Billy Kelleher
Ceist:2. Deputy Billy Kelleher asked the Minister for Health his plans to review the ownership and governance of hospitals; and if he will make a statement on the matter. [21080/17]
Priority Questions
Hospitals Patronage
I ask the Minister for Health if he has any plans to review the ownership and governance of hospitals and whether he will make a statement on the matter. Since I tabled the question, he said we should embark on a national conversation about ownership and divestment of health facilities to the State. Will he elaborate on where he sees that conversation going?
I thank Deputy Kelleher for the question. As the Deputy is aware and will appreciate, voluntary and non-statutory providers, including religious bodies, have historically played an important role in the provision of health and social services in Ireland. It is fair to say the current arrangements have grown out of a complicated past. Policy must reflect current realities as well as available options over the medium term. The recent debate surrounding the location of the National Maternity Hospital has generated increased discussion of issues of ownership and governance in our health services, and in particular our hospitals.
I am anxious not to delay the long overdue National Maternity Hospital project while this wider conversation is taking place, and that is why I have set out a process I would like to follow that is separate and distinct for the National Maternity Hospital in order to tease out the important issues that the public has expressed concern about in recent days and weeks. It is important to note that over the years not only has the role of religious personnel in the day-to-day operation of hospitals reduced but in some cases there has been a transfer of ownership to the State. Examples include the transfer Our Lady of Lourdes Hospital, Drogheda, to the then North Eastern Health Board. Other voluntary or charitable hospitals have closed, such as Hume Street Hospital, or have been subject to mergers into newly created public bodies, such as Jervis Street and the Richmond into Beaumont Hospital. Therefore, evolution is not new and change has also taken place across the wider health service in areas such as nursing homes and disability centres.
A number of our largest and most developed acute hospitals are voluntary hospitals. In contrast with health board or Health Service Executive, HSE, hospitals they have evolved governance structures with significant non-executive involvement. It is important in looking to the future that such strengths are recognised. It is also the case that in recent years, the nature of the relationship between voluntary organisations and the State has been clarified in a number of ways. The HSE operates a governance framework that governs grant funding provided to all non-statutory service providers and provides for detailed service level agreements. In the voluntary sector, it is required practice for public capital investment to be accompanied by a lien that protects the State's interest. All public hospitals are regulated by HIQA and are subject to national clinical standards and guidelines. Moreover, as part of the establishment of hospital groups, voluntary hospitals have been required to plan and deliver services in a manner that integrates service provision with HSE-owned hospitals in the region.
It is long overdue for us to try to structure this conversation about the direction people would like to take. We have seen similar conversations taking place with education. I am interested in the Deputy's view and I suggest to the House that we could benefit from such a conversation.
I thank the Minister. There is a Private Members' motion to be discussed tonight in that context and we can elaborate on it then. Much focus over the past fortnight has been on the ownership of St. Vincent's University Hospital but we are ignoring the fact that the National Maternity Hospital is a voluntary hospital in itself. The Coombe, which is intending to transfer to St. James's Hospital, is also a voluntary hospital, as is the Rotunda, which is going to Connolly Hospital. The three maternity hospitals in Dublin are voluntary hospitals as well. This leads to the greater question in the context of the establishment of hospital groups and the statutory provision of underpinning them with boards. Where will the voluntary governance structure fit into the new hospital groupings if we are to continue with the proposals that the Government has announced on having a hospital group with a governing board overseeing it? Reference has been made to the National Maternity Hospital and the controversy that has flowed from that. It concentrates the mind to a certain extent that we can no longer ignore the fact that voluntary hospitals in the main are largely funded by the State and contracted to provide services to the State. The issue of divesting and ownership are key matters that can no longer be delayed or obfuscated for much longer.
I largely agree with the Deputy. In the coming weeks I intend to go to Cabinet with proposals to put in place a process and structure to have this conversation. I am open to ideas from Opposition parties but I suggest that the forum on pluralism and patronage undertaken by the Department of Education and Skills in 2012 is a model that can work quite well. There would be a degree of public consultation and the input of clinicians. The Deputy's point is important as many of our hospitals are voluntary and many clinicians highlight the benefits of the voluntary system, preferring that system to working in a hospital that is fully owned and funded by the HSE.
