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Cabinet Committee Meetings

Dáil Éireann Debate, Tuesday - 25 September 2018

Tuesday, 25 September 2018

Questions (4, 5, 6, 7, 8, 9, 10, 11, 12)

Mary Lou McDonald

Question:

4. Deputy Mary Lou McDonald asked the Taoiseach when Cabinet committee E, health, last met; and when it is scheduled to meet again. [30410/18]

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Joan Burton

Question:

5. Deputy Joan Burton asked the Taoiseach when Cabinet committee E, health, last met. [30674/18]

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Michael Moynihan

Question:

6. Deputy Michael Moynihan asked the Taoiseach when Cabinet committee E, health, last met. [37438/18]

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Gino Kenny

Question:

7. Deputy Gino Kenny asked the Taoiseach when Cabinet committee E, health, will next meet. [37536/18]

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Richard Boyd Barrett

Question:

8. Deputy Richard Boyd Barrett asked the Taoiseach when Cabinet committee E, health, will next meet. [37538/18]

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Brendan Howlin

Question:

9. Deputy Brendan Howlin asked the Taoiseach when Cabinet committee E, health, last met; and when it next plans to meet. [37752/18]

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Joan Burton

Question:

10. Deputy Joan Burton asked the Taoiseach when Cabinet committee E, health, last met. [38378/18]

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Michael Moynihan

Question:

11. Deputy Michael Moynihan asked the Taoiseach when Cabinet committee E, health, last met. [38530/18]

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Micheál Martin

Question:

12. Deputy Micheál Martin asked the Taoiseach if he is satisfied that his Department has sufficient expertise to ensure that it can effectively service the preparation of Cabinet committee documents relating to health policy. [38687/18]

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Oral answers (9 contributions)

I propose to take Questions Nos. 4 to 12 together.

Cabinet committee E last met on 11 April 2018. The next meeting of the Cabinet committee has not yet been scheduled. In addition to the meetings of the full Cabinet and of Cabinet committees, I meet with Ministers on an individual basis regularly to focus on particular issues. In this regard I meet regularly with the Minister for Health, Deputy Harris, to discuss issues related to our health service, including last week.

Support for Cabinet committee E is provided by the social policy and public service reform division of my Department. The Minister for Health has primary responsibility for the preparation of documents relating to health policy. Government is committed to enhancing the quality of the health system. This year has seen the highest ever level of health funding in the history of our country and the Government has also allocated significant capital funding of almost €11 billion for health over the past ten years. That is double what was provided for the previous ten years. This is investment in new buildings, equipment and ICT.

However, in order to ensure meaningful and sustained improvements in the health service we also need to deliver a major programme of reform. Important milestones have been reached in recent months. The Minister for Health launched the Sláintecare implementation strategy in August. This provides the framework within which a new system-wide reform programme can be advanced. The new programme office has been established and is now led by Laura Magahy and a Sláintecare advisory council has been established, which will be chaired by Dr. Tom Keane who led the reform of the cancer services in Ireland some years ago. The new structures will support and drive the implementation of the reform programme. Work is also under way to establish a new HSE board to strengthen the management, governance and accountability of the executive. Ciarán Devane has recently been nominated as chairperson designate of the HSE. He is chief executive of the British Council and was a chief executive of the UK health charity, Macmillan Cancer Support. He is also a former member of the board of the National Health Service England.

There are so many questions grouped here that I have to insist that we stick to the time allocated. I call Deputy McDonald.

Gabhaim buíochas leis an Taoiseach as ucht a chuid freagraí. The Taoiseach recently visited the site of the former mother and baby home in Tuam where hundreds of babies are buried. As the Taoiseach knows, the survivors of the home and the families of those who resided or died there have expressed disappointment that he did not meet with them during his visit. I wrote to him in August asking that he meet with Catherine Corless and the Tuam mother and baby home survivors and I ask that of him again. We owe a lot to Ms Corless for her research which uncovered the deaths of 796 children at the home. When the Taoiseach meets with Ms Corless and the survivors, he will hear first hand of their particular healthcare needs. One child died every fortnight when the home was in operation. Many of those who survived a regime of malnutrition and neglect where measles, tuberculosis and pneumonia were rife now suffer very significant ill health and yet the Government has yet to provide a scheme specific to their needs. Three years have passed since the Commission of Investigation into Mother and Baby Homes was established and its timeline for reporting has been extended to February 2019. We know from the industrial homes and the Magdalen laundry scandals that the State moves at a glacial pace in providing redress and access to supports and services when it finally accepts wrongdoing. Survivors of the home need access to health services today. Many of them are elderly and many of them are very unwell. I ask that the State has healthcare provision in place for these survivors and I ask that the Taoiseach acts on that with all due haste.

