Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Tuesday, 7 Feb 2017

Vol. 937 No. 3

Topical Issue Debate

Hospital Waiting Lists

I thank the Ceann Comhairle for allowing us to raise this issue, which represents a decisive moment for this Dáil and for the health services. How can we accept what we saw on the "RTE Investigates" programme last night? The anger and hurt of the families who featured is repeated in thousands of homes throughout the country. We must take decisive action to address these issues. In that context, I welcome the Minister's commitment to increased financing. However, the reality is that in Ireland, there are three waiting lists in the health service. In Britain, by contrast, there is only one list. In that country, people are assigned to it when their consultant says they require a treatment or procedure, and they go off it once they receive that treatment. That is not what happens in this country, however, and it is unacceptable. As we now know, we have 23,000 people on a pre-admit list, with no monitoring of that list whatsoever.

I have no monopoly on empathy with the families whose plight was highlighted on the "RTE Investigates" programme last night. Collectively, we in this House have an obligation to address the issues with meaningful policies that will impact on people's lives immediately. We need, first, clarity on the issue of the waiting lists, in terms of who knew what, why people were on different lists and whether there was intentional reasoning to keep the list numbers down. The policies of the past six years in terms of shrinking the public hospital system via bed closures and not funding the National Treatment Purchase Fund were only ever going to lead to more people waiting for longer on waiting lists across the acute and elective hospital systems. Will the Minister commit to expanding the role of the National Treatment Purchase Fund by ensuring there is adequate funding in place, more so than just the €15 million we sought last year? Funding must be front-loaded to deal with this chronic problem immediately.

I thank the Minister, Deputy Harris, for coming into the Chamber to respond to this matter. Like the whole nation, I was very moved by last night's programme. I was not, however, shocked by what I saw, because my constituency office is full of files with details of people waiting for operations. The Minister told RTE:

It is principally about the management of resources. It is about the HSE, who are in charge of operations. They are the ones responsible for delivering our health service.

The Minister further stated that where people do not live up to their responsibilities to implement important plans, they will be removed from their roles. Will he tell us who exactly is not living up to his or her responsibilities in this matter? Is it the director general of the HSE? Who does the Minister believe should be removed from their roles given that we have children waiting 18 months and longer whose conditions are deteriorating by the day and who are suffering because they cannot get the treatment they need and deserve?

A Programme for a Partnership Government refers to the Government's efforts to ensure safe, timely care, as close to patients' homes as possible, and undertakes to reduce emergency department overcrowding and address hospital responsiveness to increased demand. As we saw in the programme that aired last night, the Government is struggling to do that. One of the most striking aspects of the report was the remark by a surgeon that if a particular patient is marked as a routine case, he or she will never be seen. Will the Minister give the House an assurance that the Government will use the National Treatment Purchase Fund to address waiting lists in the short to medium term? Will he give specific figures for how much he proposes to invest into the scheme to ease the plight of the people whose stories were so eloquently told on the "RTE Investigates" documentary?

We found out last night that there are two secret waiting lists in the health service. The HSE fiddled the figures and, in so doing, made the official lists look not as bad as they really are. Who benefited from that fiddling? The HSE did and so, too, did the Department of Health. In addition, successive Ministers for Health benefited from the fiddling of the figures, including the current Minister, Deputy Harris. Did the Minister have any idea these secret lists existed and, if not, why not?

I first raised the issue of waiting times for scoliosis patients with the Minister's predecessor in September 2015. Since then, I have raised the matter consistently as the situation worsened to unprecedented levels. The co-founder of one advocacy group, who was featured in last night's RTE programme, told me, "There are children in Ireland who are being left on waiting lists for so long that doctors are travelling abroad to study their condition because their scoliosis has developed to an extent that is not seen in other countries." Doctors are coming from as far away as Africa to examine Irish children whose scoliosis has developed beyond what is seen elsewhere. That tells its own story.

