I call on Deputy Finian McGrath who is sharing time with Deputies Seamus Healy, Joan Collins, Catherine Murphy and Richard Boyd Barrett, all of whom will have two minutes.
Health Service Budget: Motion (Resumed) [Private Members]
The following motion was moved by Deputy Billy Kelleher on Tuesday, 10 July 2012:
That Dáil Éireann:
— noting that the Health Estimate in Budget 2012 was misleading given the fact that it was based on assumptions and targets that were not deliverable by the Minister for Health;
— highlighting that enabling legislation for measures announced in the 2012 Health Estimate have not been published 7 months after being announced and therefore will impact greatly on the sector's ability to meet its budget targets;
— agreeing that, 14 months after abolishing the Health Service Executive (HSE) board, the Minister has failed to take any legislative or other action in relation to governance in the HSE and that this has exacerbated the deficit;
— acknowledging that the income streams or expected savings from:
— the cost of public beds being charged to insurance companies;
— drug pricing; and
— reducing agency costs;
will not now be achieved;
resolves that the resulting €500 million overspend in the health budget will not have an impact on front line services and patient care; and
rejects any moves to close wards, theatres or hospitals as a result of the failure to properly plan the health budget.
Debate resumed on amendment No. 1:
To delete all words after "Dáil Éireann" and substitute the following:
"— noting that the Health Service Executive (HSE) is facing a significant challenge in 2012 given the need to set expenditure levels within the parameters of the National Recovery Plan;
— acknowledging the significant reductions which the health sector has experienced over the last three years, both budgetary and staffing;
— further noting that the HSE has operated the Croke Park Agreement very effectively, with over 3,500 staff redeployed, and a reduction in overall numbers of over 6,000;
— further acknowledging that a range of measures are being actively progressed during 2012 to enhance income collection;
— commends the Minister for Health for managing within this difficult environment, and at the same time achieving:
— a 7% increase in in-patient discharges and a 6% increase in emergency department admissions;
— in relation to a basket of 24 procedures, the national target of 75% of cases treated as day cases;
— significant improvements in hospital waiting times, with 9,100 fewer patients waiting on trolleys when compared to the same period in 2011, which equates to a 19% year-on-year improvement;
— implementation of clinical programmes which saved 70,000 bed days last year, thereby allowing for more patients to be treated more efficiently;
— cost reductions within the health sector which are impressive by international standards, particularly within the hospital sector;
— 1.8 million people now with medical cards, and 130,000 with GP visit cards;
— the passing of legislation to abolish restrictions on GPs wishing to become contractors under the General Medical Services scheme which is now in place;
— progress on the preparation of legislation to allow for the extension of free GP care to persons with long term illnesses;
— progress in building primary care capacity and in chronic disease management, particularly for the management of diabetes;
— significant advances in mental health services in the implementation of A Vision for Change, in particular improved child and adolescent mental health services;
— advances in the care of older people, with almost 23,000 clients now supported under the Fair Deal scheme; and
— accelerating the type of service delivery reforms that will move to models of care across all service or care groups which treat patients at the lowest level of complexity and provide services at the best possible unit cost; and
— welcomes the determination of the Minister and Government to move towards a health system that provides access based on need rather than income, underpinned by a strengthened primary care sector, a restructured hospital sector and a more transparent ‘money follows the patient' system of funding that will be supported ultimately by Universal Health Insurance."
- (Minister of State at the Department of Health, Deputy Róisín Shortall).
I thank you, a Cheann Comhairle, for the opportunity of speaking in this urgent debate on health, including the overall management of our health service. Despite all the talk from the Minister and the Government about budgets, targets, beds, mental health and services for people with disabilities, there are still major problems in the health service. We have a huge problem in the disability sector, so I urge action and common sense in this debate.
Up to 700 young adults with an intellectual and physical disability have left school this year but there will be no place for them in September due to the disastrous management of the health service. It is a nightmare for these people and their families. I am calling for immediate action on this priority issue. The services that should be there for them were cut by 3.7% in January. Some €750,000 was cut from one service alone on the north side of Dublin. The same service now has 40 service users who are in crisis and need residential care. This service has also been told that there will be no money for it come next September.
This is what is happening to people with disability. This is the real world for the most vulnerable sections of society. Ministers should all hang their heads in shame over this issue. People with disability did not cause this economic and banking crisis; they should never be forced to pay for the actions of greedy people.
The Minister got his figures wrong concerning the €500 million overspend. People are still on trolleys and wards are being closed, as are operating theatres. Yet we see cynical attacks on staff who are doing an excellent job against the odds. This is all due to a failure to plan the health budget and a lack of common sense in dealing with health issues.
I urge all Deputies to support these issues in the health debate. It is time to take tough decisions but money should be spent on our health service via a fair and equitable tax system.
I wish to confirm that there are only three further speakers in this slot: myself, Deputy Joan Collins and Deputy Catherine Murphy. Deputy Boyd Barrett is not here.
Then you will have slightly over two minutes each.
I am happy to have a few minutes to contribute to this debate. From the outset of this budget, it was clear that there was no way a reasonable and efficient health service could be provided on the basis of the figures originally presented by the Minister. I am disappointed but not surprised that the Minister for Health is not in the House to hear this debate. He should be here.
In particular, I support the final part of the motion which "rejects any moves to close wards, theatres or hospitals as a result of the failure to properly plan the health budget". Two hospitals in County Tipperary have been affected by budget cuts. Last week during the Topical Issue debate, I referred to South Tipperary General Hospital where trolleys have been on corridors for some time. This is a progressive co-operative hospital and in his reply last week the Minister confirmed that it is working above and beyond the call of duty. There has been an 11% increase in general activity levels with a 32% rise in the level of medical activity. The average length of stay has been reduced to 3.5 days, which is less than the national average. This is a very progressive hospital yet it is being punished by the Minister and through the method by which the HSE has made moneys available to it.
Thurles Community Hospital has been rebuilt in recent years. It had 72 beds but now has 50 following the closure of 22 beds. The respite waiting list for that hospital is now at 400. The committee supporting the hospital met the Minister back in January when he confirmed that he would reopen those 22 beds. When will he do so? There is major pressure on that hospital, which is doing excellent work. The Minister has promised to reopen those beds but that has not happened. I hope the Minister will respond and tell us exactly when he is going to reopen the 22 beds.
I wish to refer to the proposed 100-bed special unit in St. Vincent's Hospital which I raised as a Topical Issue last week and which has also been mentioned by Deputy Richard Boyd Barrett. There is serious concern in an already beleaguered hospital system that the overspend will have an impact on the special unit which was supposed to open last month. In February, the Minister, Deputy Reilly, announced that it would open in June. There is no communication between St. Vincent's Hospital management, the Cystic Fibrosis Association of Ireland or the CFAI, the consultants and hospital staff about when the unit will open. How are they going to sign off on the protocol that was promised and agreed between the three groups some months ago? This should be announced today. The Taoiseach said yesterday that the Minister for Health would be here tonight to make a statement on the matter. I am hoping that he will attend the House for this debate. I can understand the pressure on him this evening concerning his own personal business, but he is the Minister for Health so he should be here to respond to the concerns of families and the CFAI about this matter. It is scandalous that the building has been built and is waiting for patients to move in, while at the same time Cystic Fibrosis patients are waiting four or five days to access beds in St. Vincent's Hospital.
The Minister may try to avoid the issue but the CFAI has contacted the Minister's office over the last week or two to try to get a response. There seems to be some ducking and diving on the matter. The families want a resolution now, as I do. A family member of mine is a CF sufferer. I want to hear when that 100-bed unit is going to open. The Taoiseach promised that the Minister would attend the House tonight.
There was a meeting earlier today of Fibromyalgia sufferers. I would like the Minister to outline his position on this subject. This medical condition is new on the agenda but is not recognised as a sickness or illness. The matter has been in the Minister's hands for the last eight months but nothing has been done due to the beleaguered state of the health service. I would like to know what is happening in this regard.
We all appreciate that there are limited funds available but we need to get the best possible services from the existing funds. At the end of the day the health service is about those who work in it and those who avail of the services provided. The vast majority of people who contact me about the health service do so because they are in a crisis situation. For example, people may be told that on medical grounds they will get a place in a nursing home, only to find later that they must wait until a place becomes available. Basically they are waiting for somebody to die. One may often see that the person caring for them is burnt out. I have seen people with chronic illnesses getting hospital appointments that are so far in the future they might not be around to avail of them. I have seen parents in a panic with young people making the transition from secondary school to adult services but such services will not be available for them this year. All the money was spent getting children from primary to secondary school - particularly those with autism - yet they cannot transfer to adult services. This means that all the money was wasted.
