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Seanad Éireann debate -
Wednesday, 29 Sep 2010

Vol. 204 No. 6

Provision of Health Services by the HSE: Statements (Resumed)

I welcome the Minister of State at the Department of Health and Children, Deputy John Moloney. Senator James Carroll was in possession. I call Senator Healy Eames. She has seven minutes.

I wish to share two minutes with Senator Twomey.

Is that agreed? Agreed.

I welcome everyone back to the House. I am delighted the Minister of State, Deputy Moloney, is present. It is good that he is in the health portfolio. He will not be surprised if I focus in particular on Galway and HSE west. He is aware that a serious high level meeting took place yesterday with the Western Regional Health Forum. The Health Service Executive says that cutbacks in the western region will result in a deferral of elective surgery for some patients. I will ask the Minister of State many questions to make the most of my time. Currently, more than 29,000 patients are waiting for outpatient services in Galway between Merlin Park University Hospital and University College Hospital, Galway. A total of 6,500 patients are waiting for inpatient procedures. I have heard that the national waiting list is 46,000. How do we have so many patients waiting for treatment in Galway? The Minister has refused to accept the historical underfunding of health services in Galway. We now know we have the busiest hospital in the country and the most dangerous hospital due to the fact we are so busy with so many people waiting. I will tell the Minister of State what I mean by "danger". I spoke today to senior management in Galway. Dr. David O'Keeffe, the clinical director and chief executive officer, has communicated to me that he has said publicly that if the hospital must come up with the €19 million by 1 January next, patient safety will be at risk because it has already given €15 million and is cut to the bone. He is saying someone will be hurt or will die. How can the Minister of State stand over that?

There has been an overrun of €149 million since the beginning of the year, €49 million of which concerns nine counties from Donegal to Limerick. The two Galway hospitals, Merlin Park and University College Hospital Galway, have been asked to make up €19 million of that sum. It would appear a commitment was given yesterday for €4 million, which reduces the amount of €15 million, but Dr. O'Keeffe states that having to come up with that amount will have implications for patient safety.

We are learning that the HSE plans to cut 7,000 temporary staff hours per week until the end of the year, affecting 4,000 staff. I spoke to one of those staff this morning, a woman working in medical records in UCHG, who said 15 of the 21 staff there are temporary. A consultant cannot operate on anyone without a medical record and the woman told me it takes hours to get the records and co-ordinate them because it is not done electronically and she may have to access them from Merlin Park or UCHG and from different departments. Would the Minister of State or I want a procedure done on us if the medical record was not available? I would not.

My central point is that if this budget is to be met, no one will go to hospital because they will be afraid to do so except in an emergency. From the information I learned this morning, I would be afraid to go to UCHG or Merlin Park because patient safety is at risk. We are looking at the possibility of serious medical error if the availability of records on time cannot be guaranteed and if the system is bursting at the seams. We have the greatest paradox in that we have a centre of excellence in name and we now have hospital over-capacity. We have had two protest marches in Galway. A mother at one of the marches stood beside me in absolute anger and told me that a surgeon could not operate on her son because elective surgery is being deferred in Merlin Park. Coincidentally, I taught that son when he was a youngster and he is now a young man of perhaps 20. It is outrageous but the HSE west is telling the surgeons in Merlin Park that they are doing too much and working too hard and that they should slow down.

The allocation of budgets is wrong. Why does the Minister of State not consider the Fine Gael fair care policy, which will fund hospitals based on procedures done and where the patient will be a person and not a cost to the system? At present, the Minister of State sees every patient as a cost to the system, which is wrong. The very first thing we should give our people is health care, followed by education. Health is a resource for living and the Government is now threatening the health of the people.

The orthopaedic waiting lists at Merlin Park contain 4,500 people waiting for procedures on hips, joints, ankles and so on. We must consider the pain, delay and serious degeneration of joints involved. Problems are being stored up for the future which will cost the health service.

My final point concerns disability services, for which the Minister of State has complete responsibility. I know the Brothers of Charity in Galway are shaking in their boots because there is talk of a 5% cut, or €2.3 million, next year, with respite care being wiped out. One person telephoned me and said: "I drove my daughter to the water but I couldn't do it." That is the value of respite care to her. I ask the Minister of State to answer my questions.

I welcome the Minister of State on our first day back following the summer recess. As a member of Government, I ask him to take control of the HSE. The Government must make itself responsible for the actions of the HSE which the people of County Wexford no longer trust. The Government has a constitutional obligation to protect patient care in this country, which is clearly not being protected by the HSE in County Wexford, the south east or throughout the country. We have been expecting investment in the accident and emergency department and the maternity unit at Wexford General Hospital but all we have seen is up to 40 beds closed in the hospital and no commitment by the Government to fund nurses on maternity leave or capital projects at the hospital that had been promised for years.