In a response I received to a parliamentary question last week, the Minister stated that the children's hospital group has begun a process of engagement with advocacy groups on developing a partnership approach to the design and planning of services for children with scoliosis. Therefore, the Minister stated, an independent clinical review of scoliosis services is not required at this time. In light of last night's programme, will he now undertake to initiate such a review?

On behalf of Ms Megan Halvey Ryan and her family, I appeal directly to the Minister here in the Chamber to intervene in her case, which was highlighted last night. Megan is 13 and suffers from scoliosis. The curvatures measured 83° on her top curve and 65° on her lower curve. She has a very high degree of rib rotation which means her internal organs are being squashed. Her consultant says she needs surgery immediately and she is still on the waiting list.

Megan cannot attend school. She has problems eating and breathing and this is due to her rib configuration because of the condition. She has poor quality of life. She is on medication to get through the day and to sleep at night.

Two years have passed since Megan's diagnosis and she has been on the waiting list in Crumlin for 18 months. Can the Minister arrange for her to receive the care and the procedure which she needs as soon as possible? Her consultant has requested it from the private sector and the Minister has the wherewithal to arrange it.

I thank the Deputies for raising this important matter and for giving me the opportunity to address Dáil Éireann this afternoon.

One thing the programme last night showed is that I am far from the first Minister for Health to try to address the issue of waiting lists. I recognise it is an issue of great concern to all parties and none in this House and I continue to believe that improving our health service requires an all-party collective effort. However, what the programme last night really brought home is the genuine pain and suffering of patients who are waiting far too long for treatment and the impact this has on their lives and on the lives of their families.

I said I was ashamed. That was not just a word; I meant it. It is simply wrong. How can anyone watching that programme not be ashamed? It is not good enough for me to just be sorry or for me to say we feel ashamed. What are we going to do about it? That is why I began unapologetically targeting resources at the specialties with particularly long waiting lists, such as scoliosis and orthopaedics, and at treating those patients waiting the longest - something that did not always happen.

More that 50 additional children and teenagers with scoliosis were treated with funding made available from the winter initiative but I recognise that this has not been enough for children such as Megan, Kira and Darragh. However, the additional investment achieved progress for those children and young people waiting over 18 months, which is obviously a completely inexcusable length of time for children with this condition to continue to wait. We also made progress on the overall waiting list of over 18 months. This was done in 2016 with limited additional funding and in a limited timeframe. Now, we must do more and I will make sure we do more.

I have just come from a meeting with the CEO of Crumlin children's hospital and the CEO of the Children's Hospital Group and the director of nursing. I am pleased to inform the House that from April, the new theatre built for the purpose of scoliosis will open. This will see 194 spinal procedures carried out in Crumlin - significantly more than last year - and will see significant reductions in waiting lists for scoliosis and waiting times for scoliosis patients. At the end of this month, I will receive from the HSE and the Children's Hospital Group an action plan for scoliosis and I will engage with all parties and none in this House and with advocacy groups in respect of that. In addition, by June we will have an additional orthopaedic post filled within Crumlin.

Therefore, we are responding to what we saw last night, which was unacceptable and needs to be addressed. Everybody in this House highlighted the many issues in the programme last night that need to be addressed. The issue of scoliosis in our children and the length of time they are waiting is not acceptable. That theatre will open in April as a result of the nurse recruitment, an extra orthopaedic post will be in place by June and we will see at least 194 procedures carried out.

In addition, we will have a priority initiative on scoliosis as part of the HSE 2017 waiting list action plan with the aim of every child being treated within the clinical timeframe and if that means outsourcing, that is what we will do as well. We will eliminate the day-case waiting list of over 18 months by the end of June through the NTPF. This will see more than 2,000 patients begin to receive their treatment from March.

The HSE action plan, which I will receive at the end of this month, will work in conjunction with the NTPF to utilise capacity within the private sector and maximise capacity and co-ordination within and between hospital groups to treat the patients waiting the longest. This will be supported by a further €10 million fund for the NTPF.

