Vol. 721 No. 4
1 Deputy James Reilly asked the Minister for Health and Children the estimated cost of the new paediatric hospital; the funding to be provided by the State; the outstanding balance; is the State funding promised in place and available to the Hospital Board or has it to be borrowed on the international bond markets; when will construction commence; has the project been formally sanctioned in the new four year plan; and if she will make a statement on the matter. [42371/10]
The new national paediatric hospital is a priority for the Government. The capital spending on it will be protected over the full lifetime of the project. The total estimated cost of the development, including the ambulatory and urgent care centre at Tallaght, is €650 million. This is €100 million less than a previous estimate because of the fall in building prices.
Of the total cost, €400 million is committed by the Exchequer and is reflected in the HSE's capital plan this year. This will be increased to a figure of €450 million in the HSE's capital plan for 2011. A total of €25 million has already been spent on the planning, design and support of the project since 2007. The balance will be met from philanthropic initiatives, estimated at €110 million, and from commercial and other sources of some €90 million. The commercial and other sources include a car park, commercial units, research funding, private clinics, universities and medical schools. One of the functions of the national paediatric hospital development board is to pursue philanthropic sources of funding. It is working intensively on this issue.
The development board is making good progress in planning and developing the new hospital at the Mater site. It has formally asked An Bord Pleanála for the project to be considered under the strategic infrastructure legislation and had an initial meeting with An Bord Pleanála on 5 November 2010. Subject to planning permission being granted, construction of the new hospital is scheduled to commence in the fourth quarter of 2011 with completion of construction scheduled for the end of 2014.
In the current economic climate to think that we will raise €110 million through philanthropy borders on the unbelievable. I need not remind the House of what is happening on the bond markets and the difficulty the country would have had to raise funds which, thankfully, it does not have to do at the moment. There is great concern on this side of the House about the resignation of the chairman, Mr. Philip Lynch. Is it correct to say that the cost of digitalising record-keeping in the hospital has been underestimated and may not be sanctioned by the Department of Finance? A figure of €150 million has been mentioned. The Minister said she has had a meeting with An Bord Pleanála but when can we realistically expect to get a decision on whether planning has been granted on the site? They are the key questions.
I detect the negative tone of the Deputy in the questions. The philanthropic contribution is highly achievable. The new person has a terrific track record in philanthropy. A foundation has been established and has received charitable status from the Revenue Commissioners. The year before last Toronto hospital raised $78 million. I visited the Starship Children's Hospital in New Zealand which receives huge philanthropic contributions. It is not unusual and I and many others believe the contribution expected to be raised over a four-year period, that is, €110 million, is highly achievable. There have already been indications from individuals of their interest in this area.
Technology it is part of the HSE's wider technology system. Routers, switches and so on will go in as part of the capital construction but technology will be part of the HSE's ICT spend over the next three years and will be a large part of the capital plan next year and in future. What the Deputy suggested is not true. A number of people try to find every single negative that they possibly can about the hospital.
Mr. Brian Fitzgerald, the financial controller of St. James's Hospital, is currently working with the two of the three children's hospitals which will be coming together, Temple Street and Crumlin, on their enterprise and resource planning. As part of that they will be examining the SAP or Oracle systems and that will then transfer over to the new children's hospital. It is estimated the ICT spend at the hospital will be in the region of €60 million.
Would the Minister like to answer my question on planning?
It is engaging with An Bord Pleanála and expects to be in a position, subject to it approving it as a strategic infrastructure project, to apply for planning permission in the first or second month of next year.
I wanted to know when it is likely to get planning permission not when it was likely to apply for it.
If it is a strategic infrastructure project the purpose of the legislation was to reduce the timeframe for getting planning permission. The idea is that the construction of the project would begin at the end of next year.
We will not expect any planning permission until the end of 2011. That is useful. New Zealand is not Ireland in 2010 or 2011. The Jack and Jill Foundation, one of the most successful charitable organisations in the country, has had to resort to seeking additional funding from the HSE because it failed to meet its targets in its philanthropic endeavours, and the people concerned are realists. We want realism not fantasy. Does the Minister really believe it is possible to raise €90 million from commercial enterprises based on a car park, which parents have been told they will be allowed free use of, and a coffee shop?
