Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Tuesday, 11 Nov 2014

Vol. 857 No. 3

Other Questions

Surgical Symphysiotomy Payment Scheme

Regina Doherty


88. Deputy Regina Doherty asked the Minister for Health if he will provide an update on the redress scheme for victims of symphysiotomy and his views on the timeframe, terms and conditions and so on; and if he will make a statement on the matter. [42729/14]

Will the Minister provide an update on the redress scheme that was established for the surviving victims of symphysiotomy? I am aware that the scheme was advertised last week and that it has been open for business since yesterday but will the Minister provide information on the terms and conditions and timeframes relating to it? I would also appreciate it if he could outline his expectations in respect of the scheme and indicate what has been the response of the victims to it so far.

I am pleased to announce that the surgical symphysiotomy payment scheme commenced yesterday, 10 November 2014. The Government has agreed that the scheme will also include payments for the small number of women who have undergone a pubiotomy. The scheme is designed to be simple, straightforward and non-adversarial and aims to minimise the stress for the women concerned. Many of the women are elderly and may not want to experience the delay, publicity and financial risks that sometimes come with a court case. I met all three support groups representing the women last September and their views have helped to shape the scheme.

Ms Justice Maureen Harding Clark, a retired High Court judge, will undertake the role of independent assessor of the scheme. Ms Justice Harding Clark, as a result of her previous work on the Lourdes Hospital redress scheme, brings valuable experience to the role of determining the appropriate level of award for each individual. The scheme is open to women who are still living and who underwent a surgical symphysiotomy or pubiotomy in the State between the years 1940 and 1990. Awards of €50,000, €100,000 and €150,000 will be offered. Women who have had a surgical symphysiotomy may accept an award of €50,000. For women who have had a symphysiotomy and have suffered significant disability, a higher award of €100,000 will be offered. Where a woman has had a symphysiotomy immediately following caesarean section, an award of €100,000 will be offered and where she has suffered significant disability following these procedures, €150,000 will be offered. For a woman who underwent a pubiotomy, an award of €100,000 will be offered and for women who have suffered significant disability following this procedure, €150,000 will be offered. Details of the terms of the scheme and how to access application forms have been widely advertised. Awards will be exempt from tax and legislation is being put in place, as a matter of urgency, to ensure the women will also be exempt from being taken into consideration for means-tested welfare schemes. The judge expects to make payments to some women before Christmas.

It is not a requirement for a woman to retain a solicitor to make an application. However, the scheme makes provision for applicants to have legal and other advice available to them in preparing to submit an application if they wish. Ms Justice Harding Clark has assured me that if women have questions on any aspect of the scheme, her staff will be available to assist in any way possible.

What the Minister said is very welcome, particularly with regard to the fact that some payments may be made before Christmas and that the women will not require the services of solicitors. I also welcome the fact that the three groups which have supported the victims tirelessly during the past ten to 12 years are recommending that they should make applications in respect of the €100,000 awards that are on offer. Some of the women with whom I have been dealing are concerned that it might be difficult for them to obtain these awards and are more disposed towards applying for the €50,000 awards.

Perhaps the Minister will set out what women must do to obtain the €100,000 and reassure them that the process will not be cumbersome and simply require the provision of proof that a symphysiotomy has taken place and letters from a general practitioner or those who have been treating them in recent years to prove their disabilities. By Jove, most of these women have serious disabilities arising from symphysiotomy. I reassure them about how simple the process will be.

Women do not have to waive their right to take a case to court as a precondition of participating in the scheme. One can opt out of the scheme at any stage up to the point at which one accepts one's award. It is only on accepting an offer that a women must agree to discontinue her legal proceedings against any party arising out of a symphysiotomy or pubiotomy.

Significant disability means medically verifiable physical symptoms or conditions directly attributable to surgical symphysiotomy or pubiotomy that have had a serious and debilitating effect on the applicant's quality of life. These include and are not confined to pelvic instability, pelvic pain, dyspareunia, urinary incontinence, back pain and pain on walking that continued for more than three years after the operation was carried out. Anyone who can show they have had a symphysiotomy, even one with no complications, will get €50,000. Anyone who can show she had any of the symptoms for three years or more after the operation can apply for the €100,000, and I certainly encourage her to do so.