I expect the action plan combining these measures to be complete by the end of this month and for patients to begin to be treated under it by March.

These measures are to support us moving towards a position where no patient waits for any procedure or any hospital appointment longer than 15 months by the end of October, which still is too long but constitutes progress.

I have also today directed separately that the NTPF will audit the practices in the hospitals highlighted by the individual cases featured in the programme last night. It is important that lessons are learnt and that the NTPF carries out its audit function to see exactly how each of those cases was dealt with in each of the hospitals. The NTPF is already undertaking a review of best international practice on waiting list data publication models and I look forward to that work being concluded.

Let me be clear. When people ask about these waiting lists, this is the waiting list model that has been in place since 2002 under six Ministers for Health and five successive Governments. It did not alter and it did not change. Perhaps I say things are "unacceptable" too much but I say it because I mean it and we will work to fix this.

The Deputies have one minute each.

I welcome the changes the Minister has made. I welcome the proposals on scoliosis. I wait to hear his proposals on the waiting list at Cork University Hospital. I wait to hear his proposals on eye operations, such as for cataracts. I know of a lady aged 90 who is being told she must wait two years before she will get her operation. That is unforgivable and is not acceptable. I accept the Minister's commitment.

While time is short, I note that notwithstanding everything else, Ireland was among the 35 countries that were assessed by the Health Consumer Powerhouse index survey of EU health and was placed 21 out of 35. It has the longest waiting lists in Europe. That is why I say this is a decisive moment. I welcome the Minister's decisive action but he needs to ensure the HSE is accountable and it is not. The HSE is not doing its job. It is getting away with this triple list, which does not make sense. We seek a single list including every patient.

The Minister must get rid of any preordained views he may have on health and the outcomes of the debate on the broader health services. He must invest in the National Treatment Purchase Fund in the short and medium term while we try to expand the capacity in the public hospital system but, more importantly, he must address an issue that is now arising in the public hospital system. Hospital managers and CEOs of hospitals are head-hunting for private patients. Private patients undoubtedly are being put ahead of public patients in public hospitals to fulfil their stretched budgets. That is an issue the Minister must examine thoroughly. I have major concerns that those who have private health insurance and who should be treated in a private facility are now in public hospitals because there is a fee per bed in this regard. That is simply inexcusable. It is wrong morally, ethically and for every other reason. Public hospitals, by and large, should be used for public patients and only if private patients cannot be treated in a private hospital should they be treated in a public hospital. I ask the Minister to visit that issue.

I note the Minister did not answer some of my questions.

I presume the Minister will do so at his next opportunity.

I also humbly suggest that if smaller hospitals were funded, it would help relieve the bigger hospitals' waiting lists. There is a great hospital in my constituency, Bantry General Hospital, and when it was being properly funded it took the pressure off the bigger hospitals in Cork. It helped with endoscopies, with rehabilitation and endocrinology and were it properly funded again, it would ease the lists in the bigger city.

I thank the Minister for his reply and his efforts in this regard. It is not only about spinal issues and I would not like to see the Minister's replies limited to that. I am familiar with, and raised with the Minister, the issue of tonsillectomy queues of young children waiting for ages.

One of my colleagues adverted to the necessity for clinical judgment to be in play here. I wonder how many cases that a consultant takes on privately are routine or acute. In other words, I mean where a consultant would sit by and watch acute patients suffer in the public system while dealing and treating with routine cases in the private system.

When will operating theatres be open at weekends? A spinal surgeon who was featured in the documentary last night is willing to work at weekends but finds it extremely difficult to make that happen in Tallaght hospital. That is merely one of the issues.

A final question to ask of the Minister, because we are so restricted in time, concerns the major investment hospitals such as Tallaght need. In respect of these three waiting lists, were the results of the documentary last night news to the Minister?

