Topical Issue Debate

Illicit Trade in Fuel

Deputy John O’Mahony

I thank the Ceann Comhairle for selecting this important topic. I have raised the issue of fuel laundering and fuel abuse on many occasions. Fuel smuggling and fuel laundering has been a problem here for many years but since the beginning of this year in particular when the sulphur content in off-road diesel was reduced, which made it much more difficult to detect illegal fuel, it has reached epidemic proportions.

The extent of the problem was illustrated when one of the fuel laundering operations uncovered this year was believed to be making a profit of €100,000 per week. Between 2005 and 2011 I understand nine illegal operations were uncovered. Up to June this year five were uncovered and I believe there have been more uncovered since then. One uncovered had the capacity to launder up to 18 million litres per annum, with a loss to the State of €9 million.

The question also arises as to how this fuel finds its way to the public. It is being sold in service stations that are rented on short-term leases. With a duty difference of almost 40 cent per litre, up to €15,000 per tanker is being made by these illegal operatives. These operations have been taken over essentially by criminal elements that have moved from the drugs trade or other criminal undertakings but the effects on the people who are upholding the law, paying their taxes and giving employment is that hundreds of jobs are being lost in the legitimate industry as a result of this activity.

The solutions to this problem are a detection method; a DNA tracer to be put in place; and an audit trail to find out where the fuel is being bought and to whom it is being sold.

In regard to fines and penalties, an issue arose this year where a garage was closed for one day and fined €3,000. If these people are making €14,000 a tanker that is not a very punitive sentence.

Deputy Ray Butler

I thank the Ceann Comhairle for giving me the opportunity to speak on this important issue of fuel laundering. This problem was recently brought to my attention by several forecourt owners and a major petrol supplier in my constituency of Meath West who informed me that approximately 15 to 20 filling stations which closed and have since reopened are now selling laundered diesel. The same forecourt owners now state that their turnover on petrol and diesel has diminished significantly as a result of the availability of laundered diesel throughout Meath West.

Statistics given to me suggest that in Ireland alone there are 120 to 150 diesel laundering providers throughout the country costing the State a possible €200 million to €300 million in lost taxes per year. These illegal suppliers are selling the laundered diesel at a profit of 40 to 45 cent per litre and are selling petrol, which has been bought legitimately as petrol cannot be laundered in the same manner as diesel, at cost price. As they say in the business, petrol is a loss leader and is only a means to encourage customers onto their premises to buy the illegal laundered diesel and to spread the word among the general community that it is available for sale. This washed diesel is detrimental to the engine of any vehicle, rendering the engine useless if used over an approximate period of time, for example, 12 to 18 months.

The forecourt owners in my constituency have said that if this practice continues their business will fall under even more stress and it will eventually result in the loss of staff at the very least. Revenue and customs officials are doing their best to address this problem but as soon as one illegal supplier is closed down another takes over the closed facility and the cycle of events commences again.

In the light of the evidence of the great extent of this illegal activity I sincerely hope that better control can be gained over this problem, whether by putting more dyes into the diesel or examining the possibility of having one form of diesel available in the market. Having spoken at length to the forecourt owners, business people and members of the general public in my constituency who have been directly affected by the effects of laundered diesel I urge that this matter be given further consideration by the Government and every effort made to eradicate the availability of this illegal laundered diesel.

Minister of State at the Department of Public Expenditure and Reform (Deputy Brian Hayes)

I thank both Deputies Butler and O'Mahony for raising this important issue that affects not just the people in the constituencies both Deputies referred to but adversely affects the ability of the Revenue Commissioners to raise tax legitimately and keep in business those suppliers and producers who are paying their taxes legitimately.