It is important to say that of the 49 hospitals we have in this country, 15 are voluntary, with two having joint boards and 32 being statutory. We speak of voluntary hospitals and joint boards in a big discussion but they include Beaumont, the Rotunda, the Coombe, St. James's, Tallaght, Cappagh, Holles Street, the Mater, the Royal Victoria Eye and Ear Hospital, St. Vincent's University Hospital, St. Michael's Hospital, the Mercy University Hospital in the Deputy's county, South Infirmary-Victoria University Hospital, Our Lady's Children's Hospital, Temple Street and the National Children's Hospital at Tallaght. The Deputy is not trying to reduce the conversation to a simple matter but anybody doing so is missing the point that we have a rich tapestry in terms of how our health service is run and governed. It is high time we had a debate on whether there are better ways to do this and what direction people want to take. We should not ignore that all the hospitals I mentioned are either voluntary or have a joint board. They provide very important services.
The conversation has started and minds have certainly been concentrated in the past number of weeks. The Minister indicated that many of the hospitals are voluntary or have other forms of governance. In the conversation that must take place about divestment or ceding of ownership, we should be conscious of the fact that we cannot pass Bills of attainder and seize hospitals. We must do what is available to us in law and right for the health services. It should be done in broad discussions with the voluntary boards to see how the State can best involve itself in the context of capital investments put into these hospitals, as well as the day-to-day management and oversight of those hospitals.
That must be reflected, in view of the fact we will end up with hospital groups with a board, and there must be streamlined accountability and governance structures in place. Having a great deal of voluntary input could create difficulties, so we must have that discussion to ensure there is seamless governance of the hospital groups with all hospitals involved.
That is right. We will also have to be very much aware of the financial implications of this.
That should be an important part of the discussion. If it is the will of the people in this country that we should embark on divestment and purchasing sites and hospitals, it means we are suggesting that we use part of the finite health budget to buy hospital facilities that are currently available to us and providing a service. Perhaps that is the direction we need to take, but we must have that conversation. The Deputy is entirely correct that it must be in discussion with the voluntary hospitals. Some political parties in the House have suggested that I should, as it were, sneak in and seize hospitals from voluntary groups in the middle of the night. There are laws and a Constitution in this country so we must have a conversation, just as we have done in education. If we have that conversation I believe the health service can benefit and we can ensure that we keep the best parts of the tapestry. Some of the hospitals I have listed on the record of the House have very fine traditions of providing an excellent health service to the people of this country. However, as we move forward and invest in and build new hospitals, the point I have heard clearly from the Irish people is that they have strong views on the type of governance structure we should have in place in those new hospitals.
Home Help Service
Louise O'Reilly
Ceist:3. Deputy Louise O'Reilly asked the Minister for Health if his attention has been drawn to a restriction on not-for-profit home helps providing additional services to clients over and above that allocated by the HSE; the reason these restrictions are in place, especially when those vulnerable persons in receipt of care may not be getting sufficient hours from the HSE; if there is a plan in place to bridge the services that these restrictions have impacted on in view of the fact that supply is not meeting demand; and if he will make a statement on the matter. [20882/17]
This question is quite simple. In an ideal world, all home help hours should be provided directly by the State. However, since the State is not doing that, the question relates to the not-for-profit service providers and the restriction arbitrarily imposed on them from providing additional hours where demand clearly exists.
Home care services are critical to support older people to stay in their own homes and communities, to prevent early admission to long-term residential care and to support people to return to their homes following an acute hospital admission. These services may be delivered directly by HSE staff or indirectly through not-for-profit and private providers contracted by the HSE.
In 2012 as part of a quality improvement programme the HSE introduced a tendering process for new home care packages sourced from private and not-for-profit providers. This process was most recently repeated in 2016.
