Dáil Éireann díospóireacht -
Tuesday, 2 Oct 2007

Vol. 638 No. 3

Health Services: Motion.

Deputy James Reilly

I move:

That Dáil Éireann,

recalling the promises made by An Taoiseach and the Minister for Health and Children in May 2007 that there would be no cut in frontline health services;

noting the:

deterioration of critical frontline hospital services in recent months, as evidenced by the:

loss of 30 nurses and four consultants from Sligo General Hospital;

cancellation of dental services for children in Inchicore and Bluebell;

dismantling of key services at mid-western regional hospital, Ennis;

immediate closure of breast cancer services at 13 hospitals nationally without alternative services being available;

closure of a 24-bed unit for the rehabilitation of elderly patients at Merlin Park Hospital, Galway,

disuse of a 17-bed surgical ward at mid-western regional hospital, Limerick; and

cancellation of essential suicide prevention training for applied suicide intervention skills training (ASIST);

calls on the Government to:

ensure that frontline health services are not reduced and that any budgetary adjustments necessary are focused on administration and bureaucracy rather than essential frontline services.

I wish to share time with Deputies Clune, Flanagan, Feighan, Deenihan, Joe Carey and Perry.

In recent weeks health services have come under consistent attack, with draconian cut-backs, continuous closures and the cancellation of critical services. Prior to the general election both the Minister for Health and Children and the Taoiseach were vehement in their denials that there would be cutbacks to health services. However, less than 100 days after their return to Government, frontline health services have deteriorated all over the country and the Government's assurances have been exposed as lies. I have decided to use Private Members' time to expose the reality of these actions, the harmful impact these decisions are having on patient lives and the effect these decisions are having on the delivery of frontline health care services.

An Ceann Comhairle

I remind the Deputy that the word "lie" may not be used and the imputation of lying may not be made in the House. He should reformulate his words.

Deputy James Reilly

I accept the Chair's correction and will rephrase by saying they have been exposed as misleading statements.

The Minister for Health and Children has refused to accept that patient services will be affected by the cutbacks but who can believe her, particularly when one of her own Ministers of State expresses concern? It is glaringly obvious that patients will be affected by the loss of 30 nurses and four consultants from Sligo General Hospital; the cancellation of dental services for children in Dublin; the dismantling of accident and emergency services in Ennis; the immediate closure of breast cancer services at 13 hospitals nationally without alternative services being available; the closure of a 24 bed unit for the rehabilitation of elderly patients at Merlin Park Hospital, Galway; the disuse of a 17 bed surgical ward in Limerick; the cancellation of essential suicide prevention training courses, known as applied suicide intervention skills training, ASIST; the closing of the rehabilitation ward in St. Luke's, Kilkenny; and the deferral of 184 posts in the western HSE, 169 of which are medical, mainly nurses.

In setting up the HSE the Minister promised it would deliver efficiencies and value for taxpayers' money but instead she has allowed bureaucracy to spiral out of control. The Minister's reaction has been to introduce cutbacks and to stop the recruitment of essential health specialists instead of targeting the expensive administrative and bureaucratic overload. The Minister's spending cuts cannot be described as a drive to efficiency, as stated by the CEO of the HSE, because they are more likely to drive services into the ground.

This is more than apparent in Sligo General Hospital where, in recent weeks, drastic cost-cutting measures have been introduced. Despite Government promises immediately before the general election that there would be no cutbacks at Sligo, management at the hospital has been directed by the HSE to cut upwards of 30 nurses and four consultant posts. The four consultants to lose their jobs are an orthopaedic surgeon, an obstetrician gynaecologist, a general surgeon with special interest in breast surgery and an ear, nose and throat surgeon.

It is inexplicable how the Minister and Professor Drumm believe that patient care will not be affected by these drastic cutbacks, which will see a 25% reduction in overall services and a 50% cut in breast surgery. It is likely that household staff will also be affected. Where does this leave women of the north west in need of breast surgery or the 365 adults and 27 children who have been waiting for surgery in Sligo for more than 12 months? These cutbacks are inexplicable and will undoubtedly affect patient care. Under the Minister for Health and Children patients are punished for health service over-spending.

At the same time, down the road at the Radisson Hotel in Sligo, the HSE conducted interviews for up to 200 middle management posts when these cuts were being announced. The HSE spent €3.5 million on hotel hire for meeting rooms which, added to the €4.5 million unauthorised overspend on information technology, totals €8 million, a damning indictment of the attitude of management in the HSE. Information technology and interviews are more important than patient care.

Not only are acute services being affected, so are community services. Schoolchildren in Inchicore and Bluebell were notified that their dentist appointments had been cancelled when a dentist who had just left the Inchicore dental service could not be replaced as a result of the HSE employment freeze. The Inchicore dental team was given no notice of the ban on employment and as a result cannot recruit a replacement dentist. If it had been given notice, it could have brought forward the start date of the new dentist so patient care would not have suffered. Again, balancing the HSE books has been allowed to take priority over patient care, leaving adults and children without essential services and treatment.

People are so angered at the recent cutbacks that they have taken to the streets in protest. On Saturday, Deputies Pat Breen and Joe Carey, together with 5,000 people, took to the streets of Ennis, County Clare in protest at the Minister's cutbacks in Ennis General Hospital. True to form, the Minister for Health and Children waited until after the general election before rubbishing the promises of local Fianna Fáil TDs. Now, Ennis General Hospital will not only see the closure of its 24 hour accident and emergency service but the mammography unit, shut down in July, will not be reinstated. I saw it last week, an empty room full of pristine equipment waiting to be used.

This is a dark hour for the health service in Clare and these measures will undoubtedly lead to unnecessary deaths as nearly half of the 100,000 people living in the county live more than an hour away from vital accident and emergency services at the Mid-western Regional Hospital in Limerick. While the Minister might argue that this move is part of a plan to improve the excellence of services I do not believe her. Regionalisation and concentration of services may be desirable in some specialties but, as the Minister well knows in the case of maternity and, particularly, accident and emergency services, proximity to emergency care can be critical not just to patient welfare but to actual survival. What about the golden hour? People in west of Clare, in places such as Carrickagholt, Kilmihil, Kilkee and Kilrush, are well over an hour from Mid-western Regional Hospital and will not get attention within the golden hour that so influences outcomes for those who are seriously ill. This emphasises the geographical location of Ennis.

In recent months a series of cancer misdiagnoses and unreliable treatment practices have exposed the frightening reality of our cancer services. Inquiries into practices at Barrington's Hospital in Limerick, along with the review of thousands of mammograms and breast ultrasounds at the Midlands Regional Hospital, Port Laoise, have led to a crisis of confidence in our cancer services. This crisis of confidence is compounded by the fact that the Department of Health and Children was aware of seven separate issues concerning the quality of breast cancer services at Barrington's Hospital 19 months ago but did nothing about it and allowed these questionable practices to continue until August of this year.

People feel isolated by the public health service and, if they can afford it at all, they are turning to private health care in the hope of a better service. If we have a free hospital service, why do more than 50% of citizens opt to pay for health insurance at considerable cost to themselves? As we now know, private patients will not always be guaranteed a better or more reliable service.