I am informed by the Revenue Commissioners, who are responsible for the collection of mineral oil tax and for tackling the illicit trade in fuel products, that they are very conscious of the threat to the Exchequer posed by the laundering of markers from mineral oil. Marked gas oil, commonly known as green diesel, is subject to mineral oil tax at a rate of €88.66 per 1,000 litres, while the rate for auto-diesel is €465.70 per 1,000 litres. In addition, marked gas oil is subject to the lower VAT rate of 13.5%. The resulting total tax differential is around 50 cent per litre. As the Deputies rightly point out, there is enormous advantage for those people who deal in this illicit trade.

This differential offers a very significant incentive for "oil laundering", that is, the removal of the chemical marker from marked gas oil to facilitate illegal use as auto-diesel. This is a particularly serious offence, carried on by organised criminal gangs. It carries a maximum penalty of €126,970 or five years imprisonment, or both. Any equipment used for oil laundering and any vehicle found to be transporting laundered fuel is liable to forfeiture.

As with other illegal activity, it is not possible to provide a reliable estimate of the extent of oil laundering activity. The Revenue Commissioners, who are responsible for mineral oil tax and the control of mineral oils, are tackling this issue on a number of fronts.

There has been ongoing extensive enforcement action, which has led to the detection of oil laundries and the prosecution of individuals and companies involved. To confirm what Deputy O'Mahony said in his opening remarks, in 2010 four oil laundries and over 288,000 litres of laundered oil were seized. Also in 2010, nine retailers were found dealing in laundered oil, and eight haulage companies were detected using laundered oil. There were four convictions for laundered oil offences.

Already in 2011, eight laundries have been detected and more than 300,000 litres of laundered fuel have been seized. There have been 11 arrests resulting from these operations, and eight tankers and 19 other vehicles have been seized. Several retailers and haulage companies have also been implicated. One can see in the difference between the figures for 2010 and 2011, even with the incomplete information we have for this year alone, the very substantial rise in this activity even in a 12 month period, to which the Deputies have referred.

Revenue has played an integral role as part of a cross-Border multi-agency organised crime task force which has been set up specifically to deal with the illicit trade in mineral oil in the Border area. The multi-agency operations are planned to supplement the normal ongoing level of Revenue detection and enforcement activity. Since its inception this combined force has successfully targeted a number of illegal operators in the Border area.

Acting Chairman (Deputy Catherine Byrne)

The Minister's time is about to conclude.

Deputy Brian Hayes

I will take questions from the Deputies.

Deputy John O’Mahony

I pay tribute to the Revenue and customs service for the increased detection but that could be viewed in another way, namely, that this practice has become so epidemic they are still only scratching the surface, so to speak. First, will the Minister indicate if extra resources have been allocated this year to the detection of these sites and service stations? Second, regarding the fuel, what is the up to date scientific diagnosis? Has science overcome the detection problem, which was increased because of the low sulphur level in diesel? Has it caught up with that? Is illegal fuel more detectable than it was six months ago, for example? If not, we still have a problem.

Deputy Ray Butler

The Minister for Finance said that a laboratory in Sligo is starting to look for better quality dyes to put into the diesel. Does he know any more about that? There are environmental concerns because much of the laundered diesel is washed through the Turkish sand that is coming into the country in container loads, all of which has to be dumped somewhere, so that will have to be looked into. I agree with Deputy O'Mahony that the hands of Revenue and Customs and Excise officials are tied because of cutbacks and the fact that they need more staff. In my area, the problem is getting out of hand and we will lose many jobs because legitimate petrol stations will close. I have heard concerns about the issue from people who have visited my constituency office. Business has gone slow at a petrol station on the Dublin Road and the owner is worried that he will go out of business if the situation continues. Fuel laundering is having a knock-on effect throughout the country.

Deputy Brian Hayes

Deputy O'Mahony made a crucial point on the science of the subject and asked, given that these substances can be washed through, whether we are any closer to developing a means whereby we can be confident that the diesel people buy is the diesel they expect. It would be wrong to say we have resolved the issue, but we are working closely with all concerned to come up with a solution. Licensing is an important issue and we have made sure that licences have been revoked or refused on the basis that we cannot stand over the authenticity of the supplier concerned. That is another important aspect.