I understand that some not-for-profit providers who are funded by the HSE to provide mainstream or core home help services were operating a limited service for clients who wished to pay for additional hours. This approach appears to have happened in a small number of cases but it was raised with the HSE in the context of a legal challenge by a group of 42 private providers in respect of the planned 2014 tender for enhanced home care. The not-for-profit providers referred to in the legal challenge were almost wholly funded by the HSE at that time, and continue to be significantly funded by HSE to provide home help services. In circumstances where a client-funded element of service was developing, concern was expressed that such arrangements may constitute cross-subsidisation or could amount to state aid.
Agreement was subsequently reached between the HSE and representatives of the private providers. Under that agreement and to avoid any doubt, the HSE made it clear that the type of arrangement I described earlier was not acceptable to the executive and was to cease. If a not-for-profit provider wishes to develop the private element of its business, in the same way as a commercial entity, it may withdraw from HSE-funded home help arrangements. This is not an issue of the State not wishing to provide support or help, but a legal issue to which we must adhere.
It is not a legal issue at all, but I wish to see the detail of the agreement reached between the HSE and the for-profit providers. We are talking about global, multinational corporations. They are people who are in the business of making a huge amount of money. The Minister of State will be aware of my views on the private sector in health care. I see the Minister nodding beside the Minister of State. He is well aware of them. However, these people make huge profits that fund big offices, branded cars and the like. The small, not-for-profit providers are effectively being locked out of this market. If somebody has an elderly relative who is receiving their home help from a small, not-for-profit provider but they wish to get an additional amount, which the State should be providing but is not, they must give money to a global corporation or a multinational company for it. It does not make sense.
Will the Minister of State publish the details of the agreement between the HSE and the private providers? Every penny that goes to the not-for-profit providers is put directly into service provision. In the case of private providers and the big global multinationals, we are giving taxpayers' money to fund their offices, corporations, backroom operations and so forth. It is not good value for money.
We wish to ensure home care is affordable for everybody. Not-for-profit organisations are not restricted, but under the current framework they must adhere to the same regulations. I understand that some of the groups might like to develop a private element of their business. They will be able to do so next year. However, based on a legal challenge that took place and a possible legal challenge in the future, we cannot have a situation where an organisation receives a block grant of funding from the State and then provides private care on that basis. What we must ensure, and we are working on this, is that we can provide a proper framework and a proper statutory home care scheme that will be affordable, accessible to everybody, sustainable for the State and that will provide choice and certainty for people into the future. Again, this is not about not wanting to provide affordable home care or about protecting private enterprise. It is the situation in which we found ourselves. I believe the only way we can rectify it is by providing a statutory framework, and we are working on that. The Health Research Board, HRB, report was published two weeks ago. We will be opening a public consultation to ensure that every group, be it statutory or non-statutory, public or private, will have its say on what that framework should be.
The providers do not get a block grant. They are funded on a per-hours basis. The Minister of State knows that. Saying they get a block grant is an attempt to make it sound as if they are part of the HSE or the Department of Health, which they clearly are not. The Minister of State knows they are not. Will she publish the details of the agreement that was reached between the Department and these global multinational corporations? With respect, the Minister of State is driving the small providers out of business. We should be encouraging these people. They respect the rate for the job, do not drive down conditions and are trying their best to be decent employers, yet here they are fighting with the Department of Health and the HSE and effectively being closed out of the market. Will the Minister of State publish the details of the arrangement she has reached with these global multinational corporations, which effectively excludes not-for-profit providers? The not-for-profit providers respect the rate for the job and put all the money into service provision, whereas others fund the global corporations that are offering services at present. It might interest the Minister of State to know that this is not a case of value for money. They charge up to €44 per hour, while the not-for-profit providers do not charge anywhere near that.
To ensure the Deputy is not under any illusion, we are not trying to protect private business here. We are trying to ensure there is a fair system. The system currently in place means we cannot provide a block grant. Most of the not-for-profit organisations receive a significant amount of their funding from the HSE. They provide an excellent service and I am not saying otherwise. They provide a service where there is a gap. However, the framework currently in place means we must have a fair system. We are working on the development of a new statutory home-care scheme, which is how we will deal many of the issues that are arising at present. I will be happy to meet with the Deputy to discuss the arrangements and the talks that have taken place with regard to the private and not-for-profit organisations.
