I welcome the representatives of the Cystic Fibrosis Association of Ireland. Perhaps Mr. Fletcher, who is making the presentation, will introduce his colleagues.
Cystic Fibrosis Services: Presentation by Cystic Fibrosis Association.
Mr. Godfrey Fletcher
I am accompanied by: Dr. Charles Gallagher, chairperson of our medical and scientific council; Ms Mary Lane Heneghan, chairperson of the association; Mr. Rory Tallon, who has cystic fibrosis and sits on our national executive committee; and Mr. Carl Rainey, vice-chairperson of the association. I am CEO of the association.
The Cystic Fibrosis Association of Ireland thanks the committee for the opportunity to present feedback on the progress made since our last meeting 16 months ago. At that meeting we asked for the support of the committee to implement the recommendations of the Pollack report so cystic fibrosis or CF services across the country could be brought up to internationally acceptable standards. In the 16 months we have made some advances and we thank all those who assisted in that progress. However, it has taken 16 months; wheels turn slowly.
In our last presentation, we requested that between €9 million and €10 million per annum in additional ongoing funding be provided for new medical posts across all the major CF centres. This would bring Ireland up to a minimum international specialist staffing requirement for CF care. CF was allocated €4.78 million in the Estimates for 2006 and a further €2 million in the Estimates for 2007. We hope the balance of the funding, approximately €3 million, will be made available in the Estimates for 2008.
Early in 2006, the HSE working group identified approximately 56 critically-needed medical posts to be specifically ring-fenced for CF services and to be filled from the allocated €4.78 million. In July and August 2006, the HSE network managers wrote to the respective hospitals and informed them of their allocations for CF care as a direct result of the 2006 budget. These letters, however, contained two caveats. We have established that all the hospitals were informed by the HSE that in order to implement the CF development plan, each hospital must achieve financial break even for the year and comply with the staff ceiling controls. As everybody knows, this is virtually impossible. We are led to believe that this diktat comes directly from the Department of Finance, through the Department of Health and Children, to the HSE. This entire process needs some new proactive thinking and we appeal to the committee for assistance in solving this issue. If ongoing funding is released by the Department of Finance to the Department of Health and Children, which in turn releases it to the HSE for specific predefined projects, then surely there should be no caveats attached. These delays cause immense frustration to the HSE, hospital administrators, medical personnel and particularly the patients.
Provided the staffing issue can be resolved, our remaining key issue is the provision of internationally acceptable facilities for regional CF centres of excellence, particularly those involved in the provision of care to adults with cystic fibrosis. Our cystic fibrosis population is thankfully aging and increasing numbers are making the transition from paediatric to adult care. Our adult CF units cannot cater for the increasing patient loads and cannot provide the isolation facilities necessary to care safely for patients with cystic fibrosis. There is an urgent requirement for specialist multidisciplinary CF units across the country. Our goal for 2007 would be to see the approval of, and the construction timelines for, new dedicated CF facilities at St. Vincent's University Hospital, Cork University Hospital and University Hospital Galway. This will be extended to other CF centres in subsequent years.
There has been much publicity recently in the media concerning the new children's hospital. The Cystic Fibrosis Association of Ireland is dismayed at the current debate regarding the location of the new national children's hospital. At present, all three hospitals, Temple Street, Tallaght and Crumlin, look after children with cystic fibrosis. Both the Pollock report published in 2005 and the HSE working group report on cystic fibrosis due to be published shortly recognise the serious lack of modern facilities in both Temple Street and Crumlin. Our view is that a new hospital is urgently required for children with cystic fibrosis and its location is the least important of the issues involved. We do not care where it is located. What is much more important is that we do not miss this opportunity to proceed and build a modern, world-class hospital that will benefit people with cystic fibrosis and help prolong their lives.
