors to make that comparison for her. It was significant that 100 dentists recently made a press statement to the effect that they were seeing the effects of excess fluoride in teeth, which causes specific problems. If this trend is showing up in teeth, it might also be a significant cause of systemic illness in livers and kidneys and could be a ticking timebomb that will have to be dealt with in 15 or 20 years. This issue should now be reviewed. I may be wrong in this, but I am concerned that our norms in this regard are contrary to what is being practised in the rest of Europe. This justifies the situation again being reviewed.
I would like to hear more about the Minister's approach to the private beds issue and why this is being done when the United Kingdom has the same number of beds. Why is the funding not being focused towards building up community nursing homes or step-down facilities in the greater Dublin region?
I welcome the Tánaiste and thank her for coming before the committee this afternoon and for being so patient, as she is covering a wide range of issues.
I will be brief, because some of the questions I wanted to ask have already been answered by the Minister. On the question of MRSA, as the Chairman says, the committee is to meet some of the sufferers, their families and associated groups, next October. I am struck, from talking to people in Sligo, particularly at funerals, that there is no public awareness of the issue. In general, people do not know what to say. Therefore, they are not talking about MRSA. Many of those who are talking cannot know what they are talking about unless they have suffered from it. One lady told me she had stopped going to Mass, because the priests should be warning congregations not to give the sign of peace as people should not be shaking hands. I laughed and said that was ridiculous as I did not believe people were thinking like that. There are billboards for all types of advertising and awareness campaigns. Perhaps the Minister might consider a national awareness programme. It strikes me that people appear to be going off on tangents when the situation might not be quite as bad as the public makes it out to be.
With regard to the long awaited medical practitioners' Bill, as someone who sat on the last Medical Council, it was an issue with which I was very familiar six years ago. There has been an expectation of new legislation for several years. The Medical Council has no remit over doctors who come to Ireland from outside the State and who are not on council's register. These doctors are not answerable to anybody.
I stand to be corrected on this but even the Department refers such cases to the Medical Council, yet the hands of the council are tied and it cannot do anything. In the past some of these doctors have come from countries where they had been struck off the register for unprofessional misconduct, possibly in cases where patients had been harmed. That is one reason for urging that the proposed legislation should be introduced quickly.
There is also the question of competence assurance. No competence assurance structures, as such, are in place in this State. How is a doctor's competence to be measure without audits by clinicians?
I also want to raise something that Deputy Fiona O'Malley has brought up with the Minister. I am glad to see that the gallery is full of journalists. When we met the women's refuge and support groups a week ago and the Rape Crisis Centres, there were no journalists in the Visitors Gallery. That is not to say they were not watching proceedings on the monitors. However, everyone who was here that morning spoke about how taken they were with the two hours spent with the women. We were sorry that there were no journalists in the Visitors Gallery to report on the meeting. As a result, through the Chairman, the committee issued its own press release that day.
Like Deputy Fiona O'Malley, I also suggest that perhaps the Department of Health and Children might be the pioneer in this regard. Six Departments are involved, namely, Education and Science; Justice, Equality and Law Reform; Social and Family Affairs; Community, Rural and Gaeltacht Affairs; Finance; and Health and Children. The women told the committee that since the remit had spread over such a wide range of Departments it was difficult to tie down any individual Department. They badly need funding right across the board.
The committee only examined the area of a woman's health and that of her children. The health and wellbeing of hundreds of children are being affected by lack of funding. It came across that the women who were affected were very brave. I thought it very sad that a woman might telephone a 999 number at night when there was no refuge in the town in which she lived. She could be brought 60 to 80 miles, while the abuser was left in the house. It is bad that such a woman and her children are taken out of the home environment because of something they did not do.
