Vol. 830 No. 3
1. Deputy Billy Kelleher asked the Minister for Health the way he will address the deep concerns of both hospital consultants and general practitioners regarding the provision of health services; and if he will make a statement on the matter. [7186/14]
I am asking how the Minister for Health will address the deep concerns of both hospital consultants and general practitioners about the provision of health care. I tabled this question because it is an issue of major concern. Hospital consultants have expressed very strong views about patient safety, the lack of consultants and supports in hospitals, the overcrowding in emergency departments and all that flows from that. A report commissioned last year outlines the difficulty the Department and HSE are having in recruiting consultants. If we allow this to continue, we will have a diminution of services because we will not have consultants to provide those services. A crisis is evolving in general practice. That is the responsibility of the Minister of State, Deputy White, so we will blame him for this particular part of it, but it is of major concern. There is no point pretending that this issue is not beginning to gather pace in terms of young doctors leaving this country because they do not want to practice here or that practices are under major pressure and strain trying to provide the primary care the Minister talks about rolling out.
There has been significant focus over recent weeks on the very demanding and challenging financial and resource constraints within which the HSE has been required to prepare and adopt its 2014 service plan. It is important to recognise that this focus is not particular to the preparation and adoption of this year's HSE service plan as similar constraints have applied in each of the last number of years as a direct consequence of the emergency financial situation the State has had to address. At such an early hour of the morning I do not want to upset the Deputy opposite, but we all know why we are in these financial troubles.
As in previous years, the delivery of the health and social care services provided for in this year's service plan will focus on the dual challenge of protecting patient outcomes while, at the same time, reducing costs. This requires increasing emphasis on models of care that treat patients at the lowest level of complexity, providing safe, quality services at the least possible cost. I commend the manner in which the HSE and its workforce have successfully focused on how best to minimise the impact of unavoidable constraints on front-line services by utilising innovative and more efficient and effective ways of using scarce resources.
This year, the HSE needs to achieve saving measures of €619 million in order to remain within the approved 2014 health expenditure ceiling. It is important to recognise that the bulk of these required savings measures, including €268 million in pay and related savings and €172 million in reductions in pharmaceutical prices and expenditures and general practitioner fees, will not impact on the general public. These savings, allied to additional cost containment measures of €129 million in areas such as public procurement, shared services, value for money and energy efficiency savings, will allow the HSE to maintain and, in many cases, improve and build on the range of services provided to the public, as they reduce the cost of delivering such services to those in need.
Additional information not given on the floor of the House
I refer to the ongoing work of the special delivery unit, SDU, which was established in the Department of Health in 2011 in order to drive down waiting times for both scheduled and unscheduled care in hospitals and to introduce a major upgrade in the performance capabilities of the health system. In the case of unscheduled care, there has been an overall reduction of 14% in the number of patients waiting on trolleys during 2013. This is on top of the 23.6% reduction achieved in 2012 compared to 2011. In terms of scheduled care, at the end of December, 99.99% of adult inpatients and day cases were waiting less than eight months, 95% of child patients on the waiting list were waiting less than 20 weeks and 99% of routine gastrointestinal endoscopy patients were waiting less than 13 weeks. The number of patients waiting over 12 months for an outpatient appointment has reduced by 95% in 2013, from a high point of 103,433 in March of that year to 4,626 at end of December 2013. The SDU and health service staff across the health system are to be commended on these positive developments.
The significant increase in the number of consultants over the past five years is also of note. In the five years since December 2008, the number of consultants has increased by 295, from 2,260 to 2,555. The number of doctors on GMS contracts has also significantly risen. On 31 December 2013, there were 2,413 GPs contracted to provide services under the General Medical Services scheme. This compares with 2,098 on 31 December 2008, an increase of 315 GP contract holders over this period.
In the light of these developments, I have every confidence that, despite the unavoidable resource reductions already referred to, the HSE will maintain core services in 2014 while also supporting the growing demand for services arising from population growth, increased levels of chronic disease, increased demand for prescription drugs, higher numbers of medical card holders and new costly medical technologies and treatments.