The committee's support has assisted in getting us to this first milestone. Its continued support is vital. The development of a world-class cystic fibrosis service is not a complex issue and can be easily resolved compared to other services. The commitment on finance for staffing exists. Strong motivations for new regional CF facilities have been and are being submitted to the HSE. With the committee's assistance and support, we can provide the quality of care that our CF population has been desperately awaiting for so long and we can develop Ireland into a world-class centre for CF care and research.
I thank Mr. Fletcher. Does any other member of the delegation want to make a presentation at this point?
I do not have any particular comment. We made the comments here in the past. Previously it was highlighted ably by our CEO, chairman and others that cystic fibrosis is now an adult disease. In the past it was a disease of childhood and now almost half the patients in Ireland are adults. In five years, more than half will be adults.
Unlike some other diseases, it is a chronic severe disease. Having cystic fibrosis is like having leukaemia from birth — it is there constantly and never goes away. We now know that with modern treatments the quality of life and life expectancy can be improved markedly.
We are here today to thank the committee for its support in the past. There have definitely been advances since we last met, but there is still a significant gap in the service in many areas and that is why we are here to answer any of the committee's questions. I thank the committee for its time today.
I thank the association for returning to us. The impact of its previous presentation on the Pollock report was quite significant. It startled many people, including myself, particularly with regard to the difficulties faced by people with cystic fibrosis and those who care for them.
I am intrigued by the problems being experienced by our guests, namely, that they have money but, because of the embargo, they cannot spend it. I seek clarification in respect of this matter because I wish to pursue it further with the Minister. We have been informed that the staff embargo no longer applies to the health area. It seems, however, that, in effect, it continues to apply. The Cystic Fibrosis Association of Ireland was allocated money and earmarked the posts that needed to be filled. However, I presume that the level of funding in question would not provide for the necessary staff into the future. That is the problem. It seems that something of a trick has been pulled in that even though the association received money, there is a difficulty in employing people because the funding was a one-off and there are no guarantees in respect of it for the future. Perhaps our guests could indicate whether this is the case.
With regard to new facilities, I presume the reference made was to additional funding allocated to the HSE under the capital programme. What indications are there that the association will receive some of this money? As I recall, the figure provided in the Estimates in respect of capital funding did not differ greatly from that allocated last year. What level of funding is involved and what are our guests' expectations in respect of it?
I also welcome the delegation. I have often advocated the process whereby groups come before the committee, make presentations and share information. Use of this process means that the committee should, it is hoped, then be in a position to recommend to Government the merits of particular presentations. While the phrase "A lot done, more to do" may come to mind, our guests have returned to the committee and acknowledged the progress made. That is important and provides a good example to other organisations that the Oireachtas committee system should work in this way.
I live in Tallaght and, in that context, I am interested in the view expressed by the delegation regarding the controversy surrounding the children's hospital and services for children. I am particularly interested in the point that modern facilities are not available in two out of the three existing hospitals. That is a fair point. The delegation also indicated that, from its perspective, the location of the children's hospital is the least important of the issues involved, which is quite a brave statement. I welcome the fact that our guests made such a statement because doing so was important.
I welcome the representatives of the association. As a former member of the executive of the association, I wish to declare an interest.
As Deputy McManus stated, it must be frustrating to receive an allocation and not be able to fill the relevant posts. We must pursue this matter because it is as if a decision was made to the effect that the association would be given the money but would not be allowed to spend it or provide the service. What, therefore, is the point of allocating the money in the first instance? I do not know why our guests are thanking us for the money that they obtained because it cannot be spent on the services required. Will our guests indicate the different disciplines involved in providing such services?
Isolation is an important issue for patients with cystic fibrosis and their families. The association's last report referred to the service in the UK, how different it is to ours and how far we are from attaining the level of service in the UK. Mr. Tallon suggested that with another little push and if the money allocated was freed up, the HSE could attain the level of service achieved in the UK. That is a far cry from the comments he made the last time he appeared before the committee when he said we were miles from that. If funding was freed up and an additional allocation provided, how close would we be to achieving the level of service in the UK, particularly in regard to isolation facilities?