I am glad to hear the genuine concern for the victims. We must acknowledge and recognise that these ladies have been through decades of suffering. The vast majority are in their 60s and 70s, and some are in their 80s and 90s. They do not want to get involved in what has been pitched in some quarters as a cumbersome process. They want to know how genuinely simple the process will be. I am glad the Minister could confirm that today. Ms Harding Clark has form in this area in that she performed superbly with the women from the Lourdes hospital redress scheme that was in place previously. The vast majority of those women were very confident and happy with the way the process was handled and with the fact that they were supported. I have no doubt the same will happen again. The process will be simple for the ladies, who are all in the autumn of their lives.

The scheme has been designed to ensure it will be simple and not cumbersome, and will not require further medical examinations, unless absolutely necessary, or people having to testify in court or produce records that may no longer exist. I refer to all the difficulties that may come with a court case. The process is designed to be simple and straightforward. It was very much designed in consultation with Patient Focus and some of the other relevant groups.

I encourage anyone who has had the complications in question to apply for the higher reward. If they do not get it, they will, at the very least, get the lower award. All that is required in this case is proof they underwent the procedure at some point. The assessor is now set up in her offices. There is a website and a telephone number. If anyone wants advice and somebody to talk through the application process, these will be available.

I do not agree that what is offered is in any way reflective of what the women have gone through over their lives. However, it is up to the women themselves to make the final decision. That is the position I have taken publicly and privately.

One matter the Minister has not mentioned in his response to Deputy Doherty is the 20-day period. Any reasonable assessment of what is involved and what challenges the women concerned would demonstrate that a 20-day timeframe in which to respond is extremely limited. It should be lifted. I do not believe there was any such time restriction in regard to the schemes related to hepatitis C and other conditions that were addressed historically. Why would the Minister force the women to respond in such a short period?

I certainly agree with the Deputy that it is a matter for the individual women to decide whether they want to avail of the scheme or pursue a court case. There is a 20-day limit but that can actually be extended. There is a provision to allow for it to be extended if the applicant can give a reason for the delay in making the application. Ms Maureen Harding Clark will be as flexible as she possibly can be in that respect.

National Stroke Programme

Denis Naughten


89. Deputy Denis Naughten asked the Minister for Health his plans for the roll-out of the national stroke programme; and if he will make a statement on the matter. [42744/14]

Since the launch of the national stroke programme, the death rate from stroke has fallen by 13% and the rate of discharge from nursing homes is up 28%, with savings of at least €21 million per year being made in reduced nursing home costs alone. Those statistics could be doubled if the Minister could provide the required investment, into both hospitals and the committee, to deliver on the totality of the national stroke programme and to install in the acute hospitals the seven telemedicine stoke machines that are currently in a warehouse in Cork.

I thank the Deputy for raising this question. Understandably, in health, we always talk about what is going wrong but the national clinical stroke programme is an example of something that has gone well and is now used as an example in other countries as to what can be done.

I am checking up on those seven pieces of equipment. I am not sure the Deputy's assertion is true. They could be spares, but I will check up on that because someone else has asked me about them.

The programme, as Deputy Naughten mentioned, started early in 2010. The mission of the programme is to deliver better care through better use of resources. The vision is to provide an integrated model of clinical care in acute and community services.

Since its implementation in 2011, the national stroke programme has resulted in improved services for stroke patients. The 24-7 access to safe stroke thrombolysis, that is, where one busts the clot that is causing the blockage of blood to the brain in a stroke, is progressing, with emergency thrombolysis provided now to patients in all regions of the country. This has involved improved hospital and ambulance protocols, health professional training and the appointment of new physicians. The national stroke thrombolysis rate has increased from 1% in 2006 to 11%, exceeding the national target of 9% and is comparable to the highest rates internationally.

Since the national clinical programme for stroke commenced, nine new stroke units have been opened, bringing the total number of stroke units in acute hospitals to 24. The programme has provided funding to support staff for the implementation of stroke unit care, with 54 new nursing and therapy posts being filled. There are 20 additional clinical nurse specialists in stroke working in acute hospital services. Good clinical outcomes are being provided through initiatives such as early supported discharge for stroke patients. Early supported discharge involves intensive specialised stroke rehabilitation provided in the patient's home for up to eight weeks. This reduces the length of hospital stay, reduces long-term dependency, reduces the risk of further disability after six months and reduces the number of patients requiring long-term care. Early supported discharge services are funded in a number of locations. The feasibility of implementing this model in geographically dispersed populations is limited but the national stroke programme continues to provide funding for these sites.

