I welcome the Minister for Health and Children, Deputy Harney, and Professor Brendan Drumm and their officials and colleagues. At 10.30 a.m., I will ask members if they wish to progress or adjourn for a few minutes. It is up to them to decide. I invite the Minister to make an opening statement followed by Professor Drumm.
Health Service: Ministerial Presentation.
It is a pleasure to be here again before the committee with my officials and, indeed, with Professor Drumm and the Health Service Executive.
I have circulated an opening statement to facilitate members and reduce the length of my opening remarks because I always find at meetings of this kind that engaging with members and answering their particular queries is more useful. By way of preliminary remarks, I want to deal with a number of policy issues. Clearly, operational issues are a matter for the Health Service Executive and can be more appropriately dealt with by Professor Drumm and his team.
Expenditure on health continues to rise at about 10% per annum. This year we will spend just under €13 billion running the services on a day-to-day basis and approximately €550 million by way of capital expenditure. It is important, given the significant three-fold increase in health spending over a nine-year period, that in addition to increasing investment in health, we reform the way we do business and that is what the Government's reform programme is all about. Certainly, we have made enormous strides, first, in creating a single unified entity, the Health Service Executive, which is not an end in itself but a means to ensure that we have a more streamlined, transparent and effective health care system.
A second important part of that reform is the establishment of the new health information and quality authority, HIQA. Recently, I published the heads of the Bill for consultation. It is always more useful to seek an input from those who are interested before a Bill is finalised. That Bill will be published in November. An enormous amount of work is under way in the Department of Health and Children and it will be a significant milestone in ensuring that, in addition to the provision of services, we have a statutory body that does not have responsibility for the provision of services but rather is involved in giving authoritative information on quality and standards.
The new social services inspectorate, the chief inspector of social services and residential care, will form part of HIQA but will be independent in the operation of its functions. This inspectorate, in addition to the current functions of inspecting places where children reside, will also inspect places where older people and people with disabilities reside, both in the public and private sectors. At present, there is no inspection regime for the public sector and I note that there is considerable interest in that area.
The role of the Department of Health and Children has changed with the reform programme and the Department is very much focused now on policy. Among the policy initiatives I want to discuss this morning is the legislative programme. This year we will publish the Medical Practitioners Bill. I hope to take this Bill through the Oireachtas by the end of this year. It is a major reform of the 1978 Act and, in particular, provides for increased lay participation on the Medical Council, gives the Medical Council a strong role in competence assurance, streamlines and has a more transparent registration system and strengthens the role of the council in the supervision of the education and training of doctors. We have also published the heads of that Bill. We received 42 submissions on it. A number of groups have asked for an extension of the deadline, which was 15 September. We have facilitated that but, notwithstanding the extension of time, work is under way on assessing those submissions. It is important legislation that I want to see go through, in addition to the HIQA Bill, this year.
We are also providing by way of the Irish Medicines Board for nurse prescribing. There was a consultation process over recent months in advance of the regulations being signed into law. Some 122 submissions were received. The signing of those regulations is imminent. They must be sent to Brussels for a three-month period before they can take effect. Nurse prescribing will be phased in. Nurses and midwives with specialist training will in the first instance be able to prescribe in line with what has been happening in other countries for many years.
In recent months we published a new cancer control strategy. Effectively, that strategy is about ensuring a high quality of cancer care. We have many hospitals where cancer treatments are provided. Our performance does not compare well with other European countries, mainly as a result of the fragmentation of services. The only area where our cancer care performance compares favourably is in children's cancer care, which is centralised at Our Lady's Hospital for Sick Children, Crumlin, even though it is delivered in a number of hospitals throughout the country.
The effect of the new cancer control policy and programme — the HSE, I understand, is in the process of appointing lead clinicians and other personnel to oversee the implementation of the programme — is that there will be designated cancer centres and regardless of where a patient is treated, he or she will get the high quality treatment regardless of the region in which he or she lives. That will be significant.
As I stated in the opening statement I circulated, we have seen a significant increase in the number of patients being treated for cancer — up 68% since 1997 — and those being treated on a day case basis — up by 127%.
In the case of cancer, BreastCheck will be rolled out to the remaining regions where it does not exist — the west and the south west — in the spring of next year and I have also put in place a programme to begin cervical screening for the entire country. The two programmes will be similar in the manner in which they are organised and administered. I hope that cervical screening can be done at primary care level, but that remains to be agreed with others. It is important that we put a cervical screening programme in place for the population. The next area where the National Cancer Forum has recommended that we should undertake population screening is colon-rectal cancer, and work is under way in the Department, with the HSE, on that issue.
On mental health, we published the report, A Vision for Change, this year. Effectively, that involves the closure of all the stand-alone psychiatric hospitals over the coming years and the provision of acute psychiatric services in general hospitals, but mainly the focus is on the provision of community-based services. The programme is to be implemented over a seven-year period. On a revenue basis, in this year's terms it involves approximately an extra €150 million, that is, approximately €21 million or €22 million per year over the life of the programme. This year we provided the HSE with €25 million towards the implementation of that programme.
From 1 November, the Mental Health Act comes into effect. In particular, the mental health tribunals come into effect. There will be approximately 3,000 tribunals a year. That will play a significant role in our mental health services. It is disappointing that it took so long to get agreement on the implementation of the Act but I am pleased that at last it is about to happen.
The sectoral plan for disability services was published in the summer of this year. With effect from 1 June next year, all those under five will have an independent assessment of need. Following the assessment of need, a statement will be provided on the level of service to be provided. If parents are not happy with that, the statement can be appealed to a process independent of those who have responsibility for the delivery of service. It will be rolled out, in conjunction with the Education Act, to those between the ages of five and 18, and in the case of all persons with a disability it must be rolled out no later than 2011. It is a significant milestone in the manner in which we treat citizens with disabilities in our community that everybody will be entitled to an assessment of their need and a statement on the provision of services that will be given and will have the capacity to appeal such assessment.
The Irish population is ageing. In the past much of our support for older people was in the area of institutional care. There are approximately 20,000 people in residential care in Ireland, that is, approximately 4.5% of those over the age of 65, which is the international statistic. However, 28% of those in residential care have either low or moderate levels of dependency and if alternatives had been in place in the past, they would probably have been able to remain in a home and community environment.
A strong focus of our support for older people is the provision of supports for people to remain in the community. On home care packages, of which I am sure the HSE will speak later, we have provided additional resources to increase the number of home care packages, but in addition to the specific packages for somebody to be cared for at home, we also must strengthen the services and expertise available at community level to facilitate people living at home through the provision of physiotherapists, occupational therapists, chiropodists etc., which are all important for older people.
A company was contracted by the HSE to implement the health repayment scheme. I understand that 11,000 claims have been verified, 8,000 in respect of those alive and 3,000 in respect of estates. The procedure is that the individuals or their estate will be contacted. They have 28 days to accept what is on offer and if they do not, they can appeal. The average payment is between €20,000 and €25,000. It is estimated 20,000 people are alive who qualify for repayments as well as between 40,000 and 50,000 estates. It will take some time to make all the repayments. The first moneys will be repaid in November.
With regard to the drugs scheme, the HSE and the Department were involved in successful negotiations with the Irish Pharmaceutical and Health Care Association. Over the lifetime of the new agreement, we will save approximately €300 million. We must be concerned about the entire pharmaceutical chain and negotiations are under way with the wholesale sector. I hope these will also be successful. These will be followed by negotiations with the retail sector. The increasing cost of drugs is a huge concern for the Irish and other health care systems.
I refer to patient safety. The House has discussed the Harding Clarke report at length. Following publication of the report, the Government asked the judge to examine a redress scheme for the affected women. She is due to report shortly about her recommendations in that regard and I very much look forward to that. However, with regard to the wider issues raised in the report, for 25 years unsavoury practices were carried out in the maternity unit of Our Lady of Lourdes Hospital, Drogheda. We must learn serious lessons from what happened regarding audit, clinical governance and so on. It is a major challenge for the Government and the HSE. We will ensure, particularly in the HIQA Bill, that many of the report's recommendations will be taken on board. There is much debate about where things happen for patients. If it is safe for something to happen in a particular environment, it will happen but if it is not safe, it will not.
I will not use powers under the Health Acts to give directions to the HSE regarding patient safety issues. We have had debates in the House over the years during which politics intervened and patients were put at risk. Any Minister of Health worth his or her salt must ensure above all else that patient safety comes first. That will be paramount in everything we do and support, notwithstanding people's concerns and fears. Sometimes fears are based on the unknown or on political and other vested interests seeking to misrepresent what may happen and perhaps using vulnerable patients in the process. We know from the report into the death of the late Pat Joe Walsh that things happened during his care that should not have happened. In particular, we must be concerned when the eminent person who drafted that report states that interpersonal relationships between clinicians interfered with patient safety. That is not acceptable. The HSE has agreed a new protocol for that region regarding the transfer of patients, which I very much welcome.
A new contract for consultants is central to the Government's reform programme. It is disappointing that the talks broke down. I hope the talks will resume as quickly as possible. The chairman of the talks, Martin Connaughton SC, is in discussions with the representative bodies and I hope a formula will be found to allow the talks to resume as quickly as possible. It is urgent and important that we have a contract of employment for consultants which delivers flexibility and teamwork and allows us to have a health care system that can function in the interests of the patients. One size does not fit all and a variety of different options will be needed in this matter. The current contract of employment is not satisfactory from the public health care system's or the patient's perspective. We are seeking to increase the number of consultants and reduce the number of junior doctors. The manpower planning programme suggests the need for 3,600 consultants and a halving of the number of junior hospital doctors. We are paying almost as much for junior doctors as for full consultants because of the method of remuneration. This model no longer makes sense because we want consultant-delivered services, which provide the clearest and best decision making.
Reform is very much about getting more for the same in many respects. I referred to Cavan hospital as an example in the House yesterday. Cavan and Mullingar hospitals have the same number of beds and budgets, but their outputs do not compare favourably. I made that comment on a television programme a number of months ago and I was heartened to hear subsequently that the authorities in Cavan had visited the Mullingar hospital on a number of occasions. I very much welcome hospital administrators doing that and learning from each other. Cavan had 11,000 in-patient cases last year while Mullingar took in 14,000. Mullingar had more than 7,000 day cases compared with 6,000 at Cavan hospital. Mullingar hospital had 41,000 outpatient cases while Cavan dealt with 32,000. Cavan hospital had 20,000 accident and emergency department visits while Mullingar had 31,000 People are not on trolleys in Mullingar hospital. When it comes to births, Mullingar had 1,900 while Cavan had 1,400. We must focus on efficiency and effectiveness to deliver the health care service our country deserves and our population wants.
Professor Brendan Drumm
I thank the Chairman for the opportunity to make this statement. There is always significant interest in development packages for the elderly and the implementation of the current package continues. The number of clients in receipt of home help services has increased by almost 15% from 41,000 in January to 47,000 in June 2006.
With regard to home care packages, we have allocated €30 million to deliver 2,000 additional places by the end of 2006. An additional 551 places had been provided by the end of June. We are focused on making more packages available later in the year and we have intentionally focused on the winter months. People are aware of the home care packages, which are designed to facilitate the timely discharge of older people from hospital, to reduce inappropriate admissions and to support older people to continue to live in their communities. The ultimate goal of this organisation and the health services should be to keep the use of long-stay facilities to an absolute minimum and we should support people to live at home as much as possible.
I refer to nursing home subvention and additional long-stay beds. A sum of €20 million has been put towards supporting and increasing numbers entitled to basic nursing home subvention and reducing the waiting lists for enhanced subvention in private nursing homes. This is being used, in particular, to support the acute hospital sector to move people to long-stay facilities. As part of the package, €8 million has been allocated for long-stay beds. More than 7,800 staff members have been formally trained in elder abuse awareness in residential facilities, which is hugely important. This could be missed without formal training. This also involves private nursing homes, hospitals and community services. A series of pilot advocacy services have been established across the country.
Building on work undertaken over recent years, the HSE is in the process of recruiting 30 new elder abuse officers to provide support to vulnerable older people in the community and work closely with fellow health care professionals, agencies and the Garda to provide guidance for older people who experience harm or abuse. These posts are part of an ongoing programme aimed at ensuring that systems and processes are in place to respond to concerns expressed both by older people, their relatives and friends.
