Dáil Éireann díospóireacht -
Wednesday, 3 Oct 2007

Vol. 638 No. 4

Adjournment Debate.

Hospital Services.

Deputy Mary O’Rourke

I am pleased to have an opportunity to air this matter. The shockwaves that were felt following the suspension of the delivery of breast services at Barringtons Hospital escaped many within the health service. A medical upset was caused, especially among women, when events unfolded there and Professor Drumm announced the HSE had no authority to investigate matters in Barringtons Hospital because it is a private hospital. The questions began to mount up and I cannot understand why there has been so little discussion of the matter.

It almost appears the issue is a reverse of the norm. Is it the situation that the Health Information and Quality Authority, HIQA, judges public hospitals but, as yet, does not have the legislative power to extend its remit to private hospitals? We have the ridiculous situation whereby if one pays money, one does not know what standard one will get, but if one does not pay, one is sure of decent standards.

Perhaps I am taking things up wrong. A number of people have contacted me to say they subscribe to the VHI and attend the Mater Hospital or the Blackrock Clinic or wherever they are sent by their doctors. They have heard Professor Drumm state neither he nor any other worthy member of the HSE has the right to judge the standards of care, or to authenticate the care, given in private hospitals. We are all of the belief these are excellent places to attend. However, it appears to be the case that if one waits for months to be called to a public hospital, one at least will be guaranteed standards of care.

When will HIQA be empowered to apply the same standards to private hospitals as apply in public hospitals? Is it a matter of a licensing arrangement whereby a body or institution has to procure a licence from a particular entity before patients will be clear and sure of what is involved?

I do not blame the Minister. The HSE has become a massive monolith. It has the power to gobble us all up. We do not know where it is going, what it is doing or what it is all about. I fear it does not know itself what it is about.

Deputy Simon Coveney

Agreed.

Minister of State at the Department of Health and Children (Deputy Máire Hoctor)

I am replying to this matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney.

I thank Deputy O'Rourke for raising this important issue. The Government is committed to ensuring the delivery of the best quality health service possible and doing so both effectively and efficiently. We believe that to do this we had to radically reform the health service and we are currently well advanced in that process.

Earlier this year we made significant progress on this journey with the adoption of the Health Act 2007. That legislation provides for the establishment of the Health Information and Quality Authority, or HIQA as it has become known, and the Office of the Chief Inspector of Social Services. This represents a crucial element of the reform programme and is a new departure for the health services.

A core function of the authority is to set standards on the safety and quality of health services and to monitor enforcement of these standards in an open and transparent way. The Act gives HIQA strong powers in this area in regard to services provided by the Health Service Executive and bodies funded by the executive to provide health services on its behalf. The process by which such regulatory regimes are first introduced in the public sector is a feature of such developments in other jurisdictions.

The authority also has responsibility for undertaking investigations as to the safety, quality and standards of services where it is believed there is serious risk to the health or welfare of a person receiving services. Recent developments, particularly those relating to the unfortunate incidents of misdiagnosis in breast cancer, have led to the commencement of two investigations by HIQA.

I am keenly aware that one of those investigations is limited by the fact HIQA does not have a remit in the private hospital sector. However, the Deputy will be aware that my Department took swift and effective action to deal with the situation. Services at the private facility concerned were suspended and an appropriate look-back at the management of cases involved in the symptomatic breast disease services delivered from that hospital is currently under way. The review group expects to complete its work next month and any follow-up action required will be taken as a matter of urgency.

I would like to emphasise the progress we have made in the area of the development of quality care standards in health. For the first time, we will now have national standards across the major programmes of care. Such standards in the field of symptomatic breast disease services have already been developed and are in the process of being rolled out. The Minister has directed the HSE to ensure compliance with the standards within the public hospital system. The Minister has also called on hospitals in the independent sector to take steps to ensure their breast cancer services comply with these standards.