The HSE is not fit for purpose but the blame does not lie with those who work in the health service, it lies here and with the previous Administration. The CSO attended a recent health committee meeting and said the financial system was not fit for purpose. If the architecture of the HSE and the financial system are not fit for purpose, what chance do we have of running a service? We need to know when the new governance system will be in place and up and running. We also need to know if the financial system will be reformed. In the absence of the urgent address of both of these issues, it will be impossible to run the service within budget.
I call Deputy Eamonn Maloney, who I understand is sharing time with Deputies Regina Doherty, Martin Heydon, Dan Neville, Jerry Buttimer and Simon Harris. Deputy Maloney has five minutes.
On the motion, which is essentially about budgeting and criticism of the Government in terms of shortcomings in the health service, one thing people on this side of the House will not be doing is taking master classes from those who previously ran the health service for 14 years. I am speaking in this regard not alone of the Fianna Fáil Party, but of the other parties and hangers on who, in terms of their speeches on this motion, were singing a different tune in their contributions during previous budget debates on health in this House.
It must be acknowledged that we have all been taught a lesson by the previous Administration. During the eight years between 1997 and 2005, Ireland's health budget tripled from €3.7 billion to €11.5 billion. No one can say the previous Government did not spend money on health. However, despite the increase in that short time, in 2006 Ireland ranked 25th among the 26 countries included in the euro health consumer index. There is something very wrong in a Government having spent this huge volume of public money on health services for a population equivalent to that of the greater Manchester area which now has such difficulties. There are legacy issues here.
There has been much talk from all sides about the need for the health system to be reformed. Our health system does not need to be reformed, rather it needs to be revolutionised. Despite all of the spending in this area by the previous Government, in respect of which no one can criticise it because that was the outlook it took, it did not work. As such, money is not the problem. It certainly was not the problem during the eight year period from 1997 to 2005. There are vested interests in health and hospitals but no one has taken them on and that is the reason we have the system we have. As I stated, our health service does not need to be reformed, rather it needs to be revolutionised and the vested interests must be stood up to.
I remind Members on the opposite side that the previous Administration, supported by others, spent more time during its final ten years in office advocating private medicine, private hospitals and tax breaks in that regard and that it was this Government and the current Minister for Health, Deputy Reilly, who ended the advance of the concept of private hospitals. We do not need more private hospitals, but a better public service. The previous Administration advocated the spending of more money in the private medicine-hospital area.
In revolutionising the health system we must first ensure equality. Inequalities and snobbery in education aside, there are many inequalities in our health system. In this country a person with money can get the best health care he or she desires while the person with no money has to join the queues. That is where we are at today. Notwithstanding that, the Opposition has to do what it must do. I am sure we will be faced with a similar motion next week. The Minister for Health, Deputy Reilly, for all of his shortcomings in the past 15 months, has never pretended that our health system would be changed in a year or five years. It will not be. Anyone who thinks otherwise is suffering from self-delusion.
I welcome to the opportunity to speak on this motion. We all recognise the importance of securing the Department of Health budget and the need for it to be ring-fenced for the areas of most need. This means that savings need to be achieved and changes need to be made.
I would like to focus this evening on the possible introduction of a patient database and prescription cloud database. Europe is heading down the e-health path, which means significant changes for patients and health professionals. One might ask how e-health care benefits patients and saves money. First, it allows for better data management and the collection of thorough information from patients, with attention to detail and delivery of same to clinicians in a coherent way. The more informed the doctor and patient, the better the delivery of care for all concerned. This would also result in fewer medication errors, fewer misdiagnoses and more optimised and coherent care plans.
As health care chains extend, the availability of shared patient information by way of a prescription cloud database, using unique medical records and PPS numbers, would result in the delivery of more coherent treatment. Spend per week by the HSE on pharmaceuticals, including payments to pharmacists, is estimated to be €3 million. As the prescription rate continues to increase, a central database, monitoring the dispensing of prescriptions, in particular, pain killers, is essential not alone from a financial perspective, but from a health promotion point of view.
The deadly problem of abuse of prescription drugs grew dramatically as they became increasingly available in our society. The introduction of databases would provide pharmacies with information on purchasers of prescription pain killers. A person who "doctor shops" and visits multiple pharmacies would easily be caught by a pharmacist checking the system. By requiring doctors to check the database before prescribing pain pills and pharmacists to monitor prescription usage, drug seekers can be caught and stopped more often. Use of this database in doctors' offices and pharmacies could help curb the excess buying of prescription pain killers.
A patient database system, such as the introduction of a patient medication card similar to that used in Denmark, would result in a more efficient health care service where mistakes are eliminated, data is transferred more efficiently and administration costs are reduced. Danish health care providers have been using an e-health system since 1996. Denmark's electronic patient medication card has helped eliminate errors and speeded up the flow of information.
The Danish national e-health portal was launched in 2003. It is a single access point to health care services for citizens and health professionals alike. Using a digital signature, Danish citizens can log on to their personal web space and use a variety of services, including reviewing their medication records and health data and communicating with
health care authorities. They can also register their final wishes in a living will and become organ donors. The introduction here of a patient medication card, similar to the one used in Denmark, would create a more efficient health care service where mistakes are eliminated, data is transferred more efficiently and administration costs are reduced. In the same way as a bank ATM card allows a person to access information relating to his or her bank account, a patient medication card allows him or her and medical care providers to access medical records and medication details. It provides direct access and up-to-date shared data about a patient's details and medical records.
Health care providers can upload information onto a secure and shared record system, accessible by way of the patient medication card, allowing, for example, a GP to upload details of a medical prescription, which pharmacists can then access and fill on demand. While the cost of implementing such a system in Denmark was initially expensive, it is estimated that by the end of 2008 the cumulative benefit was €1.4 billion in savings to the Exchequer. Messages and data transmitted by electronic communication have now reached more than 4.5 million items per month and health-care providers have benefitted from effective and efficient data transfer and greatly reduced administration costs. The patient has also benefited as there is faster, more reliable communication between health-care providers.
Similarly, a four-week UK study of 36,200 prescriptions found that 1.5% had a prescribing error, 25% of which were potentially serious. Aside from the human cost, medication errors represent a considerable avoidable expense for health-care providers. Now electronic medication records in Denmark and the Netherlands track all the medication that individuals have been given to identify who has taken what, how much and when. This information is available to providers and prescribers of medication - public pharmacies, hospital pharmacies, doctors' offices, locum posts, hospitals, mental health institutions and residential care and nursing homes. It is just one possible solution to address our ever-increasing health spend and I would like to present it to the Department with a view to having it reviewed.
I will start by challenging some of the cynical politics this evening and last night on this motion and in particular its wording. Before I was elected to this House I believed that politics - on any side of the House - was about being constructive. While we all have our viewpoints we should bring something to the table other than criticism. When those criticising were in many cases the people who gave us the difficulties we have and are just telling us what we need to do without acknowledging the financial constraints we have, it is a bit hard to take on this side of the House. I accept our health service faces challenges, but we are also making great progress in how we are dealing with them. I will focus on some areas where great progress is being made.
My local general hospital in Naas, County Kildare, had a major issue with patients waiting on trolleys. If even one person is on a trolley in Naas General Hospital this evening, that is one person too many. However, in the first six months of 2011, some 2,982 people were on trolleys in Naas General Hospital. In the first six months of 2012, that figure had reduced to 1,193, a reduction of 1,789 people on trolleys in the emergency unit in Naas General Hospital, which is 60%. If that is not progress, I do not know what is. Great credit is due to the Minister and his fact-based analysis of where the difficulties are. There have been reductions throughout the country - I took the example of my local hospital and I acknowledge the role the management and staff there played. However, further challenges remain in that regard.
