Dáil Éireann díospóireacht -
Wednesday, 7 Jul 2004

Vol. 588 No. 6

Leaders’ Questions.

Mr. Kenny

This is our last opportunity to have the Taoiseach answer questions on Leaders' Questions before the summer recess. I will start by quoting Paul Byrne of Tallaght, who said, "The next time I go to A&E again I'd rather not be breathing." He was the patient who, during a visit to hospital, found that, when he returned from the toilet, his trolley had been taken for another patient. We have had lists of promises and statistics from the Taoiseach and his Ministers over the last few years regarding accident and emergency units. On 7 January 2004 there were 179 patients on trolleys in Dublin accident and emergency units. On 3 February there were 207 patients, on 26 April 160, and on 22 June 150. The figures for summer are almost the same as for winter, despite the fact that €11 billion is being spent on health services.

That is not confined to the Eastern Regional Health Authority area, and those situations will be exacerbated by the requirements of the working time directive when it enters force later this year. Similar problems have been experienced in University College Hospital, Galway, in Mayo General Hospital in Castlebar, in the Midland Regional Hospital in Tullamore, the Mid-West Regional Hospital in Limerick, Naas General Hospital and Wexford General Hospital.

The Taoiseach has examined the economic situation, which is quite strong. He has said publicly that we have more money to spend, and the Tánaiste has said that we have three years in which to put the boot to the floor. Is the Taoiseach satisfied, and does he agree with me, that the structure that currently applies is not capable of delivering 24-hour accident and emergency services for those who need them when they need them and that it must be radically altered now? Does the Taoiseach intend providing extra moneys this year to deal with the provision of 24-hour accident and emergency cover in hospitals throughout the country for people who need it and currently cannot get it? Will it continue to be the case that, if they go there, they will find themselves lying on trolleys for days on end?

The Taoiseach

The Government identified some years ago that health reform and a change to our structures were necessary. We must change our health board system and many other structures in the health system. We have identified that and prepared and produced reports. We have passed the Health (Amendment) Act 2004. We are already trying to put extra resources into different areas of health care. I will not go through the long list of the improvements in staff and everything else. I assume that people who were there are doing a better job.

It is a fact that there are particular problems in accident and emergency departments. We have identified those problems and tried several ways of alleviating the difficulties. We have far more accident and emergency consultants in the units. We have opened additional beds and tried through various measures to eliminate the problem as far as one can. Deputy Kenny suggested that 24-hour cover is a difficulty. We must find out exactly whether it is a matter of simply having more beds. I do not like the term "bed blockers", but it means that there are people who, owing to the lack of stand-down facilities, cannot go home or get alternative accommodation, instead staying in acute hospitals longer than they normally would.

Mr. F. McGrath

Two years later.

The Taoiseach

Please listen. If that is the case——

An Ceann Comhairle

Please allow the Taoiseach to speak without interruption.

Mr. F. McGrath

Some 150 people——

An Ceann Comhairle

This is Deputy Kenny's question, and Deputy McGrath should leave it to him. The Taoiseach should continue without interruption.

Mr. F. McGrath

That is the reality two years later.

The Taoiseach

If that is the case, though we have opened additional beds, we have to try to do more in the area. Accident and emergency departments are clearly the main focus. In all surveys of patients, they say that, by and large, they find the hospital service excellent but the accident and emergency departments fairly disastrous, though not in all areas of the country. That is the challenge.

It is a question of changing some of the systems. I remember a time not that many years ago when it was not possible to have accident and emergency departments in every hospital. However, it seemed at that time that it was not so difficult in accident and emergency, though that appears a total contradiction. Now we have accident and emergency units everywhere, all well staffed.

Mr. Crawford

Monaghan is not.

The Taoiseach

If it is a question of resources——

Mr. F. McGrath

They have not delivered.

The Taoiseach

——and more staff, we will have to see what we can do. The Minister has identified the hospitals and the areas and tried to eliminate those problems.