The Deputy will be aware that last week the HSE announced a major re-configuration of the delivery of cancer care in this country which will involve the provision of services from dedicated centres of excellence. In January 2007, we also established the Commission on Patient Safety and Quality Assurance to develop proposals for a health service-wide system of governance based on corporate accountability for the quality and safety of all health services. One of its terms of reference is to specifically examine and make recommendations in regard to a statutory system of licensing for public and private health care providers and services. Needless to say, this will include hospitals in the private sector.

In short, the direction of policy is clear. We are moving towards licensing and accreditation of all health care settings against explicit standards. The commission is currently seeking submissions from the public and key stakeholders on the issues within its remit and will welcome views from all quarters. I look forward to the recommendations from the Commission on Patient Safety and Quality Assurance, which is due to report by the middle of next year. In the meantime, we will be vigorous in ensuring a speedy conclusion to the HIQA investigations and departmental actions on the recent cases which led to the current public discussion on these matters.

General Practitioner Services.

Deputy Pat Rabbitte

I am obliged to the Ceann Comhairle for giving me the opportunity to raise this issue. Last week, I attended the launch of a report of a community health project in my constituency entitled "Taking the First Steps to a Healthier Fettercairn". There are some 6,500 people and 840 local authority houses in Fettercairn. Development is well under way to bring the overall number of housing units to 1,000 within the next number of months.

Fettercairn is typical of the unimaginative planning and under-provision of facilities that went into large local authority estates in the 1970s and 1980s. It is an area of low income families with a large population of young people and one parent families. Some 1,511 males and 1,858 females finished full-time education aged 15 or under. Almost one fifth of all families are headed by a lone parent. Since the estate was built almost 30 years ago, the people have struggled to make the best they could from the spartan circumstances in which they found themselves. A Trinity College assessment in 2002 found "high levels of stress, smoking and chronic illness".

This report makes a number of recommendations in areas such as health, housing, transport and policing. The one recommendation I wish to highlight this evening concerns the need for a GP presence in Fettercairn given its population of 6,500 and the fact that there is no GP. The report also argues for a medical health centre, an effective primary health care team and access to pharmacy services, but it is the need for GP services that concerns me this evening.

Is there another community of soon to be 1,000 houses that is denied even clinic hours by a GP? I do not know how many towns in the Minister of State's constituency which will soon have 1,000 houses and a population rising to 6,500 people but no GP. This is directly related to the budgetary stroke by Government coming up to the 2002 general election, when it allowed the over 70s, irrespective of their means, free access to the GP. The doctors lost rich private clients in the wealthier parts of this city and so had to be incentivised by Government. The result has been that the poorer areas have been virtually denuded of GPs. What I want to know from the Minister of State is what steps she will take to ensure that something as basic as GP services are made available to the citizens of Fettercairn.

I do not want to compete with the Minister, Deputy Éamon Ó Cuív, or Deputy Mary O'Rourke in criticising the HSE but it was disconcerting to be present when the HSE representative admitted that because of manpower planning and the flight of GPs to more profitable areas, he did not believe a GP service could be provided in the area in the near future.

The Government — the Fianna Fáil-Progressive Democrats part of it — has taken specific actions the result of which has been to disadvantage the people of Fettercairn. The €1.9 billion funding promised to underpin the RAPID programme was never honoured. Now, the manner of implementation of the medical card for the over 70s has greatly disadvantaged poorer areas of urban Ireland. What action will the Minister take to address this intolerable inequality?

Deputy Máire Hoctor

I thank the Deputy for raising this important issue. I am replying on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

I am conscious of the complex range of social and environmental circumstances which affect Fettercairn and a number of other disadvantaged urban areas around the country. The health services have a key role to play in working with communities and a range of other statutory and non-statutory interests to ensure a co-ordinated and integrated response in such areas. I am aware also of the research study entitled "Taking the First Steps to a Healthier Fettercairn" which was launched last week. In this regard, the Health Service Executive has confirmed to the Department that it proposes to meet the Fettercairn community health project to discuss and progress activation of the report's recommendations on health services.

The national primary care strategy aims to support and promote the health and well-being of the population by providing accessible local services and thereby reducing reliance on hospital-based services. General practice is a key part of such services in the community and will be a core element of the new primary care teams which are being developed.