St. Vincent's Hospital in Athy in south County Kildare is a fantastic facility. It is a community hospital that has offered great respite throughout the years and has a long and varied history. It is one of the biggest employers in the town and has an excellent dementia-care unit. I was delighted the Minister came to the hospital and saw at first hand the great level of care the staff and management at St. Vincent's Hospital in Athy give. It recently received HIQA certification for the coming years. As the Minister saw it is an old building with many challenges. However, it got significant investment at a time when money is very scarce to ensure it could get fire certification and all the other boxes were ticked to achieve the HIQA standard. While further challenges need to be faced in the future, progress is being made.
Never before have so many people had medical cards. Catering for those people who need that State support puts great strain on the system. Some 1.8 million have medical cards with 130,000 people having GP-only medical cards. No previous Minister for Health faced a challenge on that scale and yet we are making progress.
There has been a reduction of 8,000 people working in the health system since 2007. The overall health budget has reduced by €2.5 billion in the past three years. Progress is being made in areas such as the special delivery unit over the past 16 months since we came into power and since the Minister, Deputy Reilly, assumed the position of Minister for Health. That any progress has been made in light of those figures is astonishing. However, some challenges in our health service remain to be tackled, including the use of agency workers and nurses. I have previously said in the House that where agency nursing staff are more expensive to hire we should look for some leniency from the troika to allow us to increase our staffing numbers because there are great challenges for permanent nurses who have to work when agency nurses have flexibility to pick and choose their hours.
When I researched the statistics before speaking I was struck that 17% of our health budget is spent on drugs compared with 9% in the NHS. The figure jumped out and we need to investigate it. There must be an enormous cost in the HSE not taking back walking aids, crutches and orthopaedic chairs, and savings could be made in that area. Overall the trolley numbers I mentioned and the work by the special delivery unit in reducing the 12 month waiting list by 95% show real progress. If that is what we have done in 16 months, it will be very interesting to see how the coming years pan out.
I will use my time to deal with the figures on suicide that were published today. The Central Statistics Office published figures for 2011, which show that 525 people died by suicide last year, an increase of 7%. Some 438, 84%, were men and 86 were women. I want to highlight that serious issue. There were also a further 65 undetermined deaths. In most western countries they are accepted as suicide and included in the suicide figures. Looking at it in totality and bearing in mind that these are provisional figures, in excess of 600 people died by suicide last year, which indicates a very serious public health issue. Understanding why it happens is very difficult because suicide is a highly complex issue.
I will deal with two points. First, the area of mental health and suicide prevention has been neglected over decades. I am not pointing the finger at anybody. In fact the former Minister of State, John Moloney, probably contributed to addressing the issue more than anybody else along with the present Minister of State, Deputy Kathleen Lynch. While there is movement in the area, we still have a serious issue because of the traditional neglect of mental health services and suicide prevention. While not all suicide victims suffer from mental illness, more than 80% of those who die from suicide have a mental health difficulty.
The other point is the link between suicide and economic recession. It has been well established internationally that unemployment and the threat of unemployment is a leading predictor of suicide. Research indicates that for every 1% increase in unemployment there is a 0.78% increase in the rate of suicide. During times of economic recession, the loss of employment or income, financial pressure, pressure on mortgage repayments and the loss of a home or the threat of the loss of a home are extremely stressful. Especially vulnerable people suffer from anxiety, hopelessness and despair, which lead to depression often creating relationship problems, and there is a higher level of marriage breakdown and divorce. Of course some people take solace in alcohol and drugs which are very serious in regard to levels of suicide.
Alcohol consumption plays a role in the incidence of suicide.
The Government allocated €35 million in the recent budget for mental health services and it is vital that money is spent on them. We must be vigilant in ensuring the HSE spends the money where the Government decided it should be spent, namely, on the development of mental health services. When moneys were allocated for these services in 2006 and 2007 only 50% of the allocation was spent on them.
The first step in the development of mental health services is to develop community based mental health services and the Minister has targeted this area. Currently, 150 new postholders are being recruited in the child and adolescent psychiatry area and 254 new postholders in the adult psychiatry area. These are multidisciplinary postholders - they are not psychiatrists or psychotherapists - namely, counsellors, nurses, occupational therapists, family therapists etc. We must be concerned at the level of progress that has been made to date to establish the 90 community based multidisciplinary teams that are planned for the mental health services. We have a high level of institutional treatment of the mental health service, one of the highest levels in Europe. People should be treated in their community as far as possible. These 90 community based multidisciplinary psychiatric teams are across four regions and each one will service a population of 50,000. It is important that programme is completed as quickly as possible and, having regard to the Minister's plan, that we are vigilant in ensuring that the HSE does so.
I welcome the Minister. I find the motion before us laughable given the history of the Members opposite whose party when in government was quick to run from having responsibility for the Department of Health. It offered that responsibility to Mary Harney, the previous Minister, as if it was the Sam Maguire or Liam MacCarthy Cup and happily ran to the backbenches and the plinth every time there was a problem in health. In the motion before us there is no proposal for reform. There is no single proposal - not one line - in it on how we as a nation can run our health service. The 14 years in government were lost on the Members of the Fianna Fáil Party opposite.
It is important that we consider this motion in current context. I advise Deputy Kelleher that we would all love to have a pot of gold but when it comes to health the reality is that we had a 14-year boom and bloom during which all that was done was that buildings were put up and inordinate amounts of money were spent on double jobbing and creating multiple layers of posts, the effect of which led to many departures from the health service under the retirement scheme in February. That showed that the Croke Park agreement worked quite well. That is a testimony to the staff in the health service who work hard and they and we have found that we have a Minister who is focused on reform. The clinical programmes are delivering, be it in the case of day-care admission rates, more day-care patients being treated or in the reconfiguration process. We have seen clinical leadership in the health service under the Minister, assisted by the Ministers of State, Deputies Shortall and Lynch. During the past ten months we have seen increased flexibility and productivity, an increased innovative way of doing business and a reform agenda being pursued. I want to pay tribute to the members who work in the health sector who have done this and who do not just see what they do as job. I want that put on the record.
There are different competing interests. As an interested observer, I note that those interests often do not work in the same direction. They seem to be in conflict. We as legislators, those who work in the health service, commentators and members of the pubic must accept that we must have a patient-centred approach and focus to what we do in the health sector. That requires that the competing interests step back and analyse what is best for our health sector. We spend close to €13 billion annually on health. That in an inordinate and extraordinary amount of money. Money is not the answer to problems in our health services. It is time those conflicting and vested interests were taken on. The Minister has shown in his 18 months in power that he is a man willing to embark on reform, willing to take on the challenge of change and willing to embark on a different model of health service delivery. We must take on the vested interests because we cannot go back to the same people all the time.
Part of the reform agenda must be in the area of primary care. We must change the mindset and attitude of the gnáth duine, the ordinary person, with regard to the accident and emergency department being the only place to go when one needs medical treatment. It is not.
This is like being on an oil tanker in the Atlantic Ocean - it takes a while to turn it around. I am confident we will do that, but it requires patience, innovation and a plan, all of which the Minister and the Government have.
I welcome this opportunity to speak on the issue of health and I very much welcome the attendance of the Minister for Health in the Chamber. When we talk about the issue of health, it is important to acknowledge, as my colleague Deputy Buttimer did, the work of the health professionals. All too often since the creation of the HSE, we have an image of the health service being run by men and women in suits who brief us at Oireachtas committees but day in, day out health professionals, be they nurses, doctors or health care assistants, work in our hospitals and health centres and despite the financial difficulties and the reduction in their numbers, they get on with the job. It is important to put on the record that surveys carried out reveal that patients' satisfaction with the level of care they receive once they access the service is very high.
It is clear following the years of the Celtic tiger that money alone will not fix the health service. We have seen that. We have seen money being thrown at it, health budgets being hyped up every time there was an election and money thrown around with scant regard for what it would deliver. What will fix the Irish health service is reform and management. That is what the Minister, Deputy Reilly is about, and it is what Fine Gael and our colleagues in the Labour Party said in the general election campaign. That is our commitment in the programme for Government.
The Minister, Deputy Reilly and the Fine Gael Party never said that reform would be easy. It is much easier just to throw money at problems. Crucially the Minster and the Fine Gael Party never said it would happen overnight. The Minster went further than that, he produced a timeline showing that the full reforms this party in government wants to introduce will take more than the lifetime of any one specific Government. Already after a period of 15 or 16 months progress can be seen. The figures do not lie. With the establishment of the special delivery unit, as alluded to my colleague Deputy Heydon, we have seen a significant reduction in waiting lists: the 12 month list has been reduced by 95%, the 9 month list has been reduced by 55% and there has been a 19% year on year improvement in trolley waits. These are trolley figures which show an improvement at a time when less money is being spent on the health service. Already the reforms and the new structures are working. We have seen an emphasis on the issue of primary care in the rollout of primary care centres and progress is being made in the rollout of free GP care.