The Minister did not respond about the independent clinical review. That was sought by the advocacy group and by professional people. Would having that independent review not help? I welcome that the new facility in Crumlin will be commissioned shortly, but I understand that another theatre will be closed when it comes on stream. Will closing that be an advantage? I am told by the advocacy group that one facility will replace the other, although the new one is welcomed. Hiring theatre nurses is the most important aspect of this matter. The facility is already in place but will there be nurses and back-up teams for it? That is very important. How many theatre nurses will be hired by July this year? That is the date the Minister has given for opening this theatre facility.

The Minister read from a prepared script and did not answer the questions. Did the Minister know about these secret waiting lists? If he did not, why not? How much of the delay in access to treatment for public patients is due to private patients being taken ahead of them? Is it the case that if one cannot pay one suffers, even if one is a child and that if one can pay one can go ahead even if one has less medical need? How can any health service and Minister for Health stand over that? Given that, is it not time for a well resourced, single tier health service in this country? Does the Minister not believe that the time has come for an Irish national health service?

I will focus my comments on the case of Megan Halvey Ryan. Other Members have raised broader issues. Can the Minister give me a commitment as to when Megan Halvey Ryan will receive the procedure she needs? Will it be done through the public or private sector or through the NTPF system? Many of the people who participated in the "RTE Investigates" programme last night subsequently received their treatments and procedures. That is not the case with Megan Halvey Ryan, whom I know as she is from Limerick. I am making the case for her to the Minister now and I would appreciate if the Minister would reply today or write to me as soon as possible to let me know exactly when she will receive her much needed procedure.

I will respond first to Deputy Niall Collins. I will ask the CEO of the children's hospital group to revert to the Deputy directly about Megan's situation, because she would be better placed than me to do so. I will arrange for that to happen.

I agree with Deputy Murphy O'Mahony about utilising our smaller hospitals. That is the reason I said earlier that part of the HSE's plan for this year must be about hospital groups. Where some of our larger, level four hospitals are busy there is no reason that there cannot be more elective procedures carried out in the others. I expect that to be a feature of the HSE's waiting list action plan, which we will publish at the end of the month.

With regard to issues such as cataract procedures, raised by Deputy O'Dowd, these are part of the more than 2,000 day case procedures that will be carried out with €5 million of funding from the NTPF. That will start in March. The Deputy is correct with regard to CUMH. I spoke about this yesterday on the Claire Byrne programme. I am concerned about what has happened in CUMH and I have asked the new clinical director of maternity services to report to me on that matter.

I intend to publish an action plan for scoliosis and I will take what Deputy Aylward said on board in that context. The plan for scoliosis will take on board the concerns of the advocacy groups and will dramatically reduce waiting times and waiting lists for scoliosis treatment for children and teenagers in this country. That is what we all wish to do and I will make sure we do it. If that involves outsourcing, we will do that also.

I have asked the NTPF to audit the practices in each of the hospitals featured in the "RTE Investigates" programme. I have asked it to use its audit function and check exactly how the waiting list procedure was dealt with and if everything was done correctly. We saw one case where there was a clinical note and the child did not go on a waiting list for a period of eight months. What happened there is not acceptable. I look forward to the results of the NTPF audit, which today I directed it to undertake.

Deputy Murphy O'Mahony spoke about performance and accountability. I believe managers must be accountable. I am the Minister for Health, so I set policy and provide funding. Then I expect our managers to get on with doing the job. I have written to the director general to ask how each of the managers across the health service measure up in respect of performance and accountability not just on the financial side, which they are good at measuring, but also with regard to access to services.