Last week the HSE displayed how little has been achieved in the delivery of cancer services by announcing the supposed details of its national cancer control programme. This implementation programme contains gaping holes and does not explain how or when the cancer centres will be operational or how much the plan will cost. In addition, 13 hospitals have been ordered to stop providing care to breast cancer patients immediately at Naas, Tullamore, Mallow, Cavan, Ennis, Nenagh, Loughlinstown, Dundalk, Navan, Roscommon, Portiuncula, Mercy Hospital in Cork and St. Michael's Hospital in Dún Laoghaire. We know some of these centres ceased service some time ago but when asked at last week's conference which ones, the HSE spokesperson did not know. Such is the HSE's grasp of the health service.

While we all want excellence in the delivery of cancer treatment, how can we seriously believe this is the motivation for those cuts when a letter from the board of Galway University Hospital outlines what the deferral of 184 posts in the region will mean? It will result in fewer beds being available and therefore more people on trolleys in accident and emergency units, and this will be the position with the winter approaching. Here is the really damning part: the letter states that deferrals will also result in the need to reduce breast cancer services in Galway from five to three days a week. This was to be the centre of excellence in the cancer strategy for HSE west. It is just one week old and already in tatters.

The hospital's second CT scanner will now lie idle most of the time because there are insufficient staff to operate it. Coming into the winter there will be no serology testing for atypical pneumonia, which affects many old people and is much more prevalent in winter time. It beggars belief that if these cuts go ahead, Galway will not have the facilities to test for atypical pneumonia.

Critically ill patients should not be left in a position where treatment services are withdrawn without adequate replacement services being put in place first. Under the Government's policy it is the patient who is punished and who suffers as a result.

Drastic cutbacks are affecting not only cancer patients but stroke patients also. A 24-bed unit for elderly patients is to close at Merlin Park Regional Hospital in Galway as part of the HSE's ongoing drive to cut costs.

Deputy Pádraic McCormack

It has closed.

Deputy James Reilly

I thank the Deputy. The beds in the unit were designated specifically for the rehabilitation of stroke patients. A recent audit conducted by the Irish Heart Foundation exposed how utterly insufficient hospital services are for stroke patients nationally. Although approximately 10,000 acute stroke patients were admitted to hospital in 2005, the audit found that there are only 12 designated stroke beds in our hospitals nationally. It also found that only one hospital, representing 3% of relevant Irish hospitals, has a stroke unit, compared to 91% of hospitals in the UK. Despite the revelation of these appalling statistics the Minister, Deputy Harney, thinks it is acceptable to remove what little dedicated services exist for stroke patients.

The HSE now plans to move these patients to other units on the hospital campus where there are vacant beds. These patients will not now have access to multi-disciplinary rehabilitative care that is stroke specific and more likely to meet their needs. How does this fit in with a drive for centres of excellence or is this a policy that is only applicable when it leads to savings in the short term but will cost more in the long term both financially and in terms of patient suffering? Some 350 to 500 deaths a year could be avoided if there was proper investment in stroke care but, yet again, it is the patient who is punished.

We are told an orthopaedic unit of 24 beds is also proposed for closure shortly in Galway. Despite the fact that two orthopaedic surgeons were recently added to the team, making a complement of eight, they will not be able to operate because patients would have nowhere to go after their procedure. The saying "penny wise and pound foolish" springs to mind.

Meanwhile, a surgical ward with 17 beds, which was closed in Limerick Regional Hospital and was due to reopen, remains closed. The hospital, like others, is unable to recruit extra agency nurses, as an outright ban on recruitment was put in place by the HSE. Although the HSE in the mid-west claims that there are already enough nurses in the hospital to reopen the ward, complying with such an order is likely to make staffing levels in other areas unsafe. The result is that patients are punished.

The HSE cutbacks have also affected training provided by much needed suicide resource officers. Such officers regularly organise applied suicide intervention skills training courses around the country to teachers, gardaí, youth workers and other members of the community. However, they have been instructed that they are no longer allowed to book venues for such courses. So we can have hotels booked for HSE interviews for middle management, but space cannot be booked to train people in suicide prevention.

Deputy Jimmy Devins

That is not true.

Deputy James Reilly

The public has been promised by the new Government that it is committed to reducing suicide rates, but it is clear that the Government's commitment to tackle suicide is meaningless.

Unfortunately, the examples cited in this motion do not comprise the full list of services to be affected by the Minister's cutbacks. This list is only the beginning of a raft of measures that will erode patient care and limit services. In recent days we learnt that Monaghan hospital will be stripped of further services and will have to suffer the removal of yet another ward. Where are Deputies Smith, Conlon and O'Hanlon now with their pre-election promises?

The Midland Regional Hospital in Mullingar has to cut medical day cases by 55 procedures a month. The loss of an operating theatre and six surgical inpatient beds in South Tipperary General Hospital in Clonmel will reduce activity by one third. The Midland Regional Hospital in Tullamore will see the cancellation of elective work. I have been informed by Deputy Doyle that 320 much needed ambulance staff cannot be employed because of a staff embargo.

Since the return of Fianna Fáil and the Progressive Democrats to Government, the exposure of their deceitful half truths about health services has completely undermined any credibility they might have had. Patients should not be punished for HSE mismanagement and overspending while massive bonuses are paid to management. I agree with the Minister that the HSE must manage its finances, but balancing its books should not come at the expense of frontline services and patient care. With industrial action threatened and patient care bound to suffer, it is high time the Minister took control of the situation. That is why our parliamentary party requests the Minister for Health and Children to ensure that essential frontline services are not further reduced and that necessary budgetary adjustments are focused on administration and bureaucracy rather than frontline services. In short, the patient must come first. There should be more service, transparency and accountability, with less management and administration.

Deputy Deirdre Clune

Less than two weeks ago, the Minister for Health and Children came to Cork to open a brand new maternity hospital. That hospital had been dogged by bad luck since it tried to open originally, and a severe shortage of personnel has caused stress for staff and patients alike. At the time, the Minister said each hospital would have to operate on a budget as every other organisation does, and the health service is no different. I contend, however, that the health service certainly is different because it deals with public health matters.

The cutbacks and freezes we have seen since the beginning of September will affect patients' lives and will have a detrimental effect on their families. The freeze on recruitment was implemented without consultation with staff or patients, and the resultant disruption is evident. We hear talk of potential strikes, staff being upset and pressure on patients. Most importantly, pressure is being put on existing frontline staff. When the HSE was established we were told it would lead to efficiencies in our health service with reductions in bureaucracy, but that has not come about. We have seen more bureaucracy and less frontline staff.

When the previous health boards were amalgamated I do not think anybody was told they would lose their job or that they were surplus to requirements, yet people are suffering and are bearing the brunt of the cutbacks. Frustrating levels of bureaucracy are hampering frontline staff in carrying out their duties. Today we heard that more than 41,000 people are on waiting lists, yet the Taoiseach's reaction was to state that they should consult the National Treatment Purchase Fund. While that body has a role to play, it is not the solution to waiting lists comprising more than 40,000 people. The NTPF is specific for conditions that can be measured such as tonsillitis or hip replacement, but it is not a solution for stroke victims or those requiring long-term coronary care. The Taoiseach knows that well and the point has been made before in this House.

