Leaders’ Questions.

We have arrived at a stage in this country where whatever this Government states is quite unbelievable, whether on the subject of recent events or in the form of general statements. It is a few years ago since the then Minister for Health and Children, Deputy Cowen, told us that 32,000 people were on the waiting list. In 2002, the then Minister, Deputy Martin, made a specific Government commitment that he would end waiting lists in two years. The current Minister for Health and Children, Deputy Harney, said in May this year that the HSE would find efficiencies that would not impact on patients. This is in the context of the Government giving clawbacks of over €100,000 to people who are able to buy their first house for a price in excess of €1 million. There are now 41,000 persons on the waiting lists of hospitals around the country.

The Minister for Health and Children said on 21 September that no patient would suffer because of cutbacks introduced across the country. I have met consultant after consultant who has told me that patients die at the end of waiting lists because services cannot be provided for them. Patients die, which is a direct contradiction of what the Government has been saying. Every day we hear of more and more of these cutbacks in various locations around the country such as 30 nurses and four consultants sacked from Sligo General Hospital; dental services for children in Inchicore and Bluebell cancelled; the 24-hour accident and emergency service at the Mid-Western Regional Hospital in Ennis ended; breast cancer services at 13 hospitals closed and no other service put in their place; the 24-hour bed unit for the rehabilitation of elderly patients at Merlin Park closed, with another to follow; and the cancellation of essential suicide prevention training in the form of applied suicide prevention skills. One can go into any community in this country and see what is happening.

In recent days we have learned that Monaghan General Hospital will be stripped of further services and will have to suffer the removal of another ward despite recent expenditure. The Midland Regional Hospital in Mullingar is to cut medical day cases by 55 per month. In South Tipperary General Hospital in Clonmel, an operating theatre and six surgical inpatient beds will be lost.

The Government stated clearly this month that no patient would suffer because of cutbacks. Meanwhile, Ministers sit in this House and act as if they had no responsibility in the matter, as if the HSE made its decisions at a remove from Government. I remind the Taoiseach that hospital consultants have told me, face to face, that people are dying at the end of waiting lists because they are not able to get a service which we should provide for them. Is the Taoiseach telling me that he is spending €15 billion on a world class health service? The Government is unbelievable in everything it states, from the Taoiseach to his Ministers. Can the Taoiseach say how the 41,000 patients on waiting lists can have any confidence in what they hear coming out of the mouths of Ministers of this Government?


Hear, hear.

I will tell Deputy Kenny some of the facts about the health service and answer some of his questions.

Tell him about Beaumont Hospital.

Has the Taoiseach been in Beaumont Hospital recently? It is not a centre of excellence.

Some 120,000 people work in the health service as of this morning.

The Taoiseach should check his statistics.

If Fine Gael Members do not want to listen, there is no point in me saying anything.


The Taoiseach must be allowed to reply to Deputy Kenny's question.

If the Deputy wants to come to the House and criticise everything in the health service then so be it, but I will give him some of the facts of the situation. As I said, 120,000 work in the health service and they deal with 100,000 patients per month. Both the adult and children's waiting lists, as produced by the HSE, are at record lows right across the system. Some 100,000 inpatient and day care procedures are carried out in public hospitals every month — in excess of 1 million annually. Even if 41,000 is the figure — as I said yesterday, I do not know if it is — it is comparatively low against the figures from last year, three years ago, five years ago or ten years ago. It is a much smaller proportion of the total figure.

There will always be people on waiting lists. The National Treatment Purchase Fund, which issued a report recently, states there has been a consistent pattern of reducing surgical waiting lists throughout the public hospital system over recent years. The report points out that, for most common procedures, adults and children now wait between two and five months, compared to between two and five years some five years ago.

Who was the Minister five years ago?

The Taoiseach is great with figures.

That is a simple fact according to the people who deal with the issue. If Deputy Kenny wants to say that the people dealing with the issue know nothing, while he knows everything, that is fine.

The National Treatment Purchase Fund has stated there is no need for anyone to wait more than three months for an operation and that it is unacceptable that they should do so. If people in such a situation contact the National Treatment Purchase Fund, its members will be only too glad to deal with them. As I said yesterday, some hospitals are not co-operating fully with the fund but the HSE is dealing with that issue.