Given that MRSA is rampant in many hospitals, it puts the fear of God in every cystic fibrosis patient and his or her family, who are also under threat from other serious infections in hospital. The isolation service is vital for that reason for both the physical and psychological well-being of cystic fibrosis sufferers and their families. What is the association's position on this? Cystic fibrosis patients are receiving treatment more frequently outside hospitals, which is helpful. Why is Limerick, Ireland's third city, not mentioned in the submission?
Mr. Rory Tallon
I refer to the isolation issue and how important it is to people with CF. I attend St. Vincent's Hospital and, fortunately, I have not been in for a while but I know many people who need to stay in the hospital regularly. The fear of cross-infection is very significant. The Deputy asked about international standards. St. Vincent's is the national referral centre for adult cystic fibrosis sufferers and approximately 400 people attend the hospital. Currently, if one attends the hospital, one is placed on St. Paul's respiratory ward, which is not a CF specific ward. The ward has no isolation facilities and has two cubicles, which are not en suite.
The international best practice is to have en suite single room cubicles for CF patients. MRSA is a significant threat to such patients and to the public at large but, in addition, there are other CF-specific bacteria such as burkholderia cepacia and, therefore, it is crucial to keep people with MRSA, cepacia and other bacteria with resistance to antibiotics separate from CF patients. With only two cubicles on the ward, that can only be done in a limited form in St. Vincent’s Hospital. Patients aged between 16 and 18 who have recently transitioned from paediatric units and who are unfortunate enough to have contracted MRSA will get a cubicle in St. Paul’s ward if they are lucky but there are no isolation toilet facilities. They will be subject to indignity and dehumanisation where they must use a commode in their cubicle.
In addition, people with non-MRSA infections will have to share three to six-bed wards with other people who have cystic fibrosis with active chest infections. Patients will be classed according to their bacterial status. From a medical point of view, the patients will have the same bacterial status and will be judged not to be at risk from each other but people who do not understand the medical and scientific implications of these infections are prone to raw fear and paranoia. They are afraid of going into hospital with an infection and of contracting a more severe infection so that they will take even longer to recover.
I will leave the issue of the cap on staffing to Mr. Fletcher. Deputy McManus raised the very important issue of the new facilities and the capital provision for them. This brings us to the issue of CF units raised by Rory Tallon. We now know the international minimum requirements for looking after people with cystic fibrosis in hospital and as outpatients. International documents show that people with cystic fibrosis in hospital must be treated in single rooms, without exception. They have a unique ability to pick up very resistant organisms which might not make another person sick. In the United Kingdom, for example, one finds that people with cystic fibrosis are all treated in single rooms in hospital. The question now is one of how large those rooms should be.
Ireland is unique in the developed world in not treating people with cystic fibrosis, especially adults, in single hospital rooms. Furthermore, hospitals do not have dedicated rooms for people with cystic fibrosis. There are historical reasons for this. Many people must be admitted to hospital through an accident and emergency unit. This is not related to the accident and emergency crisis issue but arises because there is no room at the inn. We do not have rooms in hospitals for people with cystic fibrosis. That is the primary issue.
The HSE and the Department of Health and Children have been supportive, as the Deputy said, and I acknowledge that. When we addressed the committee a year and a half ago we said the two key issues relating to cystic fibrosis were personnel and facilities. There have been some developments in the issue of personnel but we still have fewer than we need. There is still a huge gap in facilities. People have cystic fibrosis from birth. They usually have the condition mildly in early childhood and may be admitted to hospital only occasionally. However, once they reach the 15 to 20 age group, many go into hospital more and more often, sometimes three, four or five times a year. Some are in hospital continuously. We have patients in hospital for half of the year. As their disease progresses and they have a greater need for proper facilities, those facilities are not available.