In recent weeks, people have attended my clinics who are directly affected by these cutbacks. I was told by a man seeking dialysis treatment for his father-in-law that two dialysis units have been closed in Cork University Hospital since 11 September. Because of these cutbacks the hospital cannot meet the needs of the local population. I was contacted by a woman today whose child is receiving speech and language therapy. However, the therapist is going on maternity leave and since there will be no replacement, the services will no longer be available for that child. A class of 25 speech and language therapists graduated from UCC last June, but 15 of them have not gained employment and they are planning to emigrate to Canada or Australia. That course was developed specifically to redress the lack of speech and language therapy resources, but we now find there is no place for those graduate therapists. Patients who require such services are suffering and frontline staff are bearing the brunt of such cutbacks. According to the 2007 European Health Consumer Index, which was published yesterday, Ireland is ranked 21st of 29 countries for value for money. In the category of waiting time for treatment, Ireland ranks last. We can imagine where we will be placed in next year's index following the cutbacks of the past month, with no sign of an end to the reduction in frontline staff. Management and the HSE, not the staff and patients, are responsible for overspending the budget. That is where the solution to the problem lies.

Deputy Terence Flanagan

I support the Private Members' motion tabled by Deputy James Reilly, principally calling on the Government to "ensure that frontline health services are not reduced and that any budgetary adjustments necessary are focused on administration and bureaucracy rather than essential frontline services". The Taoiseach and the Minister for Health and Children promised in May 2007 that there would be no cutbacks or otherwise in frontline health services. How does the Minister reconcile that statement with the HSE's extension of its ban on recruitment for another month, until the end of October? The ban hurts patient care, has already led to longer waiting times and will lead to more discontent as services worsen over the winter when pressure intensifies on accident and emergency departments.

The Minister's cutbacks have had the following results — the loss of 30 nurses and four consultants from Sligo General Hospital, which will seriously affect the quality of care for patients in the west; the dismantling of key services at the mid-western regional hospital in Ennis; and the immediate closure of breast cancer services at 13 hospitals nationally, when no alternative services are available, an issue on which Fine Gael tabled a motion last week.

While Sligo General Hospital lost 30 nurses and four consultants, the HSE booked rooms in the Radisson Hotel in Sligo to interview up to 200 candidates for middle management posts. This is bizarre and the fact that the Minister allowed it to happen shows that she is out of touch with the situation in the health service. The Government should issue this health warning to the public immediately: "Whatever you do, do not get sick."

Fianna Fáil in Government is killing the health service with a lack of acute beds, frontline staff and hospital hygiene. I call on the Minister to intervene with the HSE and ensure that it lifts its ban on the recruitment and replacement of key medical staff. The embargo is a shocking decision, which is causing further hardship and inconvenience for patients. A ban which does not differentiate between a nurse or an administrative officer cannot be justified.

I thank all those who work in our health service, often under extreme pressure and difficulty for the great work they do. These cutbacks make their job worse and are badly affecting staff morale. Is it any wonder that unions such as IMPACT, the INO and SIPTU have reacted angrily to these cutbacks and are considering work stoppages and public demonstrations which may undermine social partnership? Does it make sense that staff who treat patients are being penalised for budget overruns which are nothing to do with them? Does the Minister feel that this ban on recruitment within the health service will have much impact on cost savings? I do not think it will.

The Minister's priority should be to save lives. I appeal to her to consult the HSE without fail, to deliver new staff as quickly and efficiently as possible to the frontline to deal with new patients. Political responsibility rests with the Minister and the Government and additional money should be found immediately for the sake of all essential health services and for the sake of staff and all patients.

Deputy Frank Feighan

I wish to share time with Deputy Doyle. Many promises were made before the last election, including the Taoiseach's promise that frontline hospital services would not be cut. I was almost beginning to believe it but this has gone past cynical politics. Concern is growing about the impact of the staff cuts involving 30 nurses and four consultants in Sligo General Hospital.

I congratulate Deputy Devins on his appointment as Minister of State at the Department of Health and Children. He said he was uncomfortable about the job losses and that while the HSE told patients that care would not be affected, the staff told him a different story. Will the Minister of State tell the Minister how much these staff cuts affect patient care in Sligo hospital?

There have been far too many cutbacks in the west. I have often raised the issue of the reduction of transport for patients to and from hospitals in the Mayo, Galway and Roscommon region. The old health board seems to still have autonomy and has drastically cut transport for ageing patients. Will the Minister examine that issue immediately?

Deputy Andrew Doyle

The initiative to recruit 320 new ambulance staff, experienced and inexperienced, trained and untrained, to fill vacancies that have accrued over several years has been put on hold. This jeopardises an essential frontline service and raises queries about staff morale and health and safety.

The ambulance service has taken delivery of 67 new vehicles with another 67 to be provided over the next year or so. These good plans have been brought to an abrupt halt by a unilateral decision to place an embargo on the health service. No measure of efficiency or critical need is being brought into play in this decision. The Minister should review the decision immediately and not just accede to a populist decision to use cuts to make the HSE seem more efficient.

The former East Coast Area Health Board, of which I was chairman, was responsible for the eastern region ambulance service which ran efficiently. The service is about to be nationalised but these cutbacks will damage staff morale and jeopardise the health and safety of the public.

Deputy Jimmy Deenihan

A woman contacted me today out of concern for her husband who is waiting for an operation for cancer. He is aged 32 and was first diagnosed in 2002. Unfortunately, the cancer returned last February. He waited until May for radiation treatment, but this did not shrink the tumours, and he has been waiting since then for surgery with no date given. That is outlandish and should not happen.

An incident concerning the out-of-hours radiography services in Kerry General Hospital came to my attention recently. Somebody who was seriously injured in a Gaelic game could not have an operation until the following Tuesday due to the lack of radiography cover.

At Kerry General Hospital at present, out-of-hours radiography services are available from 5 p.m. to 9 a.m. from Monday to Friday and from 5 p.m. on Friday to 9 a.m. on Monday. During these periods, one radiographer is available for the provision of an out-of-hours plain film service and one for the CT scanner service. The person on general call is on duty for a 24-hour period and covers referrals from the accident and emergency department, inpatients, both mobile and ward-bound, direct referrals from the SouthDoc service and any emergency surgical procedures in the operating theatres that require radiographic input. Given current staffing levels, the hospital cannot provide a radiographic service that will permit prolonged use of X-rays in the operating theatre out of hours. At present, it is not possible to permit surgical procedures such as intramedullary nailing of long bone fractures or stabilisation of hip fractures out of office hours.

Despite numerous requests to provide additional cover, particularly for the radiography service in Tralee, the hospital has been unable to provide this due to a lack of resources. The number of radiographers employed at present is 14.5 whole-time equivalents, which has remained unchanged since 1996. Were a second on-call rota to be provided with current staffing levels, the resultant time off would cause an unacceptable reduction in the resources available during normal hours.

The hospital will not be in a position to start a second on-call service until the radiography staffing levels have increased to a level similar to those found in similarly-sized hospitals nationwide, that is, with 20 to 22 whole-time equivalents. It is in the best interests of all to provide a second on-call service as the radiographer is placed in an invidious position whenever theatre cases and orthopaedic cases in particular arise. Invariably, such cases take a relatively long time to complete, which leaves the rest of the hospital without cover and results in the on-call radiographer being completely overstretched and harassed.

This problem is not caused by a lack of willingness on the part of the hospital's serving radiologists but by a simple lack of resources that prevents them from providing the necessary back-up service to cover emergency operative treatment of patients with long bone fractures at Kerry General Hospital at present.

I reiterate that weekends in Kerry are busy times for activities such as field sports and obviously injuries will happen. Such people should not be obliged to wait until Tuesday or Wednesday to have operations performed that could be carried out immediately over the weekend. The presence of radiography cover could save a person's entire sports career.