We do not have time to discuss the whole budget and the provisions of health care, but the feeling out there is that there is a crisis in GP services and that they are being forced to take on more complex cases. This is because of the outsourcing from the acute hospital system, the transfer of long-term illnesses and other complex conditions that are now expected to be treated in the primary setting. No additional resources have been put into GP services. GP services are under financial pressure. They are laying off staff. Then there is the added dimension of younger GPs not finding it an attractive option as a career path. That is sustainable only for so long. The budget for primary care has been consistently reduced, yet we expect GPs to take on additional responsibilities from a clinical point of view and that is unsustainable. It is time the Minister acknowledges that there is a problem and addresses it. Until he decides that, we will have major difficulty in the years ahead in terms of provision of primary care.
Let us deal with the facts rather than the hype. There are more than 200 additional GPs in the GMS than there were when we came into government. We all know we are about to enter into - I must be very careful with the language here - consultation with general practice.
Discussions.
The Minister of State, Deputy White, has already met the various organisations. We expect to hear a lot of noise from that section until the new contract is in place, but let us deal with the facts. There are more than 200 additional GPs in the service than when Deputy Kelleher was in government. He alluded to overcrowding in our hospitals. Coming towards the end of his term in government, there were 569 people on trolleys in a single day. We have reduced that number by 34% over 2012 and 2013. This year so far, we are already over 3% lower than last year. That is still too many and I want to see it improved.
It is important to have the facts out here. There are more consultants and GPs in the service than there were three years ago and we recruited over 700 nurses last year. The people who work in our health service face serious challenge and pressure but they are doing that magnificently and I congratulate them on the great improvements they have made.
We can have this debate again and again but the Minister is in his fourth year in government. He can only shelve his responsibility for so long.
We are not in government three years yet.
Former Deputy Batt O'Keeffe must have taught Deputy Kelleher mathematics.
He is going into his fourth year and it is time he would believe he can stand over his policies and decisions. There are serious difficulties in the acute hospital setting. It is difficult to get people out of hospitals. Step-down facilities are not available. We are having difficulty trying to transfer people from the acute hospital setting to step-down and then home. That is happening day in day out in hospitals across the country and this adds to the difficulties at the front end in emergency departments.
Does Deputy Kelleher have any proposals about anything on health?
I am making those points because if the Minister wants to deny the facts and the realities and what the clinicians at the coal-face are telling us, then he should deny them.
It is ten years since Deputy Kelleher had a policy on health. He has no policies.
The Government does not have any either.
We are still waiting for the White Paper on health insurance. They could not even do the sums on it - the arithmetic, the mathematics, the logarithms. The logarithms were not even on that White Paper.
What did Fianna Fáil do?
Do not forget the progressions.
And the progressions.
Fianna Fáil has been wonderful at describing the problem but not terribly good at dealing with it, as we all know. Despite a 10% reduction in staff, 20% reduction in budget and an 8% increase in our population, we have reduced the number of people waiting over a year for an outpatient appointment by 95%. The august Members of Fianna Fáil who were in government for 14 years did not even deign to count the number of people on outpatient waiting lists because they did not want to know.
We had the Minister for the hyperbole on this side of the House then.
It was very handy because my predecessor was not a member of the Fianna Fáil party, so it could leave her to deal with all the consequences.
We never abandoned our colleagues.
Out of 103,000 people who were waiting longer than a year for an outpatient appointment in March 2013, there are now only 4,500 people. I accept it is still too many but we continue to address it.
Half those people-----
Deputy Kelleher is into the old Fianna Fáil way of hype and spin. I deal in facts because-----
I am being a responsible Opposition Member.
-----I am interested in reality and the reality our citizens have to endure every day. I want to improve that experience for them. We will continue to improve the patient experience and, at the same time, continue our reforms.
Deputy Kelleher is correct that the universal health insurance White Paper will be out very shortly.
Will the sums be on it this time?
I look forward to his comments on it. I invite himself, Deputy Ó Caoláin and others to feed into that process because it will be about all of our health service. I want all of us to feel part of it and to have an input into it.
Even you Billy.
2. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the date on which the report he commissioned on charities and other bodies funded by the Health Service Executive will be concluded and published; if, in view of revelations of excessive salaries and top-ups among some charities, he will initiate a public, independent investigation, including into any agreements or understandings between the HSE and these bodies; and if he will make a statement on the matter. [6980/14]
This question seeks to establish when the report the Minister commissioned on charities and other bodies funded by the Health Service Executive will be concluded and published. Will the Minister initiate a public and independent investigation into all related matters?