Following up on the Minister's last comment, is it the case, based on a study by the Royal College of Surgeons in Ireland and the ESRI, that the early supported discharge programme, if completely rolled out, would save 3,000 patients spending too long in hospital, save 24,000 bed nights and result in a net saving to the health service of €7 million a year?

The HSE sets aside €2.4 million each year for the national stroke programme in the acute hospitals. Will the Minister assure the House that all of that money is being spent on supporting the acute stroke service in the emergency hospitals?

I assume it is. I will double-check that for the Deputy. I suspect probably a little more is being spent than that.

I am a big fan of early supported discharge. It makes a lot of sense to get patients home more quickly to do their rehabilitation at home and that produces better clinical outcomes. Unfortunately, like a lot of savings posited in health care, it is not quite that simple. I have studied the ESRI report in detail and so has the HSE. We intend to extend the early supported discharge programme, if we can. However, it is not as simple as merely stating it will save millions of euro. Commentators always put that across in health. It requires us setting up a community infrastructure first and there is an initial investment cost before one can make any savings, and the savings only arise if one then reduces capacity in the hospital because there is the cost of setting up the service in the community. The saving only arises if one starts taking staff and beds out of hospitals and I would not do that because we need those staff and beds. If I can free up staff and beds in hospitals, I want to get patients off the waiting lists and into those beds. Unfortunately, there is not a net saving. There is an efficiency, but not a saving.

The Minister said in his initial contribution the emergency thrombolysis service is available in all regions.

As the Minister is aware, it is not available in all acute hospitals. Portiuncula Hospital in Ballinasloe does not have an emergency stroke or thrombolysis service at present. Will the Minister give a commitment to the House, first, that priority will be given to the appointment of a geriatrician physician to provide a thrombolysis service at one of the emergency hospitals in the country that does not have it currently and, second, that one of the seven telemedicine stroke machines that are gathering dust in a warehouse in Cork would be installed in Portinucula Hospital in Ballinasloe and linked to Galway University Hospital? We would then have a 24-7 emergency stroke service that is available in other parts of the country but is not available at present in my region, which is putting lives at risk.

I said it is available in every region, not in every hospital. There is a difference. Trying to do everything in all 47 hospitals around the country does not produce better clinical outcomes. In fact, it can produce inferior outcomes.

As the Minister is aware, that is not the case with stroke.

The best thing we can do is think about the health service differently and make sure that patients are, first, treated from the moment they get into an ambulance, which is done a lot in other countries, and, second-----

Not with stroke.

-----that they get to the most appropriate centre as quickly as possible, which might not necessarily always be the nearest centre. If someone has a major trauma, he or she needs to go to a trauma hospital that has a trauma orthopaedic surgeon. We must begin to think differently about where ambulances take people in order that they go to the right hospital, not necessarily the nearest one.

Deputy Naughten is aware there are currently 200 consultant vacancies. I believe the position of geriatrician in Portiuncula is one of the vacancies. If it is, we will certainly do our very best to fill the vacancies. Each and every vacancy is a priority. I will not say that a consultant in Deputy Naughten's local hospital should be prioritised over a consultant service in another local hospital as quite frankly that is a parish pump approach, but I will prioritise the filling of all those vacancies as much as possible.

We are the only region in the country without a stroke service. Minutes are very important in the case of stroke.

We must move on. I call Deputy Paul Murphy.

Absolutely not. That is not correct.

Public Sector Staff Data

Paul Murphy


90. Deputy Paul Murphy asked the Minister for Health further to Parliamentary Question No. 173 of 9 October 2014 the reason almost 65% of medical and dental staff employed by the Health Service Executive are on fixed term and or special purpose contracts; and the effect that has on patient care. [42767/14]

I ask the Minister why it is the case that almost two thirds of medical and dental staff employed by the HSE are not on permanent contracts but are instead on temporary or special purpose contracts. It seems to be an extraordinarily high figure that presumably speaks to the erosion of terms and conditions and the widespread use of agency staff in the health service right across the public service. What impact does that have on patient care?