From sitting on the Medical Council I am aware that the whole area of graduate entry for medicine is nothing new. That debate has been going on for a long time. It is the norm in other countries such as Canada, the United States and Australia. The Royal College of Surgeons in Ireland has entered into the debate in the past five years and has done a good deal of work in the area. The Tánaiste should now end the debate and move matters on. Graduate entry would help, in many areas, particularly given the severe pressure on medical manpower levels. It would help significantly as regards the whole area of medical manpower.
I welcome the Tánaiste. Deputy Fiona O'Malley asked me to apologise on her behalf, as she had to attend another meeting.
I have one or two brief questions for the Minister. Does the Department or the HSE know and are the records regularly updated as regards the number of empty beds in the public service? I am not just talking about acute beds, but step-down and nursing home beds also. Are the figures updated on a 24-hourly or weekly basis?
One of the problems we face in Dublin, particularly on the north side of the city, is the provision of premises for primary care. If a doctor has to provide the premises, most centres he or she might rent or try to buy are well out of financial reach. The old health boards provided grants towards upgrading premises and equipment but simply to locate, rent and staff them is now going beyond the means of GPs. The financing of primary care units will be one of the areas of greatest need.
I welcome the Tánaiste and her officials. I wish her well in this most difficult Ministry. She was very courageous to take on the task. There is a democratic deficit since the demise of the health boards. There is no forum for public representatives or others to enter into a debate with the HSE. Will the Tánaiste get these up and running by the autumn? It is now over a year since the health boards were abolished. It is very difficult for public representatives, especially local councillors, to get information on services. I also note that the Chairman's job will be broadened and he may be engaged almost full-time in this task. There are so many queries to be raised about the health services between now and the next election.
Last year, money was approved for about 40 staff in Roscommon County Hospital, yet nothing has been done. Are people dragging their feet simply to cause political embarrassment to the Government? I am tired of this situation——
The Senator should not mention politics.
I am sick and tired of this situation arising. The Taoiseach opened an €8 million accident and emergency department in the hospital last February, yet the nine observation beds involved lie empty. Then we get publicity about more people on trolleys. It is always about people on trolleys and we never hear when nobody is on trolleys. I would love to read a story about nobody lying on a trolley in Roscommon County Hospital. Why are they dragging their feet in the HSE about these beds?
There is a lack of leadership in the HSE on this issue. It is impossible to get information and I ask the Tánaiste to intervene to get that place up and running. I cannot understand, when the money was approved last autumn, why the staff have still not been employed and the beds are still idle in an €8 million accident and emergency department.
If the Tánaiste wants to provide plans, she should do what Charles Haughey when he took the plans for Cork and got Beaumont Hospital built. He had the hospital up and running very quickly. That was the situation in which he found himself in 1977.
I only wish I could come in here and not give a sad story every time. There are so many stories.
We have heard so many good stories today from the Tánaiste.
A man is in Mayo General Hospital and has been waiting for the last two weeks. He is bleeding to death through his prostate gland. He obviously has cancer but it has not been diagnosed yet. He was seen in July 2004 by the urologist in UCHG and was supposed to be called back within six months. His daughter got an appointment for him for next October, which is much more than six months. That man is bleeding to death in Mayo General Hospital. He cannot get a bed in UCHG. He would have waited years to be seen in the first place. There are ten new patients seen in County Mayo each month, as well as ten existing patients. People wait for four to five years to have a first appointment. If it is urgent, like suspected cancer, they may have to wait one year. That man will probably not make it because of the Irish health service and I know many more like him.
I can give the Tánaiste the names of people who died because there was no service for them. However, there is a service for people with money as they can buy health insurance. This man is not getting a fair deal under our Constitution. I am very sad about that and I am sorry to tell this story to the Tánaiste, but that is the reality. His daughter spoke to me by telephone and asked me to do something. I told her that I was going in to talk to the Minister and I would tell her——
I would have thought that such an issue would be discussed in private with the Tánaiste. Every time I chair a meeting, the Deputy raises an issue that is headline grabbing. We are having a three hour meeting with the Tánaiste. We ask her to come here every three months. She has outlined major reforms which we have been examining since we commenced this meeting at 2 p.m.
