Dáil Éireann díospóireacht -
Wednesday, 13 May 2015

Vol. 878 No. 2

Leaders' Questions

Deputy Micheál Martin

First, I raise the matter of the death of a baby in Cavan General Hospital which was reported this morning. I extend my sincere sympathy to the family involved and hope the review under way will get to the truth of what happened and bring clarity to the matter for them. I raise this matter in the context of the fact that two infants died in the same hospital in 2014 and another in November 2012. Last May the then Minister for Health, Deputy James Reilly, announced in a press release that he would instruct HIQA to review and pay particular attention to maternity services at Cavan General Hospital and said the use of an external agency was essential to bring objectivity to the review. However, it now appears that no formal order was made to instruct HIQA to investigate the unit and no review was carried out. Will the Taoiseach explain why that is the case?

In its report on Portlaoise hospital HIQA stated in its recommendation:

The Department of Health must now develop a national maternity services strategy for Ireland, as specified in recommendation N7 of the Authority's October 2013 Investigation into the safety, quality and standards of services provided by the Health Service Executive to patients, including pregnant women at risk of clinical deterioration, including those provided in University Hospital Galway, and reflected in the care and treatment provided to Savita Halappanaver.

The report the Minister received on 7 April on Portlaoise hospital goes on to state the development of this strategy does not appear to have progressed substantially in the intervening period and that as a result of the investigation, the investigators believe such a strategy must be supported by a nationally mandated maternity care service. Will the Taoiseach tell us what is happening? A year ago the Minister announced that HIQA would investigate maternity services at Cavan General Hospital but no order was issued to HIQA and nothing happened. Over two years ago, following Savita Halappanaver's untimely death, a national maternity strategy was ordered but nothing happened until HIQA's report landed on the desk of the Minister two weeks ago. Two weeks later a steering group was announced. This raises a fundamental question. At the highest level, arising from HIQA's investigations, the Department and the Government were asked to conduct a national review of the safety of maternity services but that did not happen. Will the Taoiseach explain why that is the case?

The Taoiseach

First, it is my duty, with everybody else, to sympathise following the latest personal tragedy involving the death of a baby at Cavan General Hospital yesterday evening. I sympathise with the parents of the dead baby. This is the fourth baby to die at Cavan General Hospital in the past few years and clearly it is traumatic. The HSE is investigating the background and cause of this death and I do not wish to comment further until the facts about what happened are known.

HIQA's report on Portlaoise hospital has implications for maternity services throughout the country. With regard to Cavan General Hospital, I understand that, following the death of the third baby in May 2014, the then Minister for Health, Deputy James Reilly, wrote to HIQA on 14 May, requesting it to prioritise the monitoring of the maternity unit at Cavan General Hospital against the national standards to ensure safer and better health care, as part of the overall response to the Chief Medical Officer's report on maternity services in Portlaoise. HIQA subsequently sought a detailed report on the three cases involved and it was provided by the HSE.

In recognition of the wider implications of the national issues in maternity services highlighted in the Chief Medical Officer's report and as reflected in the terms of reference for the investigation at Portlaoise hospital, HIQA has started a focused programme of monitoring of compliance against the national standards to ensure safer and better health care across maternity services nationally. The programme includes the maternity services provided at Cavan General Hospital. That work has started and will be completed by the end of the year. Today representatives of HIQA are attending the Joint Committee on Health and Children, where I am sure this matter will be discussed in further detail by the representatives.

Because of his concerns about maternity services, the Minister for Health, Deputy Leo Varadkar, who is in Portlaoise General Hospital today to meet the bereaved parents of the babies who lost their lives and staff has decided to establish a national women's and infants' health programme to address and improve maternity services across the country. The programme will provide for a cross-sectoral framework for governance, integration and leadership to drive reform and standardise health care services across the 19 maternity units in the country.

Deputy Micheál Martin

It is clear that the then Minister did not order a probe as such at Cavan General Hospital. The Taoiseach used the phrase to "prioritise monitoring" at Cavan General Hospital, but the press announcement at the time indicated that the then Minister had ordered HIQA to probe the death of the baby at the hospital.

On the national maternity services strategy, in 2013 HIQA conducted a major report on the Savita Halappanaver case. As the Taoiseach will recall, it was a major issue at the time and there was huge controversy surrounding the case. It was clear back then that there was a need for a national maternity strategy to be developed. We then had the inquiry in Portlaoise by HIQA and one of its conclusions was that the Minister and the Department of Health had not followed through on a key recommendation made in the Savita Halappanaver inquiry. HIQA's report on Portlaoise hospital went on to state it had found the fact that it had not happened unacceptable, indicating: "The Authority considers the delay in developing and publishing a national maternity strategy unacceptable." The report was published in April, after the report on Portlaoise hospital.