It is important to note that a significant proportion of medical and dental staff, in particular non-consultant hospital doctors, NCHDs, are employed on a training rotation on fixed-term contracts. Most NCHDs are therefore recorded as being temporary employees. In total, approximately 5,000 NCHDs are employed on fixed term or specified purpose contracts or almost 65% of medical and dental employees in whole-time equivalent terms. Nearly 4,000 of the posts are part of a structured training programme. It is a permanent feature of medical employment that a large proportion of staff are on fixed term or specified purpose contracts at any given time. Ireland is no different from many other countries in that respect.

In July 2013 a working group was established, chaired by Professor Brian MacCraith, to carry out a strategic review of medical training and career structures. The group submitted its final report in June. My Department, in conjunction with relevant stakeholders, is pursuing implementation of the recommendations made by the MacCraith group to support NCHD and consultant recruitment and retention.

I wish to clarify those figures. The Minister said 4,000 out of the 6,221 staff on fixed term or specified purpose contracts are in training. Taking out those involved in training, how many of the remaining staff on temporary or specified purpose contracts are agency staff? What amount of money is spent on agency staff and what proportion of the money goes on agency fees, which is a complete waste from the point of view of the health service? Figures recently emerged to suggest that agency doctors can cost hospitals up to €1,000 a day and up to €300,000 a year, a portion of which is taken by the agencies in question, which speaks strongly against the notion that using temporary staff is a cost-saving measure for the State.

With the greatest respect to the Deputy, he is conflating two different issues, namely, agency staff and permanent contracts.

There are 2,600 consultants in the system, 2,200 of whom are permanent staff and 295 dentists, of whom 275 are permanent. The vast majority of consultant and dentist staff are permanent but of the 5,000 non-consultant hospital doctors only 66 are permanent, the reason being that the nature of being a non-consultant hospital doctor is to rotate from job to job every four or six months. It is not a permanent post but rather it is a training post whereby doctors move from hospital to hospital or to a post in the community in order to learn their job. It is only when a doctor has learned the job and earned his or her certificate of training or becomes a specialist, that he or she is appointed to a permanent post.

The situation is different in the case of agency staff. The use of agency staff arises where the hospital is unable to fill a post, either because nobody has applied or else to fill in for maternity leave or sick leave or to fill a vacancy which arises for some other reason. The reason agency costs have risen so high is because it has been so difficult to fill consultant posts on current salaries and to fill NCHD posts in certain remote parts of the country where it is difficult to get doctors to relocate for work.

A detailed breakdown of the expenditure on agency staff is published monthly in the HSE's performance assurance report, PAR, which is available on its website.

I agree that an important aspect is the inability of retaining trained doctors in this country, of which pay may be an element. However, another important element is the working conditions which continue to be fairly horrific, considering it is regarded as a step forward to agree not to have people working more than 24 hour shifts. This illustrates the problems facing them and it is the fundamental problem for the Minister.

I ask if the Minister may be able to shed some light on the other figures. I refer to contracts of indefinite duration in the case of staff employed on a temporary basis but as a result of staying on over a period of time have become, in effect, permanent. The HSE does not provide a breakdown but this is an important figure because those employees are potentially employed on inferior terms and conditions than those permanently employed from the outset. I ask if the Minister can access those figures and provide the House with information about what proportion of those employees classified as permanent are actually on contracts of indefinite duration.

I can provide the Deputy with a detailed breakdown of the figures to the extent that I have them. The information gives a full breakdown of fixed term, part-time and full-time posts. Terms and conditions of employment are also important, as it is not all about money, and these are improving. For example, an NCHD working more than a 24-hour shift is now relatively unusual. The residence at St. James' Hospital where doctors on call used to sleep overnight was demolished a few weeks ago because doctors in that hospital no longer have to sleep overnight. Even though we are not yet in compliance with the working time directive, we are getting closer every year. Pay is important and it is particularly important in the case of consultants. I know the Deputy is a great believer in income equality and that everyone should earn the same. Certainly if his policies were implemented we would have no consultants in this country or very few. That is just one example of where income equality is not always in the public interest.

Like in Cuba which has the highest number of doctors--------

They are working in hotels in Cuba. I have been there.