Will the Minister of State answer my specific question? Will she publish the details?
I cannot answer that now. I will meet with the Deputy to discuss it.
Mental Health Services Provision
James Browne
Ceist:4. Deputy James Browne asked the Minister for Health the action being taken on the ongoing difficulties in the provision of CAMH services; and if he will make a statement on the matter. [21081/17]
What action is being taken on the ongoing difficulties in the provision of child and adolescent mental health services?
In line with the programme for Government, I remain firmly committed to developing all aspects of our mental health services, including child and adolescent mental health services, CAMHS. Additional funding in budget 2017 has resulted in an overall provision of €853 million for all HSE mental health services. The HSE service plan for 2017 prioritises improvement of all aspects of CAMHS, including the development of early intervention counselling and prevention services in primary care to reduce pressures on CAMHS and improvements to specialist CAMHS community-based and acute inpatient care.
CAMH services have benefited from the significant additional investment in mental health in recent years, although these services face particular challenges in recruiting and retaining staff. The HSE is addressing this on an ongoing basis.
The HSE is also giving priority to reducing CAMHS waiting lists, especially for those waiting over 12 months. This is dependent on the availability of key clinicians within teams, in particular CAMHS consultant psychiatrists. We know that within mental health services, in particular CAMHS, there is a high turnover of staff. This is something with which we are trying to deal. It can be a very challenging but rewarding environment.
Additional resources have assisted in supporting 67 CAMHS teams and three paediatric liaison teams. I agree with the Deputy that we need to increase the number of people working in these teams. There are also 66 CAMHS inpatient beds in operation nationally. A new standard operating procedure, introduced in June 2015, has also provided greater clarity and consistency on how the service is delivered. Despite increasing demands overall on CAMHS, irrespective of the source of referrals, individual cases professionally assessed as requiring urgent access to services receive priority. Further acute inpatient beds will also come onstream as staffing levels increase.
The HSE service plan for this year provides for better out-of-hours liaison and seven-day response cover in CAMHS, against a background where the population of children is expected to increase by 8,500 in 2016-17. Around 18,500 children will attend the HSE CAMHS this year, including around 14,000 referrals. Detailed activity data for CAMHS, published in the HSE monthly performance reports, indicate that 68% of children referred are seen within a 12-week period.
Additional information not given on the floor of the House.
As primary care services are usually the first point of contact for children and adolescents when problems initially present, those with mild to moderate presentations are seen by psychologists in the service, unless there is a significant risk of harm, a rapid deterioration or a crisis which requires a specialist response. In order to develop early intervention services for those under 18 years of age, €5 million has been allocated to include the recruitment of 114 assistant psychologists in primary care. These posts have been sanctioned for recruitment. Despite the challenges outlined, I am satisfied that significant efforts are under way to develop all aspects of CAMHS. I am continually liaising with the HSE on the implementation of its service plan priorities for this service.
Recently released figures show that 82 posts are vacant in CAMHS, including consultants and clinical nurse specialists. The scale of the vacancies is frightening. Essential consultant, psychologist, nurse and social work posts have not been filled. About one in eight positions is vacant. The situation is made worse by the fact that the Government continues to fail and fall short of what is required under A Vision for Change. The figures show that CAMHS is clearly struggling, with only half of the required staff in place to provide a full service. Successive Ministers have promised to prioritise mental health services, but the reality is that the area continues to be a blind spot for the Department of Health. There have been recent staff shortages which have resulted in the cancellation of services in Cork, as highlighted by Deputies Billy Kelleher and Micheál Martin. This is reflected across the country, including in my county of Wexford.
