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Cabinet Committee Meetings

Dáil Éireann Debate, Wednesday - 27 September 2017

Wednesday, 27 September 2017

Questions (1, 2, 3)

Richard Boyd Barrett

Question:

1. Deputy Richard Boyd Barrett asked the Taoiseach when Cabinet committee E, health, will next meet. [39620/17]

View answer

Brendan Howlin

Question:

2. Deputy Brendan Howlin asked the Taoiseach when Cabinet committee E, health, last met. [39628/17]

View answer

Gerry Adams

Question:

3. Deputy Gerry Adams asked the Taoiseach when Cabinet committee E, health, last met; and when it is scheduled to meet again. [40412/17]

View answer

Oral answers (24 contributions)

I propose to take Questions Nos. 1 to 3, inclusive, together.

Cabinet committee E met on 12 September. A date for the next meeting is not yet confirmed. Cabinet committee E covers issues relating to the health service. As well as addressing current issues and challenges faced by the health service, the Cabinet committee will oversee the development of the Government's response to the Sláintecare report.

As I have previously stated, the Government agrees with the broad principles of the Sláintecare report, which align well with current policy direction in many cases. However, as recognised by the Oireachtas joint committee, further work is required on the costings and practical implementation challenges. In addition, the Government needs to consider the phasing and sequencing of the recommendations, given budgetary and capacity constraints.

The Minister for Health is developing a reform roadmap in response to the Sláintecare report by the end of the year and, in parallel, is establishing a programme office and recruiting a lead executive as recommended by the committee. The work will be taken forward under the auspices of the Cabinet committee.

I wish to ask the Taoiseach again about the Cannabis for Medicinal Use Regulation Bill 2016, whether it was discussed at the health committee meeting and the decision of the Government and its representatives on the Joint Committee on Health to support stopping the Bill even though it had passed Second Stage. As a doctor, how can the Taoiseach stand over a report that is essentially determined by a report from the Health Products Regulatory Authority, HPRA, which does not comprise doctors or experts in the field of medicinal cannabis, is 77% funded through fees from the pharmaceutical industry and led the committee to make a statement to the effect that "there is still a shortage of peer-reviewed evidence for the efficacy and safety of cannabinoid treatment for many conditions" while, at the same time, refusing even to take testimony from, for example, Professor Mike Barnes, honorary professor of neurological rehabilitation at Newcastle University, who wrote the authoritative report on medicinal cannabis for the British Parliament and said the exact opposite to what our committee said? According to Professor Barnes, while it is certainly true that more peer-reviewed work is always needed, it is untrue to imply that current evidence is inadequate, particularly given that there is considerable evidence of efficacy in the context of chronic pain and spasticity - both indications having licences in different jurisdictions - as well as nausea, vomiting, anxiety and childhood epilepsy.

That is just one example - I could quote more but I do not have time - of where the actual medical experts have given evidence, although ignored by the health committee, directly counter to the recommendations essentially inspired by the HPRA. I mentioned the IMO to the Taoiseach last week and he dismissed it as a trade union. It is a trade union of doctors compared with members of the HPRA, who are not doctors or experts. Will the Taoiseach continue to allow Fine Gael or, for that matter, Deputy Micheál Martin and Fianna Fáil, to block legislation which is backed up by medical and scientific evidence on medicinal cannabis?

I call Deputy Joan Burton in place of Deputy Brendan Howlin.

I want to raise a very pressing issue which involves relatively small amounts of money. It is the situation of hospices in Ireland, in our area of Dublin West, which serves Dublin 15, Dublin 7, much of County Meath and the rest of Dublin, and also the sister service in Raheny under the auspices of St. Joseph's hospice service. When the country was in financial collapse, the staff of the hospices, which are designated section 39 organisations, voluntarily took the parallel FEMPI pay cuts. Staff in hospices are qualified nurses, doctors and physicians and therapists of various kinds and are paid on HSE scales. The Taoiseach's Government is batting this back and forward. The amounts of money are relatively small. The Taoiseach's Government is refusing to fund the hospices to provide for the reinstatement of the FEMPI cuts that the doctors, nurses and home care teams, who we all praise, took. I do not think there is anybody in this Chamber who does not have personal experience of a hospice. Why has the Taoiseach and his Government failed to respond? He is passing the buck from himself to the Minister, Deputy Paschal Donohoe, who has a level of responsibility, and now onto the HSE with the Minister for Health not really being accountable on this. The hospice in Milford is affected by this. The general system of people dying, often in noisy wards in public hospitals, is completely replaced by the hospice movement providing for people in the terminal stages of illness with dignity and grace and with their families around them. I do not understand the Taoiseach's attitude. He is personally aware of the work of the hospices. I do not understand where his Government is coming from.

Given his former role as Minister for Health, I do not understand why the Taoiseach has cut €50,000 from the healthy babies initiative in Ireland which was used to promote breastfeeding. That is another issue.