Both Deputies asked what more can be done. In discussions with the Revenue, the Minister is considering measures in the context of the upcoming finance Bill to strengthen further the controls relating to all aspects of mineral oil trade. Where further measures are considered necessary, they will be put in place. There is a high level of co-operation between the Revenue and HM Revenue and Customs in the UK. Increased co-operation is the order of the day. I am not going to second guess that and go into further detail, but I assure the House and the two Deputies who raised this important issue that high-level co-operation is taking place between all agencies on this island to stamp out this practice, and this co-operation will increase further to ensure we deal with this scourge. I assure the Deputies that, even in these difficult times when the Revenue, like any public sector organisation, is finding it difficult to meet requirements because of the number of people employed in the public sector, we are determined to stamp out this practice and use every measure we can, in co-operation with our colleagues in the UK, to beat the problem. I thank the Deputies for highlighting this important issue.

Deputy Ray Butler

I would just like to say to the general public that, if they drive past a petrol station and see that diesel is 10 or 15 cent cheaper, they should be aware of the health of their car.

Product Safety Standards

Deputy Caoimhghín Ó Caoláin

Do I read the topical issue into the record or is it recorded automatically?

Acting Chairman (Deputy Catherine Byrne)

It is automatic.

Deputy Brian Hayes

Some have referred to it as a tropical issue.

Deputy Caoimhghín Ó Caoláin

I thank the Ceann Comhairle for giving me the opportunity to address the Dáil and question the Minister on this important issue. At the outset, I extend my deepest sympathy once again to the family of Dean Regan Russell. Words cannot express the grief of a family that loses a young child in such a tragic manner. I salute the courage of this family, who have bravely spoken out in order to help prevent the deaths of other children.

I attended Dean's inquest at the Dublin Coroner's Court last Friday at the invitation of the family and it was a most harrowing experience. The coroner found that Dean Regan Russell, aged 23 months, died in Crumlin children's hospital after a fatal accident at his home in Tralee in January this year. He found the toddler had been strangled by the looped cord of a window blind. Dr. Farrell stated this was not the first such child fatality and he was prompted to repeat his previous call for this type of blinds to no longer be manufactured. He stated that the configuration of looped cord has, in his experience, caused the deaths of several infants in the Dublin area alone. He described it as a dangerous design and undertook to contact all relevant authorities to reiterate the recommendation that such blinds should no longer be manufactured and are a danger, a recommendation that I emphasise he has had to make previously. The European Commission has become aware of ten such fatal accidents involving children aged between 15 months and 36 months. They occurred in Ireland, Finland, the Netherlands, Britain and Turkey in the period 2008 to 2010, and in the US 119 fatalities involving corded window coverings are reported to have occurred since 1999.

When the Minister, Deputy Bruton, replies, he might refer to the draft standards for window blinds that have been issued for public comment by the National Standards Authority of Ireland. The closing date for comments was 23 September, which was last Friday, the very day of Dean Regan Russell's inquest. As I said in my submission, the draft standards are inadequate and should be withdrawn. In light of the coroner's findings, the standard required is that looped cords for blinds should no longer be manufactured and their sale in Ireland should be prohibited in law. Simple alternative designs are readily available.

I reaffirm the call for the banning of looped cords, a call I have made at the request of the bereaved family of Dean Regan Russell and on behalf of others bereaved in this way. If the Government took this course, which I commend to the Minister, we would become a world leader in this aspect of child safety. I will certainly continue to press for this outcome. In the meantime, I ask that we urge people with looped cords on their window blinds to cut them and apply tassels or other simple safety devices to prevent children from being endangered. I observe that this type of cord is widely used here in the Houses of the Oireachtas. In the interest of setting a good example, perhaps the same should apply here.

Minister for Jobs, Enterprise and Innovation (Deputy Richard Bruton)

First, I sympathise with the family of Dean Regan Russell and indeed with Deputy Ó Caoláin, who I know is a close family friend. I cannot begin to imagine what an impact this has had on the family.