The Deputy is aware that the issue is not funding; rather, it is the recruitment of staff. As primary care services are usually the first point of contact for children and adolescents when problems initially present, those with mild to moderate presentations are seen by psychologists in the service, unless there is a significant risk of harm, a rapid deterioration or a crisis which requires a specialist response. In order to develop early intervention services for those aged under 18 years, €5 million has been allocated, to include the recruitment of 114 assistant psychologists in primary care. They have been sanctioned and are being hired. Despite the challenges outlined, I am satisfied that significant efforts are under way to develop all aspects of CAMHS. I am continuing to work with the HSE on its implementation. The recruitment of psychologists will be key in reducing waiting lists for child and adolescent services. Many children who have been referred to CAMHS services do not need to be there. Services are for those with a moderate to severe mental illness. We know that when we can provide a level of support within the community at a much earlier stage, young children are less likely to be referred. It is not just about the recruitment of key posts such as consultant psychologists. Assistant psychologist posts will also play a key role in addressing the problem we are discussing.
I thank the Minister of State. I heard what she said, but I have to question whether the matter is being dealt with with the urgency and imagination required. The National Treatment Purchase Fund was in place under previous Fianna Fáil-led Governments. Would it be appropriate to consider using it to deal with mental health services until such time as they are brought up to speed and proper services are put in place? I refer, in particular, to psychologists. Parents are deeply concerned. Over 50% of all mental health issues manifest before children reach the age of 14 years. The longer they go without proper assessments the longer they will go without treatment and the greater the consequences for them, their families and society as a whole. I ask the Minister of State to consider alternative options in order to recruit the necessary staff.
I agree with the Deputy that mental health problems arise at a much younger stage. That is why we are introducing a well-being programme in secondary schools and supports are being provided at a much younger age in primary schools.
The Deputy referred to clinical consultant posts. Recruitment to fill such posts is especially difficult. There is a shortage not just in Ireland but also throughout the world. We are working on hiring staff, in particular given the high turnover. We will increase the number of nurse training places in colleges by almost 45% in the next three years. We are increasing wages and restoring community allowances. We are working with the unions and front-line staff to make mental health services a place where they want to work. We are also investing in infrastructure to make sure the surroundings in which staff are working are appropriate. A lot of work is ongoing. As I said, the issue is not about funding; rather, it is about the recruitment of staff. We are doing everything we can in that regard. I will, of course, keep in touch with the Deputy on developments.
National Maternity Hospital
Bríd Smith
Ceist:5. Deputy Bríd Smith asked the Minister for Health the way in which the agreement with a religious order (details supplied) for the running of the new National Maternity Hospital will ensure women will have access to all services and operations, including abortion, in the future; and if he will make a statement on the matter. [20883/17]
I was fascinated listening to the conversation between the Minister for Health and Deputy Billy Kelleher. I regard it as a conversation because there was a lot of agreement. I think I counted the number of times they both used the phrase "Conversation has to be had". A conversation has to be had. The Minister needs to have a very loud, honest and public conversation with the people and explain to them why he has an agreement with a religious order to run the new National Maternity Hospital and will allow it ownership of the hospital. Some €300 million of our money is to be used to build the hospital. I ask the Minister to outline how he can justify this and ensure it will provide proper facilities to ensure women's health in the future, including abortion.
I welcome the Deputy's agreement that it is important that we have a conversation on future ownership and governance of the health service. It would be both very important and timely. In fact, it is overdue. Let us remember and recall how we arrived at this point in the case of the National Maternity Hospital.
Following extensive mediation discussions, agreement was reached late last year between the St. Vincent's Healthcare Group, a very important teaching acute adult hospital, and the National Maternity Hospital on the relocation of the maternity hospital to the Elm Park campus. The terms of the agreement which have been published in full provide for the establishment of a new company, The National Maternity Hospital at Elm Park DAC, limited by shares.
The new company will have clinical and operational, as well as financial and budgetary, independence in the provision of maternity, gynaecological and neonatal services. This independence will be assured by the reserved powers which are set out in the agreement and copperfastened by the golden share which will be held by the Minister for Health of the day. The reserved powers can only be amended with the unanimous written approval of the directors and the approval of the Minister for Health. This is a greater level of input than the Minister for Health has today in some maternity hospitals.
The agreement ensures a full range of health services will be available at the new National Maternity Hospital without religious, ethnic or other distinction. In that regard, I welcome the further confirmation by the board of the St. Vincent’s Healthcare Group that any medical procedure which is in accordance with the laws of the land will be carried out at the new hospital.