I was watching on the monitor.
I am sorry but I wish to make a point. We spent months here wondering what would happen to the HSE and we have now been told. We have been advised about the new scrutiny within the HSE. We have been advised about the home care packages and the extra 1,000 beds. As soon as progress has been made by the Government and by the Tánaiste, we hear about individual cases. I have every sympathy for the case made by the Deputy. However, if he was taking it seriously, he should have discussed it privately with the Tánaiste. I want to deal with the global issues to resolve the difficulties within the health service and not individual cases, as important as they may be. I want to move on——
I want to move on also.
I have questions to put to the Tánaiste on the global issues surrounding her Department.
I am very concerned about this individual. My concern is that the Tánaiste is not addressing the situation.
I believe she is. This is not the forum to discuss——
Why does the system have to favour someone who wants to make money?
The Deputy can discuss this——
Why can we not put the money into the system to ensure that urologists are appointed to Mayo General Hospital? If you give a man a fish, you feed him for a day, teach him to fish and you feed him for life. The reality is that the Tánaiste will not address this situation.
In September, the Tánaiste made a commitment to meet this committee to debate the overall context of resolving problems in the health services by extra funding, extra beds and extra services.
My story is the reality of the situation and I want something done about it.
We will deal with that later. It is most improper to refer to the story now.
It is not improper to talk about the reality of what is happening on the ground.
I am sure the Tánaiste will be available to listen to the Deputy afterwards.
What will medical assessment units do? They are not the answer. We have had one in Mayo General Hospital for years under Dr. John Murphy. We have problems in the hospital because we do not have enough beds.
Did the Deputy hear about the roll-out of new beds? How does he feel about it?
It will cost more. The money should be allocated to provide the beds in Mayo General Hospital, rather than facilitating the private sector.
Would the Deputy prefer to wait?
I would prefer if the money was put into the public health service. I would prefer if the money was allocated to ensure that there was an adequate number of ambulance bases in this country. The Western Health Board is unique as it has two areas outside the internationally accepted distance from an ambulance base. These areas are Mulranny in Achill and Castlerea in County Roscommon.
Can we have a question on the national issue?
What is the Tánaiste doing about this? What is she doing about helicopter emergency medical services to ensure people in urgent need of treatment receive it? People have died due to the lack of such a service.
There is a major problem with the registry of births, deaths and marriages which is being squeezed out. The Department must look into the problem. I will not waste the committee's time by speaking on the matter further but ask the Tánaiste to follow up on it.
Is the Tánaiste aware of what is happening under the Seveso directive given that a factory blew up in Italy some years ago? The directive which is law in this country relates to the danger of toxic chemicals causing long-term ill-effects such as in the case of the Rossport pipeline. Has the Tánaiste put a plan into action to deal with the issue? She has spoken about emergency plans and how they work but there is no plan in place to deal with this situation. Does she think existing emergency plans will be able to do so? No planning permission was received for the pipeline which is not recognised in Europe. Hydrogen sulphate is a dangerous chemical.
If the Deputy wishes me to arrange a meeting for him only, I will do so at a later date. However, it will not happen today. He can raise the issue in other fora. I am going to move matters on.
Is the Tánaiste aware of this dangerous situation? These are crucial issues.
There are other members who wish to table questions to the Tánaiste and they should have the opportunity.
I will be glad to hear the answers to those questions.
We had a great chance at 2 p.m., but, unfortunately, the Deputy did not avail of it.
I very much enjoyed that exchange. I am delighted that there are so many members here at the committee and so much interest in health reform.
I will start by addressing the issues raised by Deputy Cowley. If money could have solved our health problems, we would not be having this discussion. We spent €12 billion and are extremely lucky that this economy is successful enough to provide such resources. We spend €3,000per capita on health care in Ireland, €1,000 more per capita than in Northern Ireland or the United Kingdom.