The Minister of State is responsible for mental health services and for the closure of St. Senan's psychiatric hospital. Commitments have been given to invest in mental health services in County Wexford but we are becoming fearful that these may not be implemented in the way we are expecting. We have no trust in the HSE. There is need for a direct ministerial involvement in how the HSE is run and the decisions it is making. Patients' lives are being put at risk but there is a sense the HSE is one hand removed from the serious concerns of the people in the areas for which it is responsible.

I welcome the Minister of State. On 8 December 2009, the Taoiseach, Deputy Brian Cowen, sent me a letter stating:

Dear Senator Daly,

I write to you in relation to Kenmare Hospital and having spoken to Mary Harney TD. I wish to confirm that this project will go to design and planning early next year. Construction will also commence in 2010 and the project is scheduled for completion in 2011.

Having been one year old when the extension to Kenmare Hospital was first promised and having listened to endless promises, too much activity and too little action, as a citizen and a public representative I felt it was time to roll up the sleeves, put the shoulder to the wheel and once and for all get the hospital built for the people of Kenmare. The names of those people who have spent more than 35 years trying to get an extension to Kenmare hospital deserve to be put on the record: Lt. Col. Michael Harrington, Richard Doran, Mairead Doyle, Phyllis Healy, Bertie McSweeney, Una O'Neill, Maeve O'Sullivan, Ettie Sullivan, Meg Tighe, the now retired matron Mary Fitzgerald, Dr. Crushell and all the doctors in Kenmare, and May Leahy.

It is a long story. In 1974, a public representative in a village not far from my own won his first council election telling the people of Kenmare he was instrumental in getting ten extra beds for the hospital. In 1975, the Friends of Kenmare Hospital was formed to fight for an extension. In 1978, plans were even drawn up and, in 1997, following the general election, the words "Pretty Polly" echoed through this House along with a promise for Kenmare Hospital to get its long-talked about extension. It was stated in the capital programme 2000-06 that €2 million would be provided. In 2001, the then general manager of Kerry community services, Mr. Tom Leonard, acknowledged that 19% of the population in Kenmare was over 65 and the need for an extension to the existing hospital was urgent and that it was imminent. In January 2002, the hospital action group was told that an extension would commence in 2002 and a design team would be appointed. My colleague, Deputy O'Donoghue, was similarly told there would be a delay until 2003.

At another election, this one in 2002, another Deputy announced that €2 million had been secured, stating: "This is truth and fact not wishful thinking as dreamt by others." Some 30 years after first promising the extension, the boys were crying wolf once more and nothing happened.

In 2003, the Friends of Kenmare Hospital received a letter from the then Minister for Health and Children, Deputy Martin, and received a subsequent letter from the then Minister for Health and Children, Deputy Harney, in 2004. In 2005, the group was told the matter was going before the southern health board. In 2006, a Minister of State announced it would be in the 2006-10 capital programme. In June, another deputation was to meet Deputy O'Donoghue, but did so in 2007. That year, the proposed extension was included in the HSE's programme.

In May 2007 and subsequently, again benchmarked by an election, the project was confirmed once more, but the boys were crying wolf and nothing happened. In 2008, it was claimed the project was to be part of the new deal, but nothing happened. In 2009, a letter that was circulated claimed the project would go ahead in that year, but this did not come to be. At a public meeting on 1 December 2008, the HSE announced that, despite previous statements to the effect there would be an extension, a new hospital would need to be built because it would be the most economic route.

On 8 December 2009, the Taoiseach wrote a letter to me in which he stated we would get a hospital. The sleeves were rolled up and I have counted the number of telephone calls I have since made to Mr. John Browner, head of HSE estates, and Mr. Michael Fitzgerald, head of the HSE in County Kerry. We have made substantial progress. When we met on 22 December, Mr. Fitzgerald outlined the process involved in going from where we were — the letter from the Taoiseach — to where we are now, that is, tenders have come in. He outlined the steps in terms of getting a design and project team together, which has been done despite delays.

On 9 March, we met the HSE estates team in Dublin and a design and accommodation brief was completed. In my subsequent telephone calls to Mr. Browner, he assured me that delays, though occurring, would not cause the hospital to fall from the list. I commend him on his great work and dedication to this cause. On 21 July, I attended a meeting with him, the HSE and the four contractors on site in Kenmare at which he outlined some of the issues that the work on the hospital would encounter.