The HSE has indicated that while at present there is no general practice located in the Fettercairn area, there are three GP group practices and one single-handed GP providing services within a radius of 1.5 to two miles of Fettercairn. I understand that in these circumstances persons living in the area who qualify for a medical card or GP visit card can access general practitioner services elsewhere in the Tallaght area.

The Minister for Health and Children is clear that, in the context of the development of a new contract for general practitioner services, all suitably qualified doctors should have the opportunity to have a GMS contract. Such a change has the potential to increase service availability and patient choice while at the same time facilitating more general practitioners in having access to public contracts.

The development of GP out-of-hours co-operatives throughout the country is an essential part of our health service policy of strengthening primary care services and ensuring that, to the greatest extent possible, care needs are met in the primary care setting. These co-operatives offer responsive, high quality services delivered by on duty doctors, nurses and secretarial staff in well equipped, modern clinical centres. The HSE has indicated that it is examining the feasibility of establishing a GP out-of-hours service for south-west Dublin. It has also indicated that a primary care team is being established to cater for the Brookfield-Fettercairn area and clinical team meetings are expected to commence in November. There are five GPs involved in the team, which will also include a public health nurse, occupational therapist and physiotherapist.

I understand that capital funding negotiated under the local RAPID programme has been provided towards the cost of an extension to the Fettercairn community centre, which includes accommodation for the provision of health services. The Fettercairn area will also benefit from the Tallaght west childhood development initiative which is being co-funded by the Office of the Minister for Children and Atlantic Philanthropies for the period 2007 to 2012. The projects include early childhood intervention services, a healthy schools programme, an after school programme and a community safety initiative. These projects will be subject to ongoing research and evaluation. The development of this initiative has been well grounded in partnership with the local community and this contributed to its selection as one of the three pilot sites under the prevention and early intervention programme for children which was announced last year.

The range of developments and initiatives I have outlined will contribute significantly to addressing the health service needs of the Fettercairn area.

Accident and Emergency Services.

Deputy Simon Coveney

I thank the Ceann Comhairle for giving me the opportunity to raise this issue. While I could have discussed the matter during the Private Members' debate on health services, it would have been inappropriate to do so as the problem to which I refer has been ongoing for five months and is not solely related to the motion the House debated earlier.

The issue I raise relates to the Mercy University Hospital in Cork, a highly efficient institution with a significant throughput which is located in the city centre. For a number of years, the hospital has experienced a specific problem in the provision of accident and emergency services. As a result of the large number of admissions and problems arising from a lack of physical space, the hospital applied for funding for the development of a new accident and emergency department. Construction works on the new unit commenced in the summer of 2006 and were completed in January this year. While the department is now ready for use, its new equipment lies idle in its original wrapping.

An additional 25 staff are needed to run the state-of-the-art unit which will have a rapid response rehabilitation team, the first of its kind in Cork, and a multidisciplinary staff, including physiotherapists and occupational therapists. It now lies idle with its doors closed not only because of the current recruitment freeze, but because the Health Service Executive has refused to allocate funds to cover staffing costs.

Is it acceptable to approve substantial capital investment for a brand new, state-of-the-art facility attached to a busy hospital and then, on completion, announce that a staffing budget will not be made available? It is an appalling lack of foresight to proceed with a project of this nature and then refuse to staff it. Consultants, management and nursing staff are extremely frustrated at this development. The staff of Cork University Hospital are also frustrated because the new unit was built with a view to improving facilities at the Mercy University Hospital and easing pressure on Cork University Hospital. Its accident and emergency department is too small to meet current demand and has patients lying on trolleys at busy times. The lack of planning, foresight and budgetary discipline shown by the HSE means a brand new facility elsewhere in Cork cannot be opened.

It is not acceptable for the Government, which has ultimate responsibility for health care, to allow the HSE decide not to open a fantastic new facility and thereby create a white elephant. The unit, which was supposed to open in September to cater for 30,000 accident and emergency patients per annum, lies idle.

If, as I expect, I receive a standard ministerial reply, I ask the Minister of State to at least convey to the Minister for Health and Children the frustration felt by management, consultants and staff at the Mercy University Hospital Cork who worked so hard to have this capital project completed.