Such spending is only occurring now.
Simply spending money does not solve the problems. The problems identified will continue and magnify unless investment is accompanied by serious reform. That is why reform is part of the focus.
The Tánaiste must be given an opportunity to answer.
My hospital bed initiative is about taking private beds out of public hospitals in order that there will be more beds for the patients to which Deputy Cowley refers. There are more than 100 private beds in University Hospital Galway. I do not understand how so many have a philosophical objection to decanting these beds into the private sector in order that public patients can have access to them. That is what my initiative is about.
It will not happen in County Mayo.
It will not happen overnight. If I do not take this initiative, it will not happen in two or three years either.
It will happen before the next general election.
Deputy Twomey's attitude is extraordinary. I have answered questions in the Dáil from him and other spokespersons who have hounded me on the issue of the 3,000 beds. They wanted to know where they were and how I proposed to provide them. However, they suddenly take the view today that we have enough beds and that the issue is no longer about more beds but about dealing with the elderly.
It is the Minister who said it.
I said we have the same number of beds, or actually more, for the size of our population as the United Kingdom, even though only 11% of our population are aged 65 years or older compared to 17% in the United Kingdom. There are capacity problems and constraints throughout the country.
A group comprised of individuals and medics from Waterford was one of the first to come to see me about a private initiative on public hospital grounds. As part of their contract, they will cover any new beds which will become private in the hospital. They will also cover any beds vacated. The same has been said to me by doctors in Blanchardstown who had a proposal on my desk by close of business yesterday. They said that if they could have 200 beds on their campus, they would have 50 step-down beds which would be covered by their geriatricians as part of hospital's operation. They did not want any more money or geriatricians to cover them.
This is the reality of what is happening. I want to have the common contract renegotiated for many reasons because it is not realistic in terms of our medical needs in 2005. We need full-time doctors to work in the public sector and a greater recognition of research and education, among many other issues. Therefore, the contract must be renegotiated as a matter of urgency. However, under a category 1 contract, a doctor can practise public and private medicine on-site. These beds will be on-site. The big advantage is that the private beds will be provided privately and vacated beds will be converted to public beds. I genuinely believe this is quickest, less expensive and most efficient way to provide more public beds in the health care system. They will not cost €220 million, unless it is a question of 100% equity. However, I do not think that will be the case. It will probably be part equity and part borrowings and the HSE must assess whether to grant approval for a particular hospital to take this route. It must ascertain the overall cost, including tax allowances which are a cost to the Exchequer.
Deputy Cowley made a very valid point with regard to the elderly in Dublin where there is a serious problem regarding late discharges. We cannot have a situation whereby the only way one can access support for an elderly person in the community is through the acute hospital system. I had a very long meeting yesterday evening with the HSE about this matter which is a priority for us. We must deal with it on an urgent basis because it is not satisfactory that people are in the acute hospital system. I am not merely referring to the cost element and what it does to accident and emergency services. From an individual patient's perspective, one should not be in an acute hospital unless necessary. I recently attended a World Health Assembly meeting in Geneva and was very taken with a lecture given by the chief medical officer in the United Kingdom, Sir Liam Donaldson, who is leading a global alliance on patient safety. He said there was a one in 3 million chance of dying in a plane crash in the United States but a one in 300 chance of dying from medical error in hospital. Therefore, we should only be in hospital when we need to be.
There is a host of reasons for providing alternatives for the elderly. As I said, in January this year the Minister for Social and Family Affairs, Deputy Brennan, and I put a group of officials together, chaired by Ms Mary Doyle, assistant secretary at the Department of the Taoiseach. The group is about to report to us on options for the elderly in our society. We must deal with our ageing society as a serious policy issue.
There is also much confusion about the various reports. In the former health board regime there was one type of service in one part of the country and something very different in another. The new unified system provides for unified supports. I am strong fan of more supports being provided for community-based care rather than institutional-based care. Sometimes we do it the other way round whereby one receives a particular service in an institution setting but less at home. That is not good.