Yes, and I have been strongly advised that consultants' private rooms and so on will also be involved. It is realistic. I remember answering questions in this House a year ago about whether the funding arrangement we put in place for the cystic fibrosis unit in St. Vincent's Hospital was realistic; of course it was and it was bankable. Manchester spent 40 years bickering about a site. It then took nine years to decide on a preferred site and four years to build it. If one talks to the people of Manchester from all the different components of the three hospitals involved everybody was totally happy that the right decision was made and I believe that is what we need to do here. I hope to have the Deputy's support.
2 Deputy Kathleen Lynch asked the Minister for Health and Children if she will give an undertaking that all of the recommendations of the Roscommon child-care case will be implemented in full; the timeframe for the implementation of the recommendations; and if she will make a statement on the matter. [42112/10]
The report into the Roscommon case was published by the HSE on 27 October 2010. The HSE stated it is committed to learning from this and other reports to ensure that services are strengthened to help protect children to the greatest extent possible. The HSE has already provided me with an update on the actions it intends to undertake in regard to 56 of the recommendations of the report that fall within its remit.
It is the case that some recommendations made following previous inquiries were also made in the Roscommon inquiry. I am giving consideration to putting in place a mechanism to ensure that all recommendations are implemented nationally. The HSE has commissioned an independent consultant to carry out an audit of neglect cases. This process has already started in Roscommon and will then be carried out in Waterford and in an area in south Dublin. A full national audit will be carried out based on the lessons learned from these initial audits.
Some 50 recommendations were made, all of which were very sensible and, as the Minister of State said, some of which were made before in other instances. Can the Minister of State tell me how many recommendations have been implemented? One is the introduction of a national common assessment framework without delay for all child welfare and protection cases which needs to identify core components while allowing for flexibility. It is recognised that any such framework will need to be reviewed and updated as knowledge and practice develops and changes. If one does not have that, then the service will be as the Roscommon case has thrown up — patchy, in some places delivered well and in some places not delivered at all.
Another recommendation — I am merely picking two and am not even going into the issue of who is responsible for all of this — states a specialised child sexual abuse unit or team should be put in place in each HSE region to build up expertise and experience in assessment and to act as a centre of excellence when front-line workers require advice, and therapeutic treatment services should also be available for children who had been sexually abused.
Will any of the two of these, in particular, the sexual abuse unit, fall now to embargoes? Are we assured that all of these recommendations will be put in place and how many have been put in place to date?
The recommendations were only recently received, a couple of weeks ago. I propose to wait until the audit is completed into these neglect cases in Roscommon, Waterford and Dublin to see what comes out of them. Those areas are targeted because of specific previous concerns that have been raised in those areas. Based on that report, we will have sufficient information then to aggregate what has come out of Roscommon and previous cases to which Deputy Kathleen Lynch referred in her question.
I am open to suggestions on how that implementation and review will take shape. We might include the NGO sector and others with a professional interest in child protection in ensuring the implementation of the recommendations and all of the previous recommendations.
On a child sexual abuse unit, there is, of course, St. Clare's and St. Louise's units, in Temple Street and Crumlin, respectively, which provide an excellent service. It is not only children who are being abused, but children who have abused as well. There are discrete services there for the latter but it is a challenging area of the health and social services.
In terms of learning, it is depressingly familiar to hear responses that follow tragedies such as this. Yesterday, I launched the first ever hub of learning in the world for professionals which contains all the research, policy and legislation in this area accumulated over the years. That is now accessible by social workers.
I accept fully what the Minister is saying. Anyone who has any interest in this is not out to do damage. People genuinely want to do right when it comes to it. However, we do not need an audit to tell us that we need national guidelines. This report gave us that. Equally, we do not need an audit to tell us that we need a child sexual abuse unit in HSE regional areas.
My big concern is that there will be an audit which will then lead to a group of people sitting down around a table to see what happens next and this time next year we still will not be any further down the road. There are recommendations in here which need to be implemented now.
The HSE is acting on the vast majority of the recommendations. They have assured me that they have broken them down into different groups. There will be four regional workshops in early December to try to disseminate the important aspects of the report and other matters in terms of trying to improve the child protection service. The recommendations are being acted on.