An article in the written documentation I provided to the Chairman related to the Leas Cross facility which has closed. The HSE accepts fully the need for the report on Leas Cross to be made public and has stated this at all stages. We have the responsibility to publish it and want to do so, but we also have a responsibility to the people named in it. While there has been much mention of protecting HSE staff, Leas Cross was a private facility and many of its staff were not part of the HSE. Everybody who worked in Leas Cross must be allowed due process. Publication has not been possible due to the way in which the report has been drafted to date.
I am happy to provide the legal opinion that has been provided to the Health Service Executive — it has also been available to the press which has made remarkably little comment on it — to show why this is the situation. We have responsibility to be fair to everybody. We understand the frustration associated with the report remaining unpublished, but we are not trying to hide anything. We must follow natural justice as everyone here would expect in the same situation.
In terms of mental health, the HSE is implementing the recommendations of the report of the expert group on mental health in its policy document, A Vision for Change. Capital investment of €800 million and €150 million revenue funding will support the implementation of the recommendations over seven years.
The HSE's recently approved capital development plan has allocated a total of €36 million in capital moneys, raised from the sale of existing assets, to support the provision of necessary infrastructure during 2006. It has provided €25 million for the development of 21 new consultant-led mental health teams from its budget from the Department and 14 additional mental health team enhancements, which will significantly enhance mental health service availability for the public.
The Minister for Health and Children mentioned the scheme to repay public long-stay charges. I will not focus on it other than to confirm that it is up and running and will deliver according to the timelines set for it.
Since I was last here, the first of four community intervention teams was established in Cork. These teams are in addition to mainstream community services and are designed to quickly respond and put services in place to enable people who are ill but still well enough to remain at home and therefore avoid a clinically unnecessary hospital admission. This initiative is significant. Experience shows that people admitted to hospital for relatively acute issues such as chest infections tend to develop confusion delirium in hospital because of their age and subsequently can never return to their homes. Treating people in the home, which we hope to expand on further this winter through a more advanced programme called hospital at home, will provide medical services in the home and will have major long-term effects in terms of preventing people from being institutionalised. Four of these teams will be up and running in the near future, including, in addition to Cork, two in Dublin and one in Limerick. We hope to continue rolling out this programme if these four work well.
Progress has also been made on the development of primary care teams. We established an ambitious target of 100 teams this year and intend to achieve this by the end of the year and a further 150 next year. We are constantly being asked whether everybody on a primary care team will be in place, but the answer is no because the teams will continue to develop each year. We hope for increased funding so that where we do not have psychologists we can add them on and the teams will grow over the years. To a large extent the programme will never be fully complete because it should continue to develop. We will, however, identify 100 teams. I acknowledge the tremendous support for this initiative which has been noted by general practitioners on the ground and those working in community services. The initiative involves a total change in terms of how general practitioners and community services work. People have been positive in dealing with this and taking it on board.
With regard to the development of enhanced out-of-hours GP services to serve the 500,000 people based in north Dublin, we expect this service to begin shortly. The services will be provided at five centres, namely, Hartstown, Ballymun, Swords, Coolock and North Strand. Local GPs will be responsible for medical staffing and rotas, while the HSE will provide the necessary infrastructure and employ support staff such as nurses etc. One of the reasons this has taken longer than necessary is that it meant getting the total co-operation of the general practitioner group in north Dublin. The IMO has engaged in helping to deliver this much needed project. The IMO, doctors in north Dublin and the HSE have been aware that it is a service the people not only require but are entitled to demand. The new services also confirm the HSE's view that GPs are central to the reform of health services.
It is important that everyone is made aware of the HSE's national information line. We have tried to publicise this information and it is particularly important Oireachtas Members are aware of it. It is based in Ardee and has been extended nationwide. It provides a range of information on over 110 health and social service topics, including medical cards, GP visit cards, drugs payment schemes, home help services and health promotion literature. At the end of June, the line had received over 20,000 calls, a 40% increase on end-March 2006 figures. It is an important resource and we hope to continue rolling it out to give people real time information on issues such as waiting times, accident and emergency services etc. We hope people will be able to pick up the telephone to say where they are and what their problem is and we will be able to tell them what the waiting time in their local accident and emergency unit is, suggest an alternative or arrange for fast-tracking for someone at risk. This type of service will be a significant help.
I have outlined the activity of the National Hospitals Office. I recommend everybody to refer to the table in the data provided which shows, as one would expect with our rising population, that the activity undertaken is significantly higher than it was last year for both day patients and inpatients and also significantly higher than budgeted for in our service plan, yet it has been provided within budget. While people may be critical of what we supply in terms of the money we get, I wish to point out that we have supplied a significantly enhanced level of service above what was budgeted for in these critical areas. It is interesting that the patterns of activity being experienced reflect international trends. Many hospitals are seeing a decrease in their inpatient activity rates, which reflect the continuing international move towards increased day case activity. This must be taken on board when we come to discuss the location of acute hospital services.
While I acknowledge we are not yet into the busy winter period, the length of time people must wait in accident and emergency departments is decreasing. This is certainly not a victory, but it is something on which we continue to focus to ensure this area continues to improve. Since May, the average number of people waiting more than 12 hours for admission has been reduced by 13% and continues to decline while the number of people admitted in under six hours has increased.
I will now focus on how to view our accident and emergency data because it is data which is used everywhere in different ways across the public system and the political system in general. There is an unfortunate trend of adding up the numbers of people waiting in accident and emergency departments and presenting this figure as a measure of overall performance. While that figure is very convenient, it is also highly inaccurate in terms of measuring our successes and our shortfalls. Using that approach, the same significance is given to people who are waiting half an hour for somebody to carry out a test on them which is more easily done in an accident and emergency department than on a ward, as given to those who are left for over 24 hours in totally unacceptable conditions.
It will be appropriate in the case of many people to be in accident and emergency units while their acute management is being dealt with and while accepting that a decision is being made that they will require admittance. Counting that number as a total is quite disingenuous. Having patients waiting a short time for admission should in fact be considered a normal part of daily work in an accident and emergency department but someone waiting for 24 hours or even 12 hours for admission is clearly not acceptable.
Using the overall figure out of context is misleading and takes no account of that fundamental difference between the status of those two types of patients. One is receiving appropriate care and yet this is being portrayed as inappropriate care. I regard this as headline grabbing by vested interests who do not want to clarify the differences between these groups. The overall figure takes no account of the fact that many hospitals either have no patients waiting or else are only waiting for short periods. It reflects unfairly on the many people working in our services who are providing outstanding services in accident and emergency departments.
The figures show that yesterday, 42% of units had nobody waiting and the majority of our units had nobody waiting more than six hours. To put this in context, 23,000 people are seen weekly in our accident and emergency departments and approximately 5,000 of those people are admitted. One will hear nothing of 90% of that 5,000 because they were never on a trolley or never waiting. This shows how hard people work in the system. Of that 5,000, approximately 10% must wait but the majority are waiting less than six hours. The global figure approach takes no account of the thousands of people who are being admitted without delay every week but instead portrays the small number who unfortunately are experiencing delays as being the true reflection of the performance on the ground.
I suggest this is not a fair way to approach this matter. If our figures are going to be used in that way, they should be challenged because they are often used for reasons that have very little to do with patient care. I accept there are persistent issues faced in a handful of hospitals. We are very focused in dealing with these, in terms of the unacceptable conditions in which patients wait for prolonged periods of time. A winter initiative plan has been established to focus on this and to build on the work of the accident and emergency task force. It has been established to ensure the services required to address the particular demands of the winter season are in place and operating optimally so as to impact with maximum effect on our emergency departments and hospital services. The core elements of the winter initiative include promotion and prevention of health issues and the hospital avoidance and capacity issues on which we have to focus. We must focus on our own services with the communities and the hospitals working very closely together.
The Minister referred to the pricing of medicines. I confirm that the HSE is happy that it has been able to work constructively with the Department of Health and Children to bring about significant savings in what is just the first round of negotiations. If there is ever a reason for a HSE or a single authority, this is the classic example. We have been able to stand up to a very powerful industry and say we are now a single customer, working hand in hand with Government and the Department of Health and Children and we are looking for value for money. We have shown how this can be achieved.
The Minister referred to the current stage of the consulting contract negotiations and the difficulties encountered. I reiterate that while differences of opinion exist about restarting the talks, the HSE remains totally committed to developing a new working relationship with consultants in order to benefit patients and consultants. It will give them better working conditions and attract people who will not accept the long hours worked by consultants in the past.
I refer to a proposal in The Irish Times earlier this week from one of the professional representative organisations which pointed out its strong support for a public hospital-only contract and this support is to be welcomed. The IMO statement also cautioned that we need to avoid unintended consequences for hospitals, patients and doctors, of this approach. We all support the concept that consultants should have a menu of options. As the Minister stated, we need to be flexible. If we are asking consultants to accept our proposals to begin talks, we need to encourage them by offering options other than just the public contract.
We need to be aware that in addition to the introduction of public-only employment contracts, some consultants may wish to engage in private practice in public hospitals, private hospitals or community settings. In that context and considering the views expressed by the IMO, it may perhaps be opportune to look at engaging with consultants to identify other work relationships on a contractor basis. Not everybody needs to be our employee to come and work with us. This can still be done in a way that ensures equity with the public system. I concur with the Minister's view that we must get a contract working that focuses on fair play for the public patient in our hospitals. This could involve the development of a series of arrangements ranging from consultants dedicated to the public health system on an employment basis with no other commitments to the other end of the spectrum to consultants who provide a smaller number of hours to the public health system to meet specific needs that we identify as being required by our public hospitals.
It is imperative that employers and consultants work together to implement the changes that are needed to achieve a sustainable health system, with best practice and most important, a system that puts the needs and convenience of patients and families above all other considerations. We accept that the workload carried by consultants at this point will not be acceptable to young doctors in the future. We therefore need to develop structures with more flexibility to allow consultants a better work-life balance. We now have an opportunity to develop arrangements to achieve this. The challenge for the Department of Health and Children, the HSE and the consultants is to be open and flexible and to move on quickly to a new era in health care provision which will be very different from all our perspectives.
Regarding the development of the national paediatric hospital, a joint HSE and Department of Health and Children transition group has been established to carry out the preparatory work necessary to establish the hospital development board. It will consult widely with key stakeholders and provide for the participation of the three Dublin children's hospitals in the process. The work of this group is expected to be completed by the end of 2006, following which it is anticipated that the new hospital will be progressed to completion by the newly appointed development board.
I refer to the next phase of the acute hospital services in the north east. A steering group has been established to progress the recommendations in the Teamwork report which is a blueprint for the new hospital services system in the north east. The steering group will include local clinicians as well as representatives from the HSE and the Department of Health and Children. Dr. Eilís McGovern, a consultant cardiothoracic surgeon, will lead a project group. Dr. McGovern's roots are in the northern part of this country so she is well aware of the geography. She is charged with implementing the action plan provisions as set out in the Teamwork report under the direction of the steering group. One of the central proposals to be pursued is the establishment of a number of clinical networks in specified key areas.
I reiterate that hospitals in the region should continue to serve the local community and existing services should remain in place until better quality alternatives are available. There have been many issues raised in the press in the last few weeks about areas such as Monaghan and Roscommon. People are advocating the retention of services that are not in the interests of proper patient care. They are acting irresponsibly. I believe they must be scaremongering out of self-interest because I can see no other reason for doing it and it is wrong. They are doing a disservice to local people because it will do nothing but delay the introduction of better services. I have stated many times that I will not preside over a HSE that puts the views of those who make the most noise or grab the most headlines ahead of what are patient needs in terms of quality of service. That is not the reason I took on this job and it certainly is not what motivates the thousands of people who work within the HSE. Furthermore, I do not believe it motivates the Department of Health and Children or the Minister.
We said that we would not close the hospital in Monaghan. We need to build a new regional hospital. We also said that we would not remove existing services until a better quality of service is in place. Unfortunately, people do not appear to want to hear this because it does not suit specific interests and does not enable them to grab headlines. I encourage people to consider carefully the motives of those who are objecting to initiatives that will improve care and provide better outcomes. Whose interests are being kept in mind when we have had two separate independent reports running at the same time, one from an expert corporate group in studying health services and one from two eminent consultants, both of which arrived at the same conclusions? We are being told that we, as an organisation, should ignore both and tear them up because they have no relevance.
In terms of our responsibility to the public, I cannot accept that we should operate in that way. It is not in the interests of the sick people of the north east. A large number of the ill people of the north east do not attend hospitals in the region. There is no other place in Ireland that has more than 30% of its population drifting into Dublin to seek services. For elective services, up to 50% leave the north east. The people do not appear to have the type of confidence they should have in their local health service. It is incumbent on us to provide a health service in that area that will result in people using the service there. We can then know that the service we provide is up to the best standards.