Some say it is a scandal that no action followed the Savita Halappanaver inquiry.

The e-mail from which I quoted yesterday from the national incident management team stated there were numerous sad and serious cases in all sites across the country. Was Cavan one of those sites? It seems people at the higher levels of the Department of Health, the Government and the HSE were all aware that there were serious safety issues. The same applies to the case of Savita Halappanavar but, for some reason, for two years inactivity seems to have been the order of the day in establishing the national review. Why was it not established after the 2013 report?

The Taoiseach

My understanding is that the Minister wrote to HIQA on 14 May requesting that the authority prioritise the monitoring of the maternity unit in Cavan against the national standards for safe and better health care as part of the overall response to the chief medical officer's report into Portlaoise maternity services. HIQA includes Cavan in its response and as part of a national analysis of the standards that apply in the 19 maternity units around the country.

The Deputy recalls the tragedy of Mrs. Halappanavar and the number of reports that were produced following her death in Galway. The HIQA report on Portlaoise was damning in its findings and it is the first time management has been the subject of a report on its competence, or incompetence as the case may be. That report, with its eight recommendations for both the Department of Health and the HSE, has been accepted in full by both bodies and will be implemented in full. In fact the work has already started.

Deputy Micheál Martin

In 2013 HIQA said there should be a national strategy.

The Taoiseach

The opportunity will arise today, at the Oireachtas committee hearing which HIQA will attend, to deal with matters arising in the report.

Deputy Micheál Martin

It said it should happen in 2013. The Portlaoise inquiry stated it was unacceptable. Why did it not happen?

An Ceann Comhairle

We are over time and Deputy Adams and other speakers are waiting. I ask the Deputy to allow the Taoiseach to finish.

The Taoiseach

We need to focus on maternity services so that every expectant mother can look forward to giving birth in a maternity unit where the highest standards apply.

Deputy Mattie McGrath

Bring in the Minister.

The Taoiseach

I do not have the medical details of the tragedy in Cavan last night or what was the cause of the death of the little baby but I assume the investigation currently ongoing will bring it to light very quickly.

Deputy Gerry Adams

What we need to discuss today is why the HSE and the Department of Health have not acted on recommendations made by regulatory bodies such as HIQA.

The tragic death of a baby in Cavan General Hospital raises further concerns about maternity services but I do not want to make any judgment about this tragedy because I do not know what happened. I extend my sympathy to the parents of the child, the family and others who have suffered such dreadful loss. This news comes on the back of last week's publication of the HIQA report on the safety of services in the Midland Regional Hospital. I ask the Taoiseach to listen to this quotation from the report: "HIQA found that the hospital was not governed, resourced or equipped to provide 24-hour, 7-day acute surgery, accident and emergency and maternity services". The national incident management team has also said that it is aware of other "numerous sad and serious cases at all HSE sites". HIQA goes on to make the point that if the findings of previous HIQA recommendations had been implemented the risks to patients would have been vastly reduced. This is not the first time that HIQA has made this point. It made the point directly with the HSE and with the Department of Health.

I have raised this matter many times with the Taoiseach in this Chamber and I have given him a letter from HIQA enumerating its concerns. The charge from HIQA and the NIMT could not be more serious. The harsh reality is that these recommendations are being continuously ignored and have been ignored for a long time by the HSE and the Department of Health. That is the nub of this problem.

Does the Taoiseach accept that the HSE is obliged to take prompt action to implement recommendations made by regulatory bodies such as HIQA? If so, why did it not do this? Does he accept also that this is the explicit responsibility of the Department of Health and the Minister for Health? Can he explain why the HSE, the Department of Health and the Minister failed to act on these recommendations? There is bound to be an explanation. Could the Dáil and the public be given it?

The Taoiseach

I accept that the imperative now is to implement the recommendations arising from the HIQA report into the situation at Portlaoise. They have been accepted by the Department of Health and the HSE and will have implications for other hospitals in terms of demonstrating that the standards of competence and service available in the 19 maternity units around the country are of the highest order.

The decision made by the Government to transfer the health Vote into the Department of Health, so that the Minister is responsible and accountable, gives a much greater opportunity to determine where moneys are spent to ensure the adequacy of staffing and resources. The grouping of hospitals is also much better than having individual hospital entities around the country competing, as they did for so many years, for their own set of services and having to make their case each year. The fact that difficult choices were not faced up to for very many years has led to a range of services that, in some cases, have proven not to be of the highest standard. When Professor O'Higgins proposed centres of excellence for cancer a great deal of anxiety was expressed and there were public marches on the proposal. However those people, particularly women and families, who have had the traumatic experience of having to go to a centre of excellence for cancer treatment have found that outcomes are much more specific and relevant and it has proven that the decision to put the patient at the centre of the strategy was right. It means a lot to women who have gone through the trauma of breast cancer to see the capacity in a centre of excellence for the highest level of expertise and treatment.

