Tuesday, 14 June 2016

Questions (10, 11, 12, 13, 14, 15, 16, 17)

Gerry Adams


10. Deputy Gerry Adams asked the Taoiseach the dates of the last meeting and the next meeting of the Cabinet committee on health. [11763/16]

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Gerry Adams


11. Deputy Gerry Adams asked the Taoiseach the number of meetings of the Cabinet committee on health in 2016 to date. [12985/16]

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Gerry Adams


12. Deputy Gerry Adams asked the Taoiseach when the last meeting of the Cabinet committee on health took place. [12986/16]

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Micheál Martin


13. Deputy Micheál Martin asked the Taoiseach if the Cabinet sub-committee on health has met. [14453/16]

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Richard Boyd Barrett


14. Deputy Richard Boyd Barrett asked the Taoiseach the number of meetings of the Cabinet committee on health in 2016 to date; and the proposed dates for any upcoming meeting. [14508/16]

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Ruth Coppinger


15. Deputy Ruth Coppinger asked the Taoiseach when the Cabinet sub-committee on health is due to next meet. [15852/16]

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Paul Murphy


16. Deputy Paul Murphy asked the Taoiseach when the Cabinet sub-committee on health is due to next meet. [15858/16]

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Mick Barry


17. Deputy Mick Barry asked the Taoiseach when the Cabinet sub-committee on health is due to next meet. [15864/16]

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Oral answers (16 contributions) (Question to Taoiseach)

I propose to take Questions Nos. 10 to 17, inclusive, together.

The Cabinet committee on health met on 12 May 2016. The Cabinet committee has met once in 2016. The next meeting is scheduled for this Thursday, 16 June.

Does the Taoiseach believe that, given the emergency in our health services, this number of meetings - one, if I understand properly - is sufficient? The €500 million in additional funding, which is welcome, will not deal with anything other than just keeping the system upright. It will not address the core issues of funding for new services or improvements in existing ones, the availability of new drug treatments, staff recruitment, etc. According to the delayed report from the HSE in respect of January and February, 2,700 patients aged over 75 years spent more than 24 hours on trolleys in emergency departments. In my constituency, Our Lady of Lourdes Hospital still scores among the top three hospitals with the longest trolley waiting times. Some 9,381 patients were on trolleys, an increase on last year and double the March 2008 figure.

I do not know whether Cabinet sub-committees deal with the next issue I will raise, but how could they if they are not meeting? The Taoiseach regularly denies in the House that there is a moratorium on recruitment. However, in a letter from the HSE to Sinn Féin's health spokesperson, Deputy O'Reilly, the author wrote that a temporary recruitment pause was in place. That is a moratorium. We can play with fancy words and games of Scrabble with all of this, but in the meantime the patients suffer.

Another major issue is one that has been in the news recently, that of the availability of immune therapy treatments to cancer patients. Recently, I told the Taoiseach about a constituent of mine who had been on a clinical trial since 2013. She is now in remission, so her story is a very good one, but others are not receiving these treatments. Negotiations are under way, but has the Minister placed a timeframe on them? If the drug companies do not respond in a satisfactory way, will the Government use the 2013 legislation to set the price of drugs unilaterally?

I will ask my final question, since we are trying to work in a new mode. Will the Taoiseach clarify when the Minister for Health is expected to provide more details on finalising his proposals on the necessary expansion in bed capacity in services for the forthcoming autumn and winter periods?

The Minister for Health has outlined his initial priorities for the first 100 days. These include reactivation of the National Treatment Purchase Fund with a more targeted implementation; the examination of whether minor injuries units and clinics can have their opening hours extended; to establish an all-party Oireachtas committee to develop a long-term vision for health care, for which I understand he has been given approval by the parties; to establish a youth mental health commission, which will link with the action in the Civil Service renewal programme; launch a review of A Vision for Change; publish a national obesity strategy; restore the Public Health (Alcohol) Bill to the Order Paper; finalise the cancer strategy paper; look at the question of starting the planning for a cystic fibrosis unit in Beaumont; progress emergency departments in Galway and in Beaumont; and look at other issues like cardiac care in Waterford and so on.