To respond to Deputy Mick Barry about the lists, this is the same way the NTPF has calculated the list since it was set up in 2002 by the then Minister. There is nothing new here. Did I know, and did many Members of the House who have been talking about health for a long time know, that when people have their procedures and an appointment for a procedure they do not appear on the waiting list? I did. Did I know the size of that? I did not. Did I know there was a specific other list? I did not. However, I am concerned about the people who do not have appointments for hospitals and who clinically need procedures and about getting that done as quickly as possible. We are going to make serious inroads and, in response to Deputy Lahart, I did not mean to talk about scoliosis alone. Across a range of issues we will utilise the NTPF and the capacity in our public hospitals. We will hold our managers to account. I hope we will work in a cross-party way to address these serious issues.

I should point out to Deputies that, on foot of the proposal made by Deputy Martin and others this morning, the Business Committee is proposing to hold a special debate on Thursday morning on these matters which will be more extensive.

Autism Support Services

I thank the Minister of State for giving me the opportunity to raise this matter. I am speaking on behalf of the Maher family in south Kilkenny. Their son has autism and for the duration of his life the family has fought for any services they have received for him, be they educational or health. The family has always had to fight long and hard battles to get anything for him. I commend them. I have much respect and admiration for them because they have had a very hard battle.

Their son is now 16 years old and when I say the family is at a crisis point I do not do so lightly. This is not something I would have considered raising as a Topical Issue if it were not important to do so. Their son is no longer in school. When this matter came to a head the family was promised 36 hours of home support by the HSE. A behavioural therapist visited their home and it was a very positive intervention. They were very happy with it and felt it would result in many improvements for their son, with a positive knock-on effect on the rest of the family. However, without explanation or consultation, the hours were cut to ten and the behavioural therapist was not seen again in the home. The hours were increased to 15 two weeks ago, but that is still less than half the number the family were promised. The boy is unable to be in school which is detrimental not only from an educational point of view but also from a social point of view and all that is associated with being a teenager in school. He has already been denied that, so it is rather disgraceful that it is proposed to deny him the home support hours.

I have the family's permission to raise this matter. The boy's father is a paramedic and he has had to take indefinite leave from his job to help his wife in the home each day. This will have a negative impact on the family from a financial perspective. They will end up needing a great deal more support down the line if no intervention is made now. They need the 36 hours of home support. It is not a huge amount to seek, given everything else they have gone through. The hours were agreed and decided, so obviously they were considered necessary. The family also needs the behavioural therapist to come to the home to carry out his work, as agreed.

I ask the Minister to intervene and ensure the family gets this support. I also ask him to meet with the family to hear directly from them about their experiences. They represent not only themselves but many families in Carlow-Kilkenny who have had difficulties. There appears to be a difficulty with services for people with autism in the constituency. The family will be delighted to travel to Dublin to meet the Minister of State. I ask him to facilitate that visit and also to intervene and ensure they get the 36 hours of home support and the behavioural therapist visits they badly need for their son.

I thank Deputy Funchion for raising the important issue of home support hours for people with disabilities. I will take this opportunity to outline the current situation with this matter.

I assure the Deputy of the Government's commitment to providing services and supports to people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. The commitment is outlined in A Programme for a Partnership Government. It is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.

One way the HSE is working to improving the quality of life for people with disabilities is through the provision of home support hours. In the HSE’s National Service Plan 2016, the priority was to provide 2.6 million home support hours to more than 7,300 people with a disability. The actual number of home support hours provided in 2016 was higher, at 2.9 million hours. This reflects the responsive nature of the service and takes account of the fluctuation of assessed need over time, as the needs of individual people change. This is particularly relevant in the Deputy's case.

This year the Health Service Executive is committed to maximising the provision of health and personal social services, including home support services, within available resources. In its National Service Plan 2017, the HSE expects to deliver 2.75 million home support hours to more than 7,400 people with a disability. This is an increase of 150,000 hours more than the last year’s target. The goal is to help as many people as we can. This is a positive development, which I hope we can build on in years to come.

The Deputy has raised the matter of an individual case and the home support hours which are being provided to that person. I am reluctant to speak in any great detail about the specifics of any one case. This is especially true when it comes to speaking on the floor of the Dáil. However, given that the Deputy has permission from the family, it is fine by me. I have made inquiries about the case and I understand the HSE is engaging closely with the family involved.