The Deputy also said nothing had happened in respect of Portlaoise. On Leaders' Questions yesterday I dealt with the measures put in place in Portlaoise in the past 12 months, such as the new management and the memorandum of understanding signed with the Coombe Women and Infants University Hospital. Portlaoise is now part of the midlands strategy in terms of maternity services and is linked with the Coombe. An equality and patient safety position for maternity services has been filled, risk management has been strengthened, there are 16 additional midwives in place and a director of midwifery has been appointed. As I said yesterday, the recommendations of the recent HIQA report are all accepted. The training that was put in place had a full attendance from midwifery staff.

As I said, the Minister for Health, Deputy Varadkar, is in Portlaoise today meeting the parents who have lost babies so tragically and also the hospital personnel. The bluntness of the HIQA report brings into stark focus the inadequacies of a system that has grown over the years and that must be adjusted so that people can feel comfortable and happy that our maternity units have the safest standards possible for expectant mothers to give birth to their babies.

Deputy Gerry Adams

I hope the steps the Minister is taking regarding Portlaoise hospital are adequate and I wish him well. However, the Taoiseach has avoided my question.

Deputy Finian McGrath

Surprise, surprise.

Deputy Gerry Adams

The Portlaoise report was not the first time we heard about these issues. My question was why the recommendations were not acted on. This is too serious an issue for us to play politics with. What is the point of HIQA? The Taoiseach may claim he did not know about the recommendations. I walked across the Chamber and handed him a letter from HIQA which detailed the recommendations it made in the Tallaght report. It made other recommendations regarding the Savita Halappanavar case, and they were not acted on. The Taoiseach has said the Government will act on them. We are being told the problems are being found in other hospitals, including Cavan General Hospital. Contrary to the Taoiseach's response to the earlier question about the Minister for Health and an investigation, although last May the Minister said he wanted a HIQA investigation into Cavan hospital in addition to the investigation into Portlaoise hospital that was ongoing, he never formally ordered the investigation and therefore there was no review. Why was there no review? Why did the Minister not act on his public statement and follow through, as was his responsibility?

I constantly make the case here that the Government's austerity policies are decimating the health services. Now, we can see the outworking of the dysfunctional approach which does not see health as a public service and an entitlement of citizens. One example is the fact that an extra 600 midwives are required and that the number of midwives available to pregnant women is dangerously low. How many more damning HIQA reports will be ignored? When will the Government publish legislation to extend the remit of HIQA, as the Minister promised? Will the Taoiseach take the opportunity to reassure people? People know the recommendations were not acted on. It is always better to give people what the Taoiseach has mentioned many times, namely, clarity and information. Will the Taoiseach take the opportunity to explain why the Minister, Department and HSE failed to implement HIQA's recommendations? None of the Ministers for Health involved in any of the HIQA reports disagreed with the recommendations. They all said they would act on them. However, they did not. The Dáil and the citizens, particularly pregnant women, deserve an explanation.

The Taoiseach

They do deserve an explanation. As I pointed out, many actions have been taken in Portlaoise. It is not good enough that for 50 years we have relied on reports that follow tragic incidents in hospitals, taken some actions to address the findings and moved on. The point of HIQA is that it is an independent authority that can walk into a hospital and analyse, investigate and assess any sector or service. The Minister is entitled to request that HIQA produce a report and he wrote to HIQA on 14 May 2014 requesting that it examine the maternity unit in Cavan hospital. HIQA has moved to carry out an analysis of all the maternity units in the country, including Cavan.

Deputy Finian McGrath

Will the Government act on it?

Deputy Micheál Martin

What about HIQA's 2013 report?

Deputy Finian McGrath

We will have more analysis.

The Taoiseach

Arising from the latest HIQA report on Portlaoise, there are eight clear recommendations, including to establish an independent patient advocacy service; ensure the recommendations of this and previous HIQA reports are implemented; develop a national maternity strategy; expedite the necessary legal framework for hospital groups to perform their governance and assurance functions; and four more recommendations for the HSE, including the appointment of a director of midwifery in all maternity units.

Deputy Micheál Martin

The Government ignored the last set of recommendations.