On Deputy Kenny's second point, it is a fact that the HSE exceeded its allocated Vote of €14 billion by €222 million. The health service is Vote is €15 billion and the HSE gets €14 billion of that amount. At the end of August, its Accounting Officer stated that it was €220 million over budget and that it had to take corrective measures to put itself back into line, like any other agency or department. It has designated a number of areas where this has to take effect. I am not here to manage every one of those. The HSE knows its allocation. In fairness to Deputy Kenny, I do not believe he is saying the HSE should ignore the budget it agreed to last January, that it should not manage within that. That is what it must do. It has a very large capital programme this year and it got a further increase in staff numbers. It must now pull back on staff numbers at the end of the year.

They are management staff.

They are not management staff. The case in Cavan that Deputy Kenny mentioned arose because a consultant was on holidays and no locum has been put in. The HSE must manage within its budget and these are some of the effects of that.

There will soon be no full-time staff to manage patient care.

Not very many years ago legislation was introduced by Fine Gael, which I supported, so there is no criticism of that, under which health boards could not exceed their allocation and must manage within that.

What did the Government do before the election?

Deputy McCormack is not the leader of Fine Gael.

I was only asking.

The HSE must get itself into line by the end of the year. There is no alternative to that. It accepts it has an obligation to do it. This time last year the HSE had underspent and there was a race to spend the money it had in the last few months of the year. I was criticised because its capital programme was not spent. This year it has its management together——

Some management.

It is like the Irish rugby team.

It has got its systems and structures together. It has spent its capital programme and it is on target with regard to its capital programme. It is not in the same position as it was last year. Deputy Kenny's allegation that the HSE is not providing a top quality service in most areas of health is untrue. UCD did a very large and comprehensive survey of the health service, taking in more than 3,500 people. Rather than myths about it, it showed what the people who use the health service think of it. The Deputies opposite should factor that in rather than jumping up to complain because somebody has found out he or she cannot order a chair or a table out of a budget of €15 billion.

The message from the Government is that one should not get sick in this country.

It is unfair of the Taoiseach to say that Opposition Members run down the frontline staff in the health service. We recognise the pressure they are under. We recognise the job they do. The Taoiseach should remember that the people did not elect the HSE. They elected the Government. What we have now is a single person Government where every member of the Cabinet believes whatever the Taoiseach says, whether it is right or wrong.

The figures in regard to the National Treatment Purchase Fund that the Taoiseach mentioned are sanitised. They refer only to surgical cases. They do not refer to medical cases. Nor do they refer to the fact that there are huge waiting lists to see doctors in the first instance. One member of the Cabinet, the Minister for Community, Rural and Gaeltacht Affairs, Deputy Éamon Ó Cuív, who is absent this morning, said that the HSE is a complete shambles, that it is impossible to deal with it.

The ratio of persons working in the HSE is interesting. There are nine national directors and 61 assistant national directors. That is nearly seven to one. When Professor Drumm addressed this parliamentary party a number of years ago in Portlaoise he said there are 2,500 persons working in our system who do not know what their job is, who do not know where they fit into the system and who will be paid for life. The Taoiseach tells me we have a world class health system. Consultants and nurses tell me that people on the end of waiting lists are dying because they cannot access the service. Do the Taoiseach and the members of his Cabinet who believe everything he says accept any responsibility for ensuring there is real efficiency in delivering to patients the care they deserve and for which they pay, and that there are more services and less administration? The Taoiseach agreed with me earlier this year that there is an obscene bulge in the administrative recruitment sections of the HSE compared with the number of nurses and doctors in the front line who are needed to give patients the first class frontline service they deserve. Does the Taoiseach accept responsibility to ensure that taxpayers, who are now spending €15,000 million, will be happy in the knowledge that they are getting an efficient, professional service that is patient-centred and does not deal in the kind of sanitised version of a health service the Taoiseach talks about from the lofty heights of the Office of the Taoiseach?

I can only give the factual position. A total of 100,000 inpatient and day care procedures are done in the public hospital system every month, more than 1 million annually. This is not a big country. The figures are, therefore, impressive. At the end of September, which is right up to date, there were 19,083 adults and 2,320 children waiting for more than three months for hospital treatment.

They have to wait two years to see a consultant.

Those figures include both medical and surgical areas. Across the entire public hospital system that is a total of 21,403. The breakdown in regard to adults is 8,026 waiting three to six months, 6,046 waiting six to 12 months, and 5,011 waiting longer than 12 months. In the case of children the breakdown is 1,020 waiting three to six months, 784 waiting six to 12 months and 516 waiting longer than 12 months. I do not accept that 12 months is acceptable. Traditionally patients waiting for less than three months have not been included in waiting list statistics, but since the National Treatment Purchase Fund took over, it collects that information. It has confirmed that at the end of September the number of adults waiting for less than three months was 16,000.