Deputy Joe Carey

I support the Fine Gael motion. It appears that winter has come early to the mid-west. First came the chilling announcement of the withdrawal of the Shannon to Heathrow service. Today, I learned of a recruitment freeze in the airline in question. More than one month ago, staff throughout the region were informed of the Health Service Executive's, freeze. Effectively, it has downgraded services at Ennis General Hospital. This was preceded by the closure of the hospital's mammography unit despite its upgrading. Members have learned the HSE's freeze will last for another month, which will put at risk key services, will make for tougher working conditions for existing staff and will raise question marks regarding complaints about patient care in the mid-west and nationwide.

The problem is that the HSE, much like the Government, is involved in reactionary policies with no obvious long-term planning and on foot of which profit and loss are put before patient care. As the HSE has a budget of €14 billion, how can it work on a month to month basis? Although a businessman who sought funding from a bank manager would have a business plan, the HSE has no such plan. It operates on a month to month basis, which is disgraceful. How can any organisation work in this fashion?

How low can the Government go? At Ennis General Hospital, services such as palliative care, respiratory care, infection control and cardiac rehabilitation are under threat. Palliative care concerns those who are about to pass from this life and such individuals, as well as their families, require a nurse to work with them. As for infection control, the Minister has sought improvements to such services in this House to combat MRSA. This cannot happen. In respect of the vital service of cardiac rehabilitation, nurses are being informed by hospital management that they must give up this service to move into hospital wards. How can the Minister sit idly by and allow this to happen?

A report was completed recently by a medic from the University of Leeds on staffing levels at Ennis General Hospital. He recommended that a total of 26 additional nurses should be deployed at the hospital. However, only one was appointed and that post has been lost because of the cuts under discussion. At present, four nurses serve two 26-bed wards at night and patient care is at risk. I spoke to a nurse today who told me she was obliged to bless herself with holy water before going on duty at night because she was afraid the service would not be there.

This action is disgraceful. Ennis General Hospital is over budget and operates above its bed capacity, which is the reason for its overrun. At times, it operates at 117%, as its staff do not wish to turn away sick patients and should not be obliged to so do. A public demonstration took place in Ennis last weekend, at which the people of Clare said, "hands off Ennis General Hospital". They want nothing more or less than 24-hour consultant-led accident and emergency services at Ennis General Hospital.

Deputy Mary Harney

It has never had that.

Deputy John Perry

The establishment of the HSE marks the latest attempt to introduce national priorities and effectiveness into the delivery of the health services. One particular aspiration of the new HSE structure was to bring skilled and professional managers into senior positions, thereby ending the near-permanent state of budget crisis that characterised the old health boards. It is to be regretted that the HSE should be engulfed in a budget crisis of its own making so soon into its corporate life. As the crisis appeared out of the blue this September, were any delegated administrative and financial controls in place? Was the entire management hierarchy asleep throughout the summer months?

A total of four consultants were informed they were being let go from their posts at Sligo General Hospital. One week later, the breast surgery and ear, nose and throat consultants were informed they were being given a three-month extension to their contracts. Such events raise serious concerns regarding the quality of management and professionalism within the HSE. I understand it is difficult and complex to try to introduce management control and discipline to such a large structure. Consequently, I will accommodate reluctantly the viewpoint that lessons are being learned. However, it is unfortunate that this is taking place at the coalface. I hope the aforementioned type of management fiasco will be brought under control.

I seek a response from the Minister to some simple questions. What performance factors are used to determine the annual bonus payment made to the HSE's management? Is the achievement of the annual financial budget target one such factor? Will the Minister issue a written directive to the HSE in respect of bonus performance payments this year?

The HSE is an extremely large organisation with a massive financial budget. At present, it has the appearance of a large circus elephant that is behaving badly. While some questions arise regarding management competence at various levels, another factor is the obstructionist behaviour by various staff representative bodies. Partnership must be a two-way street to be meaningful and to the ordinary citizen, it appears that significant management decisions on resource allocation and flexibility in work allocations are contested endlessly. A management that is obliged to battle relentlessly with its own professional staff to achieve any worthwhile changes will be diverted from achieving its primary focus on quality patient services. There is no national crock of gold to be tapped to keep the money pouring into the health service sector. At present there is a bizarre combination of additional money being poured into the health services while simultaneously, front-line services are being curtailed and cut back. I am advised reliably that the mammography services will be withdrawn from Sligo General Hospital by the end of the year. This comes on top of the loss of 30 nursing posts and four consultant positions. While front-line positions are being cut, there is not a single reference to administrative and management positions taking any of the pain. To the citizens, it appears that this PD-FF-Green Government, and specifically the Minister for Health and Children, Deputy Harney, has lost interest in effectively running the health service and delegated all the functions to Professor Drumm and his team. As the Minister responsible for health sector reform, she must take firm control. She has established this arrangement and she must ensure that it delivers real value for all the extra taxpayers' money being spent. That is not taking place. She cannot evade responsibility or hide behind subterfuge. The country will not accept the continuation of this situation and I ask the Minister to deal with it.

Minister of State at the Department of Health and Children (Deputy Jimmy Devins)

I move amendment No. 1:

To delete all the words after "Dáil Éireann" and substitute the following:

"acknowledges the continued increase in funding for health services over each year of the last decade and the associated expansion of a wide range of frontline services, including in 2007:

the allocation of over €15 billion across Health Votes in 2007, an increase of 11.35% over the 2006 level;

the increase of €245 million in services for older people, enabling the additional provision of step-down beds, long-term care, home-help hours, home-care packages and nursing home inspections;

the increase of €100 million for services for persons with a disability, including intellectual disability services, physical and sensory services, implementation of Part 2 of the Disability Act 2005 and a range of services within the mental health services remit;

the provision of €70 million additional funding in the acute hospitals sector, allowing for the opening of new acute hospital units, improvements in neurology/neurophysiology services, and a further €10 million for the national treatment purchase fund;

the provision of over €20 million for cancer control, including screening, acute services and research;

the additional €22 million in primary and social cohesion programmes, including funding to continue the investment in primary care teams, sexual assault treatment units and social inclusion initiatives; and

the continued commitment to the personnel management and development programmes with an additional €25 million, including funding for both medical and nursing training and education;

notes the high satisfaction levels with front-line health services shown in Insight 07, the most comprehensive, objective survey of public opinion on health services which was published last week;

reaffirms the statutory requirement that the Executive should manage its budget within the Vote approved by Dáil Éireann and acknowledges that the Executive has taken measures to ensure that it meets this objective in 2007, by means of its Breakeven Plan; and

notes that it is the intention of the Executive that these measures will not impact on planned frontline services, which will be maintained in line with the National Service Plan, and that provision is being made that where critical or essential vacancies arise, they may be filled by re-deployment of existing staff."

I wish to share time with Deputies Flynn, Dooley and O'Connor.

As a background to this debate, I will mention some positive aspects of our current health services. On life expectancy, according to the European Health For All database the life expectancy at birth in Ireland has increased steeply since 1999. In that year the life expectancy at birth was reported to be 76.12 years, while the latest figures for 2005 show it has increased to 79.59 years. This continuous increase for a six-year period seems to be unique in Europe. The latest life expectancy figures show that Ireland has closed the gap with the old European Union 15 member states and has life expectancy considerably higher than the new European Union 27 member states average.

A recent survey of customer satisfaction was the first large-scale representative survey of customer satisfaction undertaken by the Health Service Executive. The information from this survey can provide opportunities for learning which will assist the HSE in planning responses in areas which matter to the users of services and the results make interesting reading.

