Tuesday, 22 June 2004

Questions (9, 10, 11)

Arthur Morgan


9 Mr. Morgan asked the Minister for Health and Children the status of the Hanly report recommendations; if these recommendations have been amended; the way in which it is proposed to proceed with implementation; and if he will make a statement on the matter. [18490/04]

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Ciarán Cuffe


51 Mr. Cuffe asked the Minister for Health and Children the status of the Hanly report; the elements of the report he has implemented to date; when he will implement the report in full; and if he will make a statement on the matter. [18476/04]

View answer

Willie Penrose


71 Mr. Penrose asked the Minister for Health and Children the progress made to date with regard to implementation of the recommendations of the Hanly report; and if he will make a statement on the matter. [18379/04]

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Oral answers (98 contributions) (Question to Minister for Health and Children)

I propose to take Questions Nos. 9, 51 and 71 together.

The Government is committed to progressing the implementation of the Hanly report for the benefit of all patients. I have established implementation groups for the Hanly report in both the east coast and mid-western regions. The groups will carry out the detailed work of identifying the services that should be provided in each hospital, in line with the Hanly recommendations.

Regarding hospital services outside these two regions, I have announced the composition of a group to prepare a national plan for acute hospital services. The group contains a wide range of expertise from the areas of medicine, nursing, health and social care professions and management. It also includes an expert in spatial planning and representation of the public interest. The group has been asked to prepare a plan for the reorganisation and development of acute hospital services, taking account of the recommendations of the national task force on medical staffing, including spatial, demographic and geographic factors. Neither the local implementation groups nor the acute hospitals review group has been able to meet due to the consultants' continuing industrial action. I again ask that all parties return to the table to progress the work of these groups.

I emphasise that the Hanly report is about developing hospitals, not closing them. In the mid-western region's acute hospitals, for example, we have increased the total staff numbers by almost 1,200 since 1997. We have provided an 80 extra consultants during that period and increased ambulance personnel by 77%. There have been important investments in Ennis, including a new €5.7 million acute psychiatric unit, and I have approved the appointment of design teams for further improvements in Ennis General Hospital and Nenagh General Hospital. These initiatives illustrate the Government's commitment to smaller hospitals as a continuing and vibrant element of our acute services.

Other key elements of the Hanly proposals are being progressed. Negotiations with the Irish Medical Organisation on the reduction of NCHD working hours are continuing in the Labour Relations Commission. A national co-ordinator and support team are overseeing the implementation process in the health agencies. Regarding the consultant contract, a number of meetings have taken place between officials of my Department, health service employers and representatives of the Irish Hospitals Consultants Association and the Irish Medical Organisation. These talks are also affected by the current programme of industrial action by the Irish Hospital Consultants Association.

On medical education and training, the sub-group of the task force which dealt with these issues has remained in place. The group has been asked to examine and report to me on the measures required to accommodate NCHD training in all postgraduate programmes and safeguard both training and service delivery during the transition to a 48-hour working week. A major national seminar was held last January involving all stakeholders including training bodies, employers and medical representative bodies. Drawing on the views expressed at this seminar and the ongoing work of the medical education and training group, draft proposals have been developed with a view to ensuring the provision of high-quality training for NCHDs in the context of the initial implementation of the 58-hour week and the eventual implementation of the 48-hour working week. I anticipate that these proposals will be submitted to me in the near future.

Is the Minister aware that the Taoiseach, the Minister for Defence and others have stated repeatedly that the Hanly report recommendations have in some way been amended? The Minister for Defence stated that in this House in relation to Nenagh hospital. Will the Minister with responsibility outline exactly where stands the Hanly report?

Noting that Hanly states that in time "in local hospitals there should not be a requirement for on-site medical presence overnight or at weekends", does the Minister accept that if adopted this would mean that most smaller hospitals will not be able to provide in-patient care or effective accident and emergency services since they both require 24-hour medical cover? Will the Minister accept that the Hanly proposals to downgrade local hospitals should be set aside because they are unworkable and unacceptable?

I do not accept what the Deputy has said. I answered a number of questions on this over recent months. I made the point earlier that following discussions with the chairman of the Hanly group in January it was agreed that there would be 24-hour medical cover in acute hospitals across the country. I explained the last time I was here that the health board in the Ennis and Nenagh area took a decision following submissions from the Irish Medical Council to advertise for the recruitment of emergency care physicians, qualified doctors——

For two years.

The Deputy should allow me to speak. This is in the context——

Deputy McManus, we want an orderly Question Time. A number of Deputies are offering.