As the Deputy knows, both the National Consumer Agency and the National Standards Authority of Ireland have a role in the matter. The National Consumer Agency has primary responsibility for non-food consumer safety, and it has been campaigning to achieve safer standards since 2002. It was at the agency's initiative that the 2009 standard that is in place was brought in, and on foot of that it placed a warning on its website, followed it up with a consumer guide on safety, wrote to 222 manufacturers and retailers, ran a nationwide market surveillance campaign and visited 97 retail outlets.

I understand from the reports that the allegation is that the products that were sold in 2010 were not in compliance with the 2009 standard, but I mention those facts to give Members a picture of the effort that was put in at that stage. People have recognised that the existing standard is inadequate. That is what prompted the request for a revision of the standard. It does not cover made-to-measure blinds and various other cases are excluded. A new standard is being developed and the closing date for comments was extended to give people a chance to make further submissions.

I am told that the difficulty with the call for prohibition from the coroner, the family and indeed Deputy Ó Caoláin, which I can understand, is that Ireland cannot unilaterally introduce such a ban. It would have to obtain approval from the European Commission and other member states, and the advice I am receiving is that such approval is unlikely to be granted because work is being undertaken on improving the standard. The best approach is to have products installed with the safety features that make them safe rather than to ban a particular type of blind. That approach is being pursued here, limiting the risks from loop chord mechanisms by requiring manufacturers to fit risk prevention measures in the design and by supplying proper safety advice with the product. I am advised that the prohibition route is not open to Ireland for unilateral action. The approach being adopted is to make all products safe.

Deputy Caoimhghín Ó Caoláin

I thank the Minister for the reply but it is a great disappointment. It beggars belief that we cannot take the simple and reasonable steps to protect young children, a number of whom have lost their lives in this jurisdiction, particularly after the coroner made his informed recommendation on Friday. Must we wait for others across the European Union to recognise the real dangers involved? It is most regrettable we cannot take the required steps and be world leaders in child safety measures.

I ask the Minister to review the decision and to examine the information he gave us today to see if there is not a way to impose an alternative design on the manufacturers. It is not a case of putting them out of business; far from it. Undoubtedly, however, easy adjustments can be made to remove the loop from the blind chord. That is the key danger.

If we were talking about a defective car, would we for a moment to say that we would not arrange for the recall of defective cars because we had to wait for some other jurisdictional call for said to happen? If defects were found in a range of vehicles provided in this country, we would take the required step to ensure they were recalled to enhance road safety, not only of the owner and user but of all road users. Why would we not apply the same thinking for this particular danger that exists in the homes of countless numbers of our citizens, if not in all our homes? The alternative is readily available. Manufacturers will not be at any greater expense and we will have removed a real threat to infant children and would be applauded internationally for it. I recommend the proposition for that reason.

Deputy Richard Bruton

A process of consultation on the new standard is under way and I will ask that the Deputy's comments are taken into account.

Deputy Caoimhghín Ó Caoláin

I have already made a submission to the body.

Deputy Richard Bruton

The complication is that many of these products were sold in accordance with the standards then prevailing. It is not open for the Government to call unilaterally for a recall of products issued in accordance with the standards that then prevailed without entering into compensation issues. We would be talking about huge numbers being recalled and I am not sure that is feasible.

The advantage of going the European route is that these standards will apply to every manufacturer and every product that comes into Ireland will be covered. The National Consumer Agency will police this and oversee it. The new standard will incorporate the safety measures that make looped blinds safe; that is the important thing. They will not allow a product to continue to be manufactured if it does not adhere to the safety standard that Deputy Ó Caoláin and I and every other parent want to see.

I will take into account what the Deputy said because he has every reason to make a strong plea and I will ask that his submission be closely reviewed in the process to see what we can do. Those, however, are the constraints that make it difficult to do what the Deputy proposes.