Hospital Facilities

Finian McGrath


91. Deputy Finian McGrath asked the Minister for Health if he will provide an update on the cystic fibrosis unit in St. Vincent’s Hospital, Dublin; and if he will make a statement on the matter. [42746/14]

I am glad Deputy Paul Murphy made the point about Cuba. It might be worth the Minister of State, Deputy Kathleen Lynch, and the Minister, Deputy Leo Varadkar, visiting Cuba to see the health service at first hand to see how services are delivered even though they do not have the resources and they are still being hammered by the United States, but that is for another debate.

My question is to ask the Minister if he will provide an update on the cystic fibrosis unit in St. Vincent's hospital. I raise this matter in light of the recent weather, the danger of infection and the fact that cystic fibrosis patients face a significant danger of cross-infection when in hospital. I ask the Minister if the service at St. Vincent's hospital is in a position to cope and if the use of individual rooms is working.

St. Vincent’s University Hospital is the designated national adult referral centre for patients with cystic fibrosis and currently provides services for over 300 adult patients. The designated in-patient and day care cystic fibrosis unit in the new seven-storey Nutley wing development at St. Vincent’s University Hospital, became operational during summer 2012 and represents a major improvement in the care of cystic fibrosis patients in Ireland. This unit provides single en-suite rooms, reflecting best practice in terms of infection control. It also provides a dedicated CF day unit, containing offices, treatment rooms, together with ten single day-treatment rooms, each with en-suite sanitary facilities for treating patients with cystic fibrosis.

Given the unique requirements of cystic fibrosis patients, there are specific processes in place at the hospital to manage their treatment and provide optimal care.

Patients with cystic fibrosis who are acutely sick and need admission to hospital are admitted that day. Patients are automatically admitted to single en-suite rooms in St. Christopher’s ward or to the other wards in the new Nutley wing.

On rare occasions when infection control issues preclude admissions to the Nutley wing, patients are admitted to a single room elsewhere in the hospital. The patients are transferred to the Nutley wing once the infection control issues have been resolved.

The HSE has confirmed that the hospital has maintained its commitment to the cystic fibrosis escalation policy and no cystic fibrosis patient has been on a waiting list for a bed. In addition, the HSE, St. Vincent’s University Hospital and Cystic Fibrosis Ireland meet regularly to ensure the system works from a patient’s perspective.

I thank the Minister for his response because it is important we keep an eye on this issue. As the Minister stated, 350 cystic fibrosis patients regularly use the unit. My experience is that the services and individual en suite rooms in the Nutley wing work. Many of us campaigned for them for many years. When the weather or climate changes, or we have an issue with mass infections or various types of flu, there could be a surge in the number of people wishing to use the cystic fibrosis unit at St. Vincent's Hospital. The Minister stated there is no waiting list and I would like him to confirm that when people turn up at St. Vincent's Hospital with cystic fibrosis complications, they do not hang around but immediately obtain a bed. We must be proactive on this issue, especially in light of our climate.

I am informed in the reply there is no waiting list, and since the new unit has opened I have not heard of any case on the waiting list. I am enough months in the job at this stage not necessarily to believe everything I am told, but certainly I have not heard anything to the contrary.

It seems to be the case based on my experience in recent months, but I want to highlight the fact we must be vigilant. It has stabilised and settled down but we must be ready for an influx of people seeking the services at St Vincent's hospital. There should never be a question of a lack of resources or money for these services. Certain issues such as health must come before tax cuts for the well-off. Any country or state which claims to be equitable and humane must put services such as health way ahead of any tax cuts for people with loads of money. Health should always come first.

The Deputy's point about a potential surge is well made. There is always the risk of a surge because of an infectious disease, and the last circumstance one would want is someone who is either immunosuppressed or has cystic fibrosis being mixed in with patients with an infectious disease. It is certainly a valid point on which I concur with the Deputy.

