Ceisteanna ó Cheannairí - Leaders' Questions

The Taoiseach and the Minister for Health launched extraordinary attacks on our hard-working front-line healthcare staff earlier this week. They sought in those attacks to place the blame for the difficulties in the health service on those staff, our doctors and nurses. They suggested that the solution to many of the pressures in our hospitals was that staff would work over Christmas. The Minister for Health, Deputy Harris, said that the Taoiseach's analysis was entirely correct. This is a complete over-simplification of the challenges facing our health services. It is a pathetic attempt to deflect from the Government's role and responsibility for the difficulty in our health service and hospitals. Blaming front-line staff who work 24 hours a day for 365 days of the year, including Christmas Day, New Year's Day and bank holidays, is not acceptable when conditions are as challenging as they are. Blaming existing front-line staff is difficult to take when there are 300 vacant consultant posts and 252 fewer staff nurses working in our hospitals this month compared to last December.

Patients have major problems accessing our healthcare service. When they do get access they are met with excellent staff or they are generally met with excellent staff. However, we have seen today how that is not always the case with the extraordinary judgment yesterday from the President of the High Court, Mr. Justice Peter Kelly, in a case involving the suspension of a junior doctor in one of our maternity hospitals. The doctor never worked as a doctor in any other hospital. Consultants who worked with him said he did not even meet the basic standards. Yet, he is reported to have obtained an impressive score in interview statistics. Mr. Justice Kelly said that the particular case is not isolated.

This is an appalling situation. I want answers to several questions from the Tánaiste today. When was the Minister for Health, Deputy Harris, informed of this particular case? The judgment was only published yesterday but it was delivered some weeks ago. Can the Tánaiste confirm that the Government is investigating this particular issue? Can the Tánaiste give guarantees that there are no other rogue doctors working within our system? I am referring to doctors who are not in a position to deliver on basic skills that people expect. What new measures will be put in place?

This problem was not only highlighted yesterday. Deputy Donnelly has referred to the recruitment of non-consultant hospital doctors on several occasions. We have highlighted the inadequacies in recruitment on several occasions. This issue is ongoing and should be a matter of priority for the Minister for Health.

Instead of attacking our doctors and nurses to get headlines and deflecting from the Government's responsibility, can the Tánaiste outline the Government plans for dealing with this serious issue and for reassuring the public that our doctors and healthcare professionals are up to standard?

There are quite a few questions there. I will deal with the first question and the commentary on what the Taoiseach had to say at the start of this week. The Taoiseach was not blaming anyone for anything. What he did was point out the reality that at the most pressurised time of year in hospitals we need to ensure we have a full staff compliment. We need to ensure that people who have the responsibility to give leadership to their health teams within hospitals are there to do that when pressure is at its most intense and acute. We need to ensure that we do not have skeleton staff arrangements at times of the year when there is significant pressure and when patient care needs to be prioritised. That was the point he made. The point that the Minister for Health, Deputy Harris, has reinforced was that of course there is a responsibility to ensure that rostering is in place to ensure the key people and team leaders as well as sufficient numbers of staff to support them are in place through the winter period. This requirement is equally important during the first two weeks of January, when we know hospitals will be under extraordinary pressure, as they are every year at that time. When Deputy Micheál Martin raised the issue of preparing for the winter pressures in healthcare and in hospitals, the Taoiseach, as always, addressed the issue directly and head-on.

We must continue to focus on capacity. This year we have added an extra 240 beds to the system and spent tens of millions of euro doing that. We need to continue to add capacity to our hospitals, but we also need to address the short-term challenges that we know are coming this winter. We need to ensure that our team leaders are in place to try to address them in person in hospitals at the times of the year when they are most needed, regardless of whether it is Christmastime. That is the point that he made, and he was right to make that point directly.

Deputy Calleary referred to the President of the High Court and his judgment, in which he said that defective procedures for recruiting doctors represent a danger to patients. He made this observation in a judgment ordering the suspension of a junior doctor. These comments have been widely reported in the media. The Minister for Health, Deputy Harris, is seeking an urgent response from his Department and the HSE on the circumstances of this specific case, the implications of Mr. Justice Kelly's judgment and the implementation of actions arising from it.

He is seeking an urgent response. That is the usual line – to seek an urgent response and hope the media go away. In March 2016 there was a similar case where a doctor was employed in four hospitals despite concerns about his performance. A file was submitted to the then Minister for Health, Deputy Varadkar, who is now the Taoiseach. Following that particular case the doctor was found guilty in a fitness to practise inquiry of 28 counts of poor performance by the Medical Council.

At that stage in March 2016 the HSE gave a commitment to establish a standardised policy to deal with references and Garda medical registration checks. That was in March 2016, some two and a half years ago. Yet, in November 2018 we have a situation whereby the President of the High Court has absolutely slammed recruitment procedures within the HSE. One need only read the judgment to see his comments on the recruitment procedures. What are those procedures doing for people who are looking for treatment from these doctors? The Government cannot simply dismiss this or do the usual thing and say the Minister is looking for a report. We need answers and guarantees that there are no more doctors of this calibre within the system. We need guarantees that they can be rooted out and that other people have not got through this flawed recruitment process. That is the assurance the Tánaiste needs to give today.

Let me give the House an absolute assurance that the Minister for Health is taking this very seriously. Mr. Justice Peter Kelly is a serious individual and when he makes a judgment like this the Government listens and acts on it.