Deputy Caoimhghín Ó Caoláin

The product is defective and manufacturers must face up to their responsibilities. Who will compensate the Regan Russell family and all of the other families for their loss?

Ambulance Service

Deputy Michael McCarthy

I thank the Ceann Comhairle for selecting this issue for debate this afternoon. I also thank the Minister for being here in person to take it.

A curtailment of the ambulance service in west Cork is being planned by the HSE. It is introducing plans to remove ambulance cover from both Skibbereen and Castletownbere between 8 p.m. and 8 a.m. and to replace the service with two rapid response cars. Neither car will have patient carrying capability and will be manned by a single paramedic. The effect of this action will be that a population of more than 82,000 people in the wider west Cork area will be serviced by just two ambulances, one in Bantry and one in Clonakilty, from 8 p.m. until 8 a.m. seven days a week. To say this is causing considerable stress is an understatement, not least given the overstretched ambulance service that already exists in the area. There is a strongly held belief that this action will endanger lives.

There is one ambulance for every 37,000 people in the country. The withdrawal of 24 hour cover in Skibbereen and Castletownbere means this figure will rise in west Cork to one ambulance for every 57,000 in County Cork. It is unacceptable in the 21st century that such a situation could prevail. I appeal to the Minister to reverse the decision.

I acknowledge the second phase of the proposal from the HSE will restore the 24 hour ambulance cover in Castletownbere. While I welcome that move, it negates the reason for removing cover from the area in the first place. I question the logic of restoring cover in Castletownbere but not in Skibbereen, which is the second busiest, and occasionally the busiest, 999 ambulance station in west Cork, second only to Clonakilty. If Skibbereen loses its 24 hour cover, it effectively means the vast area from Rosscarbery west to Mizen Head will not have a service after 8 p.m. seven days a week. This will have an adverse impact on people in Leap, Glandore, Union Hall, Castletownsend, Skibbereen, Baltimore, the islands, Ballydehob, Schull, Goleen and Crookhaven.

Another key issue to consider in the context of this proposal is that the SouthDoc service in Skibbereen closes at 11 p.m., meaning that if a GP is needed after hours, a doctor would have to come from Bantry, 30 km away. The HSE has a target time of ten minutes as a maximum time for treating a trauma casualty on-site before transporting him to hospital. The withdrawal of 24 hour cover from Skibbereen will mean that in respect of advance paramedics or ambulance after 8 p.m. or doctors after 11 p.m., this target time will not be met.

Heaping more pressure on the situation are future plans by the HSE to shut the minor injuries assessment unit in Bantry Hospital at night. All trauma patients will have to be taken to Cork city during these hours, leaving a minimum three hour absence of ambulance cover from the west Cork area. In the recent Roscommon case, the closure of the casualty department was offset by the provision of extra ambulance cover. The opposite will happen in west Cork, where ambulances will be taken out of service while the minor injury unit in Bantry is closed. There are honest fears about this and I appeal to the Minister to look at this sympathetically.

Minister for Health (Deputy James Reilly)

I thank the Deputy for raising this issue.

The HSE has confirmed to me that no ambulance stations are closing in Cork and Kerry. The opposite is true, as stations move to on-duty status and away from on-call. This means highly trained paramedic crews will be on-site in the stations to respond to calls rather than having to go to the station when called out. It also means that resources can be deployed dynamically, based on need and demand patterns, rather than simply by location, producing more flexibility and responsiveness. This will produce better response times for the people in the Cork and Kerry area and a better service.

Skibbereen will, under the new system, move to full 24 hour on-duty cover. Paramedics will be present at all times, with an on-duty ambulance during the day and an on-duty rapid response vehicle at night. The dynamic delivery model means that an on-duty emergency ambulance will be available from within the region as required.

I note that ambulance staff sought the elimination of on-call working, that it has already been reduced from 44 hours to 16 hours per week and that it will continue to decrease on a phased basis as part of the improvement of services and response times in the region. There are ongoing discussions with staff on implementing the proposals, including Skibbereen. The HSE and unions are committed to this process.