The Taoiseach

A director of midwifery has been appointed for Portlaoise hospital. The report is stark and disturbing and the recommendations are not only accepted, but will be implemented in full.

Deputy Finian McGrath

It is like the planning.

The Taoiseach

The eight babies who have passed on should have this legacy, which has been driven by the persistence of their parents.

Deputy Paul Murphy

Irish Water has issued almost 1 million bills, 592,000 of which have passed their pay-by dates. How many water bills have been paid? What is the rate of payment and non-payment? I suspect there is much more non-payment than the Government hoped. Otherwise, the Taoiseach would be shouting from the roof-tops that people were accepting the charges and we would not be faced with the bogeyman of legislation that is always just around the corner but never arrives. On 3 February, the Taoiseach told the Dáil that the legislation would be ready in the next couple of weeks. More than a couple of weeks later, on 25 March, he told the Dáil it would be introduced in a few weeks' time. A few weeks have passed, and yesterday, he told the Dáil it would be enacted before the House rises in July. At this rate, Godot himself may ramble by before any legislation comes before the House. Is the delay deliberate? Is it part of a dishonest plan designed to scare people and cynically timed to happen at the same time as the bills are dropping into letter-boxes? Is it intended to create the impression that it will enable Irish Water to reach into people's wages, benefits or pensions and deduct water charges, ably assisted by sections of the media?

The impression is untrue. It is clear the Irish Water cannot and will not be given any such power. According to the Law Reform Commission report, Irish Water is a company; it is not the Revenue Commissioners. It would have to go to court to seek attachment orders. We have been here before. In the 1990s, people were taken to court for non-payment of water charges and were threatened with disconnection. There were protests at the courts, which were clogged with non-payers. It proved seriously politically embarrassing for the then Government, which did not break mass non-payment, and the water charges were abolished. Court action cannot break mass non-payment now either. The Courts Service has said it would not be able to deal with the excessive burden. Perhaps this is the explanation for the haste with which Denis O'Brien got down to the courts before they clog up with water charges protesters. It would be political suicide to pursue court cases before a general election. The situation remains exactly as before, with no penalties for non-payment until July 2016, after the general election. Mass non-payment can sink the water charges. What are the figures? How many people have paid and how many have not? What are the rates?

The Taoiseach

The Deputy's speech is no different from the ones he has made before. He knows as well as I do that if he wants this detailed information, Irish Water will supply it to him. The Deputy said that in the 1990s people were threatened with disconnection. The Government has listened very carefully to the genuine concerns of people all over the country and has legislated for the fact that there will be no cut-off of water supply.

As I said the other day, the Government is moving to a much broader, more comprehensive and fairer system of dealing with civil debt, arising from the work done by the Law Reform Commission several years ago, in which people will not be sent to jail and the Victorian era will be said goodbye to in that regard.

The charge is now €1.50 per week for a single person and €3 a week for a household of two or more persons.

Deputy Peadar Tóibín

For now. That is the introductory charge.

Deputy Finian McGrath

What about the property tax?

The Taoiseach

Those who register will be entitled to a support of €100 assistance towards that from the Department of Social Protection.

For this modest contribution, people will receive a high-quality water supply which one would expect in a country as developed and developing as ours in 2015. We cannot go on with a system where thousands of people have had boil water notices for years, a grossly inferior wastewater and sewage treatment systems in so many towns and where 50% of the water supply, for which people have contributed over the years, leaks away into the ground. That is why it is necessary Irish Water is a separate entity, to be able to borrow on the markets to invest to fix those leaks and to provide water and sewerage systems right across the country that will bring us to the point of competency in service and standard that we should have been at for so many years.

If one looks at the record, we have had an investment of €300 million over the years which is 50% of what we should have been able to invest. We cannot do that, given the scale of the finances of the country. That is why it is necessary that Irish water be established. It is also finding out through its metering programme the scale of loss of water over the past 50 years which was scandalous. The opportunity now presents itself to bring our country’s water and wastewater systems, as well as its sewage treatment plants to the highest international standards. I am sure Irish Water will be happy to supply the Deputy with the details of bills that have been issued and paid.

Deputy Paul Murphy

I asked a very simple question.

Deputy Simon Harris

The Deputy asked the wrong question.

Deputy Paul Murphy

It was about the rate of payment. The Taoiseach’s answer is to go and ask Irish Water as if it has nothing to do with the Government. The Taoiseach was not shy in boasting about puffed-up and bloated Irish Water registration figures where the same people were responsible for them.

Deputy Finian McGrath

Remember that carefully.