Generally speaking, there is strong satisfaction with the health care services by a majority of respondents and a high degree of confidence and trust in health professionals. Emerging from the results are areas which are positive for health service provision and the HSE. A majority of respondents were admitted to hospital in a timely manner. There is relatively little evidence of any GMS/non-GMS divide in experience as reported by respondents. The level of confidence and trust in the care received in hospital and community settings is rated highly. There is a public perception of good hygiene in health care settings, although there is an age effect evident, which suggests that younger users of the services are less tolerant of poor hygiene.

A majority — 78% of inpatients, 67% of outpatients, 86% of GP patients and 78% of other community service patients — expressed definite or complete trust in the health professional they encountered. Overall, rating their experience as excellent or of very good quality were 58% of outpatients and 84% of GP patients.

According to the OECD, health spending in Ireland grew in real terms by an average of 9.1% per year between 1999 and 2004. By comparison, the OECD average was 5.2%. Alongside Norway, Ireland has the highest level of public capital investment in health as a proportion of national income. At 0.6% of GNP, this is twice or more times the level of most OECD countries.

The public voted funding for the Health group, including the Vote for the office of the Minister of Children, is €15 billion for this year, an increase of 11.35% on last year. Expenditure on the health sector has increased almost fourfold since 1997 to approximately €15 billion for the current year. All service areas have benefited from this greatly increased funding.

In the past six years gross current funding for the health services, excluding the office of the Minister for Children Vote, has increased by over €7 billion to €13.9 billion in the current year. When account is taken of the increases required to fund items such as general pay increases, benchmarking and other pay awards as well as non-pay inflation and increases in drugs costs, approximately €2.5 billion has been provided for additional investment in services. The extra investment has provided for significant improvements in our health system across all the main service areas, including acute hospitals, primary care, disability, older people, mental health and child care.

Most activities have exceeded the target levels in the HSE service plan. This does not mean that all such activities have in turn exceeded their budgets. However, some services have exceeded their budgets. Therefore, Professor Brendan Drumm, as Accounting Officer, and given his statutory responsibilities to contain spending within the limits voted by Dáil Éireann, has implemented a breakeven plan. Specifically, the HSE has determined that measures in the breakeven plan should not impact on planned front-line services.

I will refer briefly to some of the points raised by Members of the Opposition regarding the acute hospital sector. I will refer particularly to the hospital in Sligo. The Health Service Executive has informed the Department that Sligo General Hospital is reducing temporary staff in some nursing, medical and catering posts. This does not involve any withdrawal of the core services provided by the hospital. The circumstances are specific to each staff category and I will explain these to the House.

On nursing staff, as in previous years, in the summer months additional temporary staff were employed, mainly to cover annual and other leave. Thirty people were employed on a temporary basis for this reason. This compares with a total permanent nursing staff of over 700 at Sligo General Hospital in whole-time equivalent terms.

On medical staff, four temporary consultant posts, which were contracted for specific temporary purposes and time periods, have recently come to the end of their contracts. These posts were in addition to the permanent consultant complement of the hospital, which is not affected and remains the same. In orthopaedics, one of the three permanent consultants was a member of the Medical Council until his recent retirement. To maintain full orthopaedic services a locum was employed while this consultant was away on Medical Council business. Following his retirement a new permanent consultant was appointed and has taken up full-time duty in Sligo General Hospital. Therefore, there was no requirement to maintain the locum position.

In obstetrics and gynaecology, one of the three permanent consultants retired in July last, his replacement having taken up duty prior to this. In order to ensure a smooth transition, the retiring consultant was contracted on a short-term locum basis following his retirement. This arrangement can now be discontinued and the specialty has its full complement of three permanent staff.

On surgery and ENT, a temporary additional consultant was employed in both of these specialties during 2006 to help reduce waiting lists. They were not intended as permanent appointments. The hospital has had the benefit of these temporary appointments in reducing waiting lists and seeing more patients. However, within its overall funding the hospital has to make choices regarding which service pressures most need to be addressed from time to time, and therefore it was decided by the management to discontinue these temporary contracts so that the funds could be used for other service priorities. For example, the recently opened neonatal intensive care unit, which provides a much better facility for newborns, required and received more nurses to staff it. However, I am pleased to state, as Deputy Perry outlined, that the consultants in general surgery and ENT will remain in position until the end of the year so that they can complete their necessary work.

On overall consultant staff at Sligo General Hospital, additional appointments have been made in paediatrics and radiology. Further consultants in emergency medicine, pathology and radiology have been approved, and a consultant neurologist will take up his post on 1 January 2008.

From what I have outlined, it is clear that these measures do not entail a reduction in the hospital's core services. Neither will they adversely affect the quality and safety of patient care. Every effort is being made to ensure the hospital's resources are managed in an efficient and effective manner to protect core services and activity, and to deal with emerging service pressures.

This year our health services are seeing significant increases in funding, staffing and patient services. That is the record so far, and will be the overall outcome at the end of the year. In this context, the Government is clearly committed to the provision of services at Sligo General Hospital. The HSE is fully aware that it must remain within the employment ceiling negotiated with the Department of Finance.

The strategy for the future of Galway's university hospitals allows for the continuation of the development of University Hospital Galway as the major emergency and complex treatment and tertiary referral centre for the region, while Merlin Park University Hospital will be developed largely as an elective hospital with planned interventions, rehabilitation, dialysis and outpatient clinics.

The decision to suspend recruitment temporarily was taken as part of a financial break-even plan developed by the HSE national management team to ensure it remained within its Vote for 2007. I emphasise the temporary nature of this measure. As Deputies may be aware, it was reviewed by the HSE national management team yesterday. Based on this review, the HSE has decided that the financial situation is such that it is necessary and prudent to continue the overall pause in recruitment to the end of October, after which the matter will be reviewed again. I emphasise the importance of appropriate budget management by the HSE.

Since 1997 the level of expenditure on mental health has trebled. This year approximately €1 billion will be spent on mental health services. This includes an additional €51 million which was allocated in 2006 and 2007 for the development of mental health services in line with A Vision for Change and for the implementation of Reach Out, the national strategy for action on suicide prevention.

This strategy was published in September 2005 and represents Government policy. The implementation of the strategy is a top priority for me and the Government. Additional funding of €3.05 million was provided in 2006 and 2007 which brings the total funding available to support suicide prevention initiatives in 2007 to €8 million. The funding is being used to complete the availability of self-harm services in accident and emergency departments. Self-harm services are in place in the vast majority of accident and emergency departments whereby in addition to medical care, people presenting with deliberate self-harm also receive a psycho-social assessment following which they are admitted to the treating hospital, to a psychiatric hospital or discharged. Another initiative is a national positive awareness campaign which will be launched next week.

A key component of Reach Out is to develop and implement national training programmes. The National Office for Suicide Prevention is engaged in a significant level of training including the ASIST, applied suicide intervention skills training, programme and has already trained 91 trainers and delivered over 200 two-day workshops to more than 5,000 people around the country.

Concern has been raised about the cancellation of these training courses. According to information available to me, three training courses have been cancelled with a view to being rescheduled and eight courses have been rescheduled. The national office is committed to the ongoing delivery of training which has the potential to reach and inform significant numbers of people.