On the audit, that started in September and it will be finished at the end of February, not in the far distant future. There may be other concerns in Roscommon and we must be alive to that. There might be other chronic neglect commonalities in other areas to be put in the mix in terms of implementation of this area because it is a discrete area. The Ryan and Murphy reports talked about institutional care whereas we are talking about family neglect, a discrete area that needs to be looked at in a different way.
I agree with Deputy Kathleen Lynch that the recommendations need to be implemented carefully but the HSE has already begun to act on them. As I stated, we will have more information by the end of February.
3 Deputy James Reilly asked the Minister for Health and Children when the two extra consultant radiologists for Tallaght Hospital will be put in place; the way the total number of whole time equivalent consultant radiologists at the hospital compares to international best practice; and if she will make a statement on the matter. [42372/10]
Since 2005 there has been a 34% increase in the numbers of consultant radiologists, from 183 to 245. Ireland now has a ratio of one consultant radiologist per 17,959 of population, which is similar to the UK at one per 18,040 of population.
There are currently 5.54 adult consultant radiologists and two paediatric consultant radiologists at Tallaght Hospital. An additional two locum consultant radiologists were appointed to the hospital in January 2010 to assist in dealing with the backlog of X-rays. The backlog has been cleared and currently there are 0.54 locums in post at the hospital. However, on 7 September 2010 the HSE issued formal approval to Tallaght Hospital to appoint two new consultant radiologists. This is in line with the recommendations of the Hayes report. Interviews are expected to take place next month and the two successful candidates will take up duty be as soon as possible in 2011.
The Hayes report recommended that consultant radiologist staffing levels be reviewed to ensure they are appropriate to the workload in each radiology department. The HSE is committed to carrying out a review of consultant radiologist staffing levels in hospitals and to strengthening workforce planning across all radiology departments. The review will be informed by the results of a survey of consultant radiologist staffing which is currently being undertaken by the faculty of radiology. The aim is to complete this study by the end of the year.
The HSE is committed to implementing the recommendations of the Hayes report as soon as possible. I am confident that adopting this approach will help ensure the provision of a timely and quality radiology service in Tallaght Hospital.
The reports states clearly:
There were severe systemic and other weaknesses at management level, and the structures at Board level were simply not robust enough to provide the level of governance, supervision and direction required in the management of a large and complex organisation.
Indeed, the same could be said of the HSE, but we are talking about Tallaght Hospital here. Warnings were ignored or met with an ineffectual response. There were 30 occasions between 2005 and 2009 when consultant radiologists expressed concerns about the radiology department and the litany of management responses in that period demonstrates a clear awareness of the problem but no resolve to address it.
Tallaght Hospital, as the Minister correctly points out, has 13 radiologists. St. Vincent's has 16 radiologists yet Tallaght Hospital does twice the amount of X-rays. Why is this so? When will the two additional consultants be appointed and commence work? The Minister will be aware of the problems that an over-reliance on locums has caused in the past. Permanent staff are what is required here. According to the Hayes report, it took 13 years and nine years, respectively, to appoint radiologists to Tallaght Hospital. Why does it take the Department and the HSE so long to appoint desperately needed staff?
As Deputy Reilly has acknowledged, the report draws a number of conclusions. First, on the formation and governance of the hospital, there are lessons we need to learn when we are bringing hospitals together. The Tallaght model is not the way to do it. While I understand it happened in the way it did for ethos and other reasons at the time, the hospital, from a board structure, remained an amalgamation of three different foundations coming from the Adelaide, the children's hospital and the Meath.
I have had discussions with the chairman of the board on many occasions. On Tuesday last he came to see me as a result of the Hayes report. The board of Tallaght Hospital has put a smaller board in place which, effectively, will be a management board. It is a sub-group of the current board and it is a smaller group. It has also appointed Mr. William McKee, who managed health services in Northern Ireland and has a terrific track record, and he is working with the current acting CEO of Tallaght Hospital on the management issues that have arisen in the context of the Hayes report and, indeed, the PricewaterhouseCoopers report. Mr. McKee is also a member of the board of the hospital.