Co-location of private hospitals is continuing and I believe the issue will arise in questions. Expressions of interest were invited on 19 May for the co-location of private hospitals on 11 public hospital sites. A number of expressions of interest were received prior to the closing date. John O'Brien will be happy to deal with further information in that regard.
The provision of information services for Oireachtas Members continues to be frustrating for them and for me in respect of optimising it. I see it as an area of considerable importance. In June 2006, we held a briefing meeting with Oireachtas Members in the Davenport Hotel and I was encouraged by the turnout. I thank the Ceann Comhairle for chairing the meeting, at which I mentioned the need to have regular briefings between Members of the Oireachtas and the service managers in the HSE because of the frustration experienced by Members. The HSE has afforded this process a high priority. The director of the regional health office in each administrative area is responsible for arranging the briefing meetings, which will take place in Dublin because this makes it easier for Members. They will facilitate Members contacting key personnel in the delivery system. Senior managers from the area will attend these briefing meetings. Arrangements are now being finalised to begin these briefings. I hope that these area briefings will ensure that Oireachtas Members are well briefed on matters related to health and personal social services within their geographic areas, and have an opportunity to meet on a two-monthly basis to ask the questions they need to ask of our service providers.
Regarding other developments relating to providing information to Oireachtas Members, the parliamentary affairs division in my office has a number of other initiatives under way that designed to improve our capacity to provide information to Oireachtas Members. These include parliamentary questions. For the period January to June 2006, in excess of 2,200 parliamentary questions were referred to the HSE for direct response. It has issued replies to almost 90% of these and is preparing replies for the remainder. I am aware that the time taken to get the responses causes frustration. In some cases, there are good reasons owing to the complexity of the questions. They are totally justified, but just take time. However, I am aware that we need to improve on many of our response times.
We have established a dedicated e-mail account that Oireachtas Members can use for submitting inquiries. To date, this has proved an efficient and timely way of providing information. The design work on the HSE website is almost complete. The new Dáil session commenced yesterday and we will soon begin to put the answers to questions that are the subject of direct replies to Deputies and that are of a non-personal nature on to this website. Members will be able to refer people in the broader community to the website if they want to see answers to those questions. These developments are designed to improve further the provision of information to Oireachtas Members. In the event of Members having difficulty in accessing information they should contact the parliamentary affairs department, the contact details for which have been circulated to Members previously.
I thank the witnesses for attending. Since I get the opportunity to face the Minister, Deputy Harney, on Question Time in the Dáil, I will direct most of my questions to Professor Drumm this morning. We could focus on big issues such as the number of acute beds in the system, the private hospital issue, consultants' contracts and even the primary care teams. However, what is starting to affect us all is the number of small issues. Sometimes they may not be little things to the people involved, but in a forum like this they may sound like little things in the grand scheme of things. People are experiencing extreme difficulty accessing services, including gaining access to home helps and obtaining subventions. We all received letters on how the HSE is interpreting the subvention schemes and applying guidelines different from those to which we are normally used and even different from what is contained in legislation.
I asked the Minister about maternity leave yesterday. People taking long periods of leave of absence, such as those on maternity leave, are having an effect on patient care. A person going on maternity leave is often left with a backlog when she returns to work, which is inappropriate. When I asked that question of the Minister, she advised that the HSE assured her that there were no problems and that these absences were being well planned. I know of occupational therapists taking maternity leave and patients seeking assessment in respect of nursing homes or obtaining appliances in their homes who are not getting them and who are more or less being told they must wait until the occupational therapist returns from maternity leave.
The same is happening in the area of community physiotherapy. The HSE has three to six months' notice of such absences and it is not planning for that service delivery, which is having a major effect on patients. While this might sound trivial, when we are discussing consultant contract, acute hospital beds and private hospital initiatives, these are the matters that affect patients on a day-to-day basis.
I have some concerns regarding the HSE's motivation in respect of certain issues. The trolley count has been a great initiative in focusing patients' minds on what is happening in our hospitals. The HSE and the Minister might not like it because it exposes a deficit in the service. However, I have noticed that the HSE appears to have instructed hospitals that if patients are lying on day-case bed or in day wards or medical admission units, they are no longer being counted as part of the trolley watch, the initiative we use to find out what is happening in our services. In some respects the HSE is almost institutionalising cancellations. A number of people preparing for diagnostic procedures are contacted in the morning and told that they cannot come in for the investigation because a patient from the accident and emergency unit is taking up that bed. Patients do not like to complain about this because they are seen to be ungrateful when compared with the suffering of those on trolleys in accident and emergency units. However, this is a growing and serious issue.
I will try not to be too parochial. Ely Hospital in County Wexford has a fully provisioned day ward and day surgery service for carrying out endoscopies and colonoscopies. A sum of €3 million is required to make it fully operational so that we can stop the huge number of cancellations in the area. However, that funding is not available. The new Tánaiste informed us that there is €3 billion sloshing around in Government coffers and he does not know what to do with it. However, we are seeing services throughout the country being held back for the want of relatively small amounts of money. I am only focusing on an issue with which I am au fait. However, I am sure it is the same for every Deputy. The HSE needs to be honest with people and not mislead them this winter when it comes to the trolley count.
The HSE has been up and running for 18 months. I would like to know when it published its corporate governance guidelines. It is to be expected, after 18 months, that they should have been published long before now. However, I have come across some reports which suggest that the guidelines have not yet been published.
I would like to raise another issue of concern, which should be taken on board by Professor Drumm. Somebody told me yesterday that this joint committee has issued two reports on orthodontic services. The level of orthodontic care provided in the public service is so bad that it could be suggested that children in this country are almost being abused. Even though this committee has produced two reviews, no progress is being made by the HSE in respect of this incredibly important matter. This will became a major issue because the dental work that has been done on some young teenagers is a mess, to be quite mild about it. I ask Professor Drumm to give some attention to this problem.
I asked a parliamentary question yesterday about the investment of €70 million in information technology projects. Professor Drumm is fully aware of the importance of IT projects within the health service. It seems from the response I was given yesterday that none of the €70 million — I understand that a further €60 million will be made available for larger projects — has been approved by the Department of Finance for 2006, even though we have almost reached October. I did some background work on this matter to help me to understand what is going on. It seems that nobody is sure who is supposed to be providing leadership and that the person who was appointed to work as acting director of the information and communications technology directorate for a two-year period has been moved on.
Nobody in the HSE or the Departments of Health and Children and Finance has given anyone in the ICT unit any idea of when these projects will get up and running. Many of the projects are extremely important for the delivery of patient care. Some of the projects are not very big and do not require significant amounts of money. Is the HSE jinxed when it comes to computers and IT? It has not spent any money on the projects in the first nine months of this year. I understand it is advertising for a new IT consultant. I ask Professor Drumm to explain that to the committee. Is this a new departure? Will the recruitment be done through the normal public appointments system? Is the HSE changing the whole system around again? The health service IT system is extremely important — we saw what happened with PPARS. We have been told we will have to wait until next year for the PPARS report. Some people feel the HSE has completely and utterly lost direction in its handling of IT projects throughout the country.
I would like to pick up on the comments which were made earlier about the north east. I am of the opinion that there is substantial political interference in the HSE. I do not think much political responsibility is being taken, however. The letters written by Professor Drumm to Mr. Lamont of the Mater Hospital indicate that he accepts there is a certain degree of ambiguity on the part of public representatives in respect of this issue. Professor Drumm has spoken about vested interests. He has suggested that politicians may have vested interests. Politicians have a vested interest in representing the people. I have made statements about that. I do not think the HSE or the Government have indicated a viable alternative in the cases throughout the country in which it is proposed to withdraw services.
We discussed Cavan General Hospital yesterday. There is now a protocol whereby the hospital must take surgical patients from Monaghan General Hospital. I believe that the protocol in Cavan General Hospital means that consultants there are restricted from doing major gastrointestinal surgery. I ask Professor Drumm to explain why three consultants have been appointed to Cavan when there are restrictions on the type of work they are supposed to do at that hospital. During her presentation, the Minister compared the position in Cavan to that at the hospital in Mullingar. How are we supposed to improve the services in the north east by slapping restrictions on what the consultants who are appointed can and cannot do? I refer to consultants who have been appointed to a hospital that has an obligation to take patients from another hospital.
I would like to make another point while we are talking about the north east. As I said to the Minister for Health and Children yesterday, the capital project involving the expansion of Our Lady of Lourdes Hospital in Drogheda has been put on hold. The hospital authorities are supposed to take critically ill patients from all parts of the north-east region, but the HSE is not giving them the funding to extend the hospital or to look after more critically ill patients. As I explained yesterday, the suggestion that a new hospital will be developed in the north east is nothing more than a castle in the sky. It is being used as a means of diverting attention from the absolute mess in the region at present.
Those who criticise Professor Drumm really are being objective. No alternatives are being put in place. Professor Drumm is aware that the ambulance service in the north east is not of a sufficient standard to move patients from Monaghan to Cavan, or from Cavan to Drogheda. He knows that not enough paramedics are allowed to work in the region. There is no air ambulance service in the north east. The infrastructure there is not suitable. We know there has been a substantial breakdown in the existing protocols in the area. Much more needs to be done before we can start to think about running down the services in the north east. We cannot merely hope that if the services are still alive in 15 years time, they can be based in a spanking new shiny hospital somewhere in the region.
Those of us who criticise the current plans are not being parochial — we are trying to analyse what is being done in as critical a manner as possible. That is why we are trying to defend the service that is in place at present. When Professor Drumm makes a presentation like he has made today, and tries to make it seem that everything is rosy in the garden, I am reminded of the starry-eyed enthusiasm of the debutante. However, we know such a depiction does not match the reality on the ground, which is what we are actually talking about here. The Minister for Health and Children has done a massive U-turn on the consultants' contract over the past 12 months. Not much progress has been made with the reorganisation of hospital services.
Professor Drumm should acknowledge that substantial problems continue to exist in the HSE. I refer to issues relating to some extremely senior people in its human resources department, for example. Mr. John O'Brien, who is present at today's meeting, is still in an acting position even though he is responsible for all the acute hospitals in the country. Such serious issues need to be addressed if we are to reform the health services radically. Has the HSE received the implementation policy for cancer services that was promised when the National Cancer Forum announced its strategy in May of this year? We were promised that the implementation policy would be delivered by the Department of Health and Children within six to eight weeks. I would like to know whether the HSE has received that policy.
I do not want to take up all the time of every member of the delegation. I will not focus on the consultants' contract or the private hospitals initiative to too great an extent. I am surprised that Professor Drumm supports the private hospitals initiative because I am sure he sees the flaws in it which are evident to me. As it is the Minister's policy, we will have to argue about it with her. What is Professor Drumm's attitude in respect of acute beds? The health system needs more acute beds. I refer to proper acute beds rather than to phoney beds in private hospitals. The HSE should make a clear statement on that. I am aware that another bed review has been initiated. The last review made reference to 3,000 beds. Some people thought that 4,000 or 5,000 beds would have been more appropriate, but the figure of 3,000 was settled on. We should not be doing another review so soon, given that it is clear that acute beds are causing problems throughout the system.
The biggest problem in accident and emergency departments is that they are functioning as holding areas for patients who should be in other parts of hospitals. When people have been seen in accident and emergency units, they often need to be moved to wards. Professor Drumm knows as well as I do that putting such people into day wards, and thereby cancelling day surgery and ear and throat day cases, is not the way forward. We must provide more acute beds in many of our hospitals. If Professor Drumm were to argue that we should build community care units on the grounds of major hospitals, I would agree with him — such a proposal is part of Fine Gael policy. Such units are especially needed in the Dublin area, where there are up to 400 patients who are more suitable for respite, convalescent or step-down facilities. The community care units that should be built on the grounds of major hospitals, under the care of geriatricians, should be linked with local general practitioners. Such a proposal is far more sensible than the current proposal to develop private hospitals on the far side of hospital car parks. That is an argument for another day, however. It was said half the patients come to Dublin for treatment from the regional hospitals. Waterford, Drogheda, Tullamore or Castlebar are not really regional hospitals because the resources have not been put in place. That is why patients are going into Dublin hospitals.