Now that the planning application for the development has been submitted, we must turn our focus to the legal mechanisms necessary to complete the project. The hospital will be publicly funded, built on lands in the ownership of St.Vincent’s University Hospital and operated by the new company. In the next few weeks I intend to meet representatives of both hospitals and will further consider the legal mechanisms necessary to absolutely protect the State's considerable investment in the hospital, including the ownership of the new facility. I have indicated that, prior to the HSE entering into any construction contract, I will formally sanction the necessary arrangements to ensure the facilities will be legally secured on an ongoing basis for the delivery of publicly funded maternity, gynaecological and neonatal services. Over the years we have made a significant capital investment in voluntary hospitals and such facilities have always continued to be used for the delivery of publicly funded health care as intended, including Holles Street hospital.
Additional information not given on the floor of the House.
I intend to report to the Government on the project at the end of May. At that stage I expect to have further details of the legal and other arrangements envisaged and will make this information available publicly. This will allow for the necessary clarity well in advance of contractual or other commitments being entered into in respect of the project.
I reaffirm my commitment to this hugely important project. The facilities at Holles Street are no longer fit for purpose. It is also acknowledged that for optimal clinical outcomes, maternity services should be co-located with adult acute services. We need to move on with the project and provide women and infants with modern health-care facilities. I look forward to working with all stakeholders to deliver the new state-of-the-art facility.
The question the Minister asked, namely, how we had arrived at this point, is poignant. We arrived in the middle of the discussion with most of the country up in arms. Within five days 100,000 people had signed an online petition calling on the Minister not to do this. Why did they do it? I have a letter, a copy of which I understand the Minister has received. It gives a very compelling example of why we have to ensure the Sisters of Charity will have nothing whatsoever to do with the running of the new National Maternity Hospital. It points out that only last month St. Vincent's University Hospital told a woman to contact the National Maternity Hospital at Holles Street because it would not provide the procedure of tubal ligation. For those who do not know, tubal ligation is a surgical procedure of sterilisation in which a woman's fallopian tubes are clamped to stop her becoming pregnant.
This very basic, longstanding service is denied to women by the board of St. Vincent's University Hospital. How, in the name of God, is it going to deal with issues like IVF and termination of pregnancy in whatever circumstances as well as the question of sexual reassignment, which is one to which the Minister's Department is committed?
It is important to note that the arrangements in respect of this new hospital were published by my Department on 24 November 2016 of last year. The statement of 24 November covered all of these issues, including the ownership of the company, clinical independence and the composition of the board. As such, that information was first put in the public domain on 24 November which is a point it is important to make.
I want to be crystal clear about this. The hospital will have full clinical independence. I intend to ensure that clinical independence is further underpinned in legal arrangements. The Deputy does not need to take only my word for it. The Master of the National Maternity Hospital, Holles Street, Dr. Rhona Mahony, has made it very clear. Every single service available in the National Maternity Hospital, Holles Street, will be available in the new national maternity hospital, including, if the people of this country decide to change the law, any services which could then be provided which are not legally permitted now. Many people asked whether Holles Street would be able to comply with the Protection of Life During Pregnancy Act. I was in the House at the time when that was debated. The question was asked whether voluntary hospitals would comply and they have complied. This hospital will have full clinical independence, which is in black and white in the agreement. I will underpin that further in legal agreements. Let us take the next month to get this absolutely right.
I do not understand this business of the next month and I do not think anyone else does either. On Sunday, there will be another major demonstration from 2 p.m. at Parnell Square, organised by Parents for Choice, to ensure that we try to get it through to the Minister and the rest of the Cabinet that they do not get where the rest of the country is at. The vast majority wants to move to a situation where we can separate the church from the State. That is clear. It is about the fundamental democratic structure under which we should live in 2017. It will not happen overnight and we have no intention of seizing hospitals under the noses of those who run them; hospitals which, by and large, we own and which the Minister listed. We have no intention of sneaking in during the night to undermine people who provide services. However, as with the prayer debate we had last night, we should go forward on a different footing and start by pronouncing that the brand new, state-of-the-art national maternity hospital which is urgently needed and which will cost the taxpayer €300 million is not going to be subject in any way to the input and control of the Catholic Church. In particular, I refer to a discredited order like the Sisters of Charity. Can the Minister guarantee that?