The Government has to untangle a massive mess. The creation of the HSE was a disaster for the Irish health service. It is ironic that the founder of the HSE, who is now the leader of his party, put down a motion bemoaning the very monster he established and imposed on the Irish taxpayer.
I want to make a few points on issues I have noted in regard to the HSE when representatives of it have come before the Committee of Public Accounts. Part of the reason the HSE has such a deficit is due to the fact that it seems to operate in silos. No one seems to talk to anybody else. Every little section tries to make savings but there is no overall examination of the impact of these savings on the health service. For example, it seems the procurement unit is so desperate to make a saving that it does not analyse the impact of that saving on the rest of the health care service. This is out of sync with how modern health services work. To use a simplistic example, a procurement section could decide that instead of buying a bandage for €12, it would buy one for €2, thereby saving €10 but that bandage might need to be changed by a community nurse who would visit a person in his or her home every day or every second day rather than once a week and the impact of that is not taken into account. When we talk about savings in the health service, we need a much broader approach. We need people to examine the whole health care impact, the impact on the patient and the saving across the system.
It was astonishing that when the chief executive officer of the Health Service Executive was before the Committee of Public Accounts he could not tell me as a taxpayer, let alone as a parliamentarian, what increments are being paid out for people in the HSE earning €70,000, €80,000, €90,000 and more, this year. We discuss public service and public service increments and the public service versus the private service. It is entirely missing the point. There are some very well paid people in the health service at very senior managerial level and I want to know how much they are earning and how much their salaries are being increased by. The fact that the Accounting Officer could not give this information to an Oireachtas committee is quite astonishing.
It is also equally astonishing that he appeared at a committee a week after the report on the death of children in care, many of whom died in the care of the HSE and he was unable to give me an assurance that all HSE staff are now complying with all guidelines and that there are no longer shop stewards telling people not to fill out referral forms and pieces of paper.
Last night many speakers raised the issue of school-leavers with intellectual disabilities. This is a real example of the system not working. The HSE and the Department of Health are fighting, lobbying, squabbling with service providers. I believe that service providers can do more but I also believe that the families of people with intellectual disabilities do not really care about the argument; they want the solution.
The Government has had a very positive 15 or 16 months. This motion is ironic and cynical at best and I look forward to watching the continuance of the agenda for reform under the Minister, Deputy Reilly.
Deputy Michael Kitt is sharing time with Deputies Robert Troy, Timmy Dooley and Charlie McConalogue.
I congratulate Deputy Kelleher on tabling this motion. It provides the opportunity to discuss this important matter. I am very concerned at the possible closures of wards and theatres as a result of cost-cutting measures to deal with a deficit of €500 million this year. I ask if these figures were ever achievable. I have spoken to hospital managers and they are genuinely worried about the budgetary position because of cuts to their allocations. They find it difficult to make ends meet as a result. I do not think savings in the cost of drugs have been achieved. Every hospital will be forced to cut back on the use of agency staff and this is true of the Galway hospitals. The figures I have seen indicate that the cost of hiring agency staff has doubled in the period from 2008 to the present. A question arises as to which services will be cut.
I wish to speak about the HSE west region because it is the area I know better. Along with others I am concerned about the waiting times for procedures and whether those waiting times will get longer. The mental health services in Ballinasloe - a town I represent - and in other hospitals in Sligo, Galway and Clare have seen the closure of acute beds in psychiatric hospitals. A total of €35 million has been allocated to mental health services of which €24 million is dedicated to community-based teams for adults and children. It is important to ring-fence that funding.
I refer to the excellent service providers for those with disabilities in County Galway and in the western region. I wish to pay tribute to Ability West in particular. The Brothers of Charity have done tremendous work for people with intellectual disabilities and autism. It is important to have these services as local as possible. I represent a rural area and I still see people having to travel to Galway city or further to access these services. Ability West has special schools in Ballinasloe, in Carraroe, in Tuam and in Galway city. The Minister will know that a new centre will be opened in Mountbellew on Friday, 20 July. Ability West is providing high quality services and supports to over 500 children and adults with intellectual disability. The Brothers of Charity services empower people with intellectual disability and autism to live their lives as they choose. There has been a transformation in the way supports and services are provided and this is in line with best international practice. The Brothers of Charity are forming partnerships with each individual and family because it is important to design a service plan for each person with an intellectual disability. They are providing opportunities for valued social roles in their communities for people with disabilities.
I refer to the acute reduction in bed numbers at St. Brigid's hospital in Ballinasloe. I also refer to the future of the property attached to hospitals like St. Brigid's and the use of the funds arising from the sale of land or property which I contend should be put back into mental health services. I support the Society of St. Vincent de Paul which, through the Ballinasloe voluntary housing project, is trying to provide housing for the elderly.
I would like to see a museum established on the hospital grounds at St. Brigid's hospital to preserve memorabilia when the residents finally move out. I ask the Minister to consider the funding for the home help service as it provides a range of services for clients who are mainly elderly people in order to help them remain in their own home rather than moving to nursing home care. SIPTU has taken up the issue of an agenda of privatisation of the service. The most important issue is to avoid any reduction in home help hours. The advocacy group, Age Action, has called for an urgent review of the draft guidelines which the HSE uses to restrict home help services. The Irish Nurses and Midwives Organisation has also spoken out against a restricted service. Eamonn Timmons of Age Action has said that if the service is inadequately resourced and is then restructured to operate without sufficient funding and personnel, it will result in a service which poses a threat to the well-being of the very people it sets out to protect.
The Galway hospice services were established in 1990. It started with only one doctor and one full-time and one part-time nurse. It provides services to patients at home and also in the hospice centre. Carers also need to have respite from their duties. Galway hospice does not receive equity of funding. It seeks to be treated no less favourably by the HSE than comparable services in other counties.
I welcome the funding for a diploma in special dental care to upskill six dentists to address services for homeless people. One of these six dentists will be assigned to the west and I ask that these dentists be assigned as quickly as possible.
I welcome the opportunity to speak on an issue as important and emotive as our health service, a service which affects every family on this island. I commend my colleague, Deputy Billy Kelleher on bringing forward this motion and highlighting the gross mismanagement of the HSE. The Minister will speak later about the mismanagement of his affairs but this does not concern me. What concerns me are the finances and the level of services which are currently provided by the HSE. When the Minister was on this side of the House he said he would be a hands-on Minister; he said he would roll up his sleeves and that the buck would stop with him. There was a great sense of expectation. The Minister is a medical professional with many years of experience in medicine. It was thought he knew exactly what he wanted to do and what reforms he would introduce in the health service. However, little has happened, apart from the abolition of the board of the HSE and the establishment of the special delivery unit which has effectively replaced the National Treatment Purchase Fund.
We all understand the precarious financial situation of the country and while we may disagree fundamentally on how this has happened we all agree there must be reductions across the board to balance the books and to return sustainable finances for the future. This is the first time those of us on this side of the House have not had to listen to accusations it is all our fault. Instead we are discussing a potential deficit of €500 million, according to the Minister's own figures and those of his Government's 2012 budget. What is becoming patently clear is that the Minister was far from honest when he produced the Estimates for 2012. The Minister spoke of saving approximately €124 million in drugs payments as a result of a new pricing agreement with the industry. That is unachievable. The budget provided for additional income of €140 million from increased private income, of which €75 million would come from charging private patients for using public beds. According to the chief executive officer of the HSE, that assumption is not yet deliverable. The Minister spoke about reducing agency costs by 50%, given that agency staff would cost over €200 million this year. The CEO of the HSE has also said that this target is unrealistic.
It is quite clear that what the Minister proposed, and what the Government stood over, was grossly misleading, dishonest and false. As a result, we now face potential bed closures, ward closures and even the potential closure of hospitals. There are delays with the fair deal and it is taking weeks and months for medical cards to be processed. There are huge waiting lists. All Members of the House acknowledge the quality of care patients receive once they get into hospital. However, that is due to the dedication of the staff in the hospitals, who are stretched to breaking point. What is the Minister's response to that? What has happened to his and the Government's promise to protect front line services? Can the Minister give a clear commitment tonight on where the savings will now be made to reach his targets, while protecting front line services? There is serious worry among the public about this.