When I ask parliamentary questions on this issue, I never get information back to show me how they have massively increased the services we expect from such hospitals. That is why patients are drifting into Dublin hospitals — they get the resources while the regional hospitals do not, even to the point that when the Dublin hospitals are recruiting consultants, they are poaching them from regional hospitals. Consultants in regional hospitals are willing to leave because they are not getting resources. There is no CAT laboratory in the south east even though there are cardiologists. They do not have the ability to do angiograms on cardiac patients even though this is one of the largest groups of patients, after those suffering from cancer. The regional hospital in the south east does not even have a radiotherapy unit. There is no such thing as regionalisation of the health service; it is a failed policy. The argument cannot be supported when we are being told that the health service has failed dramatically in recent years.
An article was published in a Sunday newspaper on 22 January 2006 dealing with an accusation that a vested interest was holding up developments in a particular hospital. The Minister for Health and Children said some of the practices in this hospital were indefensible and highly inefficient and called on hospitals to change their ways. There were a number of problems laid out and it was surprising they were described as new when they existed when I was a medical student. Among them were consultants in public hospitals spending a disproportionate amount of time on private patients. How will private hospitals improve that situation?
A further problem arose where patients who were fit to go home on a Friday, remained in hospital because they could only be discharged between Monday and Friday. Diagnostic services close at 4.30 p.m. and there are significant numbers of patients in accident and emergency units with minor injuries. In Dublin hospitals, 20% of patients were readmitted within a week of presenting to accident and emergency departments, up to 25% of all patients were referred to Dublin hospitals from outside the capital, and not just from the north east. What has been done to correct those problems in the past 12 months?
I am trying to give ten minutes to each Opposition spokesperson. Deputy Twomey used 13 minutes so, without trying to restrict anyone, other people must take that into account.
That is totally unsatisfactory. We spent 45 minutes listening to the Minister and Professor Drumm and this is one of the few opportunities we have to find out what is going on in the health service. To limit us to ten minutes makes no sense, although I will do my best.
I am not restricting people but with eight or nine people wishing to speak, I am prioritising the Front Bench spokespersons. I did not even begin my comments by asking Deputy McManus to stay within ten minutes, I am trying to work towards that.
I know that and I appreciate it is not the Chairman's fault that democratic accountability in the health service has been funnelled into this meeting.
I do not see it that way, it is totally open.
I see it that way. Perhaps I could proceed?
I have a different opinion. The situation is open, with Professor Drumm and the Minister coming in every three months for a full session. We will make the very best of that.
I thank the Minister and Professor Drumm for coming. Two of the characteristics that can be applied to the Government on the health service in recent years is the squandering of money and resources and a growth in secrecy. Money has been wasted on PPARS and the Minister has failed to deal with nursing home charges. The Comptroller and Auditor General's report shows that GPs received €25 million they should not have because of an over-estimate. There is a major question mark about management of money at a time when there is such great need within the health service.
For example, the Government promised 200,000 new medical cards. That was a promise made to the people. As soon as Fianna Fáil and the PDs got back into power, they jettisoned that commitment and we ended up with 200,000 GP-only cards. Now that commitment has disappeared and apparently just under 30,000 cards have been given out. Why are people on low incomes who want to see their family doctor under a scheme that is good value for money being denied that access? Why can the Government, the Minister and the executive not get their act together and deliver for those people? If they got that right it would certainly mean that we would not be dealing with such problems in accident and emergency departments and other areas. The Government cannot even get that right and I would like to know why, because it is difficult to explain.
A secretive culture applies in the structures that have been established in the health service. We used to know how many people were on waiting lists for hospital procedures and operations but we no longer have that information. The National Treatment Purchase Fund publishes figures when it chooses — I have not seen figures from that body for quite a long time. It refuses to tell us the relevant costs of procedures in private hospitals.
I went to Massachusetts to look at its universal health insurance system. The culture of openness there was markedly different. The Minister is very fond of going to America to see how things work but the idea that we can operate on the basis that the information we need can be kept hidden, is risky. We do not know how many people are on waiting lists, how much it costs or if it is much more expensive for them to be treated in private hospitals here or abroad. It is time we found out and I ask both the Minister and Professor Drumm to respond to that issue.
The HSE and the Oireachtas have commissioned reports but they have not been published. I appreciate that Professor Drumm has legal advice on the Leas Cross report but the Minister has the power to ensure the publication of that report under the Health Act 2004. She can avail of the systems in the Oireachtas to put that report into the public arena. I urge the Minister to do so in the public interest.
I read today of another report of which I was unaware about an investigation into a GP and her son who is a pharmacist. I did not even know the HSE was carrying out this work but the report was not published. Why not? There is an investigation into a Brothers of Charity unit in Kilcornan, County Galway, which cares for disabled children, which has been going on for seven years. I would be grateful if we could be told why it has taken so long and why we are yet to reach a conclusion. I appreciate that it was established prior to the HSE but every time parliamentary questions are asked, a new review is instigated.
There is still a long delay between asking a parliamentary question and getting a response from the HSE. These letters should be made public. I appreciate the HSE is developing a new website. It is taking a long time but I am glad to hear there has been progress. The HSE should not censor the content of the website. A very simple long-standing practice ordains that personal details are not included in the answers to parliamentary questions, which are published anyway. I urge that this practice be applied. I refuse to allow the HSE to censor the content and I would object very vehemently if it were to happen.
As long ago as last March the Minister declared a national emergency. This time of the year probably results in the least pressure on our accident and emergency units, yet people are still waiting for considerable periods. I appreciate Professor Drumm's point about separating the people waiting short term from those who are really stuck and cannot get a bed. It is a fair point but it must be pointed out that nobody would expect to wait six hours in a general practitioner's surgery or in a clinic for private patients. There is a danger of presuming that it is acceptable for people to wait many hours, sometimes for quite minor needs that could be addressed sooner if there were better management and greater capacity.
I was in a very busy accident and emergency department the other day and was told it did not have any patients in its corridors. I believed it was great and that we should all try to emulate the Kilkenny model, only to be told that this was because there was no corridor space. I looked at the main corridor and saw it was jam-packed with boxes of medicines, syringes and all sorts of materials. It is actually en route to the fire exit. As I visited that accident and emergency department, which is in a very modern hospital, I noted that if the health and safety inspector came, as he did once, he would have a duty to close the whole place down.
The staff in the department were shifting waiting patients into the outpatients' clinic, the day clinic, which meant that 1,200 of their procedures, both day and inpatient, had to be cancelled over the past year. The chairs were literally moved out and the procedures for the day were cancelled, and the trolleys and patients were put in so nothing could be done while the people were waiting to be treated in the accident and emergency department or to gain access to a bed.
This is what is happening and I am deeply suspicious of it. We will get flimflam in terms of what is happening in our accident and emergency departments. We are already getting it from the HSE. An effort is being made to hide the problem and shift it, and people are still waiting in admission lounges. Sometimes admission lounges are used to provide for day-care patients and this has a knock-on effect. Some 22,000 elective procedures were cancelled, according to the latest figures.
There will be a downstream impact as the fire is put out in the accident and emergency units and this leads us to the central question of determining the position on additional hospital beds. The Minister might answer this because it has been asked for long enough. I am not talking about the 1,000 beds she is touting for private hospitals but about the need for 2,500 or 3,000 beds. Professor Drumm said we do not need the beds in the hospitals but in the community.
Since 1997 the number of community beds has dropped and hundreds of them have been taken out of the system. It is not as if we are seeing growth in this regard because we are not. Until we deal with the beds issue, people will be running around, both in the HSE and at hospital level, trying to put out fires. One might argue there is another review but one must ask how many reviews it takes for us to be told what needs to be done about the central issue we face, particularly at hospital level. We have a rapidly growing population, the average age of which is increasing, our bed capacity is too low, thousands of beds were removed from the system in the 1980s, which problem has not been properly addressed, and the number of community beds has decreased. We need an answer rather than being told there is another review. The problem has been an issue for too long and is not being addressed. What are the plans for the acute hospital and community sectors and what capacity is being built? How long will it take?
I visited a new oncology unit with 11 beds that was built in 18 months — credit is due to everybody who constructed it. It was the best accommodation in the hospital in question and this proves it can be done. The downside is that the system is modular and only lasts about 20 years. One does not argue when one is an oncology patient lying in a very comfortable, well-lit, modern unit. When I asked how much it cost to put up the unit, I was told it cost only €1.8 million — this must have been wrong. If this kind of response can be achieved on the ground, it begs the questions as to why bed capacity is such a running sore and why we cannot deal with it.
I appreciate that efforts and progress have been made regarding primary care teams. The correct approach has been taken and I support it fully but we should not exaggerate what is involved. Consider the point that a hundred public health doctors are not available to offer simple services. Child development services are not available in some parts of the country and one must wait months to get an occupational therapist to visit an old lady who needs supports when trying to get into her bath. Psychologists are not available because there are not enough to deal with adolescents' mental health problems or learning difficulties. These are the sinews of community care that simply do not exist.
We are told the recruitment cap has been lifted, yet I am told the opposite by others. I do not know the truth but, like Deputy Twomey, I am talking from direct experience. I can see the lack of provision at primary care level, which worries me deeply. When I hear the leader of the Minister's party saying the Government does not need money, I wonder how this squares up.
He did not say that.
He did, I listened to him very carefully. He said the Government did not need all the money it was getting from stamp duty. Let us not get bogged down in this because I want to make some other points.
Professor Drumm once said at this committee, I believe, that he did not want to frighten people by giving full figures on MRSA. I ask him to reconsider this approach. It is representative of the old secretive culture that should be gone. Every time I enter a hospital, I ask about MRSA and ascertain that it presents one of its main pressing challenges. We should share the information and determine what can be done. There is a real danger that people will say matters are all right because the hygiene audit has shown improvements — it would be hard not to show improvements and I welcome the audit — but matters are not all right. What is being done regarding pharmaceuticals and antibiotics in hospitals? What needs to be done to come to terms with this serious problem which is proving increasingly difficult to combat?
The topsy-turvy approach to consultant contracts is fascinating. The Minister stated that if public-only contracts were not accepted by June last, she would move ahead regardless. I do not know what was meant by this but there has been no movement and the issue has become bogged down. The approach is shifting from the introduction to public-only contracts to one based on the maxim, "whatever one is having oneself". While I do not argue that this new approach will not work, the discussion on the consultants' contract is always focused on consultants and doctors. I have no interest in bashing consultants but this discussion should be framed in the context of patients. How will the HSE ensure that negotiations on a new contract will result in public patients being treated as well as private patients in terms of access to consultants? Is this not the key issue?
Is the Hanly report dead or will its recommendations be introduced? I cannot fathom what happened at Roscommon County Hospital. Two completely different messages appear to be emerging, one from the HSE and the other from the Government. Will Professor Drumm explain how they have been reconciled, if at all?
Given that I questioned the Minister on the proposed new children's hospital yesterday, I do not propose to go over old ground. Serious concern is being expressed, particular by Our Lady's Hospital for Sick Children in Crumlin, about the selection of the Mater Hospital site for the location of the new children's hospital. As Professor Drumm has particular experience in this matter, it would be helpful if he commented on it. For example, will he indicate whether the proposed arrangement will include a curious lease under which the new hospital will own everything from the ground up, whereas the Mater Hospital will own everything at ground level and below, including all car parking? How would a new HSE hospital manage a system such as this in which 400 car park spaces could be whipped away from it at any stage?
Is Professor Drumm or the Minister satisfied with the prospect that there will be no paediatric hospital south of the River Liffey as far as Wexford? Access is already a considerable problem for residents of County Wicklow, the area in which I live. I am not, however, thinking purely in parochial terms. Access to the Mater Hospital site is difficult and restricted. Is the decision to locate the new hospital on the Mater Hospital site non-negotiable?
I resent the remarks made by the Minister for Health and Children, Deputy Harney, and Professor Drumm. They were outrageous, scurrilous and an insult to me, as a public representative, and to the thousands of people who demonstrated for the retention of basic health care services. To state that we are scaremongering, putting patients' lives at risk and using vulnerable patients to argue that our fears are based on the unknown and to classify us as a vested interest is an insult. We refuse to accept this type of language or the type of treatment being doled out to people in County Monaghan.
Professor Drumm referred to independent reports. The most recent independent report into the death of Mr. Pat Joe Walsh uses precisely the same language used in every other report published since 1969. The only change in this report that I can determine is that it has been souped up a little and made more attention-grabbing by removing the word "hospital" from the title "Monaghan General Hospital". Nursing homes even have the word "hospital" in their title.