Due to the specific nature of the needs of the person in question, it was agreed to introduce home supports on a gradual basis. Initially, the person is receiving home support at a ratio of two staff working with the person with a disability for ten hours. Given that there are two staff involved, this equates to 20 hours of home support. The hope is to increase this gradually to 15 hours, or 30 hours when we take the two staff into account. The HSE has informed me that the family is aware that the service will be closely monitored and reviewed by relevant professionals, in consultation with the individual, his parents and a family advocate. I will meet the family and will arrange it through the Deputy any time over the next few weeks. Parents of autistic children and teenagers have to be a major priority in the delivery of services.

I thank the Minister of State and I welcome the fact he will meet the family. It is a positive development. I would have a different understanding on the HSE's engaging closely with the family and the service being provided on a gradual basis. The ten hours of home support is in place for a year. How gradual is it? Will they have to wait another year for the hours to increase? I take exception to the issue of the two staff. There is possibly a need for two staff and I have no difficulty with it. However, the family should not be classed as having 20 hours because two staff are there. The two people are in the home for only ten or 15 hours and it is an unfair calculation on the part of the HSE.

I welcome that the Minister of State is willing to meet the family and maybe we can discuss it further at that stage. Although I would be reluctant to raise something like this as a Topical Issue matter, it is important and sometimes it is the best way to highlight the situation on behalf of the family and many others in my constituency who suffer as a result of a lack of support services for children, particularly teenagers who have autism. It can be very difficult when a person reaches the teenage years and is in that in-between stage between child and adult. I will follow it up with the Minister of State.

I will take up with the HSE again directly the issues the Deputy raised. They are very important. I will ensure the Carlow-Kilkenny disability services will continue to engage with the family on an ongoing basis regarding their son. An inter-agency and interdisciplinary case review was held on 25 January when health professionals recommended that, given the person's situation, it would be appropriate to introduce home community support for him on a phased basis. The home support services started on 30 January, one week ago. Further meetings will take place as determined by the individual's needs and will involve relevant inter-agency and professionals, the family and their advocate. The HSE has also advised the family that it is available to collaborate with the relevant professionals in the Department of Education and Skills. This is important.

I was directly involved in the negotiations regarding the HSE social care plan and I saw the gap there. The Deputy probably noticed that in the plan, funding for personal assistant, PA, hours has increased for 2017. In 2017, we expect to deliver 1.4 million PA hours to 2,357 adults with physical or sensory disabilities. This is an increase of 100,000 hours compared with 2016. When dealing with individuals and huge sums of money, we must ensure the service is delivered, in this case, to the particular young person with the intellectual disability. These are issues I want to hear about from the Deputy and the family at our meeting in the coming weeks.

The Minister of State's response suggested two staff were working with the person for ten hours. Were those two people working simultaneously with the person for the ten hours?

The question could be interpreted as giving people to believe there were 20 hours of support. Therefore, I would be concerned at the nature of the response. I am sure it is not yours.

I take the Ceann Comhairle's views on board. I already told the Deputy I would raise the issue with the HSE. I take the Ceann Comhairle's point. It is an important issue.

Thank you. It is much appreciated.

Money Advice and Budgeting Service Administration

I sincerely thank the Ceann Comhairle for selecting this important issue for discussion. I wish to share time with Deputy Martin Kenny, who also has a keen interest in the issue. In 2009, when the Citizens Information Board took over responsibility for the Money Advice & Budgeting Service, MABS, offices from the Department of Social Protection, unequivocal commitments were given that MABS would be a separate and distinct service within the Citizens Information Board. MABS companies were to remain independent with their own voluntary boards of management providing crucial local services.