No matter how often I say it, the Deputy will never be convinced or accept it because she wants to be in the politics of protest while I want to be involved in the politics of solutions.
The Minister is not saying it.
The people of this country want a new national maternity hospital which they need and deserve. If the Deputy does not believe me, she should go down to the hospital and speak to those who deliver services.
I have just said that.
Fine. She has said that.
We do not want a church-controlled one.
No, no.
That is fine. The Deputy has said that and no matter how often she says it is church-controlled, it will not be. We have heard the public's concerns and I want to use the next month to further engage with the hospitals, which is the appropriate thing to do. It is what a politician does when he or she listens to public concern. I will further engage on the issues, including the issue of ownership. However, some of the things the Deputy has said are factually incorrect. She presents them as fact but it is not true. She says the new hospital is going to cost the State €300 million. Has she considered what the proceeds from the sale of Holles Street will contribute towards that cost?
I am not worried about the cost.
Has she considered the fact that the National Maternity Hospital at Holles Street today is a voluntary hospital and not a HSE-owned one? This hospital will have full clinical independence and provide every service a women needs. Dr. Rhona Mahony and Professor Declan Keane have said it. Many doctors have said it. It will be robust in its clinical, budgetary and financial independence. We are going to get it right. What we are not going to do is fail to build it, because we need this hospital.
Has the Minister listened to the Bishop of Elphin?
Do not mind the Bishop of Elphin. Can we get on? We want to hear from Deputy Pringle.
I do not answer to the Bishop of Elphin.
That is good.
Please, Deputies.
I apologise.
Hospital Consultant Recruitment
Thomas Pringle
Ceist:6. Deputy Thomas Pringle asked the Minister for Health if he will address the ongoing delays in the approval for the appointment of consultants at Letterkenny University Hospital including a second breast cancer surgeon and an endocrinologist; and if he will make a statement on the matter. [20881/17]
My question relates to the recruitment of specialists at Letterkenny University Hospital, including a second breast cancer surgeon, an endocrinologist and all of the ancillary staff.
I thank Deputy Pringle for asking this important question. Letterkenny University Hospital provides essential and high-quality hospital care to patients in the north-west. I assure the Deputy of the continued commitment to develop services at the hospital as evidenced by the significant number of completed and ongoing capital projects there. In addition, Letterkenny has been leading the way nationally in developing cross-Border services for cardiac and cancer patients. I was delighted to visit Altnagelvin recently with the Northern Ireland health Minister to see first hand that cross-Border work. The breast cancer service at Letterkenny operates as a satellite centre of University Hospital Galway and is run by a consultant who also undertakes general surgery. It is augmented by visiting Galway-based and locum consultants. Efforts are being made to recruit a full-time locum consultant surgeon to address current service demands.
As the Deputy may know, I met recently with cancer support groups from the area and I thank them for their engagement. The national cancer control programme, my Department and the Saolta group are actively engaged in ensuring that quality breast cancer services are available. Consideration continues to be given to longer-term measures to meet future service requirements, including consultant and other staffing issues. The diabetes service at the hospital is led by a consultant endocrinologist supported by a locum consultant general physician who has a diabetic interest. Additional clinics are being provided in order to address diabetes waiting lists. The Saolta group advises that an application for a second consultant endocrinologist is currently being completed by the HSE medical directorate with hospital management. It will then be submitted to the consultant appointments advisory committee for approval. New consultant surgeons specialising in colorectal and general surgery and a consultant anaesthetist have been recently recruited and a number of consultant posts are currently undergoing recruitment processes. The hospital continues to innovate in its recruitment practices. I thank the hospital and acknowledge its work in that regard.
In my recent engagement in March with cancer support and lobby groups in Donegal, I agreed along with the national cancer control programme that there was a case for exploring possible options for co-operation with Altnagelvin on breast cancer services. It was agreed to hold a meeting in the coming weeks in Letterkenny involving Saolta, the national cancer control programme, Oireachtas Members from Donegal, Donegal Action for Cancer Care and Co-operating for Cancer Care NorthWest. I look forward to the outcome of that.