Professor Drumm informs us that the removal of 24 hour per day, seven day per week emergency care is safe and good for the people of County Monaghan. Has he read the most recent report published in the United Kingdom, Keeping the NHS Local — A New Direction of Travel, which completely opposes the failed and tried concept of developing super-regional hospitals in Britain. The HSE should take this report on board before taking action and still has time to do so.
Professor Drumm referred to people voting with their feet and attending Dublin hospitals. I cannot see how anybody can get into an already overcrowded hospital. He should not forget that for years patients from south County Meath and south County Louth have regarded Dublin hospitals as their local hospitals. I resent the fact that Professor Drumm is manipulating statistics and trying to use them against us.
It is patently obvious that Professor Drumm is unaware of the reason 10,000 people took to the streets of Monaghan at 11 a.m. on a Monday. They are not unemployed because the county has a low rate of unemployment. They are willing to demonstrate because they are concerned. Twelve days before the most recent demonstration, Monaghan town was blocked tight with demonstrators demanding service. It is apparent that Professor Drumm does not know the reason for this. I will give him six reasons people in County Monaghan are demanding the provision of basic services at their general hospital. I will first cite three cases of where people died followed by three cases where they survived.
Christina Knox, a lady in her 40s, suffered a heart attack at 9 a.m. Despite residing five minutes from her own physician in Monaghan General Hospital, she was taken to Louth County Hospital where she was pronounced dead on arrival or, to use polite terminology, DOA. Philip Courtney, a 40 year old man who played football and was quite fit, suffered a heart attack, also during the day, within sight of Monaghan General Hospital. He was brought to another hospital and pronounced dead on arrival. Benny McCullagh was also within sight of the gates of Monaghan General Hospital but died before arriving at another hospital. Benny was the main carer in his family and his wife and a daughter, who had Down's syndrome, have since died. While I do not know if their deaths are connected to Benny's, that possibility cannot be dismissed.
I will now give three examples of people who survived. When a neighbour of mine, Joe McMahon, a veterinary surgeon who does not mind me mentioning his name, developed a severe haemorrhage and his wife, a nurse in the accident and emergency department in Monaghan General Hospital, insisted that he be brought to the hospital. When he arrived at the hospital he had to be wrapped in tin foil to raise his body temperature. He would not have lived if he had travelled even as far as Clones. He is alive and well thanks to his wife's insistence that he be brought to Monaghan General Hospital.
A namesake of mine employed in the health service suffered a heart attack in Clontibret. He was given CPR and brought to Monaghan General Hospital and is alive and well today. A man aged in his 80s whose family home is opposite Monaghan General Hospital had a heart attack. His family were afraid to call an ambulance and instead placed him in an armchair in the back of a van and brought him to Monaghan General Hospital where his life was saved, although he has since died.
Of the six examples I cited, three deaths occurred when people were brought to other hospitals, whereas those who were brought to Monaghan General Hospital survived. Professor Drumm tells us that the service at the hospital is not safe and I and others are scaremongering. The people of County Monaghan resent that.
If basic, seven day per week, 24 hour services are removed from Monaghan General Hospital, it will have devastating consequences. If one suffers a heart attack, the most logical course of action is to give clot-busting medication, if possible within minutes. This fact is being overlooked. Professor Drumm indicated that the report's recommendations are based on the provision of advanced paramedic grades. There are no advanced paramedics in Ireland, although there are a few paramedics in Dublin. This is the HSE's way of sugaring a bitter pill.
I cannot accept that in the writing of any report on the health services one can ignore a Border area. Do people stop living just at the Border? There is a community on both sides of the Border and any genuine report on health services must include that area. Professor Drumm must regard Co-operation and Working Together, CAWT, the cross-Border health services body, as meaningless. It is not even brought into the equation in this report.
The provision of cross-Border services is not taken into account either. There is no mention of this in the Patrick Walsh or Teamwork reports. I do not see how these can be regarded as serious reports for us in the Border area to take on board. People in the Fermanagh, Tyrone and Armagh areas want us to have services because they would use them. That must be considered too.
The HSE must also recognise the new forums, or maybe it regards these too as meaningless bodies. At their most recent meetings they rejected the recommendations in the Teamwork and Patrick Walsh reports. That cannot be ignored.
The professionals who are expected to deliver these services are not happy with these reports. At no stage were they consulted. People walked past them without speaking to them or asking how they felt about the recommendations. That is a major issue for the medical boards in Cavan and Monaghan. The consultant surgeons there wrote to the HSE demanding that Monaghan General Hospital be put back on surgical call and be allowed to perform operations. That was prior to Patrick Walsh's death. Every consultant in Cavan and Monaghan said that.
Professor Drumm
I have a letter saying the opposite.
This is important. I did not challenge Professor Drumm. The letter appeared publicly in the local press. I doubt very much that the consultants signed two different letters.
Perhaps Professor Drumm will deny the following too but 29 general practitioners, GPs, signed a letter and sent it to the HSE requesting that services be retained at Monaghan General Hospital. These are professional people delivering services at the coalface. We cannot ignore them. These reports refer to consultation with user, patient and other interested groups but these have all been left out of the loop and ignored. Someone who is asked to write a report looks at all previous reports, jiggles them about and comes up with another recommendation to add clout to the previous ones. That is what is happening here.
Approximately 8% of the national figure for people on trolleys in accident and emergency units is in Cavan General Hospital. Our Lady of Lourdes Hospital in Drogheda issues regular radio appeals to people not to come to the hospital because it cannot cater for them and directs them to their GPs. This is the type of service we are expected to avail of daily. When one arrives at the hospital one is regarded as a second class citizen. These are serious genuine concerns. I resent the comments about scaremongering.
Professor Drumm says there is a steering group to implement the teamwork report and mentions the people on it. There is only one person from Monaghan on that committee, who is obliged to be there as chairman of the medical board in Monaghan General Hospital. He was betwixt and between about whether to sit on the committee because he is outnumbered. There are 16 people on the committee but I have not heard of any patient group in Monaghan being consulted about any form of representation there.
Will Professor Drumm clarify that the present services will remain in Monaghan General Hospital? When will the state-of-the-art six bay treatment room be opened? Staffing levels are agreed and there will be no new staff but the reassignment of staff or the filling of positions that have become vacant. I would welcome Professor Drumm's comments on that.
We will probably not do justice to the two reports, that of the Minister and that of the HSE, here today. I note that the plan for the future of mental health services was produced in the 1980s with great fanfare. The plan was good but the funding did not come through. Now the Minister's report refers to the vision for change.
I agree with the concept of community-based psychiatry and reaching people at an early stage and there is a good model for this in Cavan and Monaghan. Serious consideration should be given, however, to the concept of closing all the psychiatric hospitals. Some units are very good. Until a better location is found for the delivery of those services the Minister should reconsider this concept. I do not refer only to our unit at St. Davnet's Hospital in Monaghan. Units attached to general hospitals are not in ideal locations and do not fit well into the general scheme of service in psychiatric hospitals.
Suicide is one of the biggest killers of young people but there is no reference to the strategy for preventing this in the Minister's report. We should take every opportunity to address this problem. It kills far more people than are killed in car accidents and should always be at the top of the agenda.
The lack of funding for young people in the disability services is disappointing. Many parents tell me of the scarcity of services which are contracted to outside agencies which in turn are not funded to deliver the services. These needs arise at formative stages in a child's development, during schoolgoing years. Resources should be increased at that stage because the benefits will be seen at a later stage in the person's life. This particularly concerns children with autism who need one-to-one tuition but the teacher's hours are reduced. That is a major problem.
I thank the Minister and Professor Drumm for their presentations. Psychiatric hospitals have served the purpose for which they were built and should be replaced. I welcome this move and would like to see the provision of acute services at general hospitals fast-tracked. Will facilities be provided for people who have a chronic illness and challenging behaviour? They are normally people who have a chronic psychiatric illness and will need ongoing care. They would not normally be in an acute psychiatric unit. Will they be catered for in a high-support community residence or will a special unit be provided for them? The number of therapeutic teams leaves much to be desired. Some time ago, the Royal College of Psychiatry and other groups addressed the committee on suicide and there is a need to increase the number of therapeutic teams.
I was delighted to hear Professor Drumm's comments on Mullingar hospital. I have been saying it for years and no less a person than the Minister agrees with me. I am proud of the hospital. However, I have written to Professor Drumm on the several consulting positions in the hospital, particularly on the appointment of an endricronologist for the treatment of type 2 diabetes. Diabetes is like a train coming down the tracks with no brakes and will have serious implications for the health services. The current approach is reactive rather than proactive. Two years ago I was informed Mullingar Hospital would get an endricronologist and an endricronology department. While I understand a competition was held for the post and a candidate was recommended, as yet that person is not in place. Can the filling of consulting positions be fast-tracked? The timespan involved is unacceptable. If we are serious about providing increased levels of specialised care, we must fast-track the appointment of consultants.
What proposals are in place for the replacement of Comhairle na nOspidéal? I understand it is operating on an ad hoc basis on the approval of consulting positions.
Why have some hospitals a fine record in referring patients to the National Treatment Purchase Fund while others have a diabolical one? Some hospitals are at the four figure mark with referrals while others have less than 400. The purpose of the fund is to ensure patients can have procedures carried out that could not be dealt with by the health services. Why are the numbers so low in certain hospitals? Is there a problem with the consultants? Have they a problem with the fund? Anything that can reduce the waiting time for patients is welcome.
Concerns over diabetes are gathering momentum. Our current approach, however, has been reactive. Will a system to tackle it be rolled out? GPs have a pivotal role in this. However, by the time some people are diagnosed with diabetes, it is too late and all the services are required.
I am not convinced that the removal of the visiting committees for nursing homes and public hospitals was positive. In my 23 years as a health board member, I never came across a Leas Cross example in the midlands. Those committees had therapeutic value because, say, the local councillor would know the people in an institution. The visiting committees did a fine job. Will the Minister re-examine their re-establishment? I would like the setting up of the nursing home inspectorate to be fast-tracked. What is the status in the repayments scheme for people who wish to have a bed in a public institution but were forced to go to a private nursing home? Justice is on their side and they should be included in the scheme.
What is the next order of speakers?
The Minister for Health and Children and Professor Drumm will respond first. We started off allowing the main spokespersons to speak. We will move into the second round after we hear from the Minister and Professor Drumm. The order will be Senator Henry, Deputy O'Connor and Senators Browne and Feeney.
I indicated earlier.
Yes, you did but you are not a member of the committee. I always ensure members of the committee get priority.
There seems to be a first and second division of speakers. I hope it is not a cute way of keeping Government Deputies silent. I have just as much to say-----
Sorry, Deputy-----
I was here early and indicated I wanted to speak. I will probably miss my speaking slot here as I have to speak in the Dáil Chamber. If I do, I will be back to demand I be allowed to speak. I will not be silenced.
Deputy, you are being a bit overdramatic.
I am entitled to make my point. Being Government fodder is fair enough but there should be some equality for the membership of the committee. I am querying the style being adopted.
In fairness to the Chair-----
I am being as fair as possible. I am the only Government Deputy here since 9.30 a.m. but I still have not been allowed to speak. I will probably not be allowed speak.
Deputy O'Connor should remember the Minister is a Government Deputy and has much time.
I am sure the Minister will be happy to hear what I want to say.
We are losing valuable time. Deputy O'Connor, I am also a Government Deputy so I do not know where you are coming from on this issue.
Yes, but you were not looking to speak.
I never do.
I am making my point and I will not be intimidated.
That is the most offside remark I have heard today.
I have been sitting here since 9.30 a.m.
You can sit here for another five or six hours.
I will not be allowed to speak.
You will be allowed to speak.
I was among the first to indicate. I indicated before other members who the Chair has allowed to speak before me.
Deputy O'Connor, I have been approached by every member of the committee over the past few days to speak first. I cannot have everyone speaking first.
I was here first this morning before other members.
That is not the issue.
Then perhaps the Chair should tell us what system is being used.
Maybe if you attended the meetings more often, you might see how it works.
I am here.
Let us try and move on.
Perhaps I might clarify something. As a Member of the House entitled to attend and health spokesperson for my party, it is not my fault that we cannot access this committee as full members. The Chairman did not state that I would have the opportunity to speak in the list he has just read out. Will he confirm that I will have such an opportunity?
The list is open and transparent, and the Deputy is on it as the Member who speaks after the committee members. Is that all right? I do not make it up as I go along. Perhaps we might now proceed.
Unfortunately I too must leave. Can I ask that the questions I submitted last week be answered in writing? I also raised a question last March and received the answer today, despite the meeting having taken place six months ago. That is not the right way to do business.