The proposed restructuring of the local confederation of MABS towards a regional set-up, which would involve six to eight regional offices being established, would be a retrograde step and should be rejected outright. There are 51 MABS companies with 43 Citizens Information services all operating efficiently and effectively at the coalface, dealing with individuals and families who come with the full spectrum of problems and difficulties, especially mortgage issues.

I do not accept the excuse put forward for restructuring, namely, the difficulty of managing the 94 boards. The Citizens Information Board employs 74 staff and regularly uses consultants when required. I recall that originally only four staff were dealing with MABS when it was established by the Department of Social Welfare, as the Ceann Comhairle will probably recall himself. I have no doubt the employees and voluntary boards of management are prepared to play a constructive role in addressing any issues the Minister or Citizens Information Board has about their operations. However, nobody has spoken directly to them in this regard. Last week, the Minister of State told Deputy Martin Kenny there would be no change in the provision of front-line services.

Why are six to eight regional companies being established and how much will they cost? It would be interesting to cost them against the voluntary boards whose members come from various voluntary, State and semi-State organisations, bringing great experience. Some of them are retired and giving their time and effort voluntarily. What would be the management cost of the new regional companies and who would supervise the allocation process? The essence of MABS is about direct access at local levels to the communities it serves. Managing remotely has its own difficulties, hurdles and perspectives.

I thank the Deputy and I appreciate the time he has given to me. Tomorrow, a group is coming from the MABS organisations throughout the country to do a presentation on this in the audio-visual room. There are 51 boards, each of which is independent and managed by local people from the Society of St. Vincent de Paul, the Garda Síochána, the Department of Social Protection and various agencies and organisations in the communities where they exist. They have local knowledge and input and they give their time freely to manage the organisations. The system works perfectly and without a hitch, and has done since the establishment of the MABS organisations.

The MABS companies have an excellent model for value for money. The spend 80% of their funds on the salaries of the people who provide the front-line services. The other 20% goes to rent the offices and pay overheads.

It is absolutely perfect and it works well with no issues. The situation is that a group in the Citizens Information Board, CIB, wants to regionalise the set-up of existing services, assigning them to eight different regions, and employ a manager to run each agency in each region. I fear it is intended to privatise the service, like Seetec which provides services through JobPath and which has turned into a total disaster for the public. We do not want to let this service go down that road.

The Minister needs to issue a policy directive to the CIB under section 9 of the Citizens Information Act 2007 not to regionalise these boards. It was done before in 2009 by a previous Minister and it can be done again. This issue can be resolved. There is a perfect system working well, providing a good service and which is not broken. There is no reason to change it. The only reason seems to be that some people in the Civil Service have decided they would like to have regional organisations and structures, set up boards and get money for running up and down the country for different meetings. The reality is that the system is working and we do not want it changed. People are getting an excellent service. The only problem is that there are not enough advisers from the Money Advice & Budgeting Service, MABS, on the ground. That is what needs to change. It is not about putting more money into providing managers to run a system which is not broken.

I know the Minister of State will have a reply from someone in the Civil Service, telling him to read out the answer. We are not interested in that answer. We are interested in a bit of common sense being applied. Even after being in the Government for only nine months, the Minister of State still has a bit of common sense left which I hope can be magnified today and a solution can be provided.

The Minister of State has a great amount of common sense.

We better not tell that to the other Minister, Deputy Shane Ross.

We can leave Lord Ross out of it.

I thank Deputies Penrose and Martin Kenny for their words. I hope we have a bit of common sense when we deal with this particular issue. I am taking this matter for the Minister for Social Protection, Deputy Varadkar, who apologises that he cannot be here.

The CIB, which receives Exchequer funding from the Department of Social Protection, is responsible for supporting the provision of information, advice, including money and budgeting advice, and advocacy on a wide range of public and social services. The CIB delivers on its legislative remit through direct provision of information services and by supporting a network of delivery partners including the local Citizens Information Service, CIS, and MABS.