Tallaght Hospital, in the almost 11 years of its existence, has virtually doubled in staffing size. As they expanded the number of consultants, they did not have a corresponding increase in the diagnostic staffing, including radiologists. Certainly, lessons must be learnt from that.
The two consultants are currently being recruited. I understand the hope is that they will be in place in the early part of next year.
I hope they will be in put in place. From the time of advertising to the time of appointment and of taking up duty, generally, it could be up to 18 months. They have suffered enough in Tallaght and I note that Deputy Brian Hayes has been highlighting this point.
When will the HSE national audit, which reveals if other hospitals experienced a backlog on X-ray or GP referral letters, be completed and published? Would the Minister care to inform the House how many CEOs Tallaght hospital has had since its inception ten years ago, as opposed to all of the other hospitals which have had far more consistency?
Tallaght hospital has had six CEOs since it was formed. I knew the first CEO, who came from Canada, well. The Leas-Cheann Comhairle was a Minister for Health during some of his tenure. He was a highly impressive individual but for some reason he did not stay very long. I think there is a lesson to be learned from the fact that there has been such a rapid turnover of CEOs; six in ten years is not very encouraging. That is why the board has brought in Mr. McKee, who has wide experience, to work for a number of months along with current management at Tallaght to put into effect not only the recommendations of Hayes, but also its own PricewaterhouseCoopers report and the many other reports commissioned on Tallaght hospital.
What was the other question?
When will the other audit be published?
The national audit is very close to completion and it is intended that Dr. White will publish its outcome very soon, I believe before Christmas.
4 Deputy James Reilly asked the Minister for Health and Children the number of submissions of interest made to the Health Service Executive in relation to the voluntary redundancy programme to date; the reason for the delay in introducing the scheme; if she has a plan for a similar scheme for her Department; and if she will make a statement on the matter. [42373/10]
I announced last week that the Government had decided to fund a special voluntary early retirement and severance package in the health sector. The scheme is aimed at management and administrative staff and support grades.
There is general acceptance of the need to reduce the numbers of management and administrative staff in the health service and I have referred to this on many occasions. For that reason the Government has decided to make €400 million available this year for a specific, targeted voluntary early retirement and severance package for the health service. Applications from management and administrative staff will be prioritised over those from support staff and will be approved automatically subject to the overall expenditure cap of €400 million not being breached. This is not the first initiative aimed at reducing numbers. The number of management and administrative staff , for example, has already fallen by over 1,000 since its peak in September 2007.
I am happy to say that there has been a very high level of interest in the new scheme. As of yesterday, there had been over 8,550 expressions of interest. Management and administrative staff accounted for over 5,300 of that total and support staff accounted for 3,250. Of course, not everyone who expresses an interest in the scheme will apply. The HSE will not know the actual intentions of staff until the closing date for applications, 19 November.
The purpose of the scheme is to achieve a permanent reduction in the numbers employed in the public health service. The scheme is confined to those two categories of health service employees. It is not available to civil servants, including those serving in my Department. The numbers employed in my Department have to be reduced further to 450 by the end of December 2012 and we will use the appropriate mechanisms such as re-organisation and re-allocation of work, including re-deployment where necessary, to meet this target. However, it should be noted that the numbers in the Department of Health and Children have reduced by 25% from 641 to 477 since 2005.
I thank the Minister. Would the Minister not agree that had this initiative been undertaken when the HSE was formed, we could have saved more than €1 billion, at €200 million a year? I am delighted to hear that there is such interest in the scheme. However, I wonder why it took so long to introduce it. The Minister alluded to her Department in her reply. Clearly, there is a need for further reductions in her Department. The Taoiseach's Department organisational review programme found that some staff have little or nothing to do. Perhaps the Minister might explain to us why a redundancy package cannot be made available in a broader sense in her Department also.
To be fair, when people talk about the Department they need to realise they are speaking about organisations such as the Adoption Board, which has 29 employees. They are not all in Hawkins House. While I accept issues were raised around the organisation and management in the Department and perspectives of staff, I believe that the management team in the Department is implementing the change recommended on foot of that report. I will send the Deputy tabular details on who is in what section of the Department. We are the second largest legislation Department in the State. There seems to be a view that because we established a single entity to deliver health services, the role of Department was diminished, and it was not.