We shall now proceed. I will maintain my openness, transparency and fair play as I move into the second round. I will begin by inviting the Minister to speak. Those who feel that I am not doing a great job did not get in first. We will move on from there.
The comments and questions from committee members fall into two categories, some concerning policy and some operational issues. Others straddle the two, and I will do my best to answer them.
I believe that Deputy Twomey spoke of political interference, and I would like to comment on that because it is important to me. The Department of Health and Children is headed by politician, a Minister who is a member of the Government. Under the new reform agenda, the roles of the Department and the HSE are very clear. For the first time, we have separated operational and policy matters, although there are clearly major crossovers. It is fair to say that Professor Drumm and his team at the HSE work very closely with the Department. The Secretary General, the chairman of the HSE, Professor Drumm and I meet frequently to discuss matters of mutual interest.
However, I reiterate what I said in the Chamber yesterday. There was no political interference from me regarding such issues as the paediatric hospital. My constituency hospital is Tallaght. At no stage did I seek, nor would I seek, to influence-----
It is not claimed that the Minister sought to influence anyone.
Nor did anybody else.
As I said yesterday in the House, all that I wanted for sick children was the best outcome, and paediatrics was not something that I had ever considered before becoming Minister for Health and Children, since, quite honestly, there is no great lobby in the area. Mental provision is often considered the Cinderella of the health services, but paediatrics did not have a big lobby. However, several clinicians made the point to me that we were to build a new hospital for Crumlin and another for Temple Street and that we should consider a single, state-of-the-art tertiary facility for the sick children of the entire country. I found a great deal of merit in the argument, and I was very pleased at the outcome.
When the McKinsey report was issued in September, it was accepted by virtually every paediatrician whom I met. People welcomed it and were enthusiastic. The more difficult part was when the site was selected. As I said, the decision was made by the HSE, which accepted the recommendation of the group established to identify it. The Government then endorsed that decision, and I hope that everybody interested in paediatrics will work to realise it.
I am not a construction expert or civil engineer. I have been reading about car parks and spaces. I have been in hospitals in the United States built on very small spaces. More important than the physical building is what happens between those who work there in the interests of the children. I have been particularly encouraged by the response that I have received from the parents of very sick children, including one parent whom I met last night, who said that we should get on with the hospital without further delay.
Regarding the implementation programme for cancer control about which Deputy Twomey asked, the HSE was to come forward with that, and I will let Professor Drumm deal with it. I am more than capable of taking criticism, and Deputy McManus made several such comments. However, I will not be criticised for the nursing home charges issue. Within one month of my becoming Minister for Health and Children, in October 2005, I had sought advice from the Office of the Attorney General about the legal basis for levying the charge.
I spoke of the Minister's predecessor.
No. We are now making the repayments and have put the law on a sound basis, and everyone accepts that those in residential care should make a contribution to the costs of their shelter and maintenance. All parties have always honoured that.
Deputy McManus asked about waiting lists. In 1997, there were 27,000 on such lists. I am not making a political point here. When the National Treatment Purchase Fund was established and sought to contact some of them, it discovered that some were waiting on more than one hospital list. Others had received the treatment or no longer required it. To be honest, the statistics were very much out of date, and that is why we moved towards the new patient register. I have been asked for the current figures. So far this year, approximately 8,400 people have been waiting for either medical or surgical procedures in 19 hospitals representing 75% of activity. There has clearly been a great improvement.
The National Treatment Purchase Fund has treated approximately 45,000 people to date. Instead of people waiting two to five years, they are waiting two to five months. For the 20 most common procedures, people receive treatment within five months, and that is very encouraging.
On the issue of medical cards——
The comment is thrown out a great deal that patients are waiting two to five months. Perhaps the Minister might explain to me, since there must be something wrong with the patients with whom I deal. Is that from when I write a letter referring a patient to a hospital until the person is treated or from when he or she is seen by the consultant? What is the status?
When they are seen by the consultant, they are put on a waiting list.
So it is not from when they are referred by a GP.
That is why I recently gave the National Treatment Purchase Fund the remit of providing faster outpatient appointments in many areas. They have seen almost 5,000 to date. I accept that one gets on the list only when one has been confirmed by the consultant. That has always been the way.
It is more important to use that figure, since otherwise it is misleading.
I am comparing like with like.
It suggests to people that they will be seen within two to five months when they read that in the newspapers. However, the Minister knows as well as I that the wait until patients are seen is far longer than that. It is not appropriate to throw out such figures.
We are trying to proceed. Allow the Minister to respond.
I am comparing the situation that existed when the Deputy's party was last in office in terms of how waiting lists were and are compiled. Approximately one third of those who receive an outpatient's appointment for a surgical procedure are found not to require it when they have been seen by a consultant.
On the issue of medical cards, I do not believe in what I would call "the numbers game", since it is meaningless.
The Minister promised to——
It must depend on financial circumstances. My colleagues in Government had in their election manifesto a commitment to 200,000 medical cards. What the programme for Government mentioned was eligibility based on financial circumstances.
We have increased by €72 per week the amount that someone can earn while being entitled to a full medical card. Furthermore, we have changed the manner in which medical card eligibility is calculated from gross income to disposable income after tax, PRSI, reasonable child care costs, mortgage or rent and travel to work. We have also introduced the new doctor-only card, to which we had estimated from income data 200,000 were probably entitled. So far only 33,000 have got it.
There are two issues in that regard, the first being that our income data are out of date, since incomes are rising much faster than the available data, either from the Revenue or the CSO, confirm. Second, the reality is that we should have graduated benefits. I do not believe that it should be all or nothing, whereby on one side of the line one gets everything from the full medical card and on the other nothing. I know in particular that families with young children often carried a huge financial burden in taking them to see the GP. Those cards are very much geared to people in such circumstances.
Many of the other issues are matters for Professor Drumm, but I would like to deal with the issues raised by Deputy Connolly. In my opening comments I stated that whenever procedures were safe from a patient's perspective, they would happen. If that is not the case, clearly they will not be carried out. We have 53 acute hospitals in the country and all accept that the range of services that patients require cannot be offered by each. One does not have to be a genius to accept that. We further know that the sooner a patient gets to the appropriate treatment place the better, particularly in an emergency. If a patient is taken to an inappropriate place, his or her chances of recovery are diminished. That is a fact.
I have been in this House for 25 years. For as long as I have been here there have been issues, discussions, reports, inquiries and tragedies because there are five hospitals involved here, a considerable number for a relatively small population. Very often we have ignored those reports. It is a fact that politics got in the way of their implementation at different levels. I am not a clinician or a medical expert, but I am not going to use my political influence or the powers I have to second-guess medical expertise. If we have reports from clinical experts that say a procedure is not safe in particular circumstances, it would be very irresponsible of me and I would not be worthy of my job if I were not to pay heed to that.
Professor Drumm will deal with what will happen on the ground. My understanding is that the vast bulk of what happens at Monaghan hospital will continue to operate there. I recently visited Dundalk hospital. There was rivalry and confusion for years between Dundalk and Drogheda. Both of those hospitals now work extremely well as a single surgical department. People there told me that formerly it would have been unthinkable for Dundalk patients to go to Drogheda for treatment, and vice versa. It is running extremely well as a single department, with more patients than ever and enormous patient satisfaction. That has to be the order of the day.
I was asked about hospital beds. The Government commitment in the bed strategy was 3,000 more——
The Minister used phrases there which suggested patients were being used for reasons other than patient care and that we were scaremongering. There were a number of other phrases there which she used——
Professor Drumm used that phrase. With respect to everyone here, clinicians who have been asked to review a particular tragedy from outside this jurisdiction have more expertise than any of us to make recommendations in this area.
The Minister said we were using vulnerable patients and that vested interests were involved. She regarded us as having vested interests. The only difficulties we have as regards hospitals in the north east were with Our Lady of Lourdes Hospital, Drogheda, and those have been well aired in recent times and have been raised here in the House. I ask the Minister to withdraw her comments to the effect that we have been using vulnerable patients, are part of a vested interest group and that people are being used for reasons other than patient care.
I did not use that language; the Deputy is somewhat confused.
I certainly am not confused.
I am not dissociating myself from the remarks. If somebody believes that in order to enhance a political reputation he or she will get me to overturn what is in patients' interest, let us be clear that I will not do that.
I was elected on that basis, for reasons of deficiency of health care.
Yes, I know.
I will fight as long as I am in politics to ensure that people get a fair service.
That is the Deputy's entitlement and that is what we are elected to this House to do. That brings me to a comment made by Senator Glynn, when he asked——
Just for the record, the Minister did a U-turn on the radiotherapy report.
Deputy Twomey should let the Minister proceed.
The radiotherapy report — I do not know what that means.
She said that the radiotherapy report was an experts' study——
There are other members who want to get in.
The Minister wanted clarification.
I will clarify that. I was just going to respond to a comment made by Senator Glynn, when he asked whether politicians could serve on visiting committees. Our job, as politicians, is to hold the HSE to account, to make policy, to legislate. I do not believe we have the expertise to do the type of things suggested. I am a strong fan of the democratic system, as I always have been. Clearly, we have to understand our role, however, and I believe that is it.
As regards the radiotherapy report, I do not know what Deputy Twomey is talking about. The radiotherapy report made reference to a number of centres, in Dublin, Cork and Galway, and satellite centres connected to them at Waterford and Limerick. That has not changed and neither will it.
That is not what the Minister's predecessor, Deputy Martin, had said about a situation which Deputy Harney inherited. He was totally against the idea of satellite centres. He said that Cork, Dublin and Galway were to have centres and that the mid-west, north west and south were not part of it. The Minister did a U-turn on that in 2005.
I ask Deputy Twomey to desist. I want to try to give fair play to members. The Minister should proceed.
I want to address the last matter. As I said, the Government committed to 3,000 beds. We have been providing beds at the rate of 200 a year. To put matters in context, it was 30 a year in the time of the previous regime. I have talked about beds before. Clearly a great many more procedures are carried out on a day-case basis. It is not a matter of beds for the sake of beds. This is reminiscent of what I said earlier about numbers. I spoke about Mullingar and Cavan. I was queried about those and I gave a number of statistics. They have the same number of beds and the same budget. Mullingar has fewer consultancy sessions than Cavan. The big difference between them and the reason Mullingar is more efficient, with a larger throughput on every measurement, is that it has an average bed-stay of 4.2 while Cavan's is 7.1. We are providing more beds this year in Wexford, and proceeding with Mullingar and other areas. We need to ensure, however, that the current stock of beds is being used efficiently. I am the first to acknowledge that we have issues as regards community beds. On any day in this country's hospitals there are 200 people, either young chronically sick or elderly, who do not need to be in an acute hospital. The challenge is to provide alternatives for that group of patients. If we can do that and use the current stock of beds efficiently, then it remains to be seen how many more we need. We will provide whatever beds are necessary, but we will not provide them if they are superfluous to requirements. I do not believe anyone would want us to do that.
On suicide prevention, we have given the HSE €1.2 million extra this year. A new office has been established. In particular, the report drew attention to the 11,000 who present at accident and emergency departments each year as a result of self harm. One of the recommendations was that a counselling or referral service should be provided for those patients. We know that a third of those who commit suicide have had previous involvement in self harm. I understand that this facility is now in place in all but three of the country's accident and emergency departments. Some 40% of those who commit suicide, equivalent to 431 in 2005, are males under the age of 35. That is the fifth highest statistic in terms of the old European Union and is extremely worrying. That is why the new office has been established within the HSE, to try to ensure that we play our part in reducing the high incidence of suicide in our society.
Professor Drumm
Some of the questions were clearly cross-over. Where that is the case I shall try to avoid duplication in my responses. I shall also need some input from a couple of my colleagues.
Deputy Twomey made a distinction I have often made between acute and long-stay beds, something that is clearly uppermost in people's minds. I have been clear since taking up office that I did not accept the need for 3,000 acute beds. This is supported by reviews which have already been carried out. It is time that this country started to count its private bed capacity as "beds". Some 50% of people are in the VHI and there are about 1,800 beds. To do a bed review in Ireland and ignore the fact that 1,800 are already being paid for through the VHI would be a wonderful gift to all of us who work in the health service — in terms of allowing us to work on a very inefficient rate. Any regime will count the total number of beds in the system.