Mr. Kenny

That is more or less the same reply that the Taoiseach has given on numerous occasions in the past. The Minister for Health and Children, Deputy Martin, is being strangled by the Department of Finance and the Taoiseach's Government. Today is the Taoiseach's 2,568th day in continuous Government. There have been seven years of plenty and seven years of waste.

When the Taoiseach says that he has opened extra facilities, perhaps I should remind him that a €96 million wing of the James Connolly Memorial Hospital in Blanchardstown remains substantially idle. A brand new health centre costing €48 million in Ballymun has been lying vacant since it was finished 18 months ago, despite the fact that the Northern Area Health Board has paid €5.25 million in rent for the facility. A €26 million high-tech accident and emergency unit has been lying idle in Cork University Hospital for the past seven months. The hospital wing at South Tipperary General in Clonmel has been idle for 15 months. A €2.8 million, 90-bed unit for the elderly in Birr, County Offaly remains unoccupied. Is the Taoiseach not ashamed that he presides over a Government that has failed utterly to deal with a fundamental issue of rights for our people — access to health care when they need it?

The litany from Minister after Minister reminds me of Edmund Burke's remark that falsehood has a perennial spring. Seven years later the Government continues to spout endless lists of money spent when the evidence is available in every household in the land that this has been the worst Government in 50 years and has failed completely to deal with the nation's health issues. The Taoiseach should be ashamed of himself heading into the summer recess. Shame on him and his Ministers.

Deputies

Hear, hear.

Mr. Healy

Tuam hospital is closed.

The Taoiseach

Deputy Kenny and his colleagues never like to hear the facts but he is not going to get away with giving the impression of misleading the public.

Mr. Hayes

Show us that.

(Interruptions).

The Taoiseach

The facts are Deputy Kenny asked whether there are still problems in accident and emergency units. The honest answer is yes, in some places.

Mr. Kenny

I asked what extra moneys his Government intends to provide.

The Taoiseach

Based on all the figures for ordinary people, over 30% more receive treatment in our hospitals.

Mr. Crawford

They are not on medical cards.

Mr. F. McGrath

That is history.

Mr. Kenny

The Minister for Health and Children is strangled.

The Taoiseach

There have been 1 million in-patient treatments this year. We have far better cancer treatments and a significant improvement in heart surgery. There is a massive improvement in our maternity services. At least we built the units the Deputy mentioned and we will open every single one of them.

Ms Burton

They are closed.

Mr. Kenny

The Government should open them.

Mr. Hayes

On a point of order, the Government did not build them.

An Ceann Comhairle

Is Deputy Hayes not satisfied with his leader's handling of the question?

Mr. Hayes

I am happy with it.

Mr. Kenny

He is very happy with it.

An Ceann Comhairle

The Taoiseach's minute is concluded.

The Taoiseach

I assure Deputy Kenny that not alone did this Government build all these units but his colleagues will come along for the opening days, trying to claim some credit for them as they always do.

Mr. Howlin

When?

(Interruptions).

Mr. D. Ahern

It will be like decentralisation at home.

Mr. Kenny

We know who wrote the Taoiseach's speech.

Mr. D. Ahern

Hypocrites.

Mr. Kenny

Deputy Ahern has enough trouble in Dundalk.

Mr. D. Ahern

The Deputies got their photographs taken.

Mr. Rabbitte

Who is misleading the public? Who was it told the public two years ago, on 6 May 2002, that he would abolish public queues for hospitals? Who spoke on the radio this morning on behalf of the Royal College of Surgeons in Ireland and the Irish Medical Organisation to say that implementation of the Working Time Directive will adversely affect patient care, inevitably lengthen the queues and slow down appointments for elective treatments?

Who is fooling whom? Is it not the reality that there are new units of hospitals to the value of €416 million, as identified in the Minister's memorandum to Government, boarded up because they cannot be commissioned? Only this morning a newspaper reports a €30 million unit in St. James's Hospital, that would treat 20,000 cancer patients a year, is chained and padlocked. Cancer patients await access to Dublin's largest hospital which is padlocked and chained a year after the unit was provided.