Deputy Máire Hoctor

I will reply to this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

There are three accident and emergency departments in Cork city located at Cork University Hospital, the Mercy University Hospital and the South Infirmary Victoria University Hospital, respectively. These units are cross-covered by a team of five consultants in emergency medicine.

Funding of €4.7 million for the provision of a new accident and emergency department at the Mercy University Hospital was included in the HSE's capital plan for 2006-2010. Building works on the new accident and emergency department commenced in June 2006 and were completed on schedule in January this year. The work of equipping and commissioning the new facility subsequently commenced and this process is expected to be completed in the coming weeks.

At Mercy University Hospital the existing accident and emergency facility caters for up to 25,000 admissions every year in the city centre, while the new unit will have the capacity to cater for 30,000 patients per annum. The work of the existing accident and emergency department is underpinned by close working relationships with physiotherapists, a social worker, an occupational therapist, a radiographer, a pharmacist and other support services, including chaplains, security and housekeeping staff.

The new department consists of a large patient waiting area with a separate paediatric waiting area, a triage area, three-bay minor treatment area, ten-bay major treatment area, two-bay resuscitation room with adjacent x-ray suite and a treatment and therapies-procedures room. There are currently 46 whole-time equivalent staff in the existing accident and emergency department. This staffing includes 18 whole-time equivalent nurses, one whole-time equivalent consultant in emergency medicine filled by two consultants, two registrars, seven senior house officers, ward attendants, clerical staff and porters.

In January 2007, management at Mercy University Hospital submitted an application to the National Hospitals Office for an additional 24.5 whole-time equivalent staff to run the new accident and emergency department at a cost of €1.497 million. The HSE is in negotiation with the management at Mercy University Hospital on the provision of these additional staff. Discussions are also ongoing with staff in the accident and emergency department regarding the transfer from the existing department to the new department. I will relay to the Minister the frustration expressed by Deputy Coveney.

Garda Deployment.

Deputy Kieran O’Donnell

I thank the Ceann Comhairle for allowing me to raise an important matter regarding Limerick. Last night, there were four shootings at three different locations in the city and people going about their daily lives in quiet family areas were subjected to indiscriminate shooting. Thankfully, no one was injured or killed, but it has brought to a head the issue of the 100 extra gardaí promised under the Fitzgerald report on regeneration projects. We are falling short of obtaining that many gardaí. Current Garda numbers remain at the same figure as 12 years ago, meaning we have barely caught up. Community gardaí are being moved from their frontline duties to specialist areas.

Will the Minister fulfil his commitment to Limerick of 100 extra gardaí? For several years, Cork has had fewer headline crimes and 100 more gardaí than Limerick. To date in 2007, Limerick has seen 80 firearm discharges, which is an increase of 33% since last year, and one murder. The situation in the affected areas is intolerable. Residents' concerns about criminal elements being rehoused in their areas should be taken on board by the local authority and the HSE through consultation because their fears are legitimate rather than based on snobbery.

I demand the extra gardaí needed in Limerick. The Fitzgerald report promised a superintendent to head the operation and made the vital recommendation of a Criminal Assets Bureau branch in Limerick to deal with hardline crime. A gangland element is amassing wealth and must be tackled head-on in a firm way. There is a case for an Operation Anvil-style measure for Limerick and an agency to address drug issues, specifically the heroin problem, must be set up. The four shootings in Limerick were related to drugs and other criminal activities that must be stopped.

Community policing is suffering due to the escalation in gangland violence. The Mayorstone and Mary Street Garda stations should be operated on a 24-hour basis to provide security. Suburban areas such as Castletroy, which has a population of more than 12,000, need Garda stations and have none. All large towns of more than 4,000 or 5,000 people have Garda stations that are manned full-time. Extra community police must be on the ground and walking the beat because people in Limerick city are entitled to feel safe in their beds and neighbourhoods, but the 100 extra gardaí promised in the report have not appeared.

An Ceann Comhairle

The Deputy's time has expired.