It is important to outline to the House how recruitment in the HSE actually works. HSE recruitment is managed by the national recruitment service. Non-consultant hospital doctor recruitment is handled at individual hospital group level. NCHD interviews are held at hospital level and local clinicians are involved in interviewing and the selection process. Recruitment in the HSE is subject to the Commission for Public Service Appointments codes of practice. The HSE is also subject to regular monitoring and auditing by the commission of its recruitment and selection activities.

The HSE is currently undertaking a detailed review of recruitment processes with a view to introducing a revised model next year. The concerns that the Deputy raised are being and will be taken very seriously in the context of that review.

On Tuesday, the Taoiseach disgracefully tried to shift the blame for his and the Government's failure to tackle the perpetual trolley crisis in hospitals by attacking our hard-working and diligent nurses and doctors. Not content with insulting tens of thousands of front-line workers once, yesterday, the Taoiseach doubled down on his remarks. The Minister for Health, Deputy Simon Harris, who should know better, has now shamefully weighed in behind him. It is an absolute disgrace. Nurses' and doctors' leave is not the cause of the problem in our health service. The trolley crisis and overcrowding is due to capacity issues and the continuing and worsening recruitment and retention crisis. It is up to the Government, and the Government alone, to address these escalating issues, not ordinary nurses or doctors who serve the public day in, day out. It is the Tánaiste's and the Government's problem. After almost eight years in government, it has failed to address the trolley crisis.

When he was Minister for Health, the Taoiseach missed targets, saw record numbers of patients on trolleys, oversaw botched recruitment schemes, saw the numbers on waiting lists soar, and stumbled from one disaster to another. For him to now attack front-line public health service workers for his and the Tánaiste's failure is gutter politics. Blaming nurses and doctors will not solve a single issue in the health service, and it most certainly will not help the recruitment and retention crisis we face.

Some weeks ago, the Taoiseach launched another attack on health workers saying that despite an increase in staff, there had been no corresponding increase in productivity in the health service. That is a blatant lie. Along with his attack on them this week, it is a blatant falsehood. The Department of Health has stated on the record that accident and emergency department attendances are up; surgical day case work is up in excess of 70% over ten years; outpatient assessments have reached 3.3 million annually; and annual inpatient discharges are up by 7% over ten years. All that work is done by hard-working nurses and doctors who the Minister and the Taoiseach decided to attack.

What is needed to tackle overcrowding is a strategic plan. Do we have one? Of course we do not because the Taoiseach and the Minister for Health would rather attack nurses than put their shoulders to the wheel and tackle the root causes of this problem. That is the easy way out; it is the cop-out.

To contrast that with what is happening across the water with the NHS, it published its winter plan in September. When will we see the plan to tackle overcrowding, which will increase capacity in the health service, one that will address the recruitment and retention crisis and deliver proper step-down facilities and home care support for our vulnerable? That is what is needed, not attacks on front-line workers or stupid and insulting remarks. I ask the Tánaiste to take this opportunity to apologise to the nurses and the doctors for the Taoiseach's hurtful and ill-informed comments that he made yesterday and the day before.

I will try to address this issue honestly rather than grandstanding, as the Deputy has just done. The issue of preparing for winter requires honest conversations. This is not just the Government's problem. It is everybody's problem.

It is ours as well.

The HSE, the hospitals, the Department of Health, Government, in terms of policy, financing and budgets, need to work together-----

The buck stops here.

-----to ensure that the patient care we expect and that we need to deliver for people in hospitals, particularly through a pressurised winter period, can be as good as it possibly can be. The Taoiseach, in his usual style, was honest and upfront about one of the problems with regard to the Christmas period where there is a challenge around rostering and ensuring that senior team leaders in particular are there in person through that time of year, which is obviously a family time for many people, but we have got to prioritise patient care, even at Christmas time. That was the point the Taoiseach was making, and in my view he made it in a fair and direct way. What he is saying is that we need to work together, and the Minister, Deputy Harris, has reinforced this, to ensure we have the rostering procedures in place to ensure that senior people in particular and their teams are available at times when hospitals are most pressurised so that patient care is the No. 1 priority, as opposed to anything else, during rostering at this difficult time of year. That was the point he was making.

What is next ?

The Deputy is trying to spin that into an attack on consultants and nurses, which it never was and is not.

It absolutely was.

The nurses and doctors know it was.

The issue regarding capacity is the real issue. Everybody accepts that, but it cannot be solved overnight. This year, increasing capacity is a priority for Government. In the past 12 months, an additional 240 beds have been opened, and a further 79 additional beds are planned for the fourth quarter of 2018 and early 2019. That includes an additional 30-bed ward in Our Lady of Lourdes Hospital in Drogheda, a 40-bed modular ward in South Tipperary General Hospital, and four high-dependency beds in the Mater Hospital and Cork University Hospital, respectively. In addition, the new emergency department planned for Our Lady of Lourdes Hospital in Drogheda is due to open in early 2019.

We accept that there is a need for investment and expansion, and to increase capacity. There is a recruitment and retention issue that we are also looking to try to address but the idea that we can pretend that rostering is not an issue and that in the coming weeks and months we should not be preparing for that and having an honest conversation about it, with people who are well able to engage in that honest conversation, is political correctness gone mad.