The Minister referred to the recruitment of a full-time locum; namely a breast cancer surgeon. Is that what he said?
That is the endocrinologist.
That is okay. I wanted to clarify it. There have been numerous meetings and the Department has been good at facilitating the cancer groups in Donegal in that regard. However, meetings seem to be all we have had. In January 2016, it was announced that a second breast cancer surgeon had been approved for Letterkenny University Hospital and that recruitment would start immediately, but it is now May 2017 with no sign of him or her coming. At one stage last year, there was only one general surgeon in Letterkenny Hospital. That was the cancer surgeon who also does general surgery, as the Minister said. When a surgeon was recruited, two days of surgery were provided in the period of three months in the hospital. This is the kind of thing that is going on. While it is good that meetings are happening, we are not seeing any progress outside of the meetings. Nothing is happening.
The Saolta group has been preparing the business case for the recruitment of an endocrinologist for over two years at this stage. We are still no further on. It is impossible to escape the point that while words are being said, nothing is happening. I wonder if the creation of the Saolta group means services are being concentrated in Galway and that hospitals like Letterkenny will be left behind. That is the realisation to which many people are starting to come.
I assure the Deputy that a great deal more than meetings is happening. I have evidenced that in the fact that we have already seen some new consultant surgeons specialising in colorectal and general surgery appointed as well as a new consultant anaesthetist. A number of further posts are currently undergoing a recruitment process. I will take up with the Saolta group the point the Deputy makes about the length of time it seems to be taking for the group to apply to the consultant appointments advisory committee in relation to a consultant endocrinologist and revert to him directly on that. For clarity, I note that it is a full-time locum consultant service to address current service demands for the breast cancer service at Letterkenny. That is also under way.
In terms of the way forward in the longer term and without wishing to speak for the groups, there was general agreement among those I met to look at cross-Border opportunities and the possibility of a joint posting between Altnagelvin and Letterkenny. The purpose of the meeting that is due to take place in Letterkenny is to explore that with the national cancer control programme. I note the willingness on the part of all parties to look at that and I am happy to continue in that regard.
People in Donegal do not want to see more exploration of solutions. They want to see actual solutions being put in place. This is the actual problem. I was very much in favour of the cross-Border idea with regard to radiology, which is being rolled out in Altnagelvin. However, the elephant in the room is Brexit and how this will impact on marrying together the clinical services and providing a service, if this is how it will be done. We need to see action. It will be a shock to people in Donegal to realise a full-time locum breast surgeon is all that is being sought at present when in January 2016 the announcement was that a full-time breast surgeon would be appointed in Letterkenny. We have enough locums. We do not need locums; we need actual appointments and action. A concern we had when the hospital groups were established was whether we would see a pull of services into Galway, and this certainly seems to be what is happening. I ask the Minister to take up this point with the Saolta group. The journey time from Donegal to Galway is four to five hours. If people from Dublin were asked to travel to Kerry to see a consultant they would not stand for it and it is not fair to expect people in the north west to do so.
I will certainly raise these points with the Saolta group and will revert to the Deputy directly on them. He makes a fair point on patients travelling to Galway when, as he knows, part of the agreement on establishing a satellite unit was that it was not just meant to be patients travelling to Galway but consultants travelling to Letterkenny. This is a point I took up with the Saolta hospital group and the national cancer control programme when it was brought to my attention by cancer support groups and Oireachtas Members in Donegal. It is absolutely essential that Saolta continues to manage the satellite service at Letterkenny University Hospital and ensures consultants from Galway travel to Letterkenny. For one consultant to travel to Letterkenny to see patients rather than a number of patients having to travel to Galway was the concept behind having the satellite unit. There are certain issues for which the patient would remain in Letterkenny and the doctor would go to see them but for other issues the patient would obviously need to go to Galway. This debate has been long had. We need to see consultants travelling to Letterkenny. There has been some concern expressed by groups on it. I will revert to the Deputy further on the issues.