One of the strategic priorities for the CIB, as articulated in its strategic plan 2015 to 2018, is “to revise the structures of CIS and MABS to better serve the citizen by improving management structures and governance, managing of resources and the delivery of high quality services”. The existing network comprises 93 independent local companies, 42 CIS companies and 51 MABS companies, each with its own legal responsibility to provide services within their defined catchment area. These 93 companies have 93 individual boards, with an average of 9.2 people serving on each board. This results in a governance structure of more than 800 people for an organisation of approximately 2,800 people. Maintaining this company structure across each of these local boards consumes valuable administrative resources within the network that could otherwise be directed towards service delivery to citizens.

Small services have similar structures to larger services, with each service performing its own company administration, financial administration and reporting, including reporting to the CIB. Consolidation of board structures would reduce duplication, deliver administrative efficiencies and free up resources for more front-line activities. In turn, this would improve the service-user experience, allow for the development of specialist roles as required and achieve an improved consistency in service delivery across the network. A more streamlined service delivery partner model would also assist CIB in the fulfilment of its statutory obligations, help to promote awareness of the wide range of services and supports available to citizens on behalf of Government. In so doing, it would further raise the profile of both MABS and the CIS.

The CIB’s role in the development, operational management and oversight of the current network of individual companies requires significant administrative effort. Its many responsibilities include oversight of accounts and operations of all service delivery partner companies in keeping with good accounting practices and the implementation of recommendations from the Office of the Comptroller and Auditor General; compliance with the code of practice for the governance of State bodies; ensuring optimal access for citizens countrywide to the full range of CIS and MABS services; and the delivery of consistency of services in terms of quality and timeliness on a nationwide basis.

Since the circulation to all CIS and MABS services in September 2014 of a feasibility study commissioned by the board of the CIB on a proposed restructure of these services, there has been extensive and continued consultation with all stakeholders about what the future structural model would look like. To progress this work further, the board of the CIB recently established a restructuring sub-committee, which comprises several CIB board members, a number of staff of the CIB, and representatives of CIS and MABS services.

I thank the Minister of State for his reply. I have spoken to several personnel involved and all they have heard are these global assertions and utterances that the current situation and structures need to be reformed from a governance viewpoint. Where is the empirical evidence to sustain this? I note the review group is all made up of the CIB. That is like going to law with the devil and the court is held in hell. It is the CIB which wants to emasculate the existing structure. The Minister of State does not need to tell me about the 2,800 staff. They are not costing a tosser as they are free. This is all nonsense.

When we were in government, we made a bags of doing away with town councils. I accept there were some councils where one got elected with only 40 or 50 votes. However, we rushed to regionalise town councils which represented 4,000 people and in the process destroyed local government. I admit we did not keep our eye on that ball. This is the same. I have my eye on this ball, however, and I am not going to allow the same mistake happen. Once bitten, twice shy. I am very shy about this matter. It is a nonsense. I know those involved in the services in Longford and Westmeath and one could not get them for love or money. They are providing a service for nothing.

Section 9 of the Citizens Information Act 2007 gives the Minister a bit of power. It is great to have a little bit of power sometimes because it allows the Minister to tell bureaucrats to back off. I am a great believer in that. The Minister should just tell the mandarins and bureaucrats to settle down. This service is operating well and the structures should be left intact. The Minister should speak to the people involved directly. They will be prepared to accommodate change which is positive and for the benefit of the end users, such as those in mortgage difficulties and in the Abhaile programme. The Minister cannot travel down this road. We have travelled them enough already.

I take Deputy Penrose’s point about the town councils. It was a bad decision at the time.

The restructuring sub-committee is expected to report its findings on the optimal regional structure for CIS and MABS companies to the board of the CIB shortly. It is important to remember that the planned restructuring of services is at local company board level only.

I will bring the Deputies’ concerns about section 9 of the Citizens Information Act 2007 and the restructuring of the organisations to the attention of the Minister for Social Protection.