Vol. 591 No. 2
1 Dr. Twomey asked the Tánaiste and Minister for Health and Children if her Department has deferred until 2007 or 2008 making a major investment in the non-acute sector, especially the primary care sector; and if she will make a statement on the matter. [26414/04]
It is not correct to say that funding for the non-acute sector, including primary care has been deferred to 2007 or 2008. The total capital programme for this year is €509 million. The health capital investment framework programme for the years 2004 to 2008 proposes a total capital envelope of €2.7 billion. This includes capital investment in the non-acute hospital sector.
A number of major acute hospital projects are under way which by their nature involve significant contractual funding commitments — construction, fees, equipping — for the next few years. It is in this context, allied to the multi-annual nature of the funding programme, that a greater emphasis is being placed on the non-acute programme for the latter period of the framework. This is especially the case, bearing in mind existing contractual commitments and the timescales involved in delivering the larger projects in the non-acute sector.
There is no funding for primary care in the Government's primary care strategy to which the Minister has made no reference. While this is not what makes headline news, investment in primary care, which includes general practice services and ambulance services, is a solution to the long-term crisis in health. Will the Tánaiste agree that if there is no investment in primary care, it makes the Hanly report unimplementable? The former Minister for Health and Children, Deputy Martin, stated before leaving office a month ago, that none of the €2.5 million which is being rolled out was to be invested in the non-acute hospital sector, specifically the primary care sector. In information released under the Freedom of Information Act, the Department of Health and Children said there will be no investment in primary care until 2007. Without investment in primary care, the Hanly report, as published by the Department, is unimplementable. In regard to the consultants' contract, there is no point in negotiating it unless there is major investment in primary care. The Minister has not stated where the investment in primary care is going.
I agree with the Deputy. The development of the primary care sector is central to the health strategy. Certainly the general practitioner service is the first port of call for the majority of people. I am examining how we can develop further the potential the primary care sector offers. I said in my reply that it is not correct to say that the non-acute sector will not receive substantial funding. I have a number of projects to which I can refer but I do not wish to delay the House. Among them are projects in the mental health area which are a priority for the Government. They include the facilities of the Central Mental Hospital in Dundrum which are not appropriate to the needs of today. I intend to bring forward proposals to the Cabinet shortly on that matter. It would be my intention to dispose of some of the substantial land assets available in the health sector and to use them as additional funding on the capital side for many of the projects, such as those in primary care, which the Deputy mentioned.
I agree that funding will be put into mental health services. However, I am asking specifically about primary care to which no commitment has been given in the primary care strategy. Prior to leaving office, the former Minister for Health and Children, Deputy Martin, began to speak about public private partnerships which were not referred to when the primary care strategy was published. It appears that funding in this area has come to a stop. That is the point I make because it is the solution to many of the crises in the health service. I am surprised that investment in primary care should be stopped when there is already a manpower crisis and the hospitals with the worse accident and emergency crises are those which also have the poorest primary care services. While investment in this area does not make headline news, it is vital for the health services.
I emphasise there is no question of investment in the primary care sector being dropped. Regarding the next two questions I will take, developing out-of-hours services in the greater Dublin area is crucial to relieving many of the pressures experienced by the accident and emergency departments in the Dublin area. Primary care is developed along a number of models. I look forward to the negotiations with the Irish Medical Organisation, IMO, and consultants on the changes which are necessary to implement the reform programme which the Government has under way to unsure this country has the best possible standard of health care delivery in the world. I want people to be able to come to Ireland in the future——
Dream on.
I will not dream on. That was said about the economy ten years ago. We can do it in Ireland and that has to be the ambition. That is certainly an ambition I have set for myself.
Not if the Government does not spend.
I do not believe in being defeatist like the Deputy.
For the benefit of Deputy Gormley, in regard to priority questions only the Member who submitted the question is entitled to submit a supplementary.
I was just heckling.