Deputy Kenny has given the Taoiseach the list of hospitals we visited in Mullingar, Clonmel, Naas, the University Hospital in Cork, Wexford, James Connolly Memorial Hospital in Blanchardstown and several others. Who is the Minister responsible for health? Clearly he is the Minister for Finance, Deputy McCreevy, who brought in six-monthly returns last week showing a surplus in tax of €1,049 million and an underspend on the budget provision of €609 million. Essential moneys to commission hospitals for patients awaiting treatment for cancer cannot be provided and the Taoiseach says Deputy Kenny is misleading the House and the public. Has the Taoiseach lost all touch with reality? Does he see the embarrassment of his own backbenchers? When will he do something about the chronic state of the health services?

The Taoiseach

This year the health Estimates are up by over 10% and the capital programme for health is approximately €1 million extra. Every one of the units to which the Deputy refers was built by this Government in recent years and in the next few years every one of these units——

Mr. Crawford

They were not.

Mr. Howlin

The buildings are padlocked.

Mr. Hayes

On a point of order, they were sanctioned by Deputy Noonan. The Government has failed to open them. The Taoiseach is misleading the House.

The Taoiseach

No unit in the State, built by this Government, is closed. We are spending more on capital programmes and opening more units; we have more staff, more treatments, better services and will continue to provide that. The Deputy persists with the idea that these units were always there and are closed.

Mr. Hayes

The Government has failed to open them. The Taoiseach is misleading the people.

The Taoiseach

They are new units, newly staffed, with 30,000 extra people working in the health service. We will continue to open all those units.

Mr. Howlin

They are empty.

Ms Burton

They are closed.

The Taoiseach

We have improved the cancer service beyond all doubt.

Mr. English

People are queueing.

The Taoiseach

Deputy Kenny's party launched a small cancer programme some years ago. Deputy Rabbitte's party did nothing for it. We have put in significant funding, good units, good services and we are going to continue that. Those are the facts.

Mr. Howlin

What a joke.

Mr. Crawford

What about the cancer unit in Cavan hospital?

An Ceann Comhairle

This is a Labour Party question. Deputy Rabbitte is entitled to ask his supplementary question without interruption.

Mr. Rabbitte

The Taoiseach seems to have learnt nothing from his recent encounter with the people. The Irish Medical Organisation said this morning that implementation of the Working Time Directive would lead to a situation that was unsafe, unworkable and, in some cases, reckless. That directive must be implemented by 1 August. There are 700 nurse vacancies.

The Taoiseach talks of people blocking beds but there is bed capacity in private nursing homes that cannot be accessed because of their cost. He boasts about his friends in the construction industry building units and new wings of hospitals and says that his Government did all this. His Government has kept them closed.

His Minister brought a memo to Cabinet that someone contrived to leak into the public domain showing that €416 million worth of plant is lying idle that cannot be commissioned. Meanwhile his Minister for Finance boasts of how he intends to stay in that Department, no matter what the Taoiseach intends, and he will not provide the basic money for people in need of appointments in our public hospital system. It is a disgrace and it is appropriate that this is the final theme in this House before it rises for the summer recess.

The Taoiseach

I do not wish to enter an industrial dispute on the Working Time Directive with people who spoke on the radio this morning. However, I ask that they quickly engage with the Minister for Health and Children. It is not reasonable for any wing of the hospital service to suggest we can run our hospitals between 9 o'clock and 5 o'clock from Monday to Friday.

Mr. Rabbitte

Nobody is suggesting that.

The Taoiseach

I am sorry to say people are.

Mr. Rabbitte

No, they are not.

The Taoiseach

They are.

Mr. N. Dempsey

The Deputy is not so well informed.

The Taoiseach

The IMO will not agree on the meaning of working time and it insists that all the non-consultant hospital doctors working between 9 o'clock and 5 o'clock from Monday to Friday will not propose a working time complaint officer or agree to local implementation groups. That is their position.

Mr. Rabbitte

No. They said clinical training could not take place in those hours.