This process commenced quite some time back arising out of the HIQA report into Tallaght hospital. The HSE internal audit directorate produced a report, which has been available on the HSE website since November 2013, on the remuneration of senior executives in section 38 funded agencies which found that several unapproved allowances were being paid to senior managers. I requested the production of this report as a result of concerns I had arising from the HIQA report into Tallaght hospital in May 2012.
The HSE has taken urgent action to follow up on the findings of the audit report. Each section 38 agency was asked to confirm by 31 January this year that they would sign up to the HSE’s new compliance statement process. The compliance statement includes confirmation that all staff are paid in accordance with the Department of Health’s consolidated salary scales. The compliance statement also requires the agencies to confirm their compliance with their obligations under statute and under service arrangement with the HSE in respect of governance, systems of internal controls, taxation, finance, procurement, risk management and capital assets.
This statement will have to be approved by the board of each agency on an annual basis, signed by the chairman and another director on behalf of the board and submitted to the HSE together with the organisation’s annual audited accounts. This annual compliance statement will be required in addition to the annual service arrangement between the agency and the HSE.
The majority of section 38 agencies have now confirmed that they will co-operate with the new compliance statement process and a small number are expected to confirm this shortly. In addition, meetings have been held during the past weeks by senior managers in the HSE with the section 38 agencies to ensure those which are not compliant develop a clear plan to reach compliance as quickly as possible. In some cases allowances have been stopped. In the case of 26 agencies, in line with the Department’s pay policy, a business case is being made for the retention of unapproved allowances or of allowances in payment for more than five years.
Up to 85 such business cases have now been submitted to the HSE, which has established a review panel to assess the merits of these cases. This process will take some time and should be completed by the end of March. Where the review panel is satisfied that there are legitimate reasons for continuation of an allowance business cases will then be submitted to the Department of Health which will liaise as appropriate with the Department of Public Expenditure and Reform.
Additional information not given on the floor of the House
I am confident that the HSE will take whatever action is necessary to achieve full compliance with Government pay policy from the agencies concerned. I have no plans to establish an independent inquiry into the payment of unapproved allowances to senior executives at agencies funded under section 38 of the Health Act 2004.
Has the Minister been informed by the board of Rehab about the salary paid to the chief executive officer of the organisation? I understand the last figure for 2011 was in the order of €230,000 a year. It is important all of the entities in question are fully compliant and we have the restoration of transparency and confidence in this sector. This can only be done by adherence to the process outlined by the Minister in his reply.
Is it the case that the HSE did not request the specific salary of the chief executive officer of Rehab, as Rehab itself has claimed? Why would the HSE not request this information? Given the Minister’s statement that was interpreted as a threat to Rehab’s funding in the event of non-compliance, people with disabilities whose needs are provided for by Rehab could be put at risk. It is important the Minister’s reaction does not impact on the innocent and those who need the organisation’s services in the first place. Does the Minister agree with that?
The organisation to which the Deputy referred is a section 39 agency, not a section 38. Accordingly, it is not subject to public pay policy. Nonetheless, I, as well as the Government, believe that those organisations and charities in receipt of major taxpayer funding, anything over €250,000, should be in line with those pay policies. This process we initiated has been very careful and has followed due process. It has been fastidious in its fairness and continues to be so. We are not for turning on this matter and we will pursue this to the end. The idea of the necessity for an independent inquiry is not correct when the HSE is fully in control and bringing all these matters to light, seriatim, one by one. It will continue until we reach the end which we all wish to achieve, namely utter transparency around how public moneys are spent when they are given to organisations, be they voluntary, section 38s or section 39s. It is critically important to ensure, as all Members opposite agree, that when we give money for charitable purposes, we can have confidence that the money is spent in the manner for which it was intended, namely for services for those in need of them. That remains our position.
Given that the Government has already significantly cut funding for services for people with disabilities, will he rule out, as I believe he should, further cuts to funding for critical services destined for people with disabilities, irrespective of what ongoing strains there may be with the board and the chief executive officer of Rehab? It is important the innocent are not penalised for the failures of senior management in any entity. Likewise, it is important service-users are respected and protected while the excellent staff of Rehab providing front-line service, care and supports are recognised for the role they play, as well as fund-raisers. Those who donate are innocent and are heroic in what they provide. It is important there is no conflict in this situation. Whatever actions may need to be taken in the event of non-compliance, they should not involve a reduction in funding destined for front-line service provision for people with disabilities.