The Minister for Public Expenditure and Reform has now increased by €500 million the allocation to health. This is €800 million more than just over a year ago. Deputy Micheál Martin has raised this on many occasions. It represents an increase of 6% in spending. I wish to make it clear that it is not possible for any Minister to continue to go to that well as if nothing ever happened, so those people who are in charge of management of hospitals and who have budgets to manage had better understand that we cannot have a situation arising when there are no further Supplementary Estimates available to meet them. There has to be effectiveness in terms of the way taxpayers' money is being spent.

These are all very important cases, but everywhere I go, I hear the same story - that one can manage the impact of the moneys being allocated to a much greater extent in the interests of the patient. I hope that the allocation given last week of €500 million extra for the health area will, in the words of the HSE, stabilise this position and will allow for the very best level of treatment to be given to patients. I have to say that the vast majority of people that I meet, once they go through the health system, have nothing but words of commendation and praise for those who work in the service. It is always the blockages in the accident and emergency units or the waiting lists that cause all of the difficulties, and there are ways of dealing with these. I hope that in a situation where the Minister for Health is now speaking to each of the managers in the hospitals, particularly the acute hospitals, there will be an understanding here of getting the best effect in the interests of the patient for the moneys that have been allocated.

We do need to look at the reforms that are necessary in the health area in general, of which there are many. I hope that with the approval of parties in the House, we can focus on a ten-year strategy and a vision for the health service. Where do we want Ireland to be in terms of its health service in 2026? Issues to be addressed include a growing population, an ageing population, more home care packages, more primary care centres and more community-based facilities for people who should not have to go to hospital in the first place.

There are so many things that need to be worked on here. I have allocated, with the approval of Government, four Ministers of State to the Minister for Health dealing with specific areas like mental health, obesity, the national drugs strategy and another issue - it escapes me at the moment - so that, in the interests of dealing with what is an enormous challenge for the country, I hope that we can get best effect out of what is now a budget in excess of €14 billion.

Next I will call Deputies Micheál Martin and Mick Barry.

The Taoiseach did not answer the question on the difference between a moratorium and a temporary pause in recruitment.

Maybe when the Taoiseach rises to-----

There is no moratorium in respect of the budgets that they have. They can recruit away. Even beyond that, front-line service staff can be recruited.

I put it to the Taoiseach that the previous Government's Cabinet sub-committee on health was in many ways a place to which policies or initiatives were sent in order to avoid any action. The clear evidence of this was its one publication, the White Paper on health insurance, the status of which is unknown. Will the Taoiseach clarify whether that White Paper remains official policy or whether it has been taken off the table? Has the Government abandoned it and gone back to the drawing board?

On the chaos in emergency departments, we were promised an action plan by the end of the year. Will the Taoiseach confirm whether that is the total agenda of the Cabinet sub-committee in terms of the emergency department-----

To what is the Deputy referring?

Having an action plan for emergency departments by the end of the year.

Let me refer to the restoration of the National Treatment Purchase Fund which I initiated back in 2002. Over a sustained period it brought down inpatient waiting lists for adults to six months and for children down to three months. It was, however, more than a matter of the allocation of funding which was obviously very important; it also involved a new way of dealing with waiting lists in public hospitals, through utilising excess capacity in the private sector, in addition to using capacity within the public hospital sector effectively to reduce waiting lists. There is a great opportunity for the new Minister to achieve real action if he draws on the expertise that was available under the older treatment purchase scheme. There was a reluctance about this proposal on the part of some on the Fine Gael side during the talks on the facilitation of a minority Government and only €15 million was allocated, but more than that sum will be needed over time. Believe me - the method proved to be very effective in ring-fencing funding that went directly to the patient waiting on a list. We got rid of the era in which people were waiting for two or three years for a hip or cataract operation, for example.

My third point on the Cabinet sub-committee is related to drugs pricing and the policy on the pharmaceutical industry. On the one hand, we encourage pharmaceutical companies to come here through foreign direct investment initiatives and say we want Ireland to become a centre of pharmaceutical activity, industry and research, while, on the other, we have in recent years been very poor on new drugs and technologies and having a proper model for them.

The Deputy is running down the clock.