I cannot understand how the doctors mentioned by Deputy Cowley can provide cover out of hours on the north side of Dublin between 6 p.m. and 8 a.m. or 9 a.m. and at weekends but cannot be GPs during the day. That does not make sense. The registration of doctors is a matter for the Medical Council, not me. I intend to hold discussions with the council with regard to recognising those who qualify elsewhere. We must take a liberal approach to the issue as I did in my last job in respect of immigrant labour. We would not have sustained economic success if we had taken a prescriptive narrow approach to the issue. If a person qualifies in South Africa or the USA, we must be open enough to say he or she is suitably qualified to come and work in our health care system. A case was recently brought to my attention of a leading hand surgeon in the United States who wanted to come and work in Ireland. Apparently, he was told he would have to train for two years in Ireland before he would be able to practise here. This sounds ridiculous, although I have not yet investigated the specific case as it was only brought to my attention last weekend. We cannot have such an attitude when there is a shortage of doctors.
I acknowledge that there is a shortage emerging. It takes at least ten years to produce a general practitioner. If the shortage is beginning to emerge, what will the situation be like in ten years? We plan to seriously ramp up an increase in the number of medical students from Ireland and the European Union taken into our medical schools next year. This is a matter for me and the Minister for Education and Science. I await the Fottrell report but we will take action in advance of it. I am referring to the academic year starting in 2006, not 2005, because the CAO process is complete and the supports are not in place. We now have more nurses for our population than anywhere else in the developed world. However, we have a major shortage of doctors. We have done much regarding the education of nurses and must now do much in respect of the education of doctors.
People are sceptical about the audit. I am not an expert on how a hospital should be. I understand basic cleanliness, but it is not simply a case of whether the floors, windows and toilets are clean. It is about going right through a hospital, not just the public areas, to ensure everything operates to the highest possible standards. The auditors, who were selected by a public procurement process, have done this work internationally and have the expertise. It will not be a once-off audit.
I wish to inform Senator Feeney that there will be an ongoing campaign, including a public awareness campaign regarding MRSA. We have a long way to go to inform the public in respect of this issue. Public pressure can also help to make the right thing happen. Although one of our national advisers or experts in this area has stated that the most effective thing that can be done is hand washing, it seems to be the exception rather than the norm.
The audit will be useful. Its purpose is not to produce another report but to give us data to put things right. I am not a fan of reports or strategies as the easiest thing to do is to produce something on a piece of paper. Frequently, the hardest thing to do is to find the resources to implement it. The intention is not to put something on a piece of paper that might look good but to give us baseline data to show what must be done in each individual hospital setting to have it operate to best international practice. The countries we must emulate are the Netherlands and those in Scandinavia, which are the best in their class as far as hygiene and infection control are concerned.
In respect of the repayments issue, the legislation to be published later this year will provide for individuals to have their own accounts. The Deputy is correct that practices differ widely. I have been informed by some nursing homes and by staff in some institutional settings that visits from family or connected individuals to elderly people have increased in many instances since this controversy arose. In some cases, visitors have arrived who were never known to exist before. That worries me. I hope this is exceptional, but even if this is the case, old people depend on the State to look after them and are entitled to depend on me and my Department to ensure the legislation protects their money for their use while they are alive. It is a matter for them and not for me to decide where the money goes afterwards.
In respect of the question of fluoride in water, I do not know if Deputy Twomey is preparing for a deal with the Green Party, but I am a strong environmentalist. I once held a portfolio in the Department of the Environment, Heritage and Local Government. Some dentists have stated that fluoridation is bad but the Dental Council and the dental profession here strongly support it, as does the World Health Organisation. If that has changed, it has only done so in the last few weeks, because I informed myself of these matters approximately one month or six weeks ago, when Deputy Gormley raised the issue with me. I took home some material to read and that was the international advice and the advice from our own professionals. However, I accept that a growing number of people take a different view. Like many areas of health care, it is not a black and white issue but has shades of grey. However, if the Government thought for one moment that fluoridation did not have a positive effect, clearly it would do the right thing.