There is a need for an independent investigation. I make that case because the Health Service Executive, Rehab and other structures are making claim and counter-claim in regard to what was agreed and what was understood. I do not know, and we do not know, who is giving us the full facts. That is why an independent third party should be engaged to establish the full facts and who will have our confidence in presenting their report.
To correct the record of the House, there has not been any cut to disability. This Government spends more than €6.4 billion on disability annually. Our commitment to those with disability is very clear, and I am very fortunate to have at my side a Minister of State, Deputy Kathleen Lynch, who is in charge of this area and in charge of mental health because she is a very strong defender of those sectors, and rightly so.
Of course there have been cuts-----
No, there have not been cuts.
-----and under the Minister's stewardship.
I did not interrupt the Deputy, but as he has interrupted me I will remind him of his shroud-waving, general forecasting of doom and gloom at every availability opportunity, and the outrage auction he engages in trying to top the last outrage in which he has been involved.
No. It sounds very like the Minister's own time here on these benches. Another useless act on the Minister's part
I remind him also of his inability to accept the facts and his urgency to ignore due process and call for independent inquiries when it is clear there is a process in place that is delivering what the people need, namely, clarity and assurance that into the future any moneys given by either the taxpayer or through the goodwill of ordinary men and women who make contributions for charitable purposes will be spent on providing services to those in need and not to provide top-ups or other arrangements for highly paid executives.
I thought the Minister's qualifications were in medicine. Clearly, spin-doctoring is the only qualification he has got.
Order, please.
Sinn Féin would not know about that.
The next priority question is in the name of Deputy Finian McGrath.
Spin-doctoring, ably assisted by the Minister's colleague beside him.
Please. I am trying to introduce the next question. Deputy McGrath is not present. Therefore, we will move on to Question No. 4 in the name of Deputy Colm Keaveney. I ask Deputy Keaveney to introduce the question.
4. Deputy Colm Keaveney asked the Minister for Health the way he will address the deficit of early intervention teams for children in many parts of the country; and if he will make a statement on the matter. [7187/14]
The object of the question is to elicit a response with respect to the waiting lists nationally for the early implementation teams. I would be grateful if the Minister would give us a response to that effect.
The Government is committed to the provision and development of services for children with a disability, including early intervention services, within available resources. While these services are in the process of being reconfigured under the Health Service Executive's national programme on progressing disability services for children and young people from birth to 18 years, it is important to note that all HSE areas have significant early intervention services in place for children with disabilities, from birth to aged 18. These are provided directly by the HSE or by voluntary service providers funded by the HSE.
The aim of the programme on progressing disability services for children and young people is to achieve a national, unified approach to delivering disability health services in order that there is a clear pathway to services for all children - it is not in place at present - regardless of where they live, the school they go to or the nature of their disability. An additional €4 million has been specifically allocated in 2014 to drive implementation of the programme. This equates to approximately 80 therapy posts.
There are almost 60 geographically based multidisciplinary teams established as part of the reconfigured service model under this programme. It is hoped that a further 30 teams will be reconfigured this year, bringing the overall total to approximately 90 teams by the end of 2014. These figures reflect all children's disability teams that provide early intervention services to children from birth to aged 18. The transition to this new model is being implemented on a phased basis and, what is important, it includes consultation and engagement with stakeholders such as service users and their families.
I thank the Minister of State for her response. I draw her attention to the comments made in response to the previous question with respect to cuts in disability. While I acknowledge a transformation is taking place within the sector, the object of the question concerns the issue of the 15,000 people on waiting lists for speech and language therapy. In Dublin alone there are 10,000 citizens waiting for speech and language therapy, and in the HSE South administrative area there are 3,171 people on the waiting list. We are moving from an existing system to a projected early intervention team, EIT, system, but we still have a crisis, particularly when it comes to occupational therapies. In the HSE Dublin Mid-Leinster and Dublin North-East administrative areas, 4,000 children await occupational therapy. In the two Dublin administrative regions, 10,000 people await physiotherapy as we speak. How does the Minister of State intend to tackle these chronic waiting lists? This is a grave concern. We are in a process of transition. Obviously, what we are leaving behind us is not addressing the situation while we get to the point where EITs are up and running and fully resourced.