There is a need for the Cabinet sub-committee on health to engage with enterprise and the Department of Finance to bring about a coherent policy on pharmaceuticals, both from a pricing perspective and the perspective of attracting inward investment. No one knows where we stand on this issue. The recent developments in the use of Pembro and new cancer drugs were unacceptable. The new Minister did respond, but, unfortunately, his predecessor did not, despite the pharmacoeconomic unit having agreed as far back as last February to the release of Pembro. We need a proper policy on new drugs and technologies. It is essential. We need a coherent attitude on the part of the Government to the pharmaceutical industry and new drugs and technologies. I ask the Taoiseach to comment.

We had better bring in Deputy Mick Barry because we are running out of time.

Last night I attended a heartbreaking public meeting organised by the parents connected with Cara junior school on the Banduff Road, just outside Cork city. I was given to understand it was the only autism-specific primary school in Cork. They were the parents of 60 children, some of whom are autistic and some of whom have learning disabilities, allergies, epilepsy and sensory and behavioural health issues. They explained that the teachers and special needs assistants were brilliant but that there were no more resources available. There are no speech and language therapists in the school, nor is there an occupational therapist, a physiotherapist or a nurse. The parents have been thrown from Billy to Jack, or between the Department of Education and Skills and the Department of Health, for a considerably long time. They have got so tired of this that they have brought the matter to their local Deputies and I am bringing it to the attention of the Taoiseach today. My question is simply this: what is intended to be done for the parents connected with Cara junior school and their children and also for parents and children in similar circumstances throughout the State? Those affected in Cara junior school are not alone.

That is a question to be raised as a Topical Issue when I am quite sure the Minister would give the Deputy a detailed response. This morning, on the recommendation of the Minister for Education and Skills, the Government approved a further allocation of over 800 special needs assistants, bringing the number to 12,900, the highest number ever. There will, I believe, be a need for a further 115 next year. However, it is not just a case of making appointments of special needs assistants, whose job it is to look after the physical needs of children; it is also a case of dealing with the intervention process and meeting the needs of children at a much earlier stage. These requirements could be related to speech and language therapy services or psychological services. There could be a range of other needs. In making provision for what is a very extensive number of special needs assistants the Minister has commissioned, through the National Council for Special Education, an analysis of the outcome of expenditure and the numbers employed in this area. In other words, can more be done? Should there be a different intervention at an earlier time, or has it just become a call that the special needs assistant is a very important entity, which is the case? Should something be done at an earlier date? I do not know the details of the case the Deputy mentioned, but I am quite sure the Minister would respond to him.

The priority is to focus on universal health care and have it provided through home care packages, community facilities and primary care centres and to keep people out of hospital when they do not have to be there.

The Minister has set out his stall on waiting lists and trolleys in emergency departments. I do not see why we cannot have in the public health sector diagnostic centres that would be the match of anything provided in the private sector. Some time ago I opened a privately run unit that is open from 7 a.m. until midnight, with two facilities operating in parallel all day, every day. The number of scans that can be carried out is enormous. There is no reason, in endoscopy units and the public health system, we cannot have really effective diagnostic capacity and centres that do not close at 5 p.m. If we are serious about having an impact on waiting lists of individuals awaiting scans, we should be able to achieve this in the public sector also. There is spare capacity in many hospitals where consultants and doctors could see patients not on their own waiting lists in order to make progress.

Deputy Micheál Martin made a point about drugs. This is important. The Minister has made it perfectly clear that the trend has been to leave the decision, or the perception of it, to the Minister for Health of the day. Some weeks ago I listened to Dr. Barry talking on the radio about the reasons clinicians turned down a drug based on its effectiveness. It is at the clinical level that the discussion needs to take place. The clinical discussions on the effect on quality of life, at the cost level set by the companies, have to be dealt with in the first place by those who know what they are talking about in terms of the clinical outcomes and clinical analysis of the drug in question. The Government decides afterwards whether it can provide the funding for many of them. We know that in the next ten years there will be a range of as yet unpatented drugs to treat particularly challenging conditions. They will be very expensive. The Minister is clear that the discussions should, in the first instance, be between those who can carry out a clinical analysis of the impact of drug X or Y on the quality of life of a patient. If that is determined, the Department and the Minister can, on behalf of the Government, decide to act. Deputy Micheál Martin's point is valid, but I have outlined where the discussion should occur in the first instance.

We have only nine minutes remaining for the last batch of questions, Nos. 18 to 25, inclusive.