The Taoiseach

They and we know that is not workable. If they engage with the Minister for Health and Children we can resolve this so that from 1 August it will apply to doctors in training. They have long campaigned on the basis they were working too long. We supported that campaign and made significant improvements from the 80 or 90 hours a week they were forced to work. The Working Time Directive requires that doctors work no more than an average of 58 hours in hospital each week, and no more than 13 hours per day and receive daily and weekly rest breaks. We support that. To make it operate effectively, however, there will be an enormous cost to the State, which it is willing to pay. Negotiations must be concluded on how the rosters will work.

As regards the other issues, I will say no more than I have already said. The Government has built the units, it will open those units and it will continue to build the further units listed in a capital programme, under which funding of €36 billion will be provided in the coming years.

Caoimhghín Ó Caoláin

For the third time today and, all too sadly, for the final time for the next ten weeks, the House asks the Taoiseach to indicate the immediate and effective measures he will take during the summer months to address the crisis in the health service. He must accept the facts. The Irish Nurses' Organisation has highlighted the drastic shortage in the number of nurses. There are some 700 vacancies and it is projected that this will increase to in excess of 2,000 within the next 18 months.

The crisis continues in accident and emergency departments, particularly those in Dublin with which the Taoiseach should be familiar. My colleague, Councillor Dessie Ellis, informed me about a man from his constituency who spent three days on a trolley in the Mater Hospital's accident and emergency department. On the day the man, who had suffered a stroke, obtained a bed, there were 29 patients on trolleys in the hospital. Some of these individuals had been on trolleys for five days at that juncture.

Yesterday and again today, four women from my constituency, including an expectant mother, are bringing a case before the High Court to challenge the decision to remove maternity services from Monaghan General Hospital. In addition to the closure of these services, accident and emergency services at the hospital have also been withdrawn. The Government has stood idly by and ignored Monaghan. The Taoiseach did not refer to it earlier in the context of the list of issues relating to hospitals that need to be addressed. Citizens are being obliged to resort to the courts in order to secure their basic right to access essential hospital services.

A report into the death of a nine year old child, Frances Sheridan of Cootehill, Cavan, was published recently. The girl in question was sent home from the accident and emergency department of Cavan General Hospital and the report to which I refer illustrates a litany of errors and system failures which must raise questions about the overall management of our hospital delivery systems.

An Ceann Comhairle

The Deputy's time is concluded.

Caoimhghín Ó Caoláin

The report must invite a challenge to the ever-increasing control over the configuration of hospital services delivery by consultant interests.

An Ceann Comhairle

I ask the Deputy to give way to the Taoiseach as his time is concluded.

Caoimhghín Ó Caoláin

Will the Taoiseach cease providing a litany of statistics and information about financial expenditure and refer to service delivery?

An Ceann Comhairle

The Deputy must give way to the Taoiseach.

Caoimhghín Ó Caoláin

Will the Taoiseach respond in clear terms?

The Taoiseach

The Deputy asked me to respond in clear terms. He is aware of the details of the health reform programme. As a member of the health board in his area, he oversaw the changes that occurred there. I accept that these were obviously not to his satisfaction but he is aware of the position.

I will not provide a litany of statistics but I will state that there are 8,000 more nurses and 30,000 additional staff in the health services than was previously the case. These nurses are treating 1 million more people. The service is far better——

Caoimhghín Ó Caoláin

How does the Taoiseach propose to respond to the crisis?

The Taoiseach

I listened to the Deputy and I ask him to allow me to reply. These additional staff are serving many more people than was the case in the past. There are vacancies in the area of nursing but 8,000 more positions were created before the question of vacancies was ever addressed. A few years ago there were 2,500 vacancies but the Minister has reduced this figure to under 700. We should at least give credit where it is due.

Ms McManus

There are over 700 vacancies.

The Taoiseach

The Deputy asked in particular about what we intend to do this summer in terms of increasing the number of beds. The Minister has given €17.6 million to the ERHA alone and he has also provided money to the other health boards. This funding has already resulted in the discharge of some 300 patients from a number of acute hospitals in the eastern region who were taking up the spare capacity to which Deputy Rabbitte referred. The numbers are being substantially reduced. That is the case in all areas.