Has the Cabinet committee on health met to discuss the health budget? There are constant leaks to the newspapers that the likely level of deficit in the health service will run anywhere from €800 million to €1 billion this year. I do not know how a functioning Minister for Health can be in charge of a Department where that level of overspend, that lack of control and that lack of involvement in the management of the Department is such a regular feature of it, and Fine Gael has run that Department for over seven years.

It means that the situation for children with scoliosis, for example, will always be out of reach of being addressed. When I was Tánaiste I secured extra funding which the Taoiseach used to build the additional facilities and yet I read harrowing accounts every week from families, particularly those with children with special needs who are also affected by scoliosis. The numbers are growing and the patients are getting further away from having their surgery. How can the Taoiseach countenance a Minister in his Cabinet being entirely unable to even influence the level of the budget? How can he talk about Sláintecare happening if there is no concept of what a proper budget for the Department is? It is a total failure and shambles on the part of his Government.

The last meeting of the Cabinet committee on health was almost five months ago and the Sláintecare implementation body was launched in August in a quiet news month. I wonder if that was the reason it was launched in that month but we have to look at a number of issues. I have raised the home care packages twice on the Order of Business since we have come back. The home help system is providing an excellent service the length and breadth of the country but there is major frustration for families who are trying to get care for elderly people and who are trying to bring those elderly people back to their community where they can have a quality of life. The home help teams providing this service are saving the State millions of euro. If it is looked at in the context of the fair deal scheme or the nursing home subvention, it is clear they are saving the State millions.

The Minister of State said the staff were not available but that is not the information I have. The hours of people working on home help teams around the country are being cut. New contracts are being entered into and there are negotiations in the HSE on their pay and conditions. It is not that there are no people available to take them up.

With regard to waiting for services, particularly for young kids waiting for diagnostic services and interventions, there is a huge crisis.

I have raised this issue numerous times in the two and half years since I was elected to the House. I understand that over the summer the Minister for Health brought a memorandum to Cabinet on the medical cannabis access programme. Over the summer the Department of Health issued guidelines on the access programme, some of which are quite flawed. It has been going on for a long time and the situation has become ludicrous. A man called Kenny Tynan, a father of four from Roscommon, was granted a licence one month ago from the Department of Health which was signed by the Minister. Today he was sent an email by the medicines management programme to say it would not reimburse the licence. The licence system is unworkable. People are getting licences when they cannot afford them. On average, it costs tens of thousands to go to Holland four times a year to get the medication. The system is completely flawed. In Britain the Tory Government has changed its policy. It is very restrictive but people are at least gaining access to medical cannabis. It saves them going to the black market or going abroad. The situation is unworkable. The Taoiseach has to show leadership. This has been going on for years now. There has to be some sort of clarity either on the licence system, the medical cannabis access programme or the legislation I have put forward.

I will raise the issue of Sophia Daly. It is a case with which the Taoiseach is familiar. She is 12 years old and has cerebral palsy, arthrogryposis and scoliosis. She was diagnosed with scoliosis in 2013 and put on an urgent waiting list for surgery in April 2017. In August, 17 months later, she was taken off that list and is now not on any list even though the Minister claims only 20 people have been waiting longer than the four months which he said was the longest anybody would be waiting. I talked to Sophia's father today and she is in increasing pain. The screws in her back and hip are loosening. She may have to be taken into emergency surgery because her condition is deteriorating. Her internal organs have been affected. Her curvature has significantly increased. It is completely unacceptable. Her father, Aaron, said he has asked on several occasions to meet the Minister. The Minister, Deputy Harris, is refusing to meet Aaron. He asked me to ask the Taoiseach what he is doing about the backlog, apart from, it would appear, manipulating the figures on the extent of the backlog. What is being done with the treatment abroad scheme to clear the backlog in order that people like Sophia can get the surgery they urgently need?

Will the House agree to give five minutes from Question No. 13, which is a single question, to allow the Taoiseach to respond to these questions because otherwise he will only have two minutes to respond to quite a lot of questions? Is that agreed? Agreed.