The national ambulance service proposals are phased. In phase 1, stations in east Cork with night time on-call will have crews rostered on-duty 24-7 and 365 days a year. The more rural stations of Castletownbere, Kenmare, Bantry, Skibbereen and Caherciveen will be in later phases. The service will be evaluated after each phase.

Current evidence suggests patient outcomes can be improved by better treatment and stabilisation at the scene, followed by ongoing treatment and transport to the most appropriate centre, even if that means longer transport times. On-duty service will enable a modern emergency response service involving paramedics, advanced paramedics, community first responders and GP out-of-hours services working together to respond to emergency situations. This approach is consistent with international best practice and will ensure compliance with HIQA response times and quality standards.

On-duty rostering is one of several service enhancements. Other developments include improved arrangements for control and dispatch, practitioner deployment and inter-hospital transfers. All of these will allow the national ambulance service to provide a better, safer, more comprehensive and more efficient emergency ambulance service to the people of Skibbereen and to the Cork and Kerry region as a whole.

Deputy Michael McCarthy

I thank the Minister for being here in person and I thank him for his reply. However, I refer him to the second paragraph of his reply. He states:

That is simply not the case. That information is inaccurate. The official who drafted that response is, at worst, lying and, at best, grossly ignorant. The story is as I outlined in my contribution.

Does the Minister agree that removing an ambulance from a geographic area as expansive as west Cork will endanger lives? Would the Minister, or any other Deputy, if he were suffering a heart attack, prefer to see a car with one individual in it to an ambulance with trained paramedics? We are at least 90 minutes from Cork city. What the HSE is proposing will endanger lives.

I would be interested in meeting the official who drafted the Minister's response. If this is believed, the same individual would believe the tooth fairy.

Deputy James Reilly

I will address both points. I stated that an on-duty emergency ambulance will be available within the region as required. I did not say it would be available within the area. Regions cover larger areas. Perhaps that is what the official who drafted the reply means. Nevertheless, I would be happy to arrange a meeting between the Deputy and the individual who drafted the reply. I am not in the business of giving disinformation to the House. If the information is not accurate I would take a serious view of that.

Second, the concept of the golden hour is 40 years old and comes from military field medicine. All international experience and experts, and our own emergency department consultants and specialists, are clear that it is far more important to receive appropriate treatment in a bigger centre than to receive immediate treatment at a smaller centre where the full skill-set may not be present. That we now have paramedics on-site to commence treatment while an ambulance is on its way makes a huge difference to outcomes for patients. Paramedics and advanced paramedics are a great addition to the service and will result in many lives being saved rather than the reverse.

Industrial Action by Irish Nurses and Midwives Organisation

Deputy Billy Kelleher

I welcome the Minister to the House to take this issue. It is very topical, given the threatened industrial action in the mid-west region.

Earlier this year, the Minister addressed the annual conference of the Irish Nurses and Midwives Organisation, INMO. He clearly and concisely outlined his vision of the importance of nurses in the delivery of front line services in health. He also said he was conscious of the importance of working together and of listening to nurses and those who provide front line services. In view of what is happening in the mid-west and of the concerns expressed in Beaumont Hospital and University Hospital Galway, it is evident from his inaction that the Minister is not listening to the nurses or to representatives of those providing front line services, who are expressing grave concern about overcrowding in accident and emergency departments and patient safety.

As I looked at Deputy Reilly's website and at old press releases dating from his time as Fine Gael spokesperson on health, I got tired of reading press releases headed "Reilly slams". Reilly was continually slamming the Minister and the HSE. He was doing nothing but slamming at that time. He has now been Minister for six months. I am a fair and reasonable person, but the Minister's only major press release, PR or media hype in that time was about the sacking of the board of the HSE. He subsequently stated that he was assuming personal control of policy and budgetary parameters. Now the HSE is consistently being fingered as being responsible for budgets and for the management of hospitals. There is a disconnect and a failure of the management chain between the Department of Health, through the Minister, and the HSE. It is evident that his proposals, made with wild abandon, to abolish the HSE and set up new management structures is not working.