I will call the Deputy again.
I agree with the Deputy. What we inherited was quite significant despite a significant amount of money being spent annually. It became clear, on looking at the situation when we entered Government, that what was in place was not working and that we had to reconfigure the entire service. That is what we are in the process of doing. We have been extraordinarily lucky in getting someone like Pat Healy to come in and drive that change. He has experience far beyond anyone I know in terms of disability. I know him from his work in the south. What we are doing is ensuring children, despite the fact they may not be attached to a particular service, have access to community-based early intervention teams. It is a process of building those teams, and that is what we are doing. We have managed to get €4 million in funding this year, in very tight circumstances, to ensure that service is put in place. It will take a little more time, perhaps another year or two, but at that point I believe we will have a better service. I believe also that we must get away from the concept of having to have a diagnosis before one gets a service.
The figures for the past 12, 24 or 36 months are not too far from the original figures I had confirmed. I am concerned the Minister of State's language around this issue does not engender confidence in families who are gravely concerned that they must wait a significant length of time with respect to children who are nearly in mainstream education at this stage, with no diagnosis. The Minister of State is so optimistic about the future in terms of transformation, yet while she stood here yesterday and spoke about a unit in University College Hospital Galway, part of the roof was blowing off that building. She is transferring vulnerable service users into an inappropriate unit at UCHG where there are three showers for 40 unwell service users. Is that the type of transformation she is talking about? Is she talking about the transformation where part of the roof is blown off UCHG while the Minister stood here yesterday and robustly defended a decision-----
Thank you, Deputy.
-----to shut down facilities in St. Brigid's Hospital in Ballinasloe and transfer them to UCHG where part of the roof was ripped off in the storm yesterday evening? That was her robust plan.
I do not know how we have strayed into this area because there is another question tabled on mental health. Obviously, the Deputy felt the need to raise it earlier.
Despite the fact that I take entire responsibility for the disability and mental health service,and how we need to transform it, what we inherited was chaotic. We inherited it from the party of which Deputy Colm Keaveney is now a member.
There are fewer staff under the current Government.
No one is responsible for the type of weather we have seen in the past few weeks. Coming from Cork, I know that better than most and, when there is an issue of health and safety, that will be dealt with as a matter of urgency. My information is that, as of this morning, it is being dealt with as we speak. This is why we are building a new 50-bed unit at the same site. There is no great disagreement between us and I know the Deputy wants the new unit and that he wants people treated properly, as do I. I am not responsible for the weather and all I can do is deal with the situation as I find it.
What about the €3.1 million in St. Luke's?
When I came into office, I found a service in chaos.
5. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he has ascertained the actions that were taken in response to the concerns expressed by midwives in the Midlands Regional Hospital, Portlaoise, in 2006; the immediate action he will take to ensure best obstetric practice at this hospital; if he will ensure that the long signalled problem of under-staffing is addressed without delay; if he will initiate a Health Information and Quality Authority inquiry; and if he will make a statement on the matter. [6981/14]
This question concerns whether the current Minister for Health has ascertained what actions, if any, were taken by his predecessor, the then Minister for Health, Mary Harney, in response to concerns about midwifery staff at the Midlands Regional Hospital, Portlaoise, and what action he is willing to take to address the long-signalled problem of understaffing at the facility.
I am aware that the previous Minister for Health received representations from the then Minister for Finance in 2006 about the maternity unit at Portlaoise. As overall responsibility for the management and delivery of health services rests with the HSE, the correspondence was forwarded to the executive for attention, as appropriate. The HSE replied directly to the Minister for Finance, acknowledging difficulties at the hospital and outlining proposals to address the situation, including the recruitment of additional midwifery staff and some upgrading of the maternity facilities.
With regard to current staffing at the Portlaoise maternity unit, I understand from the HSE that a number of vacancies exist at present and that service provision is supported by agency midwives. However, the hospital has approval to recruit additional midwives up to the approved complement and this recruitment process is ongoing.