Again, I offer the example of the Midlands Regional Hospital in Mullingar. Government backbenchers have asked for examples of where savings can be made. The Midlands Regional Hospital in Mullingar is the most efficient and effective hospital outside Dublin. The Minister visited it recently, albeit secretively. The Government has promised that the money will follow the patient. I have the leaflets that were distributed by colleagues in my constituency. They state that Mullingar hospital will do better under Fine Gael, with more services and increased funding. That is not the case. Last year it cost €60 million to run the hospital but this year the budget is €56.4 million, including an overrun of €1.9 million.
The numbers using the hospital have increased while funding has decreased. The numbers have increased because the Minister reneged on the commitment given on Roscommon hospital when he closed its accident and emergency service. The numbers have also increased because the Minister reneged on his commitment on Navan hospital when it was downgraded. More patients are coming to the Midlands Regional Hospital from that area.
The Deputy is wrong there.
There are more patients. With all due respect, I know how many patients are coming to the hospital in Mullingar. I speak to the people who are dealing with them every day.
I am sure the Deputy is there night and day.
No, I did not say that. I said I speak to them every day; I do not have to be at the hospital. It is a great pity that the Minister is not present at a few more hospitals. We might not be in the mess we are in now.
Where is the commitment to the money following the patient? I raised this issue previously in respect of an empty unit of the Midlands Regional Hospital in Mullingar that is lying idle, despite the number of patients attending the hospital. I am aware of what happens to them when they go there. A member of Westmeath County Council, who is an inter-county hurler, dislocated his finger recently. When he went to the Midlands Regional Hospital he was put on a chair in an administrator's office because the hospital was at full capacity. When the trolley count is conducted, I wonder if it includes the patients that are left sitting behind the desks. I telephoned him to ask how he was and he told me that the hospital would shortly have him answering the telephones.
Last week, I tried to get a medical card for a person who was due to be discharged from St. James's Hospital. The person had been medically approved to be discharged and the only thing he was waiting for was a medical card, which he needed to get the necessary equipment to go home. He was over a week waiting for the medical card, which meant a number of additional nights in the hospital. What is it costing when one part of the HSE cannot telephone another part? The hospital could not telephone the medical card section to inform it that the man could go home if he received his medical card. We must seriously examine where we are going.
I also wish to highlight the important issue of mental health services, an area that has been the Cinderella of the health service for far too long. Will the Minister for Health reaffirm the commitment to the ring-fenced funding of €35 million for community mental health services? The Minister of State, Deputy Kathleen Lynch, reaffirmed it last week during a Topical Issue debate, but there were reports in The Irish Times last Saturday that the earmarked €35 million could be used to shore up deficits. I ask the Minister to clarify and reaffirm the Government’s commitment to the €35 million in funding for community mental health services. He has already confirmed that a number of posts due to be ring-fenced for the community mental health sector have been diverted to inpatient mental health services, albeit on a short-term basis.
I welcome the Minister and look forward to his contribution on the motion tabled by our spokesperson on health, Deputy Billy Kelleher. I compliment Deputy Kelleher for tabling the motion because it provides all Members with an opportunity to set out our concerns about the issues involved.
I will not start by beating the standard drum of blaming the Minister for everything. He has taken on the difficult job of delivering a health service. It is a difficult job in every jurisdiction in the world. Due to its nature of being demand led, at times there is an insatiable appetite on the part of some to have certain things done that are not always possible. It would be better if Members of this House contained themselves to the facts rather than to some of the excited spin that circulates. However, that also falls on the Minister's shoulders and on those of the Government backbenchers. It does not help when some of them seek to suggest that there is an air of hypocrisy or cynicism on the part of this side of the House.
We faced this problem for a number of years, certainly from when I was first elected to this House in 2007. I accepted some very tough decisions on reconfiguration that were taken by the previous Government. I received little support from anybody in the Minister's party or from members of the Labour Party. They put together outrageous statements which they could not stand over now. I question the media in terms of them holding people to account. They will hold the Minister and members of the Front Bench on this side of the House to account. Sadly, the Minister is going through that in another forum at present which I consider to be outrageous and unnecessary. However, that is neither here nor there. The media hold people to account but they do not hold many members of the Minister's party to account, as they should be, for statements they made when in the Opposition prior to the election.
The core issue is the lack of honesty in the preparation of the budget. Other Members have spoken about this. I am not suggesting it was necessarily at the Minister's direction but, unfortunately, as the Minister he must stand over it. If claims were made by the Department in the preparation of the budget that set out a programme for the year, the issue is that the Minister is not in a position to give a clear statement that he can stand over it in a way that will ensure service will be maintained at its current level. I believe there is a lack of honesty in the programme for Government, in the Fine Gael general election manifesto and in the Labour Party's manifesto. There was a lack of honesty during the Minister's time in opposition and in the way in which he fanned the flames in an effort to create the impression among the public that it was just a matter of changing the personnel in Hawkins House and abolishing the board of the HSE. The impression was created that dreadful people, including members of Fianna Fáil and the Progressive Democrats, or the former Government, had conspired with people within Hawkins House to foist some dreadful service on the people, yet the approach the current Government took when in opposition was to give the impression to the people that there was a simplified way and that one could proceed differently. The Government is now experiencing the harsh reality that I suspect the Minister, who has experience in the health service, well knew about. The Minister was a good advocate for the people he represented at the time in question.
I was taken by Deputy Buttimer's reference to vested interests. The Minister knows where the bones are buried in regard to dealing with the various vested interests. For the reasons outlined, I believe a very dishonest approach was taken during the last election campaign. The current Government knew the facts, set out its stall and alluded to a model in another European jurisdiction, the Danish model, about which we have heard very little since. It involves an exceptionally expensive method of providing a health service with universal health care. The Dutch model, unfortunately, has not been advanced at the rate expected.
The Minister abolished the HSE, accepted political responsibility and turned the clock back. Having done so, he must accept the personal responsibility this brings with it. We have seen the unsavoury letters between the Minister for Health and a Labour Party Minister. The Minister for Public Expenditure and Reform, Deputy Howlin, and the Minister for Health sit around the same table, yet the former has to write to the latter. Perhaps that is how they operate. It is quite unedifying to see a Labour Party Minister lecture a Fine Gael Minister on the imposition of cutbacks, although this says more about the Labour Party than it does about the Minister for Health. It is good to see the Minister for Health fighting his corner to ensure the continued provision of appropriate funding. However, if the current overrun is to continue - the numbers are set out clearly - we will reach a figure of €500 million by the end of the year.
A couple of facts are clear. The Minister may not have had the benefit of hearing the Taoiseach on Leaders' Questions this morning. He made it very clear to the leader of my party that there would not be a supplementary budget. Sadly, the Minister is left following the desire of the Minister for Public Expenditure and Reform, which involves imposing significant cutbacks to honour the dishonest Estimates created as part of the budget and meet the target for the end of the year. As others stated, this can mean only one thing, namely, that the level of service will have to be cut.
I have heard others say it is not a question of money. Of course, it is a question of money. Others have suggested that because there was a tripling or quadrupling of investment in the health service since 1997, money was somehow not a problem. They state that, in spite of investment, there are still problems in the health service. The reality is that the cost of delivering the service has increased, as has the cost of drugs. When Fianna Fáil left power, the service that was delivered, including at community level, was far better than it was in 1997. Using selective indicators, some suggest that the health service became worse between 1997 and 2011. The Minister knows that is not the truth.
It is the truth.
The Minister knows people are living longer and that there is much better cancer care and coronary care. He knows the level of service is much better now than in 1997. It is entirely dishonest to suggest that is not the case. The Minister should accept what has been achieved since 1997. He should accept there is a much better service and that the investment was not wasted, which is, sadly, what people are suggesting from the backbenches tonight. The latter are saying that, in spite of all the money invested, nothing was delivered.
PPARS.
I will accept that mistakes were made. The Minister used to be on the other side of the House in opposition and representing a special-interest group. He ratcheted it up well and good when he was representing the IMO and the GPs and when dealing with the medical cards for those over 70. I have no doubt he would have been outside the gates had the deal not been done. The Minister should accept there were many other actors on stage and that he was a significant one. He is now a significant actor on the other side of the House. He should accept that he now has responsibility in this regard.
