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Dáil Éireann díospóireacht -
Wednesday, 8 Jul 2009

Vol. 687 No. 4

Adjournment Debate.

Health Services.

Last year a public consultation exercise was put in place for the proposed health information Bill which will deal with the collection, use, sharing, storage, disclosure and transfer of personal health information as well as the rights of individuals to control and access their health information. The views expressed in the consultation process are rightly being taken on board in preparing the Bill. Consultation is vital to achieve understanding of the concept of communities and to win support for proposals. It also plays a vital role in informing policy makers and developing their understanding of the views and concerns of the public at local and national level.

There is a need to fast-track the development of the community consultation element of the national strategy for service user involvement in the health service. The objective of the current health reform programme is to deliver better patient care and safety. The health service has not been short of plans, reviews and reports. However, one of the criticisms of health service planning has been that it has tended to be expert driven rather than consumer led. It has thus been disempowering in nature.

The need for community input from local health service providers such as general practitioners, consultants and nurses, as well as ordinary people, is clear. The national strategy for service user involvement states that on a community level, consultation will lead to improved policies to address inequalities in health, services that respond better to the needs of the community, more equitable and inclusive services that help to address social exclusion and reduced complaints and increased trust.

To give the Health Service Executive some credit, mechanisms for complaints for health service users have already been made much easier. In hospitals and local health offices, posters and leaflets are displayed giving people information on how they can have their say. The HSE assures the public that comments and complaints are read every day and are responded to as soon as possible.

In the United States and Canada, local prospectives are developed through the use of community based workshops and forums which examine health programmes to ensure they are accessible, appropriate and relevant. Rural stakeholders, providers and communities are consulted to strengthen understanding about health issues and develop innovative solutions. That type of local consultation could and should be developed here, particularly when so much change is going on in the health service.

The HSE is working to deliver proper primary care services in our communities but what does primary care mean to the ordinary man or woman in the street? They are not looking for primary care because they are not truly familiar with what it is and what it will mean at local level.

If real practical communication systems were in place, people would know, understand and demand these services. Health service surveys point to positive feedback on hospital experiences from the vast majority of patients. However, the mistakes and the crises around misdiagnosis and the negative stories are what the public at large hear and read in the media. Consequently, the HSE frequently finds itself preparing press releases that are essentially rebuttals to various claims from pressure groups, politicians and commentators. As we have learned to our cost in the past, when you are explaining, you are losing. It is correct that the record should be put straight. However, it would be much better to be proactive, positive and communicative with the public.

The health reform debate has often been reduced to soundbite. The community should be encouraged to find their voices in ways other than through protest groups, marches and mass meetings. Those voices should be listened to and respected. After all, experts do not necessarily always have all the answers. The consultation process should be ongoing and built into the system, and not just for a formal exercise at the start of the programme.

Many column inches have been used to refer to the myriad of vested interests in the health sector. Much frustration has been articulated over the years by the Minister and the HSE with regard to those vested interests. The most important interests should be the communities that are being served.

The HSE must tell people why decisions have been made. It is not enough to say that another way of providing a service is safer if it does not explain and discuss why and how. The management structure changes announced last year should bring more decision making to regional level and hopefully assist in this task.

It has been said that the reform of the health service is like turning around an ocean liner but that is easier to do if the crew and the passengers are working with one another and understanding what is going on. I will conclude by quoting an old Chinese proverb which I believe is appropriate. It states:

Go to the people

Live among them

Learn from

Love them

Start with what they know

Build on what they have:

But of the best leaders

When their task is accomplished

Their work is done

The people all remark

"We have done it ourselves".

I thank the Deputy for raising this matter which I am taking on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

The Department of Health and Children has led the development of the National Strategy for Service User Involvement in the Irish Health Service and the office of consumer affairs in the HSE is now responsible for implementing it. The Deputy will also be aware that last year, the Minister for Health and Children was responsible for the publication of the report of the Commission on Patient Safety and Quality Assurance. That report made the following recommendation: “The proposals in the National Strategy for Service User Involvement in the Irish Health Service should be implemented as a matter of urgency to ensure that patients and their families can influence policy development, service delivery and health service development and evaluation”.

Subsequent to the publication of the report the Minister has appointed an implementation steering group led by the Department's chief medical officer. This group will oversee the various projects needed to implement the recommendations of the report. One of the projects is specifically directed at driving service user involvement in the health services.

The HSE has spent considerable time communicating and raising awareness of the National Strategy for Service User Involvement and has developed a dedicated web page with various on-line resources. The office for consumer affairs in the HSE has also established a database of contact details of service users and community group representatives who are interested in participating in local or national events relating to the design, development and-or delivery of Irish health and social services. Since its development in May, it has over 200 service users and community groups registered.