The HSE has looked at this matter and we are hoping for an announcement in the Estimates of funding for specific CF units in a number of places. St. Vincent's Hospital, as the national centre, is clearly the key area but other hospitals which have been mentioned are also very important. At present, as Rory Tallon said nicely, people who have an acute exacerbation of cystic fibrosis do not have the hospital care they need because the hospitals do not have the necessary physical resources.
Deputy O'Connor raised a very important point regarding the paediatric hospitals. The Cystic Fibrosis Association strongly supports the principle of having one primary tertiary care paediatric hospital for the care of cystic fibrosis patients. The issue of location is one that other people have looked at and I will not discuss it now.
Deputy Neville made cogent comments. Mr. Fletcher will deal with the issue of the filling of posts. The Deputy raised the important issue of the different types of posts. It is important to highlight the fact that the care of cystic fibrosis calls for a team approach. It requires a team of doctors, nurses, physiotherapists, dietitians, psychologists, social workers, administrators and database people. It has been shown internationally that with that team approach care is optimised. That is the reason the staffing needs are not just medical or nursing, although these are the most important. The needs cross the spectrum. Therefore, in the different centres throughout Ireland, paediatric and adult, we have the people necessary to provide the team care. Not all patients need all the team facilities all the time, but most patients will require all of them at some time, especially as their overall disease progresses.
The question of isolation facilities was raised. In some paediatric hospitals we have these facilities, for example in Limerick. However, for most adult hospitals we do not have isolation facilities.
Is it thanks to Mr. J.P. McManus that we have them in Limerick?
Yes. I agree on the need for such facilities, but we do not have them. The Deputy asked about the UK. If somebody from Ireland is on holiday in the North of Ireland or in the United Kingdom and gets sick with cystic fibrosis, that person will be automatically admitted to a single-bed en suite hospital room. However, if somebody from the United Kingdom gets sick while on holiday here, there is nowhere to put him or her and he or she will often have to go through the accident and emergency unit and wait for a bed, which will only rarely be in a single room as is necessary. We know clearly from the Pollock report the international requirements for care in hospital, and they have been documented on many occasions. We know these are provided in the United Kingdom and in continental Europe and throughout most of the developed world, but we do not have them here.
MRSA has been highlighted as a crucial issue for people with cystic fibrosis and it is one of the reasons we need isolation rooms for them. It has been shown that single rooms are good for the health of cystic fibrosis patients and that they reduce cross infection. Over recent years, people with cystic fibrosis have been excellent about taking care to ensure that even out of hospital they are isolated for care. What happens in hospital happens out of hospital also and socially and we applaud their efforts in this regard.
I am not qualified to speak on Limerick, but it may relate to—
We have two isolation wards thanks to J.P. McManus, so it should be a basis—
That is right, it should be. What Limerick has, thanks to J.P. McManus, is outstanding. However, there are clearly needs in the adult area. We have supported and lobbied strongly for the development of facilities for adults in Limerick and in other places such as Cork, Galway and Waterford.
I have answered some of the points raised, but Mr. Fletcher will want to address some of the questions on staffing issues.
Mr. Tallon
I point to a situation that arose this week because of the lack of an isolation unit. Someone came into an accident and emergency unit on Monday evening with a collapsed lung, but was not seen until six hours later and did not get a bed until Wednesday. As Dr. Gallagher has said, this is not an accident and emergency issue. We all know about the accident and emergency crisis. The crisis for people with cystic fibrosis is that there is no unit into which they can be brought directly to start the urgent treatment they require as soon as possible. They must suffer the pain and indignation of being placed on a trolley in an overcrowded accident and emergency unit. I do not intend to highlight the accident and emergency crisis, but the fact that there is no cystic fibrosis unit into which they can be brought directly.
Mr. Fletcher
I will answer the question on the issue of funding. The €4.78 million in funding is in ongoing funding. It is specifically designed for staffing issues and what money is there is allowed for positions in place for life. This funding will continue and will be topped up annually.
Is this amount recurring?