Reference to the two years is in the advertisement, there is no secret about that. The point I make, and which I made then, is that this was not in response to the Hanly report. This was an immediate issue on which we had to respond, namely, points made by the Irish Medical Council in communications to the health board. Deputy Ó Caoláin, coming from Monaghan, is aware of the importance of the Irish Medical Council, which is a standard-setting body, and the royal colleges, the Institute of Obstetricians, the Royal College of Surgeons, the Royal College of Physicians or whatever, in influencing what eventually happens in acute hospitals and the configuration of services. It is better to have certainty on an overall national framework as to how our acute hospitals will be organised, rather than limping on depending on the latest six monthly review of a college, which can suddenly change the capacity of a given hospital and what it is doing.

Is the Minister aware that during the local election campaign, the Minister of State, Deputy Dick Roche, allowed a letter sent to him by the Minister to be published in the local press? In the letter he gave an undertaking that there would continue to be a full accident and emergency service on a 24 hour seven day a week basis at Loughlinstown hospital. This caused a certain amount of mystification as it is a flat contradiction of the recommendations of the Hanly report, which is supported by the Government. In the Hanly report, St. Columcille's Hospital is to become a local hospital that will no longer have a full 24 hour seven day a week accident and emergency service provided to the local community. Yet during an election campaign, the Minister put commitments in writing that the service is protected into the future. How does the Minister intend to square the circle? The Minister is now contradicting recommendations of the Hanly report, even though he accepted them.

There was a great deal of mischief during the election campaign and Deputies across the House were responsible and clearly took a decision, once the Hanly report was published, to milk it for electoral advantage.

They tried to but it backfired.

That was the agenda, irrespective of what the report said. It is a bit rich——

Will the Minister answer the question? We will run out of time. This is an old trick by the Minister.

I am answering the question. With all due respect to Deputy McManus, it is very rich of her to talk about pre-election promises and commitments. That is what she did.

There he goes again.

The Hanly report did not suggest that we close accident and emergency departments next week, next year or the year after. The framework is ten years at best. The report referred to the establishment of local implementation groups, which would have some flexibility in determining how services were to be organised locally.

Is the Minister trying to convince himself? He is not convincing anyone here.

We are starting with St. Columcille's. It is in a pilot area.

Exactly. A local implementation group has been established.

It has not met.

It has not met because there is an industrial dispute over medical indemnity as the Deputy knows. That is a fundamental issue.

I am not talking about implementation bodies.

I have been interrupted consistently since I gave my reply.

The Minister is in possession.

I am talking about the Minister's duplicity.

I could equally accuse the Deputy and the Labour Party of duplicity in the manner in which it conducted its electoral campaign, but I do not want to go down that road. We have established a local implementation group.

That is not the answer.

The fear was stoked up that accident and emergency departments would close next week, in six months, next year and the year after. They will not close and if local implementation——

The Minister's Cabinet colleague had to rush to the rescue in Nenagh hospital.

What of those that have already closed?

Did the Minister go to Nenagh?

The Minister is in possession.

I was down in Nenagh.

There was a bit of a dispute over that.

I was greeted by a group led by the Labour Party Senator there, who tried to make sure that I could make no announcement at all. There was almost a sense of disappointment that I went to Nenagh and that the Mid-western Health Board did what it did, as it upset the electoral game that was going on.

I have a question on St. Columcille's Hospital and the Minister is going all over the country. The Hanly report is committed to closing the accident and emergency department in a hospital in a pilot area. The Minister is claiming at the same time that he will keep it open. He cannot have it both ways.

The Chair has no control over the Minister's reply.

Deputy McManus gets upset and goes into high dudgeon. We have expanded services in almost every hospital in this country.

There were many people upset in my constituency and they showed it at the local election.

That is nonsense. I hope the Minister addresses the House to explain that claim.

I will address the House. Let us have a rational debate on this, one that we did not have during the local elections as the Opposition did not want one. A rational debate did not suit its purposes.

I wish to raise a point of order.

The Minister should check the facts.

The Deputy can check the report by Comhairle na nOspidéil. The tables show attendance in accident and emergency departments between midnight and eight o' clock in the morning. People have suggested to me that we need 21 senior consultants to cover two attendances per night. Is that what the Opposition is suggesting? If we propose some alternative, is that akin to closing the accident and emergency department? That is the kind of duplicity that has been articulated in recent months on this issue. I only want to improve the outcome for people.

The Minister's time is limited to one minute.

We come in here and ask the Minister questions that are relevant to our brief or to our constituency. I asked the Minister a question and he was not able or willing to answer it. The Minister is a disgrace. He says one thing at election time——

The Deputy should not play that game.