The National Treatment Purchase Fund consistently highlights its concern that some patients are still waiting too long for treatment. They are offering the service in many cases but the hospitals will not use it.

One cannot get on the National Treatment Purchase Fund list unless one is on a consultant's list.

We have doubled the number of consultants. I presume they are doing their best to administer the services.

I must ask the Taoiseach to conclude.

In regard to some of the short-term difficulties the HSE is having, it must get itself within its annual budget which is employing 120,000 people and spending €14 billion. It must manage its budget the same as every other agency. It has agreed to do that.

More than 234 children have been waiting more than five years for orthodontic treatment in Kerry.

The Minister for Community, Rural and Gaeltacht Affairs, Deputy Éamon Ó Cuív, stated that the HSE is an impossible organisation with which to deal and that he can make neither head nor tail of it. He was a member of the Cabinet that invented, designed, framed and legislated for the HSE and brought it into being. If he can make neither head nor tail of it, what chance has a patient who is trying to get an operation, a parent who is trying to get an appointment with a speech therapist, or a carer who is trying to get home help and finds it impossible to penetrate the maze?

A month ago the HSE put an embargo on the recruitment of staff. That includes nurses, doctors, paramedics, the lot. It wants us to believe, and the Government supports it, that this will have no effect on patients. It does not have to recruit staff and we are to believe patients will not suffer. However, today we hear that operations are being cancelled at Cavan General Hospital because a consultant anaesthetist has gone on holidays and the HSE will not allow the hospital to hire a locum. We hear that the number of days on which breast cancer patients can be seen for biopsies at University College Hospital Galway has been cut from five to three. The head of MS Ireland said that people with debilitating neurological disorders have had physiotherapy, respite and home help services cancelled as a result of the cutbacks. We are told that an orthopaedic ward in Merlin Park hospital in Galway is due to close. All of this is in addition to the 41,000 people on hospital waiting lists and the bed closures in Tullamore, Clonmel, Limerick and Sligo about which I spoke yesterday.

By any standards, these cutbacks in the health service are affecting patients. The Taoiseach can come into this House as often as he likes and drown us in figures and results of surveys from places such as UCD. People who have used the health service will, when asked, say their experiences have been good. We have a good health service; the problem is accessing it.

We have professional people, namely, consultants, doctors and nurses, in our health service and most people's experience of it, once accessed, is good. The problem is that people are unable to access frontline services as a result of the cancellation or postponement of procedures and because appointments are not being made. One must go through a maze of bureaucracy in order to find out what is happening. The Minister for Community, Rural and Gaeltacht Affairs, Deputy Ó Cuív, has rightly described the HSE as an impossible organisation.

Is the Government taking responsibility for the Health Service Executive? The Government created it and it is, as the Taoiseach tells us, spending a great deal of money on it. Is the Government responsible for the Health Service Executive? Does the Taoiseach agree with the HSE embargo on the recruitment of staff or will he at the very least direct it to recruit and replace frontline staff? If the Minister for Community, Rural and Gaeltacht Affairs, Deputy Ó Cuív, is correct — I believe he is — what will the Government do to ensure the Health Service Executive delivers the type of health service for which it receives all of the money about which the Taoiseach keeps telling us?

A number of points have been raised. I am glad Deputy Gilmore acknowledges our health service is good and that he agrees, as I do, that the more efficient that service is in treating patients, the better. Ministers and official members of the health committee have made considerable efforts to improve the service and to ensure an efficient structure. I must acknowledge — it is easy to criticise an organisation — that the facts speak for themselves. The HSE has halved the waiting list in respect of those awaiting procedures. While this is not perfect, the waiting lists have been halved. The resources provided have been used to good effect. I accept issues remain in respect of HSE structures. However, it is striving to bring together an enormous organisation which is different from that which existed a few years ago. The operation of such a large organisation and management of 120,000 people is not easy.

The Government provided the HSE with €14 billion in funding for this year. Every other organisation that received money from Government had to manage it. The HSE did not run into difficulties last year; in fact it had not spent all its money. This year, however, at the end of August it had overspent. It is not for Government to tell the HSE how it must implement its arrangements. The management, Accounting Officers and executive of the HSE must do this.

They are wasting it.