Mental Health Services Funding

Caoimhghín Ó Caoláin


92. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the reason, despite commitments to do so, returning the year on year budgetary provision for the roll-out of community mental health services to that promised in the 2011 programme for Government, did not seek the add-on of the 2014 shortfall of €15 million to the €35 million ring-fenced for 2015 for further advances in the delivery of A Vision for Change; if he will make a commitment to have the 2014 shortfall secured for the 2016 budget provision; and if he will make a statement on the matter. [42757/14]

My question has been somewhat played around with. It should state:

To ask the Minister for Health to explain why his Minister of State, Kathleen Lynch TD, despite her repeated commitments to do so, did not, in fact, at the end of the day, seek the add-on of the €15 million unsecured in the current year to the €35 million to be ring fenced in 2015.

I can read out for the Deputy the exact same answer I gave Deputy Colm Keaveney earlier. I know it is identical because I have read it. I understand what the Deputy is saying and why he is saying it. However, I must say the experience I have gathered over the past year or two has shown me very clearly that trying to put in place the posts for a new service in mental health is quite difficult. The bulk of the posts are in place. Recruitment for the posts approved in 2012 and 2013 is continuing. At the end of September, of the 416 posts approved in 2012, 397.5 have been recruited.

Regarding the 2013 posts, the recruitment process is completed for 370 of these posts and the majority of the remaining posts are expected to be filled by the end of this year or early next year.

In the interests of debate and in order that we all know exactly where we stand, I received a note last week from the national office. We now have a national office for mental health. We have a difficulty in some areas relating to being unable to recruit child and adolescent psychiatrists. Not alone did we go to the market in this country, we also went to England because we heard of an agency there that was having some success in recruiting this very specialised consultant. Having gone and looked, however, we had no success. Not alone did we not have success, a private provider that was offering a salary of €200,000 for an equivalent post did not have success. We have a difficulty in terms of the type of specialist post we are trying to recruit and in terms of changing the service in the dramatic and quick way we are trying to do it. I am very determined that this should happen quickly. We are having a difficulty regarding the posts and that has changed my view over the past year. It is better to try to operate in terms of what we have available and get in as quickly as possible those whom we can recruit.

The only interpretation that can be put on the failure of the Minister of State to seek €15 million that was not provided for this year is that we had nowhere to spend it. We are talking about the implementation of A Vision for Change and we still do not have the model of 24-7 crisis intervention within the specialist mental health services in all parts of the country. Not all services are providing home treatment and there are very few crisis houses to provide alternatives to inpatient beds.

There has also been a large increase in the number of homeless people being admitted to inpatient units. In 2013, 245 people of no fixed abode were admitted to inpatient units, an increase of 40% on 2012. Mental health services in primary care, representing a core aspect of all entailed in A Vision for Change, are simply not able to cope with current demand. The Minister of State in an earlier response referred to the new counselling and primary care service. The HSE has advised us that the waiting list for this new counselling and primary care service is already building up. This service was only initiated nationally in July 2013. As of August, 211 people were waiting between three and six months for an appointment and 70 people had waited more than six months.

I will come back to the Deputy. I call the Minister of State to reply.

A considerable amount could be done with these moneys.

In response to the request that the Government should have made up the €15 million it held back in 2014, my position is that in the circumstances and given the logistical and phasing issues arising from recruitment and properly planned service reconfiguration, it was considered more efficient to restore the annual programme for Government allocation to 2012 and 2013 levels. Coupled with unspent 2014 moneys, this represents a considerable commitment to an increase.

Regarding counselling in primary care, CIPC, because we did not know what the demand or uptake would be or how successful it would be, a waiting list built up. That is why the €35 million in this year's service plan will be directed very clearly towards the primary care setting. I will get the Deputy an entire list of what we have done and what is available in mental health and primary care. There are constant complaints about what we do not have, whereas we have a considerable amount done.

I do not argue there have not been improvements. I am highlighting, as is my role and responsibility, what needs to be done. There is so much in the mental health area and I know the Minister of State is as aware of it as I am.

There can be no way we could fail to utilise that €15 million in the coming year.

I refer to the waiting list for CAMHS. Children continue to be admitted to adult wards with 158 admissions up to the end of June, 53 of whom were placed in adult wards, while in July more than 2,700 children and adolescents were waiting to be seen by CAMHS.

These moneys were pushed into other areas of the health budget in previous years and they could be pushed into other mental health services. If the Minister of State is not adding this money in 2015, whatever value her commitment may have, will she seek and secure it and add it for 2016?