2 Ms McManus asked the Tánaiste and Minister for Health and Children the steps she intends to take to address the continuing severe difficulties in accident and emergency units, especially in hospitals in the greater Dublin area which cause hardship for patients and staff alike; and if she will make a statement on the matter. [26412/04]
3 Mr. Gormley asked the Tánaiste and Minister for Health and Children the steps she has taken to introduce emergency measures to deal with the continuing crisis in accident and emergency units; and if she will make a statement on the matter. [26413/04]
I propose to take Questions Nos. 2 and 3 together.
This Government has over recent years introduced a number of initiatives aimed at improving the delivery of acute services and alleviating the pressures on accident and emergency departments. Improved and expanded accident and emergency departments are being provided. Recently, new departments have been provided at Cork University Hospital, James Connolly Memorial Hospital, Naas General Hospital, South Tipperary General Hospital, and Clonmel and Roscommon general hospitals.
Following a submission from the Eastern Regional Health Authority in June 2004 my predecessor approved proposals for short and medium-term action to be taken to address the problems associated with emergency departments in the Dublin academic teaching hospitals. The cost of these new initiatives is €2.4 million in a full year and includes the appointment of specialist nurses, the establishment of rapid assessment teams, a clinical decisions unit and the provision of multidisciplinary teams to assess patients.
An additional 29 emergency medicine consultant posts were approved under the winter initiative 2000-2001. There are now 51 emergency medicine consultant posts in acute hospitals which is a 260% increase since 1997. The availability of senior medical staff in emergency medicine departments should facilitate rapid clinical decision making, enhanced management, diagnosis and treatment of patients.
Pressures on the hospital system, especially in the eastern region, arise from demands on emergency departments and on difficulties associated with patients who no longer require acute treatment but are still dependent. Funding of €16.8 million has been made available to the ERHA which has resulted in some 520 patients being discharged and work is continuing to facilitate the discharge of a further 80 patients.
Planning for the discharge of patients by acute hospitals and the liaison with the community services has been prioritised on an ongoing basis by the Eastern Regional Health Authority. Initiatives such as Homefirst, Slán Abhaile and home subvention all contribute to providing alternative care packages for older people so that they can be discharged. Increasing acute bed capacity will also have an impact on the delivery of emergency services.
Notwithstanding the initiatives introduced over a period of years, there remain too many difficulties and delays in accident and emergency departments which I have already said are not acceptable. They are, however, a symptom of the underlining problem in the health care system. In dealing with the difficulties being experienced by patients, it is therefore necessary to take an holistic approach.
The effective delivery of emergency services cannot be done in isolation of all hospital services. Resolving the problems is a priority of mine. I am identifying the particular pressure points within the health system that effect the efficient delivery of emergency services. I intend to ensure the most pressing problems are addressed as a matter of urgency and in the context of the upcoming Estimates. I intend to introduce a wide-ranging package of measures that will address the problems to which I have referred.
Will the Minister accept that her reply is deeply disappointing? So far all she has had to offer is rhetoric and the repeat of measures taken in the past which have not worked. Is she genuinely not aware of the extent of the crisis in our accident and emergency departments where on a night people can occupy 100 or 200 trolleys because they cannot access a bed? Would she like to state to the House what she will do about this crisis considering that the winter has not come yet and we are in such difficulties and the elderly are suffering severely? Will the Tánaiste tell the truth about the number of acute inpatient beds that have been provided by the Government since the health strategy was published? The figure given by the Taoiseach was 900 but it turns out that was 583, which actually means just 299 inpatient beds have been provided since 2001. Does the Tánaiste think this is satisfactory and will she tell the truth so that we can at least know what we are talking about?
Will the Tánaiste use the private nursing home capacity? Will she introduce MAUs to Dublin hospitals? Will she extend medical cards to encourage access to primary care? Will she guarantee that there will be no closure or downgrading of any accident and emergency department as planned on foot of the Hanly report in order to ensure no further pressure is place on over-stretched services?
I am amused to be accused of engaging in rhetoric. Four weeks ago today I took up my position at the Department of Health and Children.
The Tánaiste has been in Government for seven years.
The Tánaiste without interruption. We need an orderly question time and the Tánaiste is entitled to be able to reply without interruption.