Without counting the total number of beds in the system we are still practically at the same level as the UK. We are significantly higher than northern European countries. If one counts the total number of beds in the private and public systems we are equivalent to or slightly higher than the UK. We compare ourselves to countries that have 20% of their populations over 65 while we have 11%. Ireland enjoys the most positive demographics for health in developed Europe. However, we are comparing ourselves to need beds at that rate, which is what the report to which the Deputy refers has done. It is crazy and if we do it, we will have a completely unsustainable health service in 20 to 30 years. In 30 years, 20% of the population will be over 65. I ask people to get realistic. If we want to run a system based on that number of beds, we will bequeath an unmanageable health system to our children and grandchildren.
I know of no business in the world that compares figures like for like when it knows that the demand is twice as high in the system against which the comparison is made. If comparisons are not standardised and based on age, then the data is pointless and misleading. That is why we need the hard information about our bed requirements and the effect of modernised systems of development in primary care systems. We can already see in our own figures that there has been a great move to day surgery. There is a need to be clear, especially in the north east, where the use of beds is incredible, to put it mildly.
I am not clear what Professor Drumm is saying. He rubbishes the target of 3,000 beds, which is his position, but we have a dearth of community nursing beds.
Professor Drumm
Absolutely.
We have many elderly people inappropriately placed. What is the HSE doing to deal with that?
Professor Drumm
I fully agree about the need for community beds. We put out expressions of interest for community beds among the private sector and we have looked at our sites to provide them on public sites. By May 2007 in Dublin alone, we will have supplied 200 extra beds in public sites in Cherry Orchard and in St. Mary's in the Phoenix Park. Those are important because they tend to give us a higher dependency. When it comes to providing beds, dependency is critical because we want to look after the people who could never be looked after at home. We have had expressions of interest in the private sector for 750 beds. We do not believe that those will be supplied because when we look at the quality of those beds, that number will drop back to 450 due to the strict inspection regimes that we now apply.
There are several other sites across the country where public beds are being brought on line. I am quite happy to provide the Deputy with a detailed outline of that situation in the next few days. This is the critical question in terms of bed capacity and Deputy Twomey has also raised this issue. However, the beds that have been put forward under the expressions of interest will not all be supplied and it will take time before they are all inspected. We can give members an outline and a fairly good insight into how many of them will become available between now and next summer, both in the public and the private system.
Professor Drumm seems to indicate that he will follow my line of thinking by building community care units on the grounds of major hospitals, as opposed to sourcing additional beds.
Professor Drumm
We are already doing that. In places like St. Mary's in the Phoenix Park, which is close to the Mater Hospital and Beaumont Hospital, there was significant capacity close to where people live. We are currently putting in 100 beds and there is also a unit in Sligo which went up in six months. We accept that these can be delivered quickly through modern, modular construction. There is no reason that we should not be providing these in any place we have land. Dependency is a big issue and we estimate that many of the high dependency beds can only be provided through our own public system.
How many new community beds will be provided by the end of 2006?
Professor Drumm
We expect to bring in between 200 and 250 beds between now and the end of 2006. By June 2007, we hope that number will be close to 1,000. As we are now applying a very strict level for licences, a number of privately provided beds will fail that test.
Is Professor Drumm talking about buying private nursing home beds?
Professor Drumm
I am talking about both.
So there will be contract beds as well.
Professor Drumm
There will be contract beds as well as publicly built beds.
I understand that but will the HSE buy up beds in private nursing homes?
Professor Drumm
Absolutely, on a contract basis. We will do both.
One of the major difficulties we have even in general hospitals is finding staff. Have staffing complements been agreed? Will staff be available for these units?
Professor Drumm
On the nursing level, there is much hope on the horizon. While we have experienced difficulties in recruiting nurses to date, we have greatly increased the throughput of nurses in our education system. In the UK, 80% of nurses who qualified over one year ago are now unemployed and the immigration of nurses into the UK has been blocked. Things are changing quite rapidly as we speak. It is no longer possible to emigrate to the UK as a nurse due to that level of unemployment. We are very hopeful that there will be an increasing supply of people to staff these units. We have major challenges in the therapy grades, but this is being addressed by increased input and expanded physiotherapy and other educational programmes. That will take longer.
Many of our trained nurses are not being retained within the system.
Other members wish to speak. The Deputy can come back with that question later.
Professor Drumm
I would like Mr. Browne to comment on home helps and subventions, as he has much expertise in that area.
Mr. Aidan Browne
There has been an increase in the number of home helps, home care packages and nursing subventions. Deputy Twomey identified difficulty in accessing home helps. For the first six months of 2006, we had 7,000 additional people receiving home help, which works out at an average of 126,000 additional hours per month. I accept fully the issue about how services are accessed across the country. A standardised approach to accessing home help is a key objective of the HSE, the first point of which is a standardised needs assessment. That process is almost complete. We will have a standardised approach to home care packages and standardised nursing home subvention access, as well as a standardised inspection regulation process. By the end of 2006, we expect to have those standardised processes in place and they should be on the HSE website and be fully transparent. The key objective is to simplify them and the same objective applies to the medical card process. People should not have to jump over several bars to get into the system.
Professor Drumm
Deputy Twomey raised the issue of cancellation and accident and emergency departments. I stress that we deal with 5,000 admissions per week and the vast majority of those people are entering the system very efficiently. There is a problem in every health system in the world in having to balance its elective capacity with its emergency capacity. If we are cancelling 22,000 elective admissions every year, the HSE must be one of the most successful organisations in the world and that is why I am challenged by those figures. We carry out 300,000 elective procedures every year. If we only cancel 22,000, then I suspect that even corporations like Coca Cola would like to see what we are doing, considering that we are facing a demand-led scheme. I have to question whether this figure is realistic, but that is the figure I am given. Some 22,000 cancellations out of 300,000 is a phenomenal performance for a system that faces demand-led-----
That does not help the 22,000.
Professor Drumm
If one wants to run an acute system that actually——
Can I——
Professor Drumm
I am entitled to speak. We run an acute system that may tonight be faced with outbursts of winter vomiting bug and so on yet we end up with that level of cancellation out of 300,000 elective procedures. One would be challenged to find any system in the world that would not have that level of cancellation.
Professor Drumm should go to Letterkenny Hospital and look at its day procedures area when it is full of patients. He should talk to a cancer patient on whose behalf I have had to harry a hospital in Dublin to gain admission after weeks of waiting. Let us not be too disconnected from what is happening on the ground.
Professor Drumm
Does Deputy McManus suggest we should be able to run a system with fewer cancellations? That is the question.
I am concerned that the accident and emergency crisis will be shifted down the line — it is happening already — with the result that elective patients will have their procedures cancelled just so Professor Drumm and the Minister can look good by reducing the pressures on accident and emergency services.
Professor Drumm
We have been very clear in what we have outlined with regard to the packages at the hospitals. One of the central pillars of incentive schemes has been the maintenance of elective activity. We will not accept otherwise. If the Deputy examines the information we have sent out — anybody can access it and it was sent to the hospitals — we stated that one of the preconditions for any activity was to maintain elective activity. We are absolutely focused on maintaining elective activity.
I will come back to the Deputy presently with regard to the individual hospitals.
That point is wrong.
Allow Professor Drumm to continue without interruption.
What Professor Drumm says is misleading. The Chair cannot allow misleading information. Professor Drumm is saying——
It is what I am saying that is important. Allow Professor Drumm to proceed.
——that every 13th patient has his or her procedure cancelled. If every 13th can of cola blew up, Coca Cola would not be too happy.
The Deputy must be fair to Professor Drumm. Allow him to proceed. The Deputy can ask questions later.
Every 13th patient — the unlucky 13th — has his or her procedure cancelled. That is not an acceptable standard. Professor Drumm knows the hospitals where clinics are being cancelled on a weekly basis.
The Deputy will allow Professor Drumm to proceed or I will suspend the meeting. I ask members who have already spoken to allow other members the time to contribute. They will have their chance to ask questions later. I call Professor Drumm.
Professor Drumm
My point is that every system with demand-led challenges will have cancellations. It is our job to minimise them. A definite part of the target system for any hospital is that it would maintain elective activity. For me to suggest that for this or any other health system there would not be cancellations based on rises in acute activity would be completely disingenuous and erroneous. No health care operator in the world could suggest that. What we must do is minimise the number of cancellations. I accept this is a challenge but it is one we take on board.
We feel there have been significant changes in orthodontics, on which Mr. Browne may be able to provide specifics. We have invested heavily in orthodontics. As I travel the country, the statistics I find suggest the situation is improving significantly but it is a challenge to deal with all orthodontic issues.
Mr. Browne
As the Deputy rightly pointed out, there is a wide level of disagreement within the service as to what is the best way to deliver orthodontic services. Earlier this year we established a review which would take account of the two reports of the joint Oireachtas committee in 2002 and 2005. We have asked Hugh Kane, who is a local health manager in Wicklow, to chair this review. The participants in the review are experts in the domain and our objective is, before the end of the year, if possible, to produce a report that will be costed and timeframed for implementation.
Notwithstanding this, in the period since the first report in 2002 up to 2006, the total number on assessment waiting lists has reduced by 60%, the total number on treatment waiting lists has reduced by 10% and the total number of patients in treatment has increased by 30%. Therefore, there is a significant level of activity in the area. In the past 12 months, we have appointed 13 specialist orthodontists, which will obviously have a dramatic effect on the waiting lists.
Professor Drumm
I ask Mr. O'Brien to comment on the capital project at Our Lady of Lourdes Hospital, which was raised by Deputy Twomey in the context of the project being held, which was not the case.
Mr. John O’Brien
There are various forms of capital programme. A major capital programme is provided for, as well as interim programmes around a range of areas such as accident and emergency. The major programme is in the broad-based capital programme of the HSE at this stage. The minor programmes are proceeding. Accident and emergency is one area on which we would want to move fairly quickly. It is not in the programme for the current year but will hopefully be included next year.
Is the major capital project proceeding at Our Lady of Lourdes Hospital?
Mr. O’Brien
It is in the overall capital programme of the HSE.
It is not proceeding.
Mr. O’Brien
It has not proceeded this year but the accident and emergency programme is the one we would hope to progress quickly.
What of cancer services?
Mr. O’Brien
The work plan for the implementation of the cancer control programme has been produced within the timeframe we discussed. The issue for the HSE is that there is no point putting the programme into position unless we have staff in position to move it along. We have done that. Internally, a number of people have gone into position and we are also in the process of trying to conclude an agreement with the British Colombia cancer agency to provide significant external support in this regard. We would hope to conclude this in the coming weeks. An advisory committee has been established and will meet for the first time tomorrow.
The programme has a nine month to one year focus, the primary part of which is to put into position the director of the national cancer programme and the main support personnel. It is very much on line and on target.
Is it over a nine-month period?
Mr. O’Brien
Yes. The idea is that the programme construct necessary to deliver on the cancer control programme will go into effect, the primary piece of that being the creation of a position of director of the national cancer programme, which will provide a unified approach to dealing with cancer across the country. That piece is well in position at this stage and hopefully will come fully into position in the early part of next year.
That is a long wait for the implementation of a new cancer programme.
The Deputy should allow Mr. O'Brien to proceed.
Mr. O’Brien
To put someone into a position of the type referred to, a three to six month wait is not a long time. We are talking about a very senior post.
Professor Drumm
Deputy Twomey stated that regionalisation is a failed policy. I hope that is not the case. Across all regions, we hope the issues raised by the Deputy are dealt with, including the installation of cardiac catharisation systems. We believe this will need a reorganisation of services in the south east, south and mid-west. One of the reasons so many patients in these areas flow to Dublin — they do not do so in anything like the numbers which flow from the north east — is because those services are not in place, and one of the reasons for this is that there is no comprehensive plan for services across the regions. It is absolutely our determination to put those plans in place across all regions, particularly regions of that size, which can easily sustain those types of services. Hence, the Deputy may take this to be our number one priority. It does not make sense for Dublin hospitals to complain about high numbers of people using accident and emergency services when they admit significant numbers of patients from across the country who could be more than adequately dealt with by properly provided services in their local areas. I fully agree with the Deputy that we must continue this policy.
Deputy McManus also raised the beds issue and I have outlined my view in this regard. However, while there were 12,145 beds in the public acute sector when the health strategy was published in 2001, there are now 13,349, which represents an increase of 1,204. While I can provide the details separately, it does not necessarily make pleasant reading in terms of where the beds were provided and where we continue to have very substantial waiting lists in accident and emergency departments. Anyone who examined the lists would be slow to argue that providing additional beds would solve the problems with the accident and emergency services.