During the course of the reconfiguration process in County Clare, representatives of Fine Gael and the Labour Party hijacked the airwaves and played politics. They stated that if the accident and emergency units were closed at night, 20 people would die. I want them to stand over these statements. The closures were brought about to protect patients. Having centres of excellence was all about ensuring patient safety. It was a question of having no staging process on the way to tertiary care. I got it in the neck from Fine Gael backbenchers at the time of the reconfiguration; they talked about people dying. I encourage Members to follow through regarding the representatives in their parties who set up the hijacking process and suggested 20 people would die. We should be told if 20 people are dying each year and what will be done about it. Will the representatives accept that what they said at the time was wrong? Little credit was given to us for doing what we did.
I want the Minister to answer some of the questions that have been raised tonight. Perhaps he will have an opportunity to do so when summing up.
I thank my party colleague, health spokesman Deputy Billy Kelleher, for tabling this motion and for putting the very important issue of health on the agenda tonight so we can consider the health service and the challenges facing it for the rest of the year. People across the country and I want to see improvements to the health service. We want to see a reduction in waiting lists, hospitals operating effectively, health service reform and a system in which people without private health insurance can obtain a hospital appointment for a required service without being told they need to provide cash that they do not have.
There are undoubtedly health services that need to be improved. Unfortunately, since the Government took office, these issues have not been addressed. We have not seen the improvement promised by the Minister when he was on this side of the House, nor have we seen the improvement he proposed to the electorate. Instead, the Minister, who promised universal health insurance for all, has overseen in his first year in office a system in which more than 1,000 people per week give up private health insurance cover only to become dependent on the public system, thereby putting further pressure on the latter.
To ensure the money being invested in the health service is spent directly on the services being delivered, we need proper planning in the HSE itself. Unfortunately, this year's regional health service plans were proposed to the Minister only around the end of January. It was approximately in March that the national health service plan for this year was adopted. Therefore, the actual plan for 2012 was not adopted until approximately three months into the year. How can this ensure the money invested leads to the treatment and service desired?
In Donegal today, the local HSE announced that a bus service that has in recent years been bringing patients in the morning to Dublin for treatment in various hospitals is to be discontinued. I ask the Minister to look into this. The patients affected simply cannot hop on an express bus. In many cases, they are sick or have ailments of a kind that require the service in question. It reflects a lack of planning, in that the Minister has thrown the HSE a budget and told it to deal with the situation as best it can while giving little or no attention to the impact on services on the ground.
Will the Minister redouble his efforts and act on the rhetoric that we saw from him while he was in opposition? Will he show signs of making progress, that is, improvements in the health service rather than more confusion and a daily game of catch-up? I commend the motion to the House.
The Leas-Cheann Comhairle might tell me when I have one minute remaining. My only regret is that we do not have more time. I welcome the opportunity to contribute on the motion and to address some of the issues raised. Fianna Fáil not only left the country's finances in chaos, but left the health services similarly afflicted.
Steady on.
Deputy Dooley believes that there is dishonesty in the Government. The people know the dishonesty of the Government of which he was a member. That is the reason he is over there and we are over here.
Will the Minister accept that he was dishonest in opposition?
Order, please.
Much of the Deputy's comments were revisionist. The Government has been tackling the crisis in a structured and systematic way. The programme for Government sets out an effective way of addressing the challenges of excessive trolley times and waiting times for patients in day treatment. Last year, the clinical programmes saved 70,000 bed days, amounting to €63 million. Money is not the issue, but it allows us to treat more patients more quickly. This is all about the patient. If something does not improve the patient's journey or outcome, it is of no value to the Government.
The fair deal supports 23,000 clients, representing a significant advance in the care of older people. Since last September, 6,000 staff have left the health service, €1.57 billion has been cut from the budget in the past two years, a further €750 million will be cut this year and 3,500 people have been redeployed, yet there has been a 6% increase in emergency department admissions, a 7.1% increase in inpatient discharges and 1.8 million people are in receipt of medical cards, the highest number in the State's history. In a short period, we have made significant progress in comparison with the abject failure of successive Fianna Fáil-led Governments. Deputy Martin's legacy in health comprises 128 reports and 132 consultancies at a cost of €13.8 million. Of course, this was the era of Noel Dempsey and the idea of what is €50 million among friends.
And the era of the Minister, Deputy Reilly, in charge of the Irish Medical Organisation, IMO.
Deputy Dooley should be quiet and be a good boy.
I will give Deputy Buttimer a tip.
Let me illustrate further examples. The former Government gave €533,000 to a management consultancy house in 2002 to develop the HSE's bureaucracy. It spent a further €660,000 on producing a value for money audit. In Deputy Martin's time as Minister for Health and Children, he accumulated €663 million in supplementary budgets. Last night, Deputy Kelleher referred to a tissue of lies.
Will the Minister tell us what he is going to do and give us less revisionism?
Be quiet.
Order, please.
Deputy Regina Doherty might learn something if she listened. She has not been around for long.
The Irish people have made their minds up about-----
You.
-----Fianna Fáil, with its "I lost it behind the radiator in the Department" Travers report and "I won it on a horse" Bertie Ahern. Fianna Fáil got out just before it needed to claim that the dog had eaten its homework. It is a bit of a joke.
The Minister should not venture there. I will give him plenty of it. I told him that I would not go there, but I will if he wants me to.
Order.
I wish to address a comment made on today's Order of Business concerning the cystic fibrosis unit. The chief operations officer of the special delivery unit, SDU, will meet the CEO of St. Vincent's hospital this Friday to agree the final statement on the cystic fibrosis unit's operating protocol. The transfer of patients to the unit will commence at the end of the month. In the unlikely event of difficulties, I will intervene to ensure that matters are brought to a satisfactory conclusion.
Maintenance charges in hospitals were increased in January and should increase the budget intake by €18 million. The concept of money following the patient was mentioned. It yielded €6 million last year and will deliver more this year.
Money followed the doctors when the Minister was around.
A significant proportion of patients who are provided with treatment in public hospitals are not charged for services because of the current rules on bed designation, representing a loss of income to our public hospitals.
Nóiméad amháin.
I regret that, as I have much more to say.
The Minister will speak for 20 minutes later tonight.
The Government has tackled the real problems in the health service instead of throwing money at them like Deputy Dooley's Government did year after year. A measurable improvement has been brought about by the SDU and clinical programmes. Most importantly, I want to thank the front line staff for their incredible endeavour in not just maintaining safe services, but in reducing the number of people on trolleys by 20% in the first six months of this year. That is measurable. It is not rhetoric or spin. That figure represents nearly 10,000, but the total is still too large and more must be done. More than 3,000 people were waiting for longer than one year for inpatient treatment, but that number has reduced to a little over 100. We will move to a nine-month inpatient time.
They did not get consultants in the first instance.
Deputy Dooley, please.
People who are registered in emergency departments will be seen, discharged or admitted within nine hours. I am more determined than ever to continue the reforms. I am also more convinced than ever that we will succeed.
Hear, hear.
We will succeed in giving people what successive Governments failed to give them, that is, a health service in which they feel safe, to which they have access and of which its employees always feel proud.
Unless they are old.
We are determined to do that and I urge the House to support the Government amendment and to reject the Fianna Fáil motion.
I have never heard so much guff in my life.
I thank the Leas-Cheann Comhairle for this opportunity to make a small contribution on the motion tabled by our health spokesman, Deputy Kelleher. The key message of this Private Members' Bill is to highlight the inefficiencies and inadequacies of the Government's proposals on health. It is important to note that there is a €500 million deficit in the Department's budget. What areas will be affected because of this shortfall? Will the deficit be reflected in losses in staff and services for the people of County Louth and others nationally?
I wish to address a number of issues. First, will the shortfall of €500 million affect current long-stay hospitals, including the Drogheda Cottage Hospital and St. Joseph's Hospital in Ardee? These hospitals are on tenterhooks wondering what will happen to their long-stay patients. Not only are patients concerned, but the staff are worried about what will happen and what the hospitals' futures will be. The Minister is familiar with both hospitals.
In the budget, an additional €35 million was allocated for mental health services, of which €24 million was dedicated to community-based teams for adults and children. On 7 July, we were told:
It is understood discussions in recent days suggested parts of a €35 million investment in mental health services could be used to offset overruns in that area. This programme has been strongly championed by Labour Minister of State for Mental Health Kathleen Lynch.