I made a private visit to Tuam on my way home from a conference in Galway. It was an opportunity for me to pay my respects to the children who were buried there and to see the site for myself. It was not quite what I expected. I expected to see the grounds of an old abandoned institution. It is not that at all; it is a very small site, almost within a housing estate, beside a large playground. I only had about 30 minutes. I would have liked to meet with Catherine Corless, representatives of survivors, residents who have concerns and the local authority but in the period I had, about 30 or 40 minutes, it would not have been possible to do that or to do any of them justice. It was a case of either postponing my visit for a later point in a few months' time or taking the opportunity to stop by and pay my respects and see the place for myself, which I did. I have replied to Catherine Corless and I will meet her with the Minister, Deputy Zappone, because the Minister is the person who is dealing with this issue for the Government and who understands it in a depth that I do not. I will meet her in due course when we are ready to make a decision on the next steps.

The Cabinet sub-committee on health has not met to discuss the HSE budget overrun but it has been discussed at Cabinet. As Deputies will know from my previous replies to questions on this issue, I tend to discuss more things with the full Cabinet than in the past. In the past, bodies such as the Economic Management Council, EMC, or smaller groups were used to discuss important issues. I decided to do it differently and to include the entire Cabinet more and to be more collective in decision-making rather than using bodies such as the EMC which excluded Ministers from decision-making in the past. I am glad to have made some changes in that regard. It has been discussed with the Minister, Deputy Donohoe, and the Minister for Health. We are trying to get an accurate fix on the likely overrun.

We often talk in healthcare about how money should follow the patient and money should get to the patient. We are not in a very good position at all to follow the money in the health service due to the very outdated financial systems so we are trying to calculate what the likely overrun is going to be for this year. As things stand, notwithstanding the fact that health has a huge allocation of €16 billion, which is the biggest ever in the history of the State, health spending is running 9% ahead of what it was last year so that overrun could be quite substantial. It could be in the region of the figures people have seen in the newspapers and that certainly limits our room for manoeuvre when it comes to the budget in two weeks' time because much of that overrun will have to be accommodated in the base for next year as well. Much of it is happening for good reasons. Recruitment is happening apace. There are 1,000 more nurses working in our public health system than we had this time last year. There have been pay increases across the board for 115,000 healthcare staff. Our children's hospital is flying up. The urgent care centre in Blanchardstown is almost roof on at this stage. We have extended things such as free GP care to carers because they need to be cared for too. We are also seeing substantial reductions in the number of people waiting for operations and procedures in our hospitals. Whether it is hips, eyes, knees, cataracts, angiograms or skin lesions being removed, there are 10,000 fewer people waiting for an operation or procedure now than a year ago. The average person is waiting less than six months now for an operation or procedure. We want to get that down to three months over the period ahead.

In terms of medical cannabis, as I understand it, it is required that one has a prescription from a consultant and that one has a licence from the Minister for Health. That is an unusual situation and not one that is desirable or workable. I can guarantee the House that the Minister for Health, while he has signed all except one of the requests for a licence, does not want to be in a situation where he is doing that. It is not the role of a politician to be signing licences for individuals to have their medicines. That is why he is developing the cannabis access programme to do it better. I understand they are running into difficulties with sourcing. If this is a medicine, it needs to be treated like a medicine and we need to make sure it is at pharmaceutical and medicine grade. They are running into difficulties in sourcing it.

On Deputy Boyd Barrett's question, I am not in a position to talk about individual cases or patients in the House. I do not have access to patients' files or records. No politician does or should. There are issues of confidentiality and privacy involved in any individual case. What I can say more generally is that patients can be moved to what is called the suspended list. A patient who may be on a waiting list for surgery may become unfit for surgery for any number of reasons for a period.

They are put on a suspended waiting list but can then be put back on the active waiting list when they are fit for surgery again but I do not have the full information on individual cases and it would be wrong for me to comment on them. I am told, however, that the scoliosis figures for the end of January show there are 188 patients of which 109 are spinal fusion patients on the list for spinal surgery. Of the 90 actively waiting, 14 are to come in, which means they have a date for their surgery, 40 are suspended and 44 are on the planned procedural list with an indicative date for their procedure. The Minister for Health has prioritised the development of a sustainable solution for scoliosis and an additional €9 million has been provided to the HSE this year specifically to develop paediatric orthopaedic services including further increasing access to those services.

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