That is not a point of order. The Chair has called Deputy Olivia Mitchell. The Minister and Deputy McManus should resume their seats.

When the transcript of proceedings is available, we will see that the Minister has given a commitment that no accident and emergency department will close.

I want to ask a more immediate question about the Hanly report, which was originally set up to deal with the European working time directive. Does the Minister accept that Hanly has failed in that respect? On 1 August, hospitals all around the country will be completely unprepared to deal with it. Arrangements are being made to cancel some services and clinics and to hire GPs to work in the hospitals, although GPs themselves are an endangered species. Is Hanly basically dead on all fronts?

It was never the job of the Hanly group to negotiate the move to a 48 hour working week.

I beg the Minister's pardon, but it was.

It was set up to produce a configuration of how-——


If interruptions continue other Deputies will be deprived of the opportunity of putting their questions.

The Hanly group was established following the report on medical manpower a number of years ago. It was set up explicitly in a non-industrial relations and a non-political context, to start with a blank sheet and ask how hospital services should be organised in the Mid-West or the East Coast Area Health Board in the context of a 48 hour working week. They were explicitly told not to get involved in the industrial relations implications. That was a matter for the Government and the social partners, not the Hanly group. It is wrong to apportion blame to the Hanly group for any industrial relations difficulties in pursuing the 58 hour working week by next August, or the 48 hour working week by 2009. That is the factual position.

Does the Minister accept that services will be affected?

The bottom line is that services will not be affected as we approach the deadline.

I am here due to the frustration in sorting out patients in the Mayo general hospital and further afield. The Hanly report seems to get away from the real needs of the people. There has been a backtrack on the report regarding hospitals in Ennis and Nenagh. Originally it was supposed to be a nursing unit from nine o' clock in the morning to five o' clock in the evening, but we now hear about a GP on cover after that. Is the Minister stating that acute medical and surgical services by consultants around the clock will continue in Nenagh and Ennis?

When the second Hanly report is implemented in Mayo general hospital, we will lose the orthopaedic service we have due to a campaign I started ten years ago. We would not have that service now only for that campaign because the institute of orthopaedic surgeons did not want it. Vested interests are doing their damnedest to stop a campaign now. I sent in a request to the Mayo general hospital, which handles the urology service for Galway, for a gentleman with prostate cancer on 30 December 2003. To date that man has not been called. Ten new patients are seen every month by two surgeons who attend on alternate months. Is the Minister aware that that list dates back to 1996? The man concerned was put on that list last December. Is that acceptable?

Mayo General Hospital, Castlebar, needs a urologist but, under the Hanly report, will not get one. As regards orthopaedic services, people believed that one would hold what one had. We need to update our urology services. The Hanly report is a disaster. The distance from Mayo to Galway is virtually the same as from Galway to Dublin. Does the Minister expect people to travel to Galway for a 20-minute prostate operation? Is it acceptable that the man concerned, who has cancer, has been waiting since last December for a urology appointment?

The Deputy asked a number of questions. There has been no back-track on promises for Nenagh or Ennis hospitals. The Mid-Western Health Board, independently of me, had to respond quickly to communications from the Irish Medical Council on the continuation of services in the accident and emergency departments in Nenagh and Ennis hospitals.

It responded to public pressure.

The Hanly report is a ten-year document which did not suggest the closure or alteration next week or next year of the accident and emergency departments in Nenagh and Ennis hospitals. The Mid-Western Health Board submitted its model to the Department and the post was sanctioned. In the cold light of day, that is what happened. People put all types of spins on the matter prior to the election. However, I am not responsible for the outcome in that regard.

The Deputy is wrong to forecast doom and gloom in the context of the acute hospital review group considering acute hospital services across the country. The Government, led by Fianna Fáil with the Progressive Democrats, has invested significantly in Mayo General Hospital, an investment which has transformed the fabric of that hospital.

What about all those people awaiting services?

Order, please. I call Deputy Crawford to put his question.

I do not suggest there is not more to be done at Mayo General Hospital. However, at some stage in the process we must acknowledge, as I did on local radio recently, the enormous investment made in that hospital. The review group is examining issues such as peripherality. I have appointed a special planner and people from the regions to take on board the needs of people living in rural Ireland and its periphery. Hanly has not yet reported on the west. Deputy Cowley will be aware that the Fianna Fáil-Progressive Democrats Government has done more for the west in terms of adding medical services than any previous Government or coalition of parties.

The Chair has called Deputy Crawford.

It has improved areas such as cardiac surgery and radiotherapy.

Hanly denies any such services for Mayo.

The Deputy must face reality. I accept the Government has more to do.