Will the promised 414 staff be recruited? Will the funding for community-based services be ring-fenced as promised? Will this be another broken promise by the Government?
There is no national strategy on dementia care, but the programme for Government commits to putting such a strategy in place by 2013. Will this commitment be impacted because of a lack of available funds? An estimated 41,740 people suffer from dementia. Projections suggest that this number will rise with an ageing population, yet the Government has made no strategic proposals. This serious issue affects fathers, mothers, brothers, sisters, aunts, uncles, grandfathers and grandmothers across the country. Who will be the voice for these people? Government action is necessary now. This is just one of the areas that are at risk and for which the Government has no plan in place to alleviate people's suffering or to aid their families. Where is their care and support?
We as a party believe that there are a number of ways in which the Government can realistically save money so that finance can be spent on serious issues, including dementia care and intermediate care. For example, agency staff costs have almost doubled in four years and will be in excess of €200 million this year. High agency costs are partly driven by absenteeism, which was at 5% in the HSE in the first four months of 2012 compared with a private sector average of 2.5%. The total cost of taxis increased by almost 10% last year, increasing from €26 million in 2010 to €28 million in 2011. Medical legal payments and costs were up from €39 million in 2008 to a projected €127 million in 2012. Overtime was €170 million last year and €69 million in the first five months of this year. The Minister, Deputy Reilly, employs two special advisers, one of whom earns €92,000 per year. In addition, two special delivery unit advisers are each on three-year contracts worth a total of almost €1 million.
Those are consultants to the special delivery unit.
Our motion reads as follows:
That Dáil Éireann:
— noting that the Health Estimate in budget 2012 was misleading given the fact that it was based on assumptions and targets that were not deliverable by the Minister for Health;
— highlighting that enabling legislation for measures announced in the 2012 health Estimate have not been published seven months after being announced and therefore will impact greatly on the sector's ability to meet its budget targets;
— agreeing that, 14 months after abolishing the Health Service Executive (HSE) board, the Minister has failed to take any legislative or other action in relation to governance in the HSE and that this has exacerbated the deficit;
— acknowledging that the income streams or expected savings from:
— the cost of public beds being charged to insurance companies;
— drug pricing; and
— reducing agency costs;
will not now be achieved;
resolves that the resulting €500 million overspend in the health budget will not have an impact on front line services and patient care; and
rejects any moves to close wards, theatres or hospitals as a result of the failure to properly plan the health budget.
Health is a significant challenge in the country. It is capital and labour intensive by its nature. Significant promises were made leading into the last general election and subsequent to it, and many of those promises have not been delivered. It is necessary to tell the people of this country honestly and in an upfront manner exactly where they stand. The abolished HSE board has not been replaced and it is not clear what will replace it. The Minister has had a short period to address these issues. At the earliest opportunity, he should address the various points made tonight.
I will confine my remarks to the motion before the House this evening and will await the personal statement from the Minister later in the House. The Minister was attending a Council meeting in Cyprus last night, and he was entitled and obliged to be there. At that time I argued that the 2012 budget and the health Estimate in particular was aspirational at best or completely dishonest at worst. The recent comments by Mr. Cathal Magee, the chief executive of the HSE, have confirmed these suspicions.
The HSE service plan and budget were overseen and approved by the Minister. At the time the plan was to published, the Minister rejected the first draft. He was effectively referring back a document drafted by his officials and departmental personnel, or, essentially, he was referring it to himself. The Secretary General of the Department sits on the interim board of the HSE and the vast majority of the board is made up of members of the Department of Health.
The motion indicates the board was abolished and now the Deputy is stating it was not abolished.
I refer to the interim board, which the Minister indicated he would replace in a short time. We are still awaiting that legislation to deal with the governance of the HSE. The Minister has argued this was a top priority but if it takes more than 16 months to achieve a top priority, I hate to think of what is down the priority list.
How about 14 years?
We should stick to the motion. It is evident that the people opposite who spoke tonight have not read the motion before the House because it relates specifically to the budget presented last year in this House. Those opposite can blame us for anything they like but they cannot blame us for presenting figures to the House last December-----
Hear, hear.
-----when the Government knew full well they would not stand the test of time in the delivery of services. The promised legislation-----
Services are being delivered in a more effective way than when the Deputy's party was in Government with much more funding.
We should stick to debating the motion.
We should stick to the facts.
We were running a budget deficit of €280 million five months into the budget of the Minister for Finance.
It was €1 billion at one stage when the Deputy's party was in Government.
There are two choices facing the Minister, the interim board of the HSE and the Department. More important, the results of those choices will be felt by the many people relying on health services every day. Mr. Magee, the CEO of the HSE, stated quite clearly that there will be massive cutbacks to services in order to address the budget deficit, which is projected to reach over €500 million by the end of the year if something is not done.
I am not raising that as a hare as the Minister's Cabinet colleague, the Minister for Public Expenditure and Reform, Deputy Howlin, is writing to the Minister opposite, pleading and begging for him to take a hands-on approach to address the budget deficit.
According to Deputy Dooley he was lecturing me.
He may not be lecturing the Minister but he is not being listened to anyway.
We are at one mind. Ad idem.
We have a budget deficit that is completely out of control.
That is hyperbole.
The only way it can be reined in is by massive cuts to services, as was pointed out by Mr. Magee on 29 June this year. Those opposite should not delude themselves that they can in some way eliminate €500 million by magic.
Is that not what the Deputy's party did?
It cannot be done.
What about Noel Dempsey and Dermot Ahern? Tweedledum and Tweedledee.
We will wait for Tweedledum and Tweedledee later. I will confine my remarks to the motion before the House this evening. I will give the Minister the due respect he deserves when he makes his personal statement this evening and clarifies the issues about which people are concerned.
The governance issue has been raised. Price-referencing, generic substitution and agency staff are issues that have been highlighted as being aspirational by Mr. Cathal Magee, who is the Accounting Officer of the HSE. He has indicated that at best, they formed an "unrealistic target".
He is not the Minister.
Is the Deputy in regular communication with him?
The Minister must give a commitment in the House this evening that there will be no diminution of services to the public to address the Minister's failure to oversee his budget. That is the purpose of this debate. We can talk about abstract figures but there are two choices facing the Minister. We are in July and the budget deficit is running out of control. We have yet to see any form of legislation required as a consequence of the 2012 budget to effect the savings highlighted at the time. We are talking about savings in 2012 of €543 million, with most of this requiring legislative changes. We have not seen the heads of Bills or the actual Bills.
We are in July and the next opportunity to bring forward legislation will be September or October. The Minister may say he can work miracles and believe he has amazing capabilities; he might have much confidence in his own ability. Nevertheless, I assure the Minister that services will be affected and he will rob Peter to pay Paul with issues like mental health and disability services. All the crocodile tears from the other side of the House will be in vain because there will be no ring-fencing. Money will be taken from the budget to shore up what has been an abject failure in management.
As the Minister noted, "the year ahead represents a huge challenge but also a great opportunity to change the way we work so we can deliver the health care we all desire for our citizens." I concur with the statement but the only problem is that the Minister has not stepped up to the challenge. He certainly has not grasped any opportunity because in the seventh month of 2012, the budget is in chaos. That has been admitted to by those at the top of the HSE, unless the Minister is to dismiss the remarks of Mr. Magee at the committee which he and I attended.
We are calling for the Minister to state clearly-----
The comments to which the Deputy refers were made at a meeting of the Committee of Public Accounts, which neither of us attended.
I was there.
I attended a meeting of the health committee where Mr. Magee was quite clear about the difficulties. The communication between the chief executive and the Minister does not seem to be what it should be. The Minister has said he will take a hands-on approach but those lines do not seem to be as open and effective as they should be in a normal working environment.
They seem open to the Deputy.
I thank all the Members who contributed to the debate. It is disappointing the Minister did not use the opportunity to give a clear commitment he will address the budget deficit without attacking the front line services over which everybody on the Government side shed crocodile tears this evening and yesterday. What matters is putting money where their mouths are. On this occasion it is going into a big black hole because of the Minister's failure to bring forward legislation to effect the changes he stated in the House last December were necessary to ensure the budget would be effective and would deliver the services he so admirably promised in recent times.