During those seven years I have been well aware of the substantial funding that has been given to the health services. There has been a threefold increase in funding in that period. If money alone could solve the problem, we would not have one.
Will the Tánaiste answer the question?
Will the Deputy allow the Tánaiste to reply? She is entitled to the same courtesy as was afforded the Deputy. The Deputy is not entitled to interrupt.
Ask the Tánaiste to tell the truth.
I ask the Deputy to allow the Tánaiste to reply. She is wasting time on her own question.
I tell the truth. I will not tell lies and I will not play politics with patients. Among the measures that will be introduced are some of the matters mentioned by the Deputy and they will be addressed in the context of the Estimates, having considered the issues and spoken to those involved in delivering the services. It will not be a top-of-the-head, impatient response. Rather, it will be one that will work to change the experience of patients in accident and emergency departments in Dublin.
Annually, 1.2 million people attend accident and emergency facilities in Ireland, which is more than a quarter of the population, many of whom are on repeat visits. This is a huge volume of activity. Therefore, we must ensure that the experience of those who are required to attend accident and emergency departments is a positive one and that the service is run efficiently.
Some 78% of those who present in accident and emergency departments in Dublin do not require to be admitted to a hospital bed. We must find a speedier and alternative way to develop out of hours facilities, particularly in Dublin — in north Dublin, they are almost absent — to take some of the pressure off the accident and emergency services. We must also ensure that the late and delayed discharge of patients, in respect of which I just received information last week, is dealt with. We now know the nature of the patients' situations and what alternative facilities they require. For example, in the Mater Hospital, approximately 31 of the 68 patients are suitable for alternative facilities such as nursing homes or returning to their own homes.
The Tánaiste has known that for seven years.
This is not Deputy Seán Ryan's question.
I assure the Deputy that the data I have received was not available to me four weeks ago.
The Tánaiste's predecessors did nothing.
The remedy will cover enhancing primary care, particularly out of hours cover; medical assessment units such as those referred to by Deputy McManus and improving discharge policy so that there are alternative facilities in place that will facilitate the discharge of patients who do not need an acute bed that costs approximately €5,000 per week. These are among the initiatives we are examining. There are also issues in regard to the availability to clinicians of diagnostics on a 24 hour basis in order that they can make clinical decisions about their patients.
Does the Tánaiste accept that——
Excuse me.
Deputy Gormley has been called. He also has a question.
I have a supplementary question.
Does the Tánaiste accept that despite being in power for seven and a half years, the Government has failed miserably to address the accident and emergency crisis? Is she telling the House that where Deputies Cowen and Martin failed, she will succeed and that she will produce a world class health system? Is she living is cloud cuckoo land? How will she do this without spending money? Does the Tánaiste agree that we need to make up for the years of under-spending in the health service and that we cannot solve the accident and emergency problem unless we deal with the bed capacity problem, to which the Tánaiste only referred briefly in her answer?
The consultants and every oneelse tells us this is a bed capacity problem. Can the Tánaiste explain to people who are on trolleys or in chairs where are the 3,500 beds, which were in the system in 1990? Will she speed up the introduction of these acute beds because surely this is the nub of the problem?
I do not agree that my predecessors failed. Turning the health services around will not happen overnight, as I have already stated. We will not create the world class system — that we could and will have — in two and a half years, just as we did not turn the economy around in such a short time. However, I remain optimistic and positive that Ireland can achieve a world class health service in terms of how health care is delivered when the reforms that are under way are fully implemented. Clearly, if everything was well we would not be engaged in this programme of radical reform.
The new HSE will take office from next year and we will have a more centralised and clearly more efficient manner in which to manage the health service, which has been a difficulty in recent years. We have learnt from experience that putting more and more money into an unreformed system does not make sense. This is why more money must be accompanied by reform. Next year there will be substantially more money. To meet the health service pay bill alone will cost an extra €550 million, which is not an inconsiderable sum.