I am struck by the almost laissez-faire approach of the Taoiseach and Government in the area of health. Did I hear correctly we were given a date for the last meeting but no date for the next? The number of people on hospital waiting lists in August increased for the month by 3,500 so we now have almost half a million people awaiting outpatient treatment. The Minister for Health tried to bury this bad news by releasing it late on a Friday evening. Trolley numbers are also up. August saw 7,781 admitted patients on trolleys. That is an increase of 27% on 2016. I do not know about anybody else but that fills me with fear and trepidation as we head through the autumn and into the winter time. The reality is the level of overcrowding now in our emergency departments remains at a record high. In the first eight months of 2017, 65,455 people admitted for care were on trolleys. That is up 7%. It is absolutely shocking. I have no sense of any plan emerging to deal with it. Yesterday there were 494 people on trolleys. In Cork, there were 50 patients in the ED and 51 in Limerick. It is very clear these people are being failed. What will the Taoiseach's commitment be in respect of the budget? I have heard him time and again offsetting his responsibilities to the HSE. We are all aware of the statutory function of the HSE but the Taoiseach is in charge. What plans does he have in the budget to recognise these crises?

Three weeks ago, my colleague, an Teachta Louise O'Reilly, published a proposal to establish Comhliosta, an integrated hospital waiting list management system, to try to tackle the waiting lists more efficiently and reduce waiting times. This would create a new model to maximise the capacity of the public hospital system. I recommend that initiative to Government.

As I will be discussing in a later question, the Taoiseach has a very well deserved reputation for believing in spinning every situation. I thought his performance yesterday was particularly good in terms of the question on health.

I thank the Deputy very much.

During Leaders' Questions, the Taoiseach cited the National Treatment Purchase Fund as an initiative that was delivering improvements. What he did not say was it was he and his Government that abolished and fought against its retention. James Reilly mothballed it in terms of waiting lists. Does the Taoiseach accept the policy of diverting money from the National Treatment Purchase Fund was wrong and that waiting times just went too long and that people are waiting far too long?

In terms of health policy in general, there is a bit of confusion. I will hear the Taoiseach's reply on it. The Taoiseach has clearly abandoned the compulsory insurance policy and White Paper, which we were promised in 2011. We were promised it up to about 2015 to 2016. Now we have the Sláintecare report. Other Deputies have mentioned the 645,000 people on waiting lists, emergency department overcrowding, huge problems across the board, 459 people on trolleys yesterday, the hospice situation and the situation of section 39 staff. We raised it with the Taoiseach and he has been very dismissive of it. They are in a really tough situation now. They took a cut at the time and they have not got the allocation from the pay award. They are meant to compete with the other hospitals and everybody else for staff on lower wages. It is not sustainable and it is wrong to put our hospices in that situation. I thought there would be big plans on health following the Taoiseach's election but I have not seen any. Is the Sláintecare report Government policy now or not? The Taoiseach used the phrase "the Government's response to Sláintecare" as if to say the Oireachtas had produced Sláintecare. What is Government policy or Fine Gael health policy because I cannot find it anywhere? Perhaps the Taoiseach will clarify that particular point for me.

The Taoiseach has four minutes to respond to all the questions.

I should point out that most of these were not issues that were discussed at Cabinet committee E but I will try to answer some of them if I can. The medical cannabis regulation Bill was not discussed at the committee. The Health Products Regulatory Authority, HPRA, formerly known as the Irish Medicines Board, has access to experts in pharmacology, medical staff and medical advice and the committee decided not to proceed with the Bill based on that advice.

On the pay question-----

And ignored all the other advice.

-----as relates to section 39, I understand it relates to bodies that are funded in the main, although not entirely, by Government, in which staff are not considered to be public servants. As a result of that, these bodies were given a block budget from which to pay their staff salaries but also to pay for other things and are not therefore bound by FEMPI, either on the way up or on the way down.

They were bound on the way down.

They did take the FEMPI cut on the way down.

They took the FEMPI cut.

The Taoiseach has one minute left.

Regarding people awaiting outpatient appointments, it is important to have a fuller understanding of what waiting lists and waiting times mean. More than half of those who are now waiting either for an outpatient appointment or for surgery wait less than six months. By the way, I do not think six months is anything to be proud of, but it is important to point that out. About a third of them wait less than three months. Therefore, even if everyone waited less than six months or less than three months, 500,000 people would still be on waiting lists. What is crucial-----

Is waiting time.

-----for individuals is how long they wait.

It would actually be possible to have greater numbers on waiting lists, but people waiting less time.

We all know that.

The key thing to look at is the number of people who have been waiting more than three months or more than six months as the case may be.

It is encouraging that in August we saw a fall of 2,000 in the number of people waiting for inpatient operations and day-case procedures. It appears that traditional funding for the HSE and the dedicated funding for the NTPF had an impact on that. I acknowledge that was something Fianna Fáil sought in the confidence and supply agreement and it appears to be having some success. We need to consider whether additional funding will be required for that next year.

In response to the question on budget announcements, as I have said previously, the budget will be announced on budget day.

I understand the Taoiseach is taking Questions Nos. 4 to 6, inclusive, in the names of Deputies Adams, who is being substituted by Deputy McDonald, Deputy Howlin, who is being substituted by Deputy Burton, and Deputy Micheál Martin, together.

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