Mr. Fletcher
This amount is recurring. The sum of €2 million given in the last budget Estimates will mean an additional €6.78 million in this current year. If we are given more in next year's Estimates, then it will be up to the crest of €9 million which we want in order to attain the basic international standards recommended for cystic fibrosis care. This is a very important factor. The money will be available next year but the issue is the embargo, the ceiling.
The Deputy stated that there was no longer an embargo. I refer to a letter dated July 2006 from the HSE to Tallaght Hospital. It states that it is correct the hospital has been allocated a certain amount of money and certain posts will be provided. The letter states that in terms of financial accountability it is critical that implementation of any new developments are timed in the context of hospitals achieving financial break-even for the year. It states that this objective also applies to the WTE controls, even if they are approved as part of the previous year's developments.
I refer to another letter just received on 12 January 2007 from Tallaght Hospital but I have the same letter from most of the administrators of hospitals around the country involved in cystic fibrosis care. In the letter the administrator wishes to reassure us that the filling of the cystic fibrosis posts under the recommendations of the national working group on cystic fibrosis services is a priority for the hospital. However, it states that the hospital has particular ceiling issues that the HSE requires it to adhere to. Notwithstanding this, the letter states the hospital is happy to confirm that arrangements are in train to effect the recruitment of the above-mentioned staff very early in the year. The hospital administrators are trying to do their best.
I have included a pie chart with the presentation to the committee which illustrates that 57 positions were approved for 2006 out of the €4.78 million allocated. It can be seen that more than 50% of the positions have not been advertised as yet because of the ceiling issue. Those positions that have been filled were positions already in place and being funded by various charitable organisations, including the Cystic Fibrosis Association. When the association was informed the money had been allocated, it decided not to continue with its funding and advised the hospitals to make the appointments and this is what has happened. This is the only reason those positions are in place, apart from one consultant in St. Vincent's Hospital. I may be misleading the committee because with regard to St. Vincent's Hospital, I was informed last week that all positions, bar three positions, have been advertised.
The crucial issue is that money is there and positions have been identified. The HSE should spend the money. Another €2 million has been identified for next year and more staff positions can be created. When will the HSE let the hospital administrators know that they will be getting that money and what those positions are? It has taken until July for the letter relating to 2006 to be issued. What will be the situation in 2007?
Like Mr. Fletcher I am very confused. The money has been allocated by the Minister for Finance in the budget. Have the positions been approved?
Mr. Fletcher
The positions have been identified.
By whom?
Mr. Fletcher
By the HSE working group.
Okay.
Mr. Fletcher
The HSE network managers have written to their respective hospitals to inform them of the positions they are allowed to have and the moneys allocated for those positions.
Okay.
Mr. Fletcher
The hospitals have been told they are allowed to hire people to fill the positions, as long as they are on budget and within—
Can we leave the budget aside? That is a separate issue. What is the second caveat?
Mr. Fletcher
The hospitals have to be within their ceilings for staff numbers.
Will Mr. Fletcher explain that to the committee?
Mr. Fletcher
I am led to believe there is a ceiling on staff numbers throughout the entire public service. It relates to the need to control overall public expenditure. Every hospital has to keep staff numbers within a certain limit.
I think that is the crucial point.
Could I just—
I want to qualify what I have said. The more I hear about this matter, the more confused I get.
The hospitals have to sack someone to get someone else in.
Who has said there is a ceiling in each hospital? Is Mr. Fletcher telling the committee that when somebody in the Department of Finance allocates money to a hospital to finance a post that has been approved, in effect, somebody else in the Department writes to the same hospital to tell it that it cannot employ the person in question?
Mr. Fletcher
Yes.
Does Mr. Fletcher have proof of that?
Mr. Fletcher
Yes. The HSE is saying that every hospital has a budget for staffing. While a hospital might be allocated money, it cannot use it to hire more staff unless it remains within its ceiling of staffing.
Can I—
This is where I am confused. I understand that a hospital cannot hire additional staff if it has a fixed budget. We are all aware that the hospitals were given extra money in the budget, however.