I assure the Deputy that actions are being undertaken across our health services with a view to improving patient safety and providing a more patient-centred model of care. In particular, patient safety has been made a priority within the HSE's annual service plan through specific measures focused on quality and patient safety. My Department is leading the development of a code of governance which will clearly set out employers' responsibilities in achieving optimal safety culture, governance and performance. I have asked HIQA to ensure that my patient safety priorities are included in the monitoring programme against the national standards for safer better health care. I have instructed the national clinical effectiveness committee to commission and quality-assure four priority national guidelines on sepsis, clinical handover, maternal early warning score and paediatric early warning score. This body of work is in progress and well advanced.
My Department, in conjunction with the HSE, is developing a new national maternity strategy to provide the strategic direction for the optimal development of our maternity services. In light of the reports of a number of perinatal deaths at the hospital in recent years, I have asked the Chief Medical Officer to provide me with a report on the issues arising as quickly as possible. This report will inform the terms of reference of any subsequent HIQA review into the issue.
I extend my deepest sympathy to the four families we know of who lost infants in tragic circumstances in the Midlands Regional Hospital, Portlaoise. As the parents stated, they have been treated disgracefully in their words, which are absolutely correct. They were kept in the dark about how and why they suffered these tragic losses. The HSE has admitted serious failings and I ask the Minister whether this underlines the absolute need for full openness and transparency in the investigation of what happened and why. That needs to be established quickly. The revelation that staff at Portlaoise hospital had already raised the alarm and wrote to Brian Cowen and Mary Harney about concerns about obstetric care in 2006 is alarming, given that it has not been satisfactorily addressed in the years since. When was the Minister made aware of the previous representation and identified need? When was he made aware of the actual need in his role as Minister since he took office?
I noted at the health committee meeting last week that the scop of Dr. Holohan's report had not been worked out. It should include all relevant issues. Will the Minister confirm that it will include the inadequate staffing levels at the hospital?
There is a report being compiled by the Chief Medical Officer. He and I met three of the families concerned. Like the Deputy, I reiterate my sympathies on their losses and I apologise for the way they were treated subsequent to their losses. I am committed to a transparent and accountable health service and a patient safety agency that will be set up in the next quarter so that patients have an advocate they can go to and so that what happened in Portlaoise can never happen again. If someone has a complaint and it is not being dealt with expeditiously by the people concerned, the person can go to the patient safety agency to receive help, advice, support and encouragement to pursue the issue to its natural conclusion. I assure the House, the Deputy, the families concerned and the broader public that we will get to the bottom of this and that we will find out where are the issues and problems and that we will fix them. Unlike before, we will not use the report to downgrade and undermine the hospital further but rather to support it to deliver services that the great people who work there, in many instances, are striving to deliver.
I welcome the last remarks by the Minister. Only in the fullness of time will we have the opportunity to test them but I hope the commitment will be delivered upon. Will the Minister confirm the scope of the report of the Chief Medical Officer? Will it include address of the staffing levels and understaffing over the number of years involved? It is crucial to establishing the full facts. In his first reply, the Minister said staffing issues are being addressed. I note that he referred to "up to the approved complement" in his first response to the question. My understanding is that the current ratio of midwives to births is 1:55, when the internationally recognised norm is 1:29. What is the Minister referring to when he says staffing levels are being increased up to the approved complement? Whose approval and whose standards? It is hugely important that we know exactly what we are talking about. What are we talking about? Will the Minister quantify the number of new midwives expected? Where does it come in the internationally recommended norm of 1:29 births?
I assure everyone that the Chief Medical Officer's report will be comprehensive and it will be an important signpost for HIQA when it engages in its review of the situation in Portlaoise. It is in everyone's interests that the problem not just be addressed but fixed so that people can have confidence into the future in that hospital and in all our maternity services. I thank the families for taking the time to speak to me and the Chief Medical Officer. Their contribution and their story, which was harrowing to go through again, has informed the Chief Medical Officer of the issues he must address and it will allow him to address it in a comprehensive way, which might not have been possible without the benefit of their time.
On a point of order, has the time limit for questions changed? The last question took eight and a half minutes.
There is no change in that regard. I take full responsibility for trying to keep people to six minutes but I can only do my best. We will get to the Deputy's question as soon as we can.