The Labour Relations Commission, LRC, has offered to intervene tomorrow in the industrial action in the mid-west. The front line service providers, to whom the Minister said he would listen, are clearly stating that patient safety is at risk. They say shortcuts will be taken and there is a major concern about accident and emergency services in the mid-west and in University Hospital Galway. The closure of the accident and emergency department in Roscommon is putting added pressure on other accident and emergency departments.

I do not mind a volte-face or a U-turn, but the Minister is embracing reconfiguration with the zeal and enthusiasm of a latter-day convert. Every day, he is driving this reconfiguration, sometimes without discussion with local communities. This is evidenced by the comments of Deputy McCarthy about the reconfiguration of ambulance services in west Cork.

It is time the Minister took a hands-on approach. He must not wash his hands of this issue. He should roll up his sleeves and get involved, as he said he would do, in ensuring a proper chain of management from the Department of Health, through the Minister who would be accountable to the House, to the HSE.

I am also disturbed by the Government's lack of urgency in dealing with health issues. The Minister established a Cabinet sub-committee on health which has never met. It is six months since the Government came into being but the Cabinet sub-committee on health has never met.

The Minister must be honest about the commitments he has made. His policies are not working on the ground and patients' lives are being put at risk.

Deputy James Reilly

The wildness of the Deputy's imagination is matched only by the wildness of his rhetoric. After six months we have made considerable progress, notwithstanding the mess that was left for us to clean up.

Deputy Billy Kelleher

There is no need for that now.

Deputy James Reilly

There was an overrun of €70 million in our hospitals from last year. We are trying to retrench the runaway and out of control budgets in our hospitals which occurred during the first three months of this year under the watch of the previous Government either by intent or through neglect. On top of this, to address the financial morass in which the previous Government left the country we must take almost €1 billion out of the health system, keep the service running and put in train a reform programme.

I put it to Deputy Kelleher that this industrial action serves no useful purpose. I am concerned about the further stoppage planned for tomorrow and urge the INMO to reflect on the impact this action will have on the general public and on patients in particular. I find it hard to reconcile that the nursing unions are taking this industrial action given they are parties to the public service agreement which focuses, in particular, on the need to deliver services in the changed circumstances in which, thanks to the previous Government, we now find ourselves and on co-operation between management and unions.

The shared focus of all those working in the health service should be on safeguarding front line care in the face of our continuing very serious economic situation. The Mid-Western Regional Hospital Limerick was €16.2 million over budget at the end of July 2011 and has had to take measures to reduce its spending, including a prohibition on staff overtime and the hiring of agency staff. As in all areas of the economy and the public service, we must focus on solutions, including efficiency, flexibility and innovative working in order to maintain our public services in the face of economic crisis.

Industrial action by any group will simply exacerbate our problems and, in the case of nurses, may impact negatively on patient care. In recent months, I established a special delivery unit, SDU, under the leadership of Dr. Martin Connor. The SDU is working to unblock access to acute services by improving the flow of patients through the system. It is focusing initially on emergency departments and will be working to support hospitals in addressing excessive waiting times for admission to hospital. The SDU is due to submit a report on the Mid-Western Regional Hospital Limerick to me on Thursday. I look forward to the co-operation of all health service staff with the special delivery unit, which is aimed at ensuring that patients receive safe and appropriate service when they present at our acute hospitals.

In the case of Mid-Western Regional Hospital Limerick, it is vital that we focus on solutions, including the introduction of new rosters and redeployment of nurses to areas of greatest need in the hospital. New rosters become even more important in light of the need to maintain and improve services in a financially constrained context. As regards pressures in the emergency department, it is clear that risk issues arising from overcrowding should be regarded as a problem with which the entire hospital must deal. Hospital management cannot accede to a demand that no extra beds should be put up in wards. This is provided for in the escalation policy and represents a lesser risk than allowing an unsafe build up of trolleys in the emergency department.