With regard to children being placed in inappropriate places, my research tells me that they are usually aged 16 or 17. I was worried that this involved a younger cohort but, nevertheless, when young people are placed in inappropriate beds on adults wards and beds are available within the CAMHS unit, a question needs to be asked. I have asked that question of those charged with both delivering the service and inspecting it. We need to have a conversation about what is causing the delay and why there are such waiting lists.

We are looking for a child and adolescent psychiatrist but we cannot get one. We have tried not only on these shores, but also abroad. A private service offering much more than we are offering cannot recruit such a psychiatrist. There are difficulties in some areas and we have to recognise this difficulty. I am not certain how to resolve it but we are working on a solution.

Will the Minister of State secure the missing €15 million?

Health Services Provision

Finian McGrath


93. Deputy Finian McGrath asked the Minister for Health his plans to provide a resolution to the issue of patients on trolleys in major hospitals here; and if he will make a statement on the matter. [42747/14]

What are the Minister's plans to provide a resolution to the issue of patients on trolleys in our major hospitals? Since August, despite all the talk, and despite all the PR for the past three years, the number of patients on trolleys has increased by 19%. Nationally, that means the number has increased from 3,913 to 4,648. Will the Minister deal with this scandal of patients being on trolleys for 24 to 36 hours? It is an absolute disgrace. We need action and not more talk or waffle.

The Department and the HSE both believe that trolley waits are an unacceptable feature of the Irish health care system which must be addressed. Figures for 7 November show that compared to the baseline year of 2011, there are 32.3% fewer patients on trolleys, equivalent to 24,851 patients. However compared to 2013, there are 3.1% more patients on trolleys. This is equivalent to 1,559 additional patients. Performance in this area occurs against a background of a population which is experiencing significant ageing with those over 80 years increasing by some 4% annually.

I am advised by the HSE that it is introducing a range of measures to minimise the numbers of patients waiting on trolleys. The special delivery unit is working with hospitals to improve access times to appropriate care and to reduce length of stay for key conditions. New pathways of care continue to be introduced to improve patient flow through hospitals including minor injury, medical assessment and surgical assessment units and specific pathways for frail older people.

This work is supported and facilitated through the clinical programmes and the involvement of senior clinical decision makers at all stages of the patient journey. The special delivery unit is also working with the hospital groups to maximise capacity to accept emergency department patients by ensuring that appropriate activity is performed at each individual site. An in-depth review of individual sites is due to commence within the next month, which should lead to a sustainable improvement.

The Government has also provided additional funding of €25 million in 2015 to address delayed discharges. This funding will be targeted at hospital and community services which can demonstrate initiatives to address specific needs of delayed discharge patients most positively and therefore improve timeliness for admissions from emergency departments and waiting lists.

The Minister referred to sustainable improvement. Currently, there are 700 people fit for discharge in our hospitals and a resolution of that issue would help to alleviate this crisis.

However, the other issue is trolleys being moved up the wards to cover up and massage the figures. That is not acceptable and it is not an example of good practice. Acute hospital beds cost approximately €1,000 each and, therefore, cost effectiveness is an issue in the context of the number of trolleys. The Minister needs to up his game. We need less spin and we need to get people off trolleys and out of our accident and emergency departments. We also need to provide a quality health service, which is the real issue. We have been conned about these figures over the past three and a half years. Deputy Varadkar is the new Minister and he has the opportunity to up his game and deal with the real issues.

I would like to correct one of the Deputy's comments. We are not moving patients on trolleys up the wards to massage the numbers.

That is not what we are told.

It is well known.

Then the Deputies are not being told the truth. I will be happy to inform them if they care to listen.

We move people on trolleys up to the wards to reduce overcrowding in accident and emergency departments but they are counted in the figures. The HSE figures that are produced include people on trolleys on ordinary wards. This is not being done to massage figures because they are in the figures.

If the Minister visits a hospital, there will not be anyone on a trolley. Patients will be moved while he is there. That is what is done when Ministers visit hospitals. The nurses will tell the Minister that, and the same happened with the former Minister. When he visited a hospital, patients on trolleys were moved.

It is being done to get them out of the accident and emergency departments and to reduce overcrowding. I would be happy to give the Deputies more information but they are not interested in knowing the facts and, therefore, I will not bother.

We want a straight answer.