In light of the increased information around suicide and self-harm it has been agreed with the National Office for Suicide Prevention that an interim target for a 10% reduction in suicide be achieved by 2010. In addition, a target has been set of a 5% reduction in repeated self-harm by 2010 and a further 5% by 2016. Deputies will agree these are ambitious targets but I am optimistic they will be achieved within the allotted timeframe.

Between 1997 and 2006, additional revenue and capital funding of €851 million has been invested in health-funded support services for people with disabilities, of which €549 million was provided for persons with an intellectual disability and those with autism and €302 million was provided for people with physical or sensory disabilities. An additional sum of €75 million for revenue purposes was provided for disability services in the 2007 budget. This sum incorporates the 2007 element of the Government's multi-annual investment programme for the national disability strategy, which is committed to providing some €900 million capital and revenue funding over the period 2005-09.

I am pleased to say dental services for children in Inchicore and Bluebell have not been cancelled. A vacancy arose for a general dental surgeon and this vacancy will be filled in early November. Dental services for children in the target groups of second, fourth and sixth classes will continue from that date.

An additional €255 million was allocated in budget 2007 towards improving services for older people and palliative care for 2007. This is in addition to the €150 million package that was put in place in 2006. In two years the Government had added in excess of €400 million to services for older people. Almost three quarters of this is being allocated to develop further the community-based services that help older people remain in their homes and for additional residential long-stay places for those who can no longer live in the community.

From 1 January 2007 there are no longer three separate rates for subvention. Persons who apply may receive any amount up to a maximum of €300 per week. Additional funding of €55 million was provided for this purpose in budget 2007. In addition to the increased rate of basic subvention, additional funding of €30 million has been made available in 2007 for enhanced subvention.

The Government has delivered unprecedented levels of investment in the health service. In the past six years gross current funding for the health service, excluding the Office of the Minister for Children Vote, has increased by over €7 billion to €13.9 billion in 2007. When account is taken of the increases required to fund items such as general pay increases, benchmarking and other pay awards, as well as non-pay inflation and increases in drugs, costs of approximately €2.3 billion have been provided for additional investment in services.

We must look to developing a system that provides a real incentive for good performance, by the HSE itself and all other service providers so that these major funding increases translate into visibly better services for patients, the most important people in the health service, and all service users across the country.

Deputy Beverley Flynn

Like other speakers I welcome the expenditure of €15 billion on health and compliment the Minister on the significant improvements that have been made in the health service, especially during her tenure. I wish to focus on a number of issues in particular in this regard.

One of the issues that has been close to my heart in recent years is services for older people. As a member of the Oireachtas Joint Committee on Health and Children for the past ten years, especially during the tenure of the current Minister, one of the issues I raised continually related to the equalisation of subvention rates across the country. At one stage the difference between a subvention rate in the west and the east was as much as €500 per week, which was a significant disparity. The Minister made a commitment to the committee to address this matter and I am pleased to say she did so prior to the end of the previous Government. Currently an equal rate of €300 applies across the country. Provision is still available for enhanced subvention and in the east people probably receive a greater enhanced subvention than those in the west.

I would urge that the needs of each individual be taken into account in addition to the costs involved. I accept this is a criterion for enhanced subvention but it is still difficult for people in the west to afford expensive private nursing home care. That said, the situation has improved significantly. I also welcome the increase in home care packages, as it is preferable for a person to be looked after in his or her own home. The provision of funding in this regard by the Government is a big step in the right direction. I am delighted that 2,000 extra home care packages were provided in 2006.

Another issue about which I complained on a number of occasions is that we in the west did not appear to be getting our share of this service. Again, that situation has improved and I compliment the Minister on her commitment in this regard.

Hospital staff is a key issue, especially since the HSE has introduced a ban on recruitment, as is the question of whether services in hospitals have been affected.

In my local hospital, Mayo General Hospital, one physiotherapy position is vacant at present and has not been renewed. I am particularly concerned with this situation, while recognising that the hospital must work within its whole-time equivalent staffing level, which is 1,046 for this year. Staffing levels were as high as 1,088 at times during the year, which is obviously unsatisfactory and means the hospital must get back into line. However, I am concerned about frontline services, particularly physiotherapy services, as there is a waiting list of four to five week at present for people requiring acute physiotherapy and up to nine months for people requiring routine physiotherapy. Given the Minister's statement on this matter, I recognise she is anxious that frontline services will not be affected. I hope this vacancy is filled as a matter of priority.

Moreover, although the matter is currently under review, three radiographers at Mayo General Hospital are on short-term contracts and 14 nurses who have retired or gone on maternity leave have not been replaced. While the hospital must operate within the complement of staff available to it, it cannot operate without 14 nurses, three radiographers and a physiotherapist without affecting frontline services. I am particularly concerned about this matter.

On cancer services, I welcome the Minister's announcement on the centres of excellence, which is the right way forward. It is important that we focus on better outcomes for individuals who have cancer. Unfortunately, it must be recognised that there are no centres of excellence above a line running from Galway to Dublin. It was stated that a centre of excellence must deal with a population of 500,000, which is supposed to justify four centres of excellence in Dublin, but I do not agree with this strategy.

I live in an area for which the centre of excellence will be located in Galway. I do not have a difficulty with this but I hope that, in the next year or 18 months, it will operate in consultation with the consultants who are currently operating in Mayo General Hospital and dealing with 72 cases per annum, and with Sligo General Hospital. Breast cancer services is the area which is probably most in the public domain due to the closure of some of the centres. I do not have a difficulty with such closures because, like the Minister, I would agree that if a hospital is dealing with fewer than 20 cases per annum, it should not be operating in the area of breast cancer. However, given that Mayo General Hospital is dealing with 72 cases per annum, consultants are travelling to Galway to participate in operating procedures and there is a full multidisciplinary team examining all cancers, it is important we keep an open mind and perhaps develop a network approach.

The Minister suggested two years ago at the Joint Committee on Health and Children that we would visit Sloan-Kettering Hospital in New York and we did so. It operates a network service which operates very effectively. We should keep an open mind when dealing with this issue in the west and north west.

Deputy Timmy Dooley

I welcome the Minister to the House and welcome the opportunity to contribute to this debate, particularly in light of the increase in funding of health services which was noted by my colleagues. Recent OECD statistics suggest that from 1999 to 2004 there was an average increase of approximately 5.2% across the OECD, while Ireland experienced a 9% increase. Some will of course suggest that we did not spend enough on health for many of the years before 1999, which I am sure is an arguable case.

I also welcome the Minister's recent meeting with a group of mayors and Oireachtas Members from County Clare. Deputy Joe Carey, who attended that meeting, is present in the House. Whether he will share my sentiments is another question but I am sure we will hear from him at a later stage.

The Minister set out clearly at that meeting what has been happening with regard to Ennis Hospital. She demonstrated that there has been an increase in the staffing budget over five years, with the budget increasing from €14.2 million in 2001 to in excess of €22 million in 2007. This is extremely welcome and is a vote of confidence in the staff of the hospital and in how it has been managed to ensure it delivers the best possible service to the people of the county. The Minister recently confirmed €40 million for the capital programme at the hospital, which is welcome. As that figure of €40 million refers to 2006 figures, I am sure it will be significantly increased by the time the project is completed.

It is important the HSE, through the Department, seeks to expedite the delivery of capital projects. It erodes public confidence when a project is awaited for a long time and is announced on a number of occasions. By the time it is delivered, public confidence in the facility has been lost and whatever is delivered at that stage is often not accepted. This continues to lead to the perception that there is a weakness in our overall health service delivery.