Deputy Billy Kelleher

While I welcome the Minister's reply it lacks answers. Are we questioning the validity of the INMO to raise serious issues of concern with regard to patient safety? It has tried everything else and now believes industrial action is the only way it can get the Minister to listen to its concerns in respect of the serious shortcomings that are now evident in the health services. The Minister can engage in all the historical debates he wants about how we got where we are. When in opposition, he knew where we were and gave many commitments in that regard. Political choices are being made every day by this Government. The Government made the political choice not to burn the bondholders and to provide funding for job creation but has made no political choices in regard to the critical area of patient safety and health provision. The only political choices it has made in this area relate to increased capacity and ensuring reconfiguration of hospitals throughout the country is expedited while not ensuring proper procedures and extra facilities are put in place in the context in particular of University Hospital Galway, which the Minister, amid fanfare, also visited.

I wish the special delivery unit and Dr. Connor well. However, it is evident from what is happening in the North that this will run out of steam very fast. While in the short term it might assist in addressing hospital waiting lists, the situation in Northern Ireland illustrates it will not work in the longer term. The special delivery unit informed the Mid-Western Regional Hospital Limerick of its proposed visit well in advance. It is clear that management of the accident and emergency department was changed in advance of that visit. Staff have told me there were few hospital trolleys on the corridors at the time of that visit because of the forewarning by the special delivery unit of its visit. The Minister should refer the Mid-Western Regional Hospital Limerick to the Health Information and Quality Authority, HIQA, which should undertake a full audit of it in the context of patient safety. Nurses are not taking industrial action for the good of their health rather they are doing so for the good of patients.

Deputy James Reilly

The Deputy has made several points, all of which I would like an opportunity to address.

Acting Chairman (Deputy Catherine Byrne)

The Minister has two minutes to respond to Deputy Kelleher's supplementary questions.

Deputy James Reilly

The Deputy's suggestion that we should send HIQA into the hospital until such time as the SDU report is available and the actions recommended therein are taken is nonsense. If there is a need to send HIQA in following that report, consideration will be given to the matter. It is to misunderstand what the SDU does to say that it must make a morning raid in great drama. Its purpose is to examine, analyse and issue recommendations to support management and staff of the hospital. I have no doubt it will make those recommendations. As I said earlier, I cannot see how taking industrial action will improve or make safer the situation for patients.

The Secretary General of the Department of Health, Mr. Michael Scanlan, received a letter today from Mr. Fergal Hickey, President of the Irish Association of Emergency Medicine, the salient part of which states:

Many Irish hospitals are overcrowded. The fact that they or the HSE choose to manifest all of the overcrowding in the emergency departments is inappropriate, clinically unsafe and inequitable. There is now irrefutable international and national evidence that preferentially condensing all of a hospital's overcrowding into one single clinical area, the emergency department, increases the risk of avoidable death and harm not only for those hospital in-patients who remain in the emergency department because no bed is available for them but also for emergency department patients who can be discharged and those who do not wait in the ED to be seen because of excessive delays. A better, fairer, safer way to treat all patients during times of emergency department overcrowding is by implementing a simple patient care practice used successfully in other developed health care systems, namely, the full capacity protocol. Full capacity protocol is an internationally validated protocol. The IAM believes strongly that the full capacity protocol, FCP, is a reasonable measure and fair approach to the significant dangers created by overcrowding of emergency departments. One or two additional patients admitted to multiple hospital wards at times of significant emergency department overcrowding is much safer and more clinically just for all patients than is allowing tens of additional patients to be detained for more than six hours in a single dangerously overcrowded compromised emergency department.

Dáil Éireann díospóireacht - Tuesday, 27 Sep 2011