On primary care, it is not correct to state the Government has done nothing. It has doubled the amount of money spent on the general medical service since 1998. That is a fact, even though Deputy Twomey keeps telling me the number of medical cards has decreased by 100,000. However, we have doubled the amount going to general practitioners. This does not include the drugs bill. Hence, the colleagues of Deputies Twomey and Cowley get double the amount they received in 1998 from the public purse through the general medical service at a time when the number of cards has decreased. I am not making an issue of this but am simply stating it as a fact. I will not sit here and concur that nothing has been done in respect of primary care. That is an important element of primary care. I accept the primary care strategy cannot be implemented using public money because we do not have the resources. I understand that €1 billion is required for capital expenditure and the strategy would have ongoing revenue implications to the tune of a couple of hundred million euro per annum.
Perhaps the billions given away by Ray Burke in 1987, or in 1992, when the Taoiseach was Minister for Finance——
We want to use innovative methods and this is a priority for the HSE——
Billions were given away before we even got them.
I have had some discussions with Professor Drumm. As the joint committee is aware, it is his intention to bring an adviser in the primary care area on board. Developments at primary care level are an important part of the reform agenda.
Deputy Fitzpatrick asked about empty beds. Yes, we know about the empty beds in the public system. Contrary to a press statement issued by the Irish Nurses Organisation yesterday, there are not 481 vacant beds in the acute hospital system. Unfortunately, this sort of assertion is aired as fact when someone is prepared to issue a piece of paper. The HSE has corrected this. I do not know what has happened in County Roscommon, but I will check and reply to Senator Leyden, if that is in order.
Perhaps we can discuss the individual case mentioned by Deputy Cowley privately.
I thank the Minister.
I am unsure whether I have dealt with everything.
What about the European working time directive?
It is being implemented by 2009. We are down to 58 hours and must reduce this to 48 hours by 2009, which is under way. The working time directive is a factor but as we move to consultant-led services, we badly need more consultants. I would like to see the renegotiation of the contract in order that we can have more full-time public consultants. We will achieve the best results in the public hospital system if we have more full-time consultants and I am strongly in favour of that. I hope we can make it happen.
The proposed medical practitioners Bill is due later this year. That is the intention and I hope we can keep to that timeframe, despite the fact that so many Bills are in train. The issue of competence assurance is important. Senator Feeney has much expertise in this area as she served on the Medical Council and chaired its ethics committee, but the legislation is seriously out of date. It is an important area. It is now easy to open a hospital and perform procedures and we must have appropriate regulation of professionals. It is a self-regulated profession, albeit under statutory supervision, but the council must be given proactive powers to intervene. In the interests of patient safety, this is extremely important. I hope I have answered——
What about the consultative councils?
I have dealt with that issue. They will be up and running in the autumn.
Is that definite?
Yes. Of course, the HSE will come before this joint committee. Although it is not for me to tell the joint committee what to do, it would a good thing for it to meet the new CEO early in the autumn session. He will start his job in three or four weeks' time and I know he is anxious to engage with the joint committee. It would be a good idea to meet him early.
I thank the Tánaiste who has given three hours to the joint committee. We have invited Professor Drumm to appear before the joint committee in the next session, as soon as he has taken up his appointment. I thank the Tánaiste for going through all the questions posed. From my perspective, she is in control and on top of her brief. The only fear from some quarters is about her meeting all her commitments and promises within the two year period. I look forward to this and I am sure she will do so. I ask members to remain to conduct some ordinary business.
The joint committee went into private session at 4.40 p.m. and adjourned at 4.50 p.m. until 10.30 a.m. on Thursday, 21 July 2005.