The real concern of the people of Kenmare is that we not delay. Tenders will be out next Tuesday and a decision will be made on who will win the contract. JJ Rhatigan, Glenbeigh Construction, Western Building Systems and BAM Construction are in the hunt for this contract. The original cost was supposed to be €6.5 million, but it will come in for less. There is no better time to get value for money.

The people of Kenmare have been fighting long and hard for a new hospital. We have overcome many disappointments, only some of which I have outlined. We have come a long way and do not intend to fail now. I hope the Minister of State, Deputy Moloney, will assist us in Kerry if there are any hiccups. The Government has a number of problems with hospitals around the country and I do not intend to add Kerry to the list, but I want to ensure the hospital for Kenmare gets built 35 years, going on 36, since it was first promised.

There is a saying that activity should never be mistaken for action. When I received the letter from the Taoiseach, Deputy Cowen, on 8 December 2009, I did not want the activity surrounding such letters — getting a press release out for a bit of PR and letting the matter die — to occur this time. For this reason, I have called meetings with and continually made telephone calls to Mr. Browner, the HSE, the Kenmare hospital action group and others to ensure we got to this point, a stage we have never reached before. Tenders are in and are being decided upon. The winning tender will be decided next Tuesday. I look forward to inviting the Minister of State to open the hospital when it is ready. He might be a senior Minister by that time.

Deputy Healy-Rae will give the Senator a ring sometime during the week.

I look forward to the telephone call.

Twenty minutes.

We will not say yet.

I thank Senators for the opportunity to conclude this debate. A number of the issues raised are specific to my Department, but I should respond to those raised in the past few minutes.

Senator Healy Eames made a case. Least of all, I must acknowledge her concerns. As we are all aware, all Departments, including the Department of Health and Children, are operating under budgetary constraints. It is important to point out that, although this is the case, safety and patient care must be to the forefront. As we approach the forthcoming budget, we are all aware that we are discussing a saving of €600 million within my Department. It is important to recognise that cuts and reductions apply across the regions, not just the west. I do not say this in a flippant manner, as I fully appreciate people's concerns. I cannot dispute the figure of 29,000 people because I am not aware of it, but I accept the bona fides of what has been mentioned.

Like the Senator has always done, I accept that the call for reducing the number of administrative staff, which is often made, is a popular one. I have never been one to believe in that call, given the obvious case for the importance of medical records and backup facilities. However, I must reiterate that the Government's intention is to maintain patient safety levels and present the best level of service.

I will refer to the specific points raised regarding the west and budgetary issues. At the end of July and based on a projected estimate to year end, the HSE identified a potential excess in HSE west of €65 million. It is important to point out that this has been represented as a substantial reduction on the excess of €133 million projected two months earlier. Obviously, continued management of expenditure is demanded.

I do not want to separate the concerns of people representing the west, but HSE west and the health sector unions signed a framework document at a Labour Relations Commission hearing in August agreeing to engage with one another in addressing the budget deficit while protecting services and jobs, which is the most important commitment. This agreement offers the best approach to meeting the health care demands of the people of that and all regions.

Notwithstanding the considerably difficult financial environment in which we live, the Government is determined to do everything possible to protect patient services. It is important that we respond to priority demographics and other needs and support ongoing reform of public services throughout the regions. Without co-operation and flexibility, services to patients cannot be protected. There is a responsibility on everyone concerned to live within our budgets and these are the budgets that have been allocated.

We should all work together to protect patient safety. While I am taken by Senator Healy Eames's reference to Dr. O'Keeffe, it is the Government's responsibility to protect patient safety. This must be the underlying commitment and all talks on funding and budgetary requirements will be based on it.

Points were raised about my area of responsibility, the disability sector and the withdrawal of respite care services. When the threat of withdrawal was visited on doors several months ago, I made it clear that it was never the Government's intention to cut respite care services. The notion of reducing funding and, potentially, services in the west was not dictated by the Government. The priority was to retain and support front-line services. Following the meetings held in May and June, I asked the director for disability services and local health managers to engage with all groups to ensure the threat of reduced funding would not lead directly to reduced services, including respite care. I will meet the national umbrella group tomorrow with a view to putting this in train.