Mr. Fletcher
Yes.
If the hospitals have extra money, surely they can spend it to hire new staff.
Mr. Fletcher
The hospitals have two budgets — a financial budget and a head count budget. They have been given a financial budget, but they have not been given a head count budget to accompany it.
Can I—
Is Deputy Devins finished?
Not quite.
I will not cut the Deputy off.
Unfortunately, I have to leave the meeting.
I will give way to Deputy McManus.
I thank the Deputy. I would like to return to an issue I raised earlier in the meeting. I have to go somewhere else, unfortunately. Can the committee write to the Ministers for Health and Children and Finance on this specific issue? It is important to pursue the matter because we have been given ministerial guarantees that the embargo on public service recruitment no longer applies. As Mr. Fletcher has said, he has clear evidence that the embargo is continuing to operate, even though additional moneys have been allocated for the hospitals system.
Mr. Fletcher
Yes.
That is extremely serious. Will the committee agree to write to the Ministers in question?
Sure. The Deputy can take it that the matter will be raised — absolutely.
All right.
I support Deputy McManus in this regard. I would like the committee to be furnished with evidence that this policy is coming from the Department of Finance, rather than the hospitals.
Mr. Fletcher has already read from a letter that was sent to Tallaght Hospital.
Mr. Fletcher
The letter was sent from the HSE to Tallaght Hospital.
Okay. I would like to focus on that point. We heard a few minutes ago from Mr. Fletcher about a letter that was sent to Tallaght Hospital. The committee wishes to respond to the association on that point by stating that the contents of the letter constitute a clear breach of what it has been told. The committee has often made the point that its functions do not include increasing levels of funding or personnel. It is clear that the relevant finances have been allocated in this instance. Professor Drumm and the Minister for Health and Children will attend a meeting of this committee on 15 February next. The committee is giving the association a commitment that its members will pursue this matter on that occasion. We are not in a position to give commitments of that nature very often. We will ask how the impression can be created that the health services are being advanced, on the one hand, while facilities are being taken back, on the other hand. It is clear that this is a significant issue for the committee.
Members' hands are usually tied when we hear presentations at this forum, as it is clear that we cannot increase finances. We can give the delegation a commitment that this will be the first thing we will pursue, along with the fact that funding which was allocated to Sligo Hospital had not even been advertised, which was highlighted by Deputy Devins not long ago. The failure to develop services after funding has been put in place is creating a great deal of concern among the public. Someone must be responsible for dictating that policy. It is not enough to blame the Department or the HSE — we need to know who dictated the policy in question. We will ask Professor Drumm who that person was. We will ask the committee secretariat to write to the HSE about the matter in advance of next month's meeting, so that it will be fresh in the minds of the HSE representatives when its delegates come to the meeting. They will know all the details.
Mr. Carl Rainey
We do not have evidence that this diktat, if I can call it that, came from the Department of Finance. We have been led to believe from hearsay that the ultimate authority comes from that Department. If the committee wants a copy of the letters which have been referred to, it should let us know.
The committee would like to acquire copies of the letters.
Mr. Rainey
We understand that the committee will need to see the letters before it can raise any issues about them.
Mr. Fletcher
The committee could get them under freedom of information but it would take some time.
I am sure Mr. Rainey will furnish Deputy Devins and other members with them.
Mr. Rainey
I will briefly address the issue of the national children's hospital. Around five years ago, when I became chairperson of the Cystic Fibrosis Association of Ireland, the organisation decided to commission the Pollock report. As part of this process, I travelled around the country to speak with members of all the branches of the association and their families. The message that emerged loud and clear from these discussions was that our members do not care where they have to travel to access facilities provided proper, world class facilities are provided somewhere.
The sum of €500 million available to build the new national children's hospital will give us what we want. The current squabble could delay the process by five or six years. Having waited ten or 15 years for a new hospital, it is time the hospital was built.