Deputy Paul Murphy

It is a bit like “Blue Peter”. Earlier, we prepared in advance and asked Irish Water what the levels of payment were. It said it would not give us those figures as it regards the levels of payment and the number of people who have paid now to be statistically insignificant. That means 500,000 bills and 500,000 people are somehow statistically insignificant. Opinion polls are done with a sample of only 1,000 people.

Deputy Finian McGrath

More porkies.

Deputy Paul Murphy

Does the Taoiseach not know what the rate of payments is? Has Irish Water not informed him? Will he find that information and give it to the House?

Will the Taoiseach confirm that the legislation will require court cases? Will he allay the scaremongering in which he has been deliberately engaged, suggesting that Irish Water will be able to take them?

We have had court cases before about disconnections. The Taoiseach was a Deputy then, supporting the Government parties when people were dragged to court. This was met with protests and the then Government could not break non-payment. The same will happen here. People will have enough reasons after seven years of non-payment.

An Ceann Comhairle

Has the Deputy got a question?

Deputy Paul Murphy

Will the Taoiseach give us the figures? Will he confirm that he is talking about court cases rather than direct deductions, in other words, that Irish Water will not be able to directly deduct? Is he seriously considering any court cases in advance of the general election? If so, does he have clear prospects lined up?

Deputy Simon Harris

Deputy Paul Murphy is obsessed by this.

The Taoiseach

I know Deputy Paul Murphy is elected by the people and good luck to him. Sometimes, however, he feels he is Julius Caesar and that he can dictate whatever he wants to do himself. I am not going to spoon-feed Deputy Paul Murphy.

Deputy Micheál Martin

In fairness, Julius Caesar was a bit more sophisticated than that.

Deputy Timmy Dooley

Et tu, Blueshirt?

The Taoiseach

I advise him to toddle along to the audio-visual room at 4 p.m. today where Irish Water will give him the answers to any questions he wishes to ask.

Deputy Paul Murphy

When we asked Irish Water, it said it would not give us the information.

Deputy Paul Kehoe

He can have a protest outside the audio-visual room.

The Taoiseach

That is open to every Deputy, including Deputy Paul Murphy. He can go and ask Irish Water instead of expecting me to spoon-feed him.

With respect to the legislation, the Government expects to have legislated for this before the end of this session. The matter will be discussed here and in the committee rooms as one would expect. No doubt, Deputy Paul Murphy will be fully entitled to contribute with his constructive suggestions to that debate. I look forward to hearing him and his understanding of how important it is that we have a proper water supply for people and for business, as well as proper wastewater treatment plants across the country. He should go along at 4 p.m. and participate in the democratic presentation that will be there for him. When the Bill comes into the House, I look forward to his constructive suggestions.

Deputy Ruth Coppinger

What is the point of Leaders' Question then?

The Taoiseach

To tell you where to go.

(Interruptions).

Deputy Róisín Shortall

Will the Taoiseach repeat what he just said?

Deputies

He should withdraw that.

Deputy Róisín Shortall

Will the Taoiseach repeat what he just said? A Cheann Comhairle, on a point of order. The Taoiseach has brought the House into disrepute with that comment. I ask that he withdraw it.

The Taoiseach

What comment?

Deputy Róisín Shortall

Every Member of this House has a mandate and a right to be treated with respect.

Deputy Micheál Martin

It is bringing the House into disrepute. The Taoiseach said the purpose of Leaders’ Questions was to tell the Deputy where to go. He should withdraw it.

The Taoiseach

Yes, I said the Deputy can go to the audio-visual room at 4 p.m. to hear Irish Water.

(Interruptions).

Deputy Róisín Shortall

That is not what the Taoiseach said.

An Ceann Comhairle

Will you resume your seat Deputy? You are out of order.

Deputy Micheál Martin

Julius Caesar had many rights.

Deputy Róisín Shortall

A Cheann Comhairle, you have a responsibility to-----

An Ceann Comhairle

Will you resume your seat Deputy? You are out of order. It was Deputy Paul Murphy’s question.

Deputy Róisín Shortall

-----to protect the rights of Members of this House. The Taoiseach should not have made that comment to the Deputy.

(Interruptions).

An Ceann Comhairle

Will you resume your seat Deputy? You are heading for more trouble now. Are you looking to get thrown out again?

Deputy Micheál Martin

The Taoiseach should withdraw his comment.

(Interruptions).

Deputy Ruth Coppinger

A Cheann Comhairle, you have been quick enough in the past to berate us for making comments and asking us to withdraw them.

An Ceann Comhairle

Resume your seat.

Deputy Ruth Coppinger

Could the Taoiseach repeat the comment and withdraw it?

Sitting suspended at 12.38 p.m. and resumed at 12.48 p.m.