It is too simplistic to state that this is a matter of more beds. We need more beds but we also need practice reforms, reforms in working methods, new facilities that do not require beds such as medical assessment units and more out of hours cover, particularly on the north side of Dublin where it is almost absent. These are among the reforms proposed as well as step-down and alternative facilities for those who are in acute beds just because there is no alternative.
The time limit of 12 minutes has expired for this question.
It is disgraceful for the Tánaiste to take two questions together since neither questioner has had an opportunity to ask a supplementary question. It is unacceptable.
If Deputies did not interrupt, they might have an opportunity to ask a supplementary question. Deputies McManus and Seán Ryan interrupted. There were just three minutes remaining for Deputy Gormley's question and reply, whereas Deputy McManus had nine minutes for her question and reply.
4 Mr. Neville asked the Tánaiste and Minister for Health and Children the strategy to implement the 33 recommendations of the review completed in June 2004 of the care and treatment of a person (details supplied) in the course of her admission to the acute psychiatric in-patient unit at the Mid-Western Regional Hospital in September 2004; and if she will make a statement on the findings of this review. [26576/04]
The case referred to by the Deputy is a tragic one and I extend my condolences to the family concerned. Deputy Neville raised the matter on the Adjournment some time ago but it falls today to consider what progress has been made on the implementation of the recommendation.
The Mid-Western Health Board established an independent review committee in October 2003 to examine the circumstances of the tragic death of the patient, which occurred in September 2002. The final report of the committee was presented to the Mid-Western Health Board on 28 June 2004. A copy of the report was also made available to the family of the deceased and to my Department.
Officials of my Department recently met senior management of the Mid-Western Health Board to discuss the measures being taken to implement the report's recommendations. They were informed that the Limerick mental health service welcomed the report and its recommendations, which provide a means to guide continuous improvements within the service. The recommendations have been converted into detailed and specific action plans and a working group has been established within the Mid-Western Health Board to implement the actions identified. The working group has been meeting regularly since early September and implementation is being monitored, reviewed and directly supported by the executive of the Limerick mental health service.
Among the recommendations made by the committee is the need for progress on the development of an inpatient unit for children and adolescents in Limerick. I am pleased to inform the House that approval has been given for the appointment of a design team for the development of a 20-bed child and adolescent in-psychiatric unit on the Mid-Western Regional Hospital campus. Proposals for a high observation unit within the adult acute psychiatric unit in Limerick are also at an advanced stage, and this development is in line with another of the committee's recommendations.
On receipt of the report of the review committee last July, my colleague, the Minister of State, Deputy Tim O'Malley, referred it to the Mental Health Commission. The commission endorsed the recommendations of the committee and indicated that those recommendations, which are applicable to all mental health service providers, would be incorporated in the quality framework currently being developed by the commission. This framework includes the development of standards for mental health care, clinical governance and codes of practice.
Additional information not given on the floor of the House
The annual inspections by the Inspector of Mental Health Services provide for the ongoing monitoring of such policies and standards by the Mental Health Commission. We will continue to monitor developments in the mental health services to ensure that the recommendations of this report are fully implemented.
I thank the Minister of State for his reply and join him in expressing sympathy to the family concerned. Does the Minister of State agree that this report offers a unique and rare window to difficulties arising in our psychiatric services and exposes ten issues that arose regarding this tragic death? Does he agree that the culture of secrecy in our psychiatric services, protected by the stigma surrounding mental illness, does not facilitate open discussion on the difficulties arising in the psychiatric services? I request that he officially publish the report to allow full and detailed discussion of it. If this death occurred following an appendicitis or an accident with ten issues arising which seriously affected the life of the person concerned, there would be a national discussion on it.
Does the Minister of State agree that the fact that this patient was removed from a private hospital in Dublin to a public facility in Limerick exposes that money decided the fate of the patient because of the money-orientated nature of the services? Will he agree to an independent inquiry into the death of another patient which took place one year earlier in October 2003 in the same unit? Will he respond to the call by the trade union representing the staff in this unit for this unit of the Mid-Western Regional Hospital to be closed?
The Deputy has raised a number of issues. He referred to the number of recommendations made. However, 33 distinct recommendations were made.