Within primary care, 19 projects are currently being supported under a joint funding initiative between the HSE and the Combat Poverty Agency, the purpose of which is to support and enable disadvantaged communities and groups to participate in local primary care teams and networks. Within the hospital setting, the HSE has committed in its service plan to the following: making available high quality information to service users about their treatment and care; involving service users as much as they want in decisions about their treatment and care; ensuring service user involvement leads to service improvements; guaranteeing service user involvement in service development; and promoting the HSE comments, compliments and complaints policy, “Your Service Your Say” to all service users.

The Department of Health and Children is committed to engaging service users in its policy development work and the Office of the Minister for Children and Youth Affairs has shown considerable leadership in the engagement of young people. The HSE is currently focusing on ways for services users to comment on the quality of care in a national patient survey programme. This is to be piloted in October and preliminary results are to be made available in early February.

Other developments include the following: service panel guidelines are currently being circulated for consultation and will be disseminated across the HSE in October 2009; draft national guidelines for service users outlining what service users can expect from the HSE and what the HSE can expect from service users are also being developed and will be available for consultation shortly; and 30 volunteer patient advocates have been trained through the National College of Ireland and will be working in both the private, public and voluntary sectors.

This demonstrates the considerable commitment that the Minister and the Department of Health and Children, including my office, have given to the importance of involving service users in all areas of our work.

Services for People with Disabilities.

I raise this issue because I attended a meeting today of the Walkinstown Association for Handicapped whose members confirmed to me the level of cuts involved. Three kitchen staff have been let go, a modern kitchen closed and a woman who was involved in holistic therapy lost her job yesterday. In addition, those who were in the rehabilitative training programmes, who had been promised that at the end of their term in those training programmes, which would last up to three or four years, they could move to day services have now been told there is no availability of such services because of the decision by the HSE not to provide funding for that and not agree to the transfer.

I met with a number of the clients, as they are known, and their frustration was clear. They are well able to understand, despite their various disabilities, the seriousness of what is happening to them and the fact that services are being cut. They will miss the people they have become familiar with who provide services such as hot meals every day. Their future is to sit at home or in the residential units in which they live. That is if they are allowed to do so, because not all residential units allow residents to remain throughout the day.

Respite weekends for clients have also been cut. These were a major attraction because they provided a break from the daily routine. Clients looked forward to travelling to various places for a weekend, which could be done at very little cost because most of the work of the Walkinstown association is done voluntarily or at less cost than similar services provided by other service providers and much cheaper than the private services contracted by the HSE.

It has been proven time and time again that the Walkinstown association has given value for money. It deals with some of the most disabled people and most difficult cases, whom other private or HSE services cannot deal with. Anyone who knows their clients sees the progress they make when continuous service is available to them.

The HSE has refused to meet the management of the Walkinstown association to deal with its failure to agree a budget or to announce the final detail of the budget cuts. Therefore, the remaining services of the Walkinstown association are under threat because the HSE cannot agree figures or announce a budget for next year. The HSE says the cost in any of its other services is €80,000 per client. The Walkinstown association provides a residential service for €35,000 per client, which is a huge saving. Instead of cutting the Walkinstown association budget, the HSE should encourage the association to take more clients and money should be provided for that. The Walkinstown association has proven that it gives value for money.

This measure is contrary to the commitments given when we debated the Disability Bill. Promises were made that services for disabled people would not be cut. When the Opposition argued that the legislation should be rights based we were told that was not necessary because the Government could guarantee that services would not be cut. A number of years later, one of the services in my constituency which serves its clients to the best of its ability faces huge cuts.

I presume the same is true of other services throughout the country. I can only deal with the one that has been highlighted to me. It is a scandal that the weakest and most vulnerable bear the brunt of cuts which should not be required.

I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. At the outset, I reaffirm the Government's steadfast commitment to people with disabilities in Ireland and to the national disability strategy and its long-term goals and objectives, which we will continue to pursue in the coming years in partnership with all the key stakeholders.

Since 2005, the Government has provided significant additional resources for services and supports for effecting real change in the development of services for people with disabilities. The multi-annual investment programme, which was a key component of the Government's disability strategy, had by the end of the period 2005 to 2008 provided the following for the intellectual disability services: 804 new residential places; 307 new respite places; and 1,863 new day places. In terms of services for people with physical and sensory disabilities, 275 new residential places and 911,626 extra home care-personal assistance hours have been provided for. In addition, in the same period, 195 day places have had their services enhanced with the provision of additional supports to provide for school leavers or other adults with significant disabilities. Some 406 places in the intellectual disability residential service have been enhanced, 61 respite places have been enhanced while 43 residential places in the physical and sensory disability services have been enhanced.