The type of upgrades which will take place as part of this capital programme, such as the upgrading of the accident and emergency unit, the medical and surgical radiology department, the outpatient department and the day-surgical unit, which will have an increase of 14 beds, are all welcome and demonstrate the massive Government commitment to the delivery of health services to the people of County Clare. Planning permission for the capital project is due in the coming days. I appeal to the Minister, through the HSE, to expedite the construction of the project so local people do not continue to believe it will never happen.

For far too long, there has been a situation where the biggest cry in County Clare from a medical perspective has been associated with the belief that the hospital will close. While the Minister has sought to cast aside that notion on every occasion of which I am aware, I am not sure the people accept her assurances. I accept them, and I know the efforts the Minister is making in this regard.

The Minister also referred to the upgrade of the delivery of accident and emergency services at the hospital with the introduction of emergency care physicians to provide around the clock medical cover, the introduction of consultant sessions, the upgrade of the radiology capacity at the hospital and the revenue funding that has been set aside for the CT scanner. I appeal to the Minister to use what influence she can in trying to ensure a 16-slice CT scanner is provided at the hospital instead of the six-slice scanner referred to in the revenue funding. Work has been done on reducing the waiting list in this area.

The one outstanding issue at the hospital is that of accident and emergency services and the concern for these services in light of the Teamwork report. I appeal to the Minister to bring forward the publication of that report to as near a date as possible so we can have an informed debate on the delivery of future accident and emergency services at the hospital, taking into account the west Clare peninsula and the fact it is such a distance from Limerick General Hospital. We need clarity on this issue and I would welcome a debate at a later stage.

Deputy Charlie O’Connor

I compliment Deputy James Reilly, who is proving to be a very busy doctor, on again giving us the opportunity to speak on issues of concern to us. It is good we have returned to real business in the Dáil because I have been telling anyone who wants to listen that this is what the people want us to do. Some Members will know I live in Tallaght. As I go about my business, that is the kind of issue people are talking to us about——

Deputy Mary Harney

Is the Deputy sure he lives in Tallaght?

Deputy Charlie O’Connor

The Minister knows that. If she had not moved on, I might still be a community worker and not lucky enough to be a Deputy.

Deputy Mary Harney

Nobody knew the Deputy lived in Tallaght until now.

Deputy James Reilly

He was never on the health board there.

An Leas-Cheann Comhairle

The Deputy without interruption.

Deputy Charlie O’Connor

Deputy Jimmy Devins was my colleague on the Joint Committee on Health and Children and I am glad he is now taking such an interest in the area. I applaud his appointment and that of Deputy Máire Hoctor who, by the way, has visited Tallaght at least twice since she was appointed. I hope other Ministers of State visit the area.

Deputy James Reilly referred to almost every hospital in the country except Tallaght Hospital, which gives me the opportunity to refer to Tallaght.

Deputy James Reilly

We mentioned Tallaght ten times for the Deputy.

Deputy Charlie O’Connor

The Minister knows my views on cancer services and my response to last week's report, and she knows what I want achieved for Tallaght. I will be very delicate because I do not want to upset any negotiations that might take place but I hope the right job is done.

It is important it is understood that even on the Government benches there are serious concerns about the freezing of appointments. I do not want to appear other than a fan of the HSE. However, Deputy James Reilly and I were colleagues for a long time on the health board at a time when the board answered questions and provided information to public representatives. It was not left to us to get memos from other people or to read in the newspapers what is being done. Many serious issues are being dealt with at present and the HSE should get its act together with regard to keeping public representatives informed.

The Health Service Executive indicated recently that Tallaght hospital would not be rewarded with additional consultants because of the performance of its accident and emergency unit. This policy discriminates against my constituents, the residents of the area. If there is a problem in the hospital, the HSE should take action against those who run the hospital, to whom I do not wish to be unfair. While people in Tallaght are satisfied with the Government's efforts to address health issues and the generous funding made available to the health service, they do not want to languish on trolleys in accident and emergency departments.

The motion refers to dental services. I was a member of a group chaired by Deputy Fiona O'Malley, which made recommendations in respect of orthodontic services. I hope some recognition will be given to the dental service.

Deputy Jan O’Sullivan

I wish to share time with Deputy Caoimhghín Ó Caoláin.

I thank Deputy Reilly for providing a further opportunity for the House to debate the health service in Private Members' time. My party leader, Deputy Gilmore, raised the issue of health cutbacks on Leaders' Questions. The Government's attitude is that cuts to frontline services have nothing to do with it and are a matter for an agency, the HSE, which must live within its budget. The HSE is not an ordinary publicly-funded body which must live within its budget. It was established almost three years ago when the Minister took the political decision to centralise public health services under the HSE and, in so doing, depoliticise the delivery of services, an objective which has been achieved.

Like Deputy O'Connor, many Deputies have raised in the House problems they have encountered in securing replies to parliamentary questions submitted to the HSE. As a former member of a health board, I have found it much more difficult to find out what is going on in the health service than I did prior to the establishment of the HSE.

It is not good enough for the Government to wash its hands of the problem of health cutbacks by arguing that the HSE has a responsibility to balance its budget. The HSE is critically important in terms of the delivery of health services, for which the Government has responsibility. It is difficult to ascertain what is taking place within the HSE. Why did it fail to spend approximately €100 million of its budget last year? I understand it returned this money to the Exchequer, yet it has already managed to go almost €200 million over budget this year. This matter needs to be examined before deciding to cut frontline services. It is wrong to use such a blunt instrument when, as Deputy Reilly noted, recruitment for middle management positions continues and an overspend has occurred on the information technology budget — we are all familiar with the PPARS overspend.

No one knows the reason bonuses were awarded to senior HSE managers. One would expect that a key target of any organisation would be to stay within its budget. If that is the case, why would senior management of an organisation which failed to stay within budget be given bonuses? A series of questions on the delivery of health services must be answered before the Government can stand over a cut in frontline services. As the political head of the Department of Health and Children, it is incumbent on the Minister to answer these questions.

Earlier, my party leader asked why advertisements for the position of chief nursing officer in the Department, which commands a salary of up to €100,000, have been placed in newspapers when frontline services are being cut.

Deputy Mary Harney

Nurses do not feel more strongly about any other issue.

Deputy Jan O’Sullivan

It sends out the wrong message when frontline services are being cut.

Deputy Mary Harney

I will deal with the matter tomorrow.

Deputy Jan O’Sullivan

The Minister of State at the Department of Health and Children, Deputy Devins, referred to statistics which indicate high levels of satisfaction with health professionals. I agree that members of the public are satisfied with the high standards of service delivery across the health sector. However, staff morale is being significantly weakened by the use of the blunt instrument of cutting services across the board.

I do not propose to discuss individual examples but we have specific and definite information concerning cuts to frontline services in hospitals in Sligo, Clonmel, Ennis, Tullamore, Galway, Limerick and elsewhere. In addition, expensive equipment in hospitals will not be used to capacity because overtime will not be provided for staff who could use the equipment in acute cancer services and other areas. Cutting frontline services and prohibiting the recruitment of additional staff is a crude instrument.