Deputy Kieran O’Donnell

I call on the Minister of State to provide the House with the news of increased Garda numbers in Limerick city.

Deputy Máire Hoctor

I wish to respond on behalf of my colleague, the Minister, Deputy Brian Lenihan, who expresses his apologies for not being available.

I thank Deputy O'Donnell for raising this matter on the Adjournment and assure him that the Minister and I share his concerns about crime in Limerick. However, as the Deputy is aware, the Garda Commissioner has direct responsibility for the allocation of Garda resources. I am informed by the Commissioner that the number of operational gardaí in Limerick city as of 1 October 2007 was 436, an increase of 39 since 31 December 2006. Garda resources in Limerick are further augmented by the presence of members of a number of Garda national units such as the National Bureau of Criminal Investigation, the Garda National Drugs Unit and the Criminal Assets Bureau. This upward trend in the allocation of Garda personnel to the Limerick city districts shows the commitment of the Government and the Commissioner to meeting the targets set out in the Fitzgerald report in respect of Garda numbers.

The Government has committed to bringing the strength of the force to 15,000 fully attested members by 2010 and to 16,000 by 2012. The additional gardaí will be placed in frontline operational policing and will increase the ratio of gardaí to population throughout the country.

Operation Anvil is central to the strategy of the Garda Síochána in combating serious crime, in particular, murder. The operation, which commenced in the Dublin metropolitan region in May 2005 and was subsequently extended nationwide at the Minister's request, has proved to be successful in disrupting the criminal activities of a number of key criminal gangs. It has resulted in a number of high profile arrests and the acquisition of intelligence on the movements of criminals. Notable improvements have been achieved in the recorded number of incidents of crime being targeted by the operation. The most recent figures available show that under the operation, 92 arrests have been made in connection with murders and 1,080 in connection with serious assaults. Some 768 firearms have been seized or recovered and 37,427 drug searches have been conducted.

A suggested possible solution to problems is a more localised structure for the Criminal Assets Bureau. While a greater focus on local issues by specialised Garda units could bring specific expertise to bear on matters of concern, we must act in a manner that ensures that the resources available to, for example, the bureau are used in an optimum fashion.

We must rid ourselves of any misconception that the bureau's work happens in isolation or that it is of a centralised nature without connection to what is happening in local areas. The bureau's success can be attributed in no small part to the use of knowledge made available by local sources. This is facilitated by the work carried out by trained criminal asset profilers who have been appointed in every Garda division. The use of local asset profilers was developed by the Criminal Assets Bureau in conjunction with the Office of the Director for Public Prosecutions in 2004. The programme ensures that a fully trained asset profiler is in place in each of the 25 Garda divisions and a full complement of divisional profilers is being maintained.

A key function of the profilers is to ascertain and build information at local levels and point out individuals at whom the bureau's work can be targeted. Such information is then investigated and followed up by CAB. Management of An Garda Síochána and the chief bureau officer of CAB are keeping the situation under review to ensure resources are allocated in the most effective manner possible.

The underlying trend in crime statistics showing a drop of 1.1% in crime recorded in the year ending 30 June is encouraging, but there are no grounds for complacency. The Minister has discussed these figures with the Garda Commissioner, particularly the increase of 3.2% in the second quarter of 2007 compared to the second quarter last year. The Commissioner has advised that the Garda is undertaking a number of specific targeted operations directed against particular types of crime in areas where increases have been taking place. Garda personnel assigned throughout the country, together with overall policing arrangements and operational strategy, are continually monitored and reviewed. Such monitoring ensures that optimum use is made of Garda resources and the best possible Garda service is provided to the public.

As the House is aware, the Fitzgerald report concerns taking a holistic approach to the problems suffered by innocent people living in certain areas of Limerick. These people and communities have been the subject of persistent attacks on their lives and safety. The Government is committed to addressing the problems and bringing the perpetrators to justice. The gardaí in Limerick are to be commended for the high detection rate of the more serious crimes committed in the area.

The Dáil adjourned at 9.40 p.m. until 10.30 a.m. on Thursday, 4 October 2007.