Due to the current economic situation, it has not been possible to provide significant levels of development funding for additional services in 2009. However, the HSE and voluntary disability service providers are working together to ensure that the existing resources available for specialist disability services are used in the most effective manner possible. The common aim is to ensure that the needs of as many individuals as possible are catered for within the resources available. Both the voluntary sector and the HSE are committed to the best use of available resources in a creative and flexible manner to be as responsive as possible to the needs that present.

With regard to the six individuals concerned, I understand from the HSE that they completed their rehabilitative training in February. This training has been extended until the end of September of this year. At that point, additional funding will be available for the provision of day places generally and their position will be reviewed in that context. The HSE and the Department of Health and Children will monitor the situation to ensure that, as far as possible, the needs of each young person with a disability leaving school or rehabilitative training in 2009 will be addressed.

Hospital Services.

I thank the Ceann Comhairle for granting me the opportunity to speak on this Adjournment debate. The announcement of the closure of respite beds in Cherry Orchard Hospital caused consternation and huge distress to patients, who felt there was no available alternative, and to their families.

I welcome the news I received today from the HSE that respite beds are being provided. However, these beds are being provided in a private facility. In its statement, the HSE indicates that this is more cost effective, but I question that. How can it be more cost effective to have such a facility in a private rather than a public unit. The HSE refers to the maintenance of staff and paying staff overtime over the summer.

My real concerns are that this may be the tip of the iceberg and what will happen in the autumn. We have been told that these places will be brought back to Cherry Orchard in October, and I hope that is the case. The HSE also states the alternative provision is in the locality. It is not clear what locality means. No further information has been given on this point. I sincerely hope the alternative will be easily accessible. The people concerned are likely to be elderly and have elderly relatives. It is important to them that their families are able to visit them. Many of them do not have cars and are dependent on public transport. If the alternative service is not in an area where there is good public transport and within a reasonable distance it will be extremely difficult for them. This aspect must be considered. By providing these beds in a private unit, are we chipping away at the system? What will happen in the autumn? Have we a guarantee that the places will be restored in the autumn?

I thank the Minister of State, Deputy Andrews, for taking this debate. However, I am disappointed that the Minister for Health and Children is not present because this matter affects many families in her constituency. Many of the families who use this service live in Clondalkin and Palmerstown, which is in our constituency of Dublin Mid-West.

Cherry Orchard is very close to these families and many of them have become used to the service provided there. I spoke to families who use the roll-over respite care beds. This means they use the service every second week. Given the way in which beds are available to patients for different parts of the week, which itself is welcome, the many families that get to use the service will be affected. They have become used to the service, but they themselves provide the HSE with a good service because they perform all caring tasks for patients when the latter are not in Cherry Orchard Hospital.

As Deputy Upton stated, the new arrangements proposed for the summer months will cause the families much hardship, as many of them are not well off and might not have access to cars, nor might there be public transport to the private nursing homes that are proposed to be used instead. Like Deputy Upton, I question whether the proposal is more cost effective than employing extra staff to keep the unit open, which would allow the families to continue using the service during the summer months.

There is no similar proposal in respect of long-stay patients. Indeed, most people would view closing a hospital for the summer months and moving long-stay patients absurd. If it is not acceptable for long-stay patients, it is not acceptable for patients who use this respite care service. They make the HSE a significant saving by not handing their relatives into its care on a long-stay basis. They care for their relatives 24 hours per day every other day of the week for most of the year. When compared with the hardship caused to families who should be protected from such, cost effectiveness does not make sense.

I will be taking this matter on behalf of the Minister for Health and Children, Deputy Harney. I thank the Deputies for raising it, as I am provided with an opportunity to reaffirm the Government's commitment to services for older people generally and, in particular, to the important area of developing day and respite care. Government policy in respect of older people is to support people to live in dignity and independence in their own homes and communities for as long as possible. Where this is not feasible, the health service supports access to quality long-term residential care where appropriate. This policy approach is renewed and developed in the latest partnership agreement, Towards 2016.

The Government's objective of continued development of community-based services for older people is reflected in the funding given to the system in recent times. Since 2006, just over €500 million additional funding has been invested in long-term care supports for older people. This includes the largest ever investment, in excess of €200 million, specifically to develop community care services. These measures have been designed to enhance services already put in place by the Government and to widen the range of services available to older people. In this context, more than €16 million has been provided in the past three years for new day and respite care services. An extra €1.1 million in 2008 allowed for 345 new places, bringing the total provision to approximately 21,500 places.

The HSE has committed through the National Service Plan 2009 to delivering services within its Vote provided by the Oireachtas. It will manage the provision of respite care beds at Cherry Orchard Hospital within this context, taking account of the priority the Government and the HSE have given to services for older people. Cherry Orchard Hospital has a complement of 262 places, comprising 192 for elderly care, 35 for young chronic sick and 17 for persons with HIV or AIDS.