The Government has stated that frontline services should not be affected——-

——and that resources which must be clawed back must be taken from non-emergency areas. The Government has told the HSE that where difficulties arise, they should be addressed in conjunction with the staff under the partnership programme which deals with such issues. The HSE has taken our advice and is seeking to address its problems in an organised manner.

The reality is that Government, through the Department of Health and Children, the health committee and Cabinet health committee, is in daily contact with management of the HSE. The Minister for Community, Rural and Gaeltacht Affairs, Deputy Ó Cuív, pointed out a few areas wherein he believes his Department could help the organisation.


He cited an example of funding allocated to his Department for the provision of ambulances in rural areas and suggested this might be of assistance to the HSE. The Minister is directly engaged in the provision of funding, under the aegis of programmes operated by his Department, to assist the HSE and I believe this is the right thing to do.

A brief supplementary from Deputy Gilmore.

I am fascinated by the manner in which the Taoiseach describes the Government's relationship with the HSE. He seems to think it is the function of Government to advise the HSE or to have a word in its ear with, perhaps, a member of Cabinet then taking a kick at it when it is sufficiently popular to do so. Will the Taoiseach take any responsibility for the HSE? The function of the HSE is, as the Taoiseach stated, to deliver a health service. At the end of the day, patients in Cavan have had their operations postponed this morning and women in Galway are concerned about when they will be called for biopsies. This is the real, human end of the problem. The Taoiseach can talk about statistics and structures all he likes but, at the end of the day, this is about individuals in hospital waiting rooms trying to access a service which is difficult to access. It is quite clear that the HSE is not working or delivering. The Taoiseach repeatedly talks about the amount of funding it receives but at the end of the day the service that should be provided is not being provided. The main problem which arises does not relate to individuals or managers in the Health Service Executive but with the Government which refuses to take responsibility for it.


Hear, hear.

The Taoiseach believes his role is the provision of advice to the HSE by way of a word in its ear. I put it to the Taoiseach that the embargo in respect of recruitment did not arise out of thin air. I do not believe the HSE simply decided one morning to introduce an embargo on staff recruitment.

Deputy Gilmore must put a question to the Taoiseach.

Did the Taoiseach or Government tell the HSE not to recruit more staff? Is he insisting its budget is now more important to him than the patients it serves?

Hear, hear. That is the issue.

The current embargo has been in place for a month and is now to be extended for another month. Will the Taoiseach issue a direction to the HSE to recruit frontline staff so that the service can at least continue at whatever unsatisfactory level it operated up to now?

If, as the Minister for Community, Rural and Gaeltacht Affairs, Deputy Ó Cuív, says, it is not working, will the Taoiseach do something about it? The current situation, whereby the State, as the Taoiseach rightly points out, is spending a great deal of money on the health service which is not delivering the goods to patients at the end of the line, cannot be allowed to continue.

It will probably receive another €80,000 for that; a bonus.

In reply to Deputy Gilmore, neither the HSE budget nor its approved staffing level has been cut. There has been no cut in its service agreement——

There has been.

There has been no cut in the resources provided for its service agreement or in its staffing level for 2007.


There has been no cut. The budget allocation, service agreement and staffing levels for 2007 have not been cut. This is a fact.

A woman in Galway cannot get four hours home help. I will give the Taoiseach the facts later.

Another fact is that the HSE is seeing tens of thousands more patients in a faster time than has ever happened in the Irish health service. It is competently extending and advancing a more sophisticated service to patients in public hospitals and in community care than ever before. More community care packages and services than ever before are being provided throughout the country.

That is not correct.

Where are they? They certainly are not in Cavan-Monaghan.

Deputy Gilmore rightly stated there are a number of difficulties with the HSE. I have admitted that a consultant anaesthetist in Cavan is on two weeks annual leave and that at local management level it was considered that some of the non-essential caseload could be left aside for two weeks and a consultant locum would not be appointed.

Local management is blamed.

That was the decision taken locally. The Cabinet does not sit down and make calls about staff resources in each hospital and area of the country.


What is Deputy Ó Cuív saying?

What the Cabinet is doing——

Is discussing spin.

The Cabinet regularly sits down with the management of the Health Service Executive and the Department of Health and Children and we work through the HSE reform programme to make sure we get best value for our investment in services and resources and that the thousands of additional staff at the level of consultants, junior hospital doctors, nurses and others are used to the best advantage. That is what the Cabinet does.

It is not doing enough.

We are not involved in every separate decision but we are helping the HSE to structure its reform programme in an efficient way to ensure that it can see even more patients more quickly in the future.