Amendment put:
The Dáil divided: Tá, 90; Níl, 42.
Tá
- Bannon, James.
- Barry, Tom.
- Breen, Pat.
- Butler, Ray.
- Buttimer, Jerry.
- Byrne, Catherine.
- Byrne, Eric.
- Cannon, Ciarán.
- Carey, Joe.
- Coffey, Paudie.
- Collins, Áine.
- Conaghan, Michael.
- Conlan, Seán.
- Connaughton, Paul J.
- Conway, Ciara.
- Corcoran Kennedy, Marcella.
- Costello, Joe.
- Creed, Michael.
- Daly, Jim.
- Deenihan, Jimmy.
- Deering, Pat.
- Doherty, Regina.
- Donohoe, Paschal.
- Dowds, Robert.
- Doyle, Andrew.
- Durkan, Bernard J.
- English, Damien.
- Farrell, Alan.
- Feighan, Frank.
- Ferris, Anne.
- Fitzgerald, Frances.
- Fitzpatrick, Peter.
- Flanagan, Charles.
- Flanagan, Terence.
- Griffin, Brendan.
- Harrington, Noel.
- Harris, Simon.
- Hayes, Brian.
- Hayes, Tom.
- Heydon, Martin.
- Humphreys, Heather.
- Humphreys, Kevin.
- Keating, Derek.
- Keaveney, Colm.
- Kehoe, Paul.
- Kelly, Alan.
- Kenny, Seán.
- Kyne, Seán.
- Lawlor, Anthony.
- Lynch, Ciarán.
- Lynch, Kathleen.
- Lyons, John.
- Maloney, Eamonn.
- Mathews, Peter.
- McCarthy, Michael.
- McEntee, Shane.
- McGinley, Dinny.
- McLoughlin, Tony.
- McNamara, Michael.
- Mitchell, Olivia.
- Mitchell O’Connor, Mary.
- Murphy, Dara.
- Nash, Gerald.
- Neville, Dan.
- Nolan, Derek.
- Noonan, Michael.
- Nulty, Patrick.
- Ó Ríordáin, Aodhán.
- O’Donnell, Kieran.
- O’Donovan, Patrick.
- O’Dowd, Fergus.
- O’Mahony, John.
- O’Reilly, Joe.
- Perry, John.
- Phelan, Ann.
- Phelan, John Paul.
- Rabbitte, Pat.
- Reilly, James.
- Ring, Michael.
- Ryan, Brendan.
- Shatter, Alan.
- Shortall, Róisín.
- Spring, Arthur.
- Stagg, Emmet.
- Stanton, David.
- Timmins, Billy.
- Tuffy, Joanna.
- Wall, Jack.
- Walsh, Brian.
- White, Alex.
Níl
- Adams, Gerry.
- Browne, John.
- Calleary, Dara.
- Collins, Joan.
- Colreavy, Michael.
- Cowen, Barry.
- Crowe, Seán.
- Daly, Clare.
- Doherty, Pearse.
- Donnelly, Stephen S.
- Dooley, Timmy.
- Ellis, Dessie.
- Ferris, Martin.
- Flanagan, Luke ‘Ming’.
- Fleming, Sean.
- Fleming, Tom.
- Halligan, John.
- Healy, Seamus.
- Healy-Rae, Michael.
- Kelleher, Billy.
- Kirk, Seamus.
- Kitt, Michael P.
- Mac Lochlainn, Pádraig.
- McDonald, Mary Lou.
- McGrath, Finian.
- McGrath, Mattie.
- McGrath, Michael.
- McGuinness, John.
- McLellan, Sandra.
- Moynihan, Michael.
- Murphy, Catherine.
- Naughten, Denis.
- Ó Caoláin, Caoimhghín.
- Ó Fearghaíl, Seán.
- Ó Snodaigh, Aengus.
- O’Brien, Jonathan.
- O’Sullivan, Maureen.
- Pringle, Thomas.
- Ross, Shane.
- Stanley, Brian.
- Troy, Robert.
- Wallace, Mick.
Tellers: Tá, Deputies Emmet Stagg and Paul Kehoe; Níl, Deputies Michael Moynihan and Seán Ó Fearghaíl.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to."
The Dáil divided: Tá, 91; Níl, 43.
Tá
- Bannon, James.
- Barry, Tom.
- Breen, Pat.
- Butler, Ray.
- Buttimer, Jerry.
- Byrne, Catherine.
- Byrne, Eric.
- Cannon, Ciarán.
- Carey, Joe.
- Coffey, Paudie.
- Collins, Áine.
- Conaghan, Michael.
- Conlan, Seán.
- Connaughton, Paul J.
- Conway, Ciara.
- Corcoran Kennedy, Marcella.
- Costello, Joe.
- Creed, Michael.
- Daly, Jim.
- Deenihan, Jimmy.
- Deering, Pat.
- Doherty, Regina.
- Donohoe, Paschal.
- Dowds, Robert.
- Doyle, Andrew.
- Durkan, Bernard J.
- English, Damien.
- Farrell, Alan.
- Feighan, Frank.
- Ferris, Anne.
- Fitzgerald, Frances.
- Fitzpatrick, Peter.
- Flanagan, Charles.
- Flanagan, Terence.
- Griffin, Brendan.
- Harrington, Noel.
- Harris, Simon.
- Hayes, Brian.
- Hayes, Tom.
- Heydon, Martin.
- Humphreys, Heather.
- Humphreys, Kevin.
- Keating, Derek.
- Keaveney, Colm.
- Kehoe, Paul.
- Kelly, Alan.
- Kenny, Seán.
- Kyne, Seán.
- Lawlor, Anthony.
- Lynch, Ciarán.
- Lynch, Kathleen.
- Lyons, John.
- McCarthy, Michael.
- McEntee, Shane.
- McGinley, Dinny.
- McLoughlin, Tony.
- McNamara, Michael.
- Maloney, Eamonn.
- Mathews, Peter.
- Mitchell, Olivia.
- Mitchell O’Connor, Mary.
- Murphy, Dara.
- Murphy, Eoghan.
- Nash, Gerald.
- Neville, Dan.
- Nolan, Derek.
- Noonan, Michael.
- Nulty, Patrick.
- Ó Ríordáin, Aodhán.
- O’Donnell, Kieran.
- O’Donovan, Patrick.
- O’Dowd, Fergus.
- O’Mahony, John.
- O’Reilly, Joe.
- Perry, John.
- Phelan, Ann.
- Phelan, John Paul.
- Rabbitte, Pat.
- Reilly, James.
- Ring, Michael.
- Ryan, Brendan.
- Shatter, Alan.
- Shortall, Róisín.
- Spring, Arthur.
- Stagg, Emmet.
- Stanton, David.
- Timmins, Billy.
- Tuffy, Joanna.
- Wall, Jack.
- Walsh, Brian.
- White, Alex.
Níl
- Adams, Gerry.
- Browne, John.
- Calleary, Dara.
- Collins, Joan.
- Colreavy, Michael.
- Cowen, Barry.
- Crowe, Seán.
- Daly, Clare.
- Doherty, Pearse.
- Donnelly, Stephen S.
- Dooley, Timmy.
- Ellis, Dessie.
- Ferris, Martin.
- Flanagan, Luke ‘Ming’.
- Fleming, Sean.
- Fleming, Tom.
- Halligan, John.
- Healy, Seamus.
- Healy-Rae, Michael.
- Kelleher, Billy.
- Kirk, Seamus.
- Kitt, Michael P.
- Mac Lochlainn, Pádraig.
- McConalogue, Charlie.
- McDonald, Mary Lou.
- McGrath, Finian.
- McGrath, Mattie.
- McGrath, Michael.
- McGuinness, John.
- McLellan, Sandra.
- Moynihan, Michael.
- Murphy, Catherine.
- Naughten, Denis.
- Ó Caoláin, Caoimhghín.
- Ó Fearghaíl, Seán.
- Ó Snodaigh, Aengus.
- O’Brien, Jonathan.
- O’Sullivan, Maureen.
- Pringle, Thomas.
- Ross, Shane.
- Stanley, Brian.
- Troy, Robert.
- Wallace, Mick.
Tellers: Tá, Deputies Emmet Stagg and Paul Kehoe; Níl, Deputies Michael Moynihan and Seán Ó Fearghaíl.
Question declared carried.