We take a similarly strong view. We support having one paediatric, tertiary referral hospital for cystic fibrosis patients but do not propose to discuss the issue of location.
On the point made by the deputation pertaining to the recruitment of consultants, I raised this issue at the previous meeting of the joint committee and at a recent meeting attended by the Minister for Health and Children and Professor Brendan Drumm. In Mullingar, where I live, my experience of pressing for some time to have approved consultant posts filled has shown that the process is as long as a wet Sunday. I do not understand the reason for the delay in filling approved positions for which funding is available. Questions must be answered.
Ms Mary Lane Heneghan
I am the national chairperson of the Cystic Fibrosis Association of Ireland and will give a perspective from Galway where I live. The association is seeking new positions in Galway's main hospital which does not offer a service for adults. Some of the available funding will be used to recruit a clinician to deal with adults. The association has worked closely with management and the paediatrician in the hospital and the post will be advertised in the next two weeks. This is a welcome development but we still do not have facilities for adults. Nevertheless, young people aged up to 13 years and older will no longer have to travel to Dublin because they will be able to get treatment in their own area.
While I accept that, the time span involved is too long. There is no logical reason it should take so long to recruit consultants when the posts have been approved and finance has been made available. I accept glitches may have occurred in some cases but none has occurred in the cases to which I refer. What is the reason for the delay?
Mr. Rainey
We are as perplexed as the Senator.
The questions have been asked and must be answered.
Mr. Fletcher
In response to Deputy Neville's question on the types of positions available as part of the €4.78 million, a total of 57 positions were approved under this funding. They were: two consultants; eight nurses; ten physiotherapists; six senior dietitians; 3.3 social worker posts; 2.8 psychologist posts; 2.5 secretarial positions; 0.5 data clerk posts; 3.75 pharmacy positions; two pulmonary function technicians; and 6.5 medical scientists. Combined, these posts produce costs equal to the funding allocated. A further €100,000 was allocated to the national cystic fibrosis registry but it did not receive this funding for 2006. A sum of €60,000 was also allocated to the HSE organ procurement review, a body reviewing organ procurement. With regard to Limerick, there were 4.5 posts for the adult side and 3.5 posts for the paediatric side.
It is interesting to note there was no occupational therapist which is very important.
Mr. Fletcher
I cannot comment on that.
Deputy Neville raised an important point. The aim of the funding, which was at a basic level, was to put out the major fires. I agree it is an important need in the long term. When this funding comes through it will be only the first tranche of the necessary funding based on 2004 staffing needs. Those figures will have to be increased based on figures for 2007 or 2008.
There are great employment opportunities in occupational therapy.
That is correct.
Ms Lane Heneghan
I thank the Chairman and members of the committee for inviting us here today and for their support.
On behalf of the members, while we are happy to hear the presentation we are not happy to read the letter that has been circulated. I will not go into the detail of it except to say it is clear the implications of the appointment to the position were dependent upon staffing levels. There is no doubt anyone getting the letter would see, as Deputy Neville pointed out, the appointment would be made at the expense of an existing staff member.
The second point is the appointment is contingent on the hospital remaining within budget. That is a classic catch-22 situation in that funding has been offered but it cannot be taken up. The committee is able to pursue an issue like this and we will bring it to the attention of Professor Drumm before he and the Minister come before us in early February. We make a pledge to work to resolve the situation.
From reading the letter it is clear a major doubt remains over this issue. We want to see services expand. Criticism is often focused on the health budget and services not being brought down to ground level. Between that and the recent appointment of consultants in the north west not being advertised it is evident why the public is so annoyed that services are not apparent on the ground in spite of the huge increase in funding for the health service. This is the second example of this in five weeks. We pledge to pursue the issue and we will make contact with the witnesses following the meeting with Professor Drumm. I thank the witnesses for their presentation.
The joint committee adjourned at 3.50 p.m. until 9.30 a.m. on Thursday, 25 January 2007.