I do not believe that the extra 30,000 staff or the additional billions of euro provided are not being used properly.

Mr. Durkan

There is something wrong.

The Taoiseach

There are still problems in some areas, particularly in respect of accident and emergency services. I object to the view that hospital beds, capacities, facilities and the numbers of consultant, paramedical and medical staff have not increased to a position where they are now far more extensive than ever before. I accept that units have been completed which have not yet been opened. These will be opened.

Mr. Durkan

When?

The Taoiseach

There are other units on which work has commenced. We are spending more than any other country on our capital programme for health and we will continue to do so.

Members should not try to indicate, as the Dáil session draws to a close, that nothing is happening. When the health Bill comes forward, I hope Members will support the Minister for Health and Children.

Deputy Ó Caoláin referred to consultants and others. As soon as we——

Caoimhghín Ó Caoláin

Face up to the consultants.

The Taoiseach

This morning, a section of the medical service is trying to suggest that we can roster people for duty from 9 a.m. to 5 p.m., five days a week. That is baloney and it is not acceptable. These are the issues we need to address.

(Interruptions).

Mr. J. O’Keeffe

The Government is baloney. That is the problem.

Mr. Durkan

What the Taoiseach said is an admission of failure.

Caoimhghín Ó Caoláin

I am glad the Taoiseach has highlighted a matter on which we can agree in respect of the health services and the particular influence that continues to be exercised by the consultant representative offices. However, the Minister cannot, Macbeth-like, wash his hands of ultimate responsibility. That is what is actually happening.

We all recognise and acknowledge that there is more money being spent on the health services today than at any time in the past.

(Interruptions).

An Ceann Comhairle

Deputy Ó Caoláin to continue, without interruption.

Caoimhghín Ó Caoláin

What is the Taoiseach going to do to address the specific areas in respect of which urgent action is required? We cannot allow the current position to obtain. Trundling out statistics time and again and offering only a defensive response will do nothing to meet the needs of people who are suffering. What is the Taoiseach going to do immediately to avert the possibility of there being some 2,000 nursing vacancies during the next months? He should be specific.

He stated that he would like to see the various units completed under the €400 million capital programme opened. However, he has not stated that he will not only support but will insist on the provision of €50 million for resources to ensure that the doors of these units are opened. Included in these units is that at St. James's Hospital which could cater for some 20,000 cases annually.

An Ceann Comhairle

I ask the Deputy to give way to the Taoiseach as his time is up.

Caoimhghín Ó Caoláin

Will the Taoiseach give an assurance that this €50 million will be provided to the Minister to allow these units to be opened immediately?

An Ceann Comhairle

Deputy Ó Caoláin should give way to the Taoiseach. There cannot be a separate Standing Order for the Deputy.

Caoimhghín Ó Caoláin

I would not expect there to be such a Standing Order. We are seeking real answers from the Taoiseach.

The Taoiseach

The Deputy inquired about the ERHA. I stated that additional staffing and resources have been provided and that several hundred cases have already been discharged as a result. The Minister is actively engaged in trying to recruit nurses. He has already reduced the number of vacancies from approximately 2,500 to 700.

As regards some of the new units, it is not merely a question of opening the doors. The Minister has been continually providing resources. The units will be opened but they must be equipped, commissioned and staffed.

Ms Burton

The equipment is already in place at Blanchardstown.

Caoimhghín Ó Caoláin

Will the Taoiseach provide the Minister with the necessary funding?

The Taoiseach

The Minister is engaged in progressing this matter and he has been provided with enormous funding under the capital programme.

There are now over 50 emergency medicine consultant posts. Those occupying them are providing substantial assistance in terms of providing service in accident and emergency departments. We accept that in some areas we must provide more step-down beds to resolve the issue. I said that at the very start to Deputy Kenny. I hope in the months ahead we will be able to complete that process.

Mr. Durkan

The backbenchers are getting very uneasy. They could be about to stampede.