Yes, but ten issues arose regarding the death of the patient involved.
I am glad implementation of each of those recommendations is under way at the relevant levels in the mental health services. The report is being treated with the utmost seriousness. Those 33 recommendations are being acted upon. I am not aware of the earlier case to which the Deputy referred. If he communicates with me on it, I will raise the matter further.
A parliamentary question has been tabled on it.
The Deputy will appreciate that I am representing the Minister of State, Deputy Tim O'Malley, and I am not apprised of that case, but I will follow it up for the Deputy.
I am prepared to consider the Deputy's request for publication of the report, but as I understand it, the report is available to the public. I do not know in what format the Deputy wants it to be published.
I want it to be laid before the Dáil or in whatever format is the norm. It is not published.
I will give consideration to the Deputy's request for publication of the report.
On the lack of openness on this matter——
I was referring to the psychiatric services.
—there has been no lack of openness in this House on discussion of this matter. Deputy Neville raised it on the Adjournment and today during Question Time.
That was not my question.
I am answering the Deputy's question. There has been no lack of openness or candour in the replies prepared for me on this matter, which has been raised by the Deputy on the Adjournment and today on Question Time.
As regards the openness of matters which fall within the province of the Mid-Western Health Board, that is a matter within the province of that board. When the Oireachtas in 1970 decided to establish the health board machinery, clear accountability structures were laid down within that machinery where the chief executive and the relevant officers reported to a board. I appreciate that at this time that structure is not in operation but we are about to introduce radical legislation that will refashion that system. The period to which the Deputy referred is a period in which there was a health board, the Mid-Western Health Board, in existence in that area. That matter was within the functional area of that health board and it was its responsibility to deal with the issue of accountability.
We would like an investigation into all such deaths. There was openness in regard to this person's death.
We have exceeded the time allowed for this question and must move on to the next question.
On a point of order, is this not another example of how this system is being used by the Minister of State so that he does not give answers?
That is not a point of order.
Deputy Neville has not been able to ask a supplementary question, as happened earlier in the case of my party colleague.
That is not a point of order.
This is a disgrace. The Minister of State was waffling and did not give Deputy Neville an opportunity to ask a supplementary question.
The Deputy is using up time. I call Question No. 5.
May I ask a brief supplementary question?
In fairness to——
We rarely have an opportunity to raise this issue in a general way.
Deputies McManus, Gormley and Twomey did not have an opportunity to exceed the time allocated for their questions. I call Question No. 5.
Every suicide in this State should be investigated in the same manner as this one was. I welcome the openness in which this case was dealt with.
5 Mr. J. Breen asked the Tánaiste and Minister for Health and Children the action she intends to take to combat the spread of the MRSA superbug that appears to be rampant in hospitals here; and if she will make a statement on the matter. [26548/04]
In 1999 the National Disease Surveillance Centre was asked to evaluate the problem of antimicrobial resistance, including MRSA, in Ireland and to formulate a strategy for the future. It gave detailed consideration to these issues and drew up a strategy for the control of the resistance in Ireland, which was launched on 19 June 2001. This report contains a wide range of detailed recommendations to address the issue, including a strategy to control the inappropriate use of antibiotics.
Approximately €16 million in funding has been made available to date, of which €4.5 million was provided this year to health boards to implement the strategy.
A national committee comprised of a wide range of experts was established in 2002 to develop guidelines, protocols and strategies in regard to antimicrobial resistance. As part of its remit it provides advice to the regional SARI committees in each health board area which were established as a result of the strategy's recommendations. Tackling this problem is a multi-faceted issue which will require action on a number of fronts. Implementation of the strategy is taking place on a phased basis.
Since 1 January this year, MRSA bacteraemia is included in the revised list of notifiable diseases of the infectious diseases regulations so hospitals are now legally required to report an incidence of the infection.