The disability sector receives €1.6 billion in funding, rightly so. However, the real challenge is to ensure the money is spent wisely. I put together a value for money process over a year ago — not because of the demonstrations which took place two months ago — to ensure money given to the disability sector was spent on front-line services. I am often challenged to explain what the value for money review group is doing. Essentially, its purpose is to ensure we provide front-line services and that money is well spent. The underlying commitment I have given on behalf of the Government is that whatever is saved through the review will be retained for the disability sector. In case somebody does not believe me, I have copper-fastened my commitment by nominating two people involved in the disability sector to the review group. The delivery of services in the disability sector is not reliant solely on the outcome of the value for money review. Before the end of the year I will also be presenting a paper to the Government on direct or individualised payments. I will also suggest the possibility of providing funding through fostering to allow a choice of services.

I hope I have put to bed the notion that the Government is withdrawing respite care services. As a result of the difficulties experienced several months ago, talks are ongoing with all the service providers and will culminate tomorrow.

Deputy Twomey has gone overboard in his comments about not trusting the HSE. The service cuts unfortunately required owing to budgetary restraints in all Departments will apply in Wexford as in the west or the constituency of Laois-Offaly. I presume the Deputy was referring to the capital programme for mental health services, as well as the reconfiguration of services.

I thank the Deputy for his contribution and do not wish to give a cosy response to him on the position in Wexford. The commitments I have given on hospital closures, including St. Senan's Hospital, are based on the sale of lands within the mental health system. We have secured €10 million this year. I want to build a belief on this issue because often people read banner headlines about reduced funding for mental health services but do not look around them. Of course, I do not believe mental health services receive sufficient funding, but it is up to me to try to secure further funds. In moving from institutional to community care and closing old hospitals the real issue is bringing funding for mental health services to the level achieved several years ago.

When I tell people that I will close the old institutions in the next three years, I have to give meaning to my commitment. With the funding I secured last year I tried to prioritise the reports of the inspector of mental hospitals which outline the awful conditions in some hospitals. This year my Department turned the sod on a 100-bed unit in Mullingar to replace wards in St. Loman's Hospital. Similarly, we turned the sod in Clonmel four months ago. The new psychiatric unit in Letterkenny will allow us to discontinue referrals to the old hospital. For the first time since 1815 there will be no further referrals to Grangegorman because the new hospital in Blanchardstown is now open. More importantly, the moratorium has been partially lifted to meet nursing requirements. Next month we will process the planning application for the acute psychiatric unit at Beaumont Hospital.

I accept these measures will not deal with all of the issues raised. Budgetary constraints will impact on most of the services we had hoped to develop this year, but the Government's underlying commitment to ensuring patient safety remains in place. I do not believe for one second that any policy initiated by the Government or delivered by the HSE will have an adverse effect on patient safety which must be the hallmark of health policy.

I cannot speak about Kenmare hospital because I do not know a lot about it. However, if the Government has made a commitment to develop the hospital, who am I to believe it will not be met? I will revert to Senator Daly on the issues he has raised and accept his invitation to sign the tender as soon as it crosses my desk.

On a point of order, I contributed to a debate in the House on 16 June. I appreciate I cannot intervene again, but on that date I put a number of questions to the Minister for Health and Children. I asked her views on how the HSE conducted its business, whether she could account for the practice of not telling the truth to the public, if she was willing to state she accepted responsibility for the actions of the HSE——

I will conclude by noting that I asked her whether she had assumed the role of public apologist for the HSE. I also wanted to know what she thought of the HSE's breach of a promise she had given to the people of south Tipperary.

That is not a point of order.

She said decisions on health services would not be taken without consultation.

I cannot indicate what reply a Minister might give in the House.

I asked a number of questions——

I know the Senator did.

I did not receive an answer.

I cannot indicate what answers the Minister might give.

I understand that.

There is no provision for the Senator to intervene at this stage and she did not raise a point of order.

I was attending a meeting with the HSE.

The debate on No. 3 has concluded.

I want to know whether the Minister is going to answer my questions. I have not yet received a response.

Is the Minister not obliged to answer questions?

She did not answer any of my questions.

The content of a Minister's or a Minister of State's speech is a matter for him or her to decide. The Minister of State, Deputy Moloney, has spoken and the statements have been concluded. There is no provision for me to allow further contributions.

The Government side engaged in a filibuster and the Minister sat in the House for an hour while the debate was guillotined. We were told she would respond to our questions.

It is up to the Minister.

They have not been answered.

On a point of order, does a Minister have a responsibility to answer questions put by Members of the House?

I cannot indicate what a Minister will say. The content of a Minister's speech is a matter for him or her to decide.

It makes a joke of the Seanad.

That means a Minister has no responsibility to answer questions put. It is unbelievable.

Sitting suspended at 5.20 p.m. and resumed at 5.30 p.m.
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