The House has not received an answer to a question raised by many Members, including some Government backbench Deputies, as to what will happen to patients in hospitals where cancer services are cut immediately. No information has been provided on how these patients will be accommodated in the proposed centres of excellence. I fully support the centres of excellence concept but we need to know what will happen to the patients in question and how they will be treated. I presume, for example, that a general surgeon who currently performs a certain number of breast cancer interventions in a hospital that is set to lose its cancer service will remain in his or her current post. In such circumstances, how will the breast cancer service he or she provided continue to be delivered. From where will the necessary resources come?

Deputies Clune and Flynn referred to cuts in paramedic services, including physiotherapy, occupational therapy and speech therapy. These cuts will badly affect those who rely on these services, many of whom are on waiting lists. The latest cohort of dieticians, another occupational group in this category, will graduate in the coming weeks. As the recruitment freeze will still apply, they will have no alternative but to emigrate in search of work because none of them will be employed in the health service here. Generally, graduates find temporary positions and are eventually appointed to permanent positions. The recruitment freeze raises a strong possibility of a brain drain of expensively trained health professionals.

The "HSE Watch" section on the Labour Party's website features a comment from a physiotherapist who was due to take up a permanent physiotherapy post in Dublin in the next few weeks. Having given notice, the person faces unemployment due to the recruitment freeze and is seriously considering a career abroad, never to return "to these medieval medical services". There is a real danger that health professionals will leave the country and possibly not return.

In my previous portfolio as the education spokesperson of the Labour Party, one of the issues we discussed was the need to train more physiotherapists, dieticians, occupational therapists and speech therapists. A degree of success has been achieved in this regard through undergraduate, postgraduate and nursing programmes. However, if we create circumstances in which these trained professionals see no alternative but to move abroad to work, we will undo some of the good and expensive work invested in building up the professional base in the health service.

MS Ireland has stated that physiotherapy, respite care and home help cuts will be inflicted on people with neurological illnesses. The result will be a reduction in frontline services to the most vulnerable people.

According to an RTE report today, there are 41,400 people on waiting lists. The figure includes 12,000 adults who have been waiting for more than six months and 2,200 children who have been waiting for more than three months. These figures directly contravene a commitment in the health strategy to ensure that, by the end of 2003, no adult would have to wait longer than six months and no child longer than three months for treatment. The HSE's strategy of imposing a recruitment freeze, therefore, has a direct effect on Government policy. The Minister and the Government cannot wash their hands of this issue because it affects Government policy on the reduction of waiting lists. The Minister may assert that there is no proof that a cut in frontline services leads to increased waiting lists, but any reasonable person would suggest that a reduction, such as closing services at 5 p.m., would have an effect. It is a policy issue, which is the Minister's responsibility.

An Leas-Cheann Comhairle

The Deputy has 30 seconds.

Deputy Jan O’Sullivan

Instead of listing the frontline services to be affected, I wanted to go under the surface, question the logic of using a recruitment freeze to address the mismanagement of a budget when that mismanagement was not investigated in detail and ask why frontline services are being cut, which is the point of this motion. We should examine the various layers of management in the HSE despite the original intention to cut down on bureaucracy. The motion goes deeper. The adopted strategy, a crude instrument, is not appropriate and is affecting health services.

Deputy Caoimhghín Ó Caoláin

I thank Deputy Jan O'Sullivan for sharing her time. I want to begin my contribution in support of this motion by congratulating the people of County Clare who turned out in such numbers in Ennis last Saturday in defence of their hospital. Some 5,000 people took to the streets to oppose the disgraceful decision of the Government and the HSE to axe 24-hour accident and emergency services at Ennis General Hospital. If such a demonstration had taken place in some quarters of this city, I have no doubt that RTE and some of our so-called quality newspapers would have covered it extensively, but this significant event received scant attention in the national media, thus suiting the agenda of the Taoiseach, the Minister and the HSE, the hospital services centralisation policy of which treats communities in the regions outside Dublin with contempt.

It is scandalous that the HSE is imposing a ban on recruitment of staff at hospitals and other health care facilities in a cost-cutting exercise on top of ongoing backlogs and delays in the appointments of frontline staff in our health services. There is a shortage of health professionals across a range of services and further hardship is being imposed on patients as hospital waiting lists will inevitably lengthen as a result of this decision.

During the general election, Fianna Fáil, the senior partner in the coalition, urged people to support it to take "the next steps". It seems the next steps are health care cuts in the public system while the Government carries on with its disgraceful plan to reward the private for-profit health system with public land and tax breaks under the notorious co-location scheme. The HSE has cited an alleged overspend of €140 million by hospitals to justify these cuts, but the HSE announced last July its final abandonment of the failed PPARS computer system, which cost €130 million by 2005. The Government and the HSE are jointly responsible for failed policy and gross mismanagement, leading to poorer care for patients.

The disadvantaged parts of the health service will be worst hit by the recruitment freeze. Earlier this year, the HSE announced 60 new consultancy posts for hospitals throughout the State, but none of them was allocated to the north-east region comprising Cavan, Monaghan, Louth and Meath. The current HSE cuts serve to compound that gross injustice.

The health service unions are fully justified in contemplating protest action. The false claims by the Minister and HSE chief executive Brendan Drumm that the cuts will not affect patient care are being fully exposed with hospitals having to curtail services. The Taoiseach has remained silent on these cuts while both he and the Minister have attempted to hide behind the HSE, but they cannot shirk their responsibility for these unnecessary cuts. Despite the vibrant economy of the past decade and a HSE that the Minister claims has streamlined the running of the health services, the Government is still presiding over fundamentally flawed policies and gross mismanagement, leading to poorer health outcomes for public patients. I emphasise that they are public patients.

The health service unions deserve public support in their efforts to resist these cuts. It is right for the motion to refer to the dismantling of key services at Ennis. As a Cavan-Monaghan representative, I know all too well the devastating effect of the axing of vital accident and emergency services. Lives will be lost. Further pressure will be put on neighbouring accident and emergency departments that must cope with the additional patients who would normally have had access to the closed units. These are the facts.

Currently, some 15% of the population are more than one hour travelling time from an accident and emergency unit. If the notorious Hanly report is fully implemented, that percentage will rise to 30%. Nearly one third of the population will be more than an hour from accident and emergency units with the inevitable result of lives lost. Despite this, the Government and HSE centralisation drive goes on without the fully equipped and fully resourced ambulance and paramedic services being put in place as promised.

In August, a survey published in Britain confirmed the link between distance travelled by ambulance to hospital emergency departments and the risk of death. The survey published in the Journal of Emergency Medicine confirmed that increased distance from the departments is associated with an increased risk of death. The Government must heed this warning from the neighbouring island, which adds to the voices of communities throughout the State which feel threatened with the loss of accident and emergency units.

The findings of the survey may seem obvious and it is all too tragically so for the communities served by Monaghan General Hospital, which have seen deaths as a result of the longer journey times imposed by the cutting of services at our hospital. However, this is an important study because it was carried out in the context of the British Government's proposals to close accident and emergency units in smaller hospitals. I hope this issue will be revisited.

The policy pursued by the Minister and the HSE to dangerously over-centralise all acute emergency care services has been repeatedly rejected by the people. The Minister should not cite the recent general election results as an indication of approval for her reappointment or the configuration of the Government, as nothing could be further from the truth. The Government must scrap its policy and ensure that existing emergency services, including hospital emergency units and ambulance services, are enhanced and developed. Closed or curtailed emergency units, such as those at Monaghan, must be fully restored. The threat to Ennis and other hospitals must be lifted. It is time for the Minister and others with responsibility to realise that nothing less is acceptable.

Debated adjourned.