I am disappointed with the Minister's response. It is similar to a response given to a Priority Question on this matter in June 2001. Is the Minister aware that Ireland has the third highest incidence of infection from the MRSA bug in Europe? The incidence of the infection here is 42% compared with 44% in UK and 44% in Greece. The incidence of the infection here is the same level as that reported in Portugal, Malta, Italy and Croatia. Will the Minister explain why no statistics have been available since 2002 on the incidence of infection from the MRSA bug in this country? At that time it was indicated that 474 contracted the bug, but we have not been told how many people lost their lives as a result of contracting it. In the UK 7,000 to 8,000 people a year lose their lives as a result of contracting the MRSA bug. The UK authorities ask hospitals, in their own interests, to display the number of people who contracted the infection in their hospitals.
Has the Minister ever spoken to anyone who contracted the MRSA bug? If not, she is looking at a person who has. I contracted it in March and nearly lost my life. I have been told by my consultants that I will get back only 60% of the use of my right arm. The Minister trots out the same reply——
A question, please, Deputy.
The Ceann Comhairle is a doctor and he will be aware of what I have suffered. He knows about the MRSA bug.
I am here in my capacity as Ceann Comhairle and the Deputy must ask a question.
What measures will the Minister put in place? She should not trot out the same answer that the former Minister, Deputy Martin, gave in 2001, as she has done. I have with me a copy of Deputy Martin's response. Is the Minister aware that a survey shows that in hospitals this year, 55% of doctors did not wash their hands between seeing patients, 35% changed their white coats only once per week and 9% wore gloves only when they were examining patients.
The Deputy should ask a question.
I suffered from the MRSA bug. As I stated in the Chamber when the Minister was appointed, I waited for 17 hours in a hospital in the west to get an antibiotic to save my life. Is this a health service of which we can be proud? We have ploughed money into it and have got nothing back. We have abused money.
Will the Deputy allow the Minister time to answer his question? We are running out of time rapidly.
I am genuinely sorry that Deputy James Breen had this experience. I was not aware of it. As I am sure he knows, the bacterium lives in about 33% of normal, healthy people. It lives harmlessly on the skin and in the nose of approximately one in every three people in the country. It causes problems when it gets the opportunity to enter the body. The Deputy is correct that the most effective way of dealing with it is hand hygiene. It seems incredible but we had to issue guidelines on hand hygiene recently. When I saw this in my briefing note, I had to check whether it was correct. The guidelines are for those who work in health care settings and equally to those visiting patients that suffer from the bacterium. The chief medical officer, to whom I spoke before Question Time, said to me that the most practical and sensible thing we can do to stop the spread of the bacteria in a health setting in which people are particularly vulnerable and sick is to encourage hand hygiene and the washing of hands. The guidelines are intended to achieve this and money is being made available to the different regions with a view to implementing best practice in this area.
Can I ask the Minister one question? I will be her guinea pig.
The six minutes allowed for this question have concluded.
I will be her guinea pig in an investigation into how I contracted the MRSA bug.
I call Question No. 6——
Will she carry out the investigation into how I contracted MRSA?
—in the name of Deputy Burton.
I will be her guinea pig because I nearly lost my life.
The Deputy will have to find another way of raising the matter.
I nearly lost my life because of this bug. When will the Minister——
The six minutes allowed for the question have concluded.
—carry out an investigation? I will be her guinea pig in an investigation——
Deputy James Breen——
——into why I contracted the disease.
In fairness to other Deputies who have submitted questions——
I am asking the Minister a question.
—they are entitled to have answers from the Tánaiste.
I will be her guinea pig. Will she carry out an investigation?
Will the Deputy resume his seat?
It nearly cost me my life.
Deputy James Breen——
Can the Minister defend that?
Will the Deputy resume his seat?
Will the Minister have an investigation carried out?
Will the Deputy resume his seat?
I will resume my seat when-——
There are other Deputies in the House who are entitled to have their questions answered.
Will the Minister answer my question?
The time for the question has long since concluded.
Will the Minister answer my question?
I have called Question No. 6 in the name of Deputy Burton.
The Minister should answer the question.
I assure the Deputy that if he makes available to me in private the details of his case, with which I am not familiar, I will certainly examine it. If he contacts me in my office, I will certainly look into the matter, if I can.
I thank the Minister.