I call Deputy Crawford to put his question.

Hanly denies that.

The Minister should listen to what is being said. He stated that it is wrong that anybody should have to wait six months to find out what is happening. However, that is what is happening in terms of Monaghan General Hospital, which is reviewed every six months.

The Minister did not visit the hospital prior to the recent local and European elections but visited it prior to the last general election. Accident and emergency services at Monaghan General Hospital closed during the first week in July 2002. During his visit, the Minister gave a commitment to five Oireachtas Members to do his best to have them reopened as quickly as possible. Is the Minister prepared to give to Monaghan General Hospital the same commitment he is making to the hospitals in Nenagh and Ennis? He has invested a great deal of money in the hospital in Castlebar.

I was delighted with Mr. Kevin Bonner's appointment to the review group. That group suggested that a minimum of €14 million was needed if the hospital was to reopen its accident and emergency service. However, the Minister provided only €2.7 million in that regard. Is that fair play to a Border area which suffered so much as a result of the Troubles? The Minister's representative, Mr. Paul Robinson, stated today on radio that he has overall responsibility in this area. The Minister can no longer place the blame on the health boards. Mr. Robinson stated that the Department has come a long way in terms of the development of hospital services in the eastern health board region.

Is the closure of Monaghan General Hospital to accident and emergency and many other services the way this Minister wants to go? Is he prepared to give a commitment to reopen services at Monaghan General Hospital, as he did in regard to the hospitals in Nenagh and Ennis?

The Deputy's question is based on the false premise that I——

It is based on facts.

——have responsibility in terms of what happens at the hospitals in Nenagh and Ennis. The health board came up with that proposal in terms of emergency care physicians in Ennis and Nenagh.

Is the Minister blaming health board members for that decision?

I am not placing the blame on them, I am stating the reality. This is not a question of placing blame. The health board looked at the problem innovatively in response to the Irish Medical Council which was threatening, in terms of communication to the board, to close accident and emergency services in Ennis and Nenagh. The board responded with its proposal which the Irish Medical Council accepted. That is the reality of the situation.

The North Eastern Health Board has drawn up proposals for Monaghan General Hospital, a matter of which I am sure the Deputy is aware. I urge Deputy Crawford and others to speak to the various interests in Monaghan with a view to getting people around the table. I understand the board recently produced a reasonable set of proposals. I met the Mid-Western Health Board and the medical board in Cavan, both of which urged that there be closer liaison between the two hospital campuses and that a set of proposals be tabled which could lead to constructive dialogue and engagement between the various parties with everybody signing off on the proposals to begin the journey onwards. Unfortunately there has been a lack of agreement between the parties involved. The degree of unwillingness of certain quarters to put their heads above the parapet and take risks in progressing some of the issues has held up progress.

The Deputy referred to the closure of on-call services at the hospital. Earlier I raised with Deputy Ó Caoláin the question of why the hospital originally went off-call — the Royal College of Anaesthesia undertook its own examination of services and came to the conclusion that they did not meet its standards. It pulled the rug on the continuation of on-call services at Monaghan General Hospital.

The Minister refused funding to bring the services up to standard.

We all know that but, unfortunately, what then happens is that political polemic takes over and we get more heat than light.

We must move on to the next question as the time for dealing with this question has elapsed.

That is what happened.

May I ask a brief supplementary, a Leas-Cheann Comhairle?

We have gone well beyond the 18 minutes allowed. We have gone way over the time. I ask the Minister to deal with Question No. 10.

I would like to state why Monaghan General Hospital is off-call. The Minister's proposal provides for cover from 9 a.m. to 5 p.m.

It involves 24-hour medical cover and includes a mechanism by which we can explore the issue further. If we could get people together, we would make progress.

Will the Minister give to Monaghan General Hospital the same commitment he has given to the hospitals in Ennis and Nenagh?

We must move on. The Chair has ruled that we will discuss Question No. 10.

I alone cannot sort out the problem. People in Monaghan have to take on some of the responsibility.

There are no boards to blame now.

I ask the Minister to deal with Question No. 10.

It is about time the Minister faced up to his responsibilities.

No, the Minister has not.

I have been very facilitative in terms of trying to create solutions.

No, the Minister has not.

I will say no more on the matter.

There is no point.

Deputy Crawford knows the answer as well as anybody else. Unfortunately, the political polemic has taken over.

We must move on to Question No. 10.

The Deputy knows it was the Royal College of Anaesthesia which dealt with the matter and it had a legitimate right to do so. Such issues require an imaginative response.

The Chair has called for Question No. 10 to be dealt with.