The summer is the peak leave period for hospital staff. When this is combined with a significant number of staff absent on parental leave, it is difficult to maintain the full range of services throughout the summer. Cherry Orchard Hospital is making arrangements to ensure that all commitments to those availing of these services and their families are maintained during the coming months. Measures have been taken to ensure that all commitments for respite care are met to ensure that no one receiving respite care or their family is left without a service.

The HSE is conscious of the importance of the respite facility of Cherry Orchard Hospital. The latter is identifying suitable private providers that will be in a position to provide respite places to overcome the challenges faced over the annual leave period. The balance of the respite service will continue to be provided in the hospital.

Schools Building Projects.

A number of months ago, the Department of Education and Science put the construction of several primary schools, two of which are in north County Wexford, out to tender. It has come to my attention that CLG, the successful company in the tendering process, subcontracted certain works to a company called OkoHaus Superstructures Limited, which has gone into receivership and a number of subcontractors within which remain unpaid. Some €14,000 is outstanding in respect of a crane hire company while the company that put the roofs on the two schools has not been paid. Approximately €200,000 is outstanding in respect of these and other companies, including scaffolders.

These are State contracts. It is not a civil matter between two people. The State asked people in the private sector to submit competitive tenders to ensure that the properties would be built. It has a responsibility to ensure that people who worked on the contract are paid. The information supplied to me via parliamentary questions and other sources is that the Department and CLG are washing their hands of the issue, claiming it to be a matter for OkoHaus Superstructures Limited.

No one in the State wants to take responsibility for anything. These schools have been built to educate children. It is a State contract and the State is obliged to ensure that those who are owed money are paid. They do not care whether they are paid by the State or CLG as long as they are paid for the work done. The Minister of State, Deputy Barry Andrews, probably has a script prepared and cannot be au fait with this matter, but any company that leaves people unpaid should not be considered for any other State contract until that issue is resolved.

I am taking this Adjournment matter on behalf of my colleague, the Minister for Education and Science, Deputy Batt O'Keeffe. I thank the Deputy for raising the matter, as it provides me with the opportunity to outline to the House the strategy for capital investment in education projects and also to outline the current position in respect of the two schools in Gorey in particular.

The allocation of funding for school buildings in 2009 is €614 million, representing a significant investment in the schools building and modernisation programme. This level of funding, at a time of great pressure on public finances, is a sign of the Government's commitment to investing in school infrastructure and will permit the continuation of progress in the overall improvement of school accommodation. It is a significant level of capital investment that reflects the Government's commitment to continue its programme of sustained investment in primary and post-primary schools.

I wish to outline the position in respect of the two schools in Gorey to which Deputy D'Arcy referred. In time for a September 2008 opening, two eight-classroom schools for Gorey were provided as part of the Department's rapid delivery programme for developing areas. This programme provided new schools in rapidly developing areas in a short timeframe. Where possible, as in the case of the two new schools in Gorey, the programme delivered permanent accommodation from the outset, avoiding the necessity for temporary prefabricated accommodation.

The construction of the buildings in question was procured by the Department under a design and build contract. Accordingly, the Department is not responsible for the recording or approving of subcontractors employed by the design and build consortium. As such, I am satisfied that no responsibility or power rests with the Department to intervene in or resolve contractual issues relating to those subcontractors. A school building project is a complex arrangement of contractual relationships between the client, the main contractor, specialist subcontractors, domestic subcontractors, suppliers of materials, suppliers of plant, etc.

In general, all subcontractors employed on schools building projects are employed directly by the main contractor or indirectly by the main contractor through other subcontractors. It is a matter for all subcontractors to agree terms and conditions and a schedule of payments with the main contractor or the entity with which they are in contract. The Department has no direct contractual relationship with subcontractors engaged by the main contractor and holds no information relating to them. It is unreasonable to expect any company within the chain to be held to account for issues relating to one of the other companies for which it has no direct control.

I am satisfied the company employed by the Department as the main contractor for the schools to which the Deputy refers has acted appropriately and in accordance with its contract with the Department and is not in breach of any rules or regulations governing public procurement.

It should be noted that the vast majority of contracts for both major and minor schools capital projects are between individual school authorities and main contractors. These contracts are placed following a public tendering process operated by the school authorities in conjunction with their design team. Generally the Department is the contracting authority only in those cases where the property or site is in the ownership of the Minister for Education and Science. I thank the Deputy once again for raising this matter.

The Dáil adjourned at 11.05 p.m. until 10.30 a.m. on Thursday, 9 July 2009.
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