With regard to the redundancy, I would have wished to have done it earlier; that is true. It was not possible to get agreement on the matter when the HSE was being established. It was not possible to reach agreement with the staff representatives on people being made redundant. In fact, not only was it not the view of the staff representatives, but it was the view of the political parties opposite. There was concern at the time that this was part of a great plan to fire thousands of people. That was never the plan. However, the view was taken for many reasons that one needed to establish the organisation to see its strengths and weaknesses before one began a restructuring programme. It has not been possible to get either the money or the agreement before now for this. We have now and let us make it happen, and I hope it does happen.
Will the Minister make available to members of her Department a redundancy package? I hope when she mentions the Adoption Board that she is not alluding to it as having little or nothing to do.
They are part of the staff in the Department. That is the point I was making.
That is right, but I do not think they were singled out in the report as the inference might suggest.
No, I am simply stating that my Department has reduced its staff by approximately 25%. The Deputy may know, because the Department is dealing with him on his Private Members' Bill, that a very small number of people are in each division of responsibility. This plan is not open to the Civil Service; it is open only to the HSE. The incentivised early retirement scheme is open to public servants but this particular redundancy proposal is confined solely to the HSE.
5 Deputy James Reilly asked the Minister for Health and Children her plans or those of the Health Service Executive to alter services provided at a hospital (details supplied); and if she will make a statement on the matter. [42374/10]
It is the policy of the Government to support older people to live in dignity and independence in their own homes and communities for as long as possible. Where this is not feasible, we support access to quality long-term residential care where appropriate.
Quality of care and the safety of residents are the key factors driving developments in the provision of long-term care. All current residential facilities for older people have to comply with the Health Information and Quality Authority's national quality standards for residential care settings for older people in Ireland and the Health Act, 2007 (Care and Welfare of Residents in Designated facilities) Regulations 2009. The provision of long-term care also has to be informed by local demographic needs.
There are 11 Health Service Executive community hospitals or nursing units operating in Donegal with a maximum 489 beds. Within the Lifford area, there are HSE facilities in Stranorlar, Ramelton and Buncrana and private nursing homes in Letterkenny and Convoy.
Lifford Community Hospital, established in 1799, operates in nightingale style wards. There are no single rooms in the hospital. It has a total of 40 beds and it is currently operating as a 20-bed unit. It is now providing 12 continuing care beds, five respite beds with three beds for assessment, rehabilitation and palliative care.
The director of nursing is in contact with residents and their families regarding any concerns they have about the hospital. No decision has yet been made about what services can be provided safely and in line with national standards at this hospital. I have, however, asked the HSE to continue meaningful consultation with residents and their families and that all options for their future care will be explored by the HSE with them.
I thank the Minister of State response. I refer to this hospital at the request of Barry O'Neill, who is a councillor in the area, to ensure that it is not further downgraded. The Minister of State alluded to it being a 40-bed unit; I visited it in June when 30 beds were in operation and now there are 20 beds. There seems to be a fairly aggressive downgrading of the hospital. These hospitals are extremely important in community care, particularly in areas such as Donegal which has a very rural spread with very long distances and difficult roads to traverse from one place to another. Everyone in the House would agree that the best outcome for people if they have to go into a nursing home is that it be in their community where their friends and loved ones can visit them. Otherwise, what happens is that they wither on the vine. Will the Minister of State give a commitment that this facility will not be further downgraded or closed?
As I stated, no decision has been made on what will happen in the future, but I have written to the HSE and asked it to consult at all times with the families. Obviously, their safety is what is of utmost importance to me and to the HSE. We will consult with the families and the residents at all times.
Will the Minister of State kindly reassure the House that the HSE will not continue with its previous history of using reports that identify deficits in care as an excuse to close facilities instead of addressing the issues raised by the reports?
It has until 2015 to address the issues but it must deal with them. These facilities are being inspected, often for the first time. Many of them are very old buildings. As I stated, I have asked, in the interests of patient safety, that consideration is given to patients remaining in the own communities and in the local area.