The growth in secrecy——
Not if the Health Service Executive got it right.
Professor Drumm
Let us see. However, while substantial increases have been provided in places with the longest waits, the waiting times have not moved one iota subsequently. It is hard to put it together.
As for the growth in secrecy, I hope this is not the case. While we continue to be criticised for PPARS and I am continually told of a democratic deficit within the Health Service Executive, PPARS was governed and implemented by the health boards. Although I took it on board, the expenditure and structures were put in place when the health board system was in operation. The challenge for us now is to establish whether we can get it right.
As for GP overpayments, etc., these are all issues with which I believe the Health Service Executive can now deal much more robustly at a national level. At present we are implementing extremely advanced information technology structures within the GMS payment board. GPs will be able to use their mobile telephones to remove or add patients, as well as to determine their eligibility. Such developments are now possible and much better accountability is needed. The Comptroller and Auditor General has also examined this issue and the Health Service Executive is beginning to address it nationally. The manner in which the modernised GMS structures work is an example of how well things can be done. This is to the benefit of the GPs, who often lost out under a system in which they could not register for ages a patient they were treating, and from our perspective in terms of governance.
The Minister for Health and Children has dealt with GP-only medical cards. The Health Service Executive has put much effort into advertising them and from our perspective it is incredible that people have not taken them up in larger numbers.
Professor Drumm should try selling Coca Cola and give the people what they want, which is medical cards.
Professor Drumm
While I understand the number of medical cards has also increased significantly, we can make the figures available.
On the question of how many people are waiting for procedures, the Minister dealt with the National Treatment Purchase Fund, which is not part of our organisation. As for parliamentary questions, we absolutely accept Deputy McManus's comments. I am informed that the rules regarding the contents of replies to which the Deputy referred will also be required for our website.
The Deputy hit on a very important point when referring to waiting periods of up to six hours. One issue concerns those awaiting admission. A second issue concerns those people who come to accident and emergency units and who are obliged to wait for extraordinarily long periods before being seen. This raises the more fundamental question as to why so many people come to accident and emergency departments. The answer is that they come to wherever accident and emergency services are established. For example, attendance at accident and emergency units is highest in the midlands where three accident and emergency departments serve a relatively small population. It is lowest in the north west where two accident and emergency departments are located 70 miles apart. Hence, if the service is provided, people will come. We must provide alternatives. The waiting time for those who come and do not require admission is an important question which has not been dealt with. We must focus on this issue.
GPs are the first to point out the absence of occupational therapists and psychologists. Our point is that while large numbers of occupational therapists and psychologists are located in some areas, they are often unavailable to GPs or the public in terms of generic services. The main reason the entire reorientation of the health services must work, including the move to primary care centres and the allying of community services, is that at present people are in silos. Thus, if one has a disability or is elderly, one may gain access to an occupational therapist. However, if one comes in from the street having suffered an injury, one's GP may be unable to find an occupational therapist because one does not fit into a silo. The same is true for psychology, etc. This is one of the critical reasons people must be induced to operate at a population level, rather than at a disease or disability level. It is one reason this process must begin to work.
As for the consultant contracts, I cannot go into details as to what we will put on the negotiating table. However, we fully accept that the focus of the consultant contracts must be to achieve equity for the public rather than the private patient entering the system, be that through public or private hospitals. At all stages we must accept that because people with severe illnesses will access the public system, there will be private patients within the public system. However, we must achieve equity and we are determined to do so.
I have certainly been caught in cross-fire in respect of the children's hospital. I spent half my life reading nasty letters in the newspapers from people on the north side of the city informing me that I wanted it to be located on the south side. Subsequently, when it was decided to opt for the north side, letters appeared in the newspapers saying that I had always wanted it to be located on the north side. My scrapbook makes interesting reading in this regard. However, I do not believe that anyone can claim to have made greater efforts in the past 15 years to get a single children's hospital. That so many people now have an opinion on it is somewhat ironic, as it took many years to get anyone to express one. I can guarantee the committee that no one interfered with the process politically.
Is it my choice? Were I working in Crumlin hospital, I am sure that I would love to see it located there and that I would be one of the first people to tell the committee so. The bottom line is that the decision has been made. Neither I nor anyone else who may be discommoded by it can be permitted to prevent what is a hugely exciting opportunity for the children of Ireland. This must be seen as a step from unbelievable facilities, both in Temple Street and Crumlin hospitals, to a situation in which we will have the potential to achieve a world-class service. As for specifics, unless they were of huge importance in terms of stating whether it was wrong or right, there would always have been arguments. While I could put forward the case that I would have been on the other side of the argument, that is not the important issue. The important issue is what is right for the kids. This will move us to an entire new era.
I can understand why Deputy Connolly might be upset at some of the things I had to say about what is going on in the north east. I can assure him the comments are certainly not attached to him or to anyone personally but to a lobby pertaining specifically to Monaghan Hospital rather than to the north east. However, I wish to deal with a couple of the issues raised. I cannot ignore two independent reports and I do not believe the Deputy can do so either. I do not believe that anyone there has the expertise to say, "Tear them up" — to do so is not an honest approach to patient care and quality. It is putting one's head in the sand and the people do not deserve that.
The issue of the United Kingdom reports was central to the group that actually carried out the review of the north east and we are well aware of those reports. However, the reports deal with a completely different population density from that with which we are dealing and certainly do not promote the provision of acute surgical services at every turn or corner.
I refer to the existing overcrowding in Cavan and Monaghan hospitals and in the north east in general raised by the Deputy. The Teamwork report made it clear that the level of admissions to hospital in the north east is not only massively out of line with the rest of the world, it is totally out of line with other parts of Ireland. For some reason, one's chances of being hospitalised in the north east are extremely high. While the Minister compared Cavan to Mullingar, admission levels are extremely high throughout the north east. We do not understand why admission levels for acute surgery are hugely higher than those which obtain in the rest of Ireland or anywhere else in the world. Moreover, medical admissions throughout the north east are extremely high.
If one admits such numbers of patients, one will certainly fill hospital beds and undoubtedly leave people on trolleys in Cavan General Hospital. The explanations for this are unclear to anyone within the Health Service Executive. However, at a management level we will move to determine how this can be dealt with. If admission rates in the north east can be reduced to those which pertain everywhere else — we have no reason to suggest that people in the north east get sicker than anywhere else — then one should not have any patients waiting on trolleys in Cavan Hospital. This is an issue with which we intend to try to deal. The Teamwork report told us that while there are nearly 1,000 acute beds in the north east, there was no justification for anything above 800. Moreover, if one were to take into consideration the fact that 30% of the population come to Dublin for their care, the figure of 800 beds would constitute a significant oversupply. Therefore, shortage of beds in the north east cannot explain why patients wait on trolleys in Cavan General Hospital or cannot get into hospitals in Drogheda. This must be accepted.
Raising specific cases involving people who have died is scaremongering. People die outside Cork hospital, at the gates of or within half a mile of St. James's Hospital and all over this country but we do not build hospitals beside the site at which they die. We cannot deal with people in the health services on that basis. If we are to deal with them on this basis, somebody needs to produce the figures to show that people in Castletownbere have a higher mortality rate from myocardial infarction than people in Cork. However, these figures are not available. Do people in Donegal town, who live between 30 and 35 miles from Letterkenny and Sligo, have higher death rates from myocardial infarction than people elsewhere in the country? I am not aware that they do and the relevant data can be found in the health atlas. Do people in Carrick-on-Shannon, who must travel over 30 miles to Sligo for hospital services, have higher mortality rates than people in Sligo town? There is no evidence that they do. It is not acceptable to us to cite specific instances because every person in every town in Ireland, including towns with massive hospitals, will, unfortunately, identify 20-year-olds who die, never mind 40-year-olds. To say that somebody died because he or she did not get into a hospital is unfair and unfortunate and I suggest that——
I did balance that. The three people were alive when ambulance services reached them but dead on arrival at hospital. I balanced that with the cases of three people whose lives were saved.
Professor Drumm
Absolutely, and we can come up with——
(Interruptions).
Deputy Connolly——
There is a very crucial issue here. Can Professor Drumm accept——
Other members wish to contribute.
On a point of order-----
Deputy Connolly can make a point later on.
(Interruptions).
Professor Drumm
Let me finish by saying that the size of the population means nothing in terms of death rates. Death rates are based on the population and are no different in those towns from any other town in Ireland. It does not matter if there are 1 million or 1,000 people in the town, the death rate should tell us the answer. The evidence is not present to support what is being said.
Enniskillen is now due——
Can I interrupt Professor Drumm for one moment?
I must take the Chair in the Seanad at 12.30 p.m. and have a few comments to make.
It is Senator Henry's turn to speak. Later on, we will return to the members who have been waiting to speak.
I welcome the Minister to the meeting. I very much support what both the Minister and Professor Drumm are attempting to do in respect of keeping people at home and community interventions. However, there is still a major problem with home helps. For example, uniformity of assessment of people across the country is being carried out but will there be uniformity of payment to home helps across the country? How much are they paid? These people are extraordinarily important in keeping people at home. Mr. Browne mentioned that a locum should be available to a person but if there is no locum for the elderly person at home, he or she cannot wait two weeks to get a cup of tea while the home help has his or her well deserved holiday. Therefore, it is extremely important that these interventions are very well organised.
Deputy Connolly has spoken about access to emergency services. Is the pre-hospital emergency service system being rolled out across the country because thrombolytics could be given by it, which would be very helpful? In respect of waiting times in admission to accident and emergency departments, there are quite a few international surveys on the subject. I certainly remember one from Australia. These surveys concluded that there was a poorer outcome if people were kept waiting in accident and emergency departments longer than they should be. This does not relate to when investigations are being carried out but it is not a good idea to hold someone overnight.
In respect of mental health, there is a definite need for acute beds. Psychiatrists keep telling me that they are very anxious about the fact that there may not be enough acute beds left. I support having the mental health services associated with general hospitals but we need to watch that. Very little appears to be happening with child and adolescent services. We know that the earlier the intervention with mental health problems, the better the outcome is likely to be.
We frequently discuss orthodontics but in many cases, it is cosmetic. On the other hand, we are very much behind the times in respect of the development of maxillofacial surgery, which is a very serious issue. Plastic surgeons are performing cleft palate surgery and so forth but the maxillofacial surgeons have so much to do with regard to cancer patients and accident victims that they are not in a position to deal with serious orthodontic cases. This matter should be examined.
I was not simply in one small Dublin hospital which closed down, I was in two. Therefore, one could say I was akin to Typhoid Mary. Therefore, I understand the emotional impact of small hospitals losing their modus operandi, aside from being closed down, which must be taken into account. From the Fitzgerald report onwards, there has been both political and clinical interference with making progress on the rationalisation of acute hospital services in this country. After 40 years, it is depressing to see it arising again. I do not believe Deputy Connolly is attempting to enhance his political reputation because he was elected to bring forward the position of Monaghan General Hospital. Patient safety issues are the really important issues but it must be slightly galling for him when he sees members of the major Government party stating that the Taoiseach has promised that there will no change but we hear otherwise from the Minister and Professor Drumm. I apologise for having to leave the meeting.
Can I proceed with the rest of the members who wish to speak before the votes are taken? Would the Minister and Professor Drumm be satisfied with this?
I must also leave. Professor Drumm's remarks about the IT issues raised by me are on the record.
Like the would-be Ministers for Health and Children present, I have plenty of opportunities to talk to the Minister for Health and Children. Therefore, most of my questions will directed at Professor Drumm. In respect of the document that was given to us this morning, I take the point made by Professor Drumm about parliamentary questions and how they are being dealt with. However, a quality audit is required because the answers to some of them are very frustrating. I do not wish to become agitated about anything but I regularly put down parliamentary questions as part of my campaign to have the Millbrook Lawns Health Centre redeveloped seven years after it was damaged by fire. My questions are sent to the HSE. Mostly, HSE staff telephone me to ask the location of Millbrook Lawns. If a few of Professor Drumm's officials wish to meet me on the Luas some day, I will bring them out to Tallaght and show them where the centre is. I am not being flippant because this is a serious issue for my community. There have been great developments in Tallaght in respect of health centres but Millbrook Lawns Health Centre is a disgrace. Staff and patients in the centre are coping with a very difficult situation and it is time the matter was put to bed. I ask Professor Drumm to take a particular interest in this matter. I do not wish to be any more parochial than any of my colleagues but I have heard every town in Ireland mentioned this morning. Therefore, it seems reasonable for me to mention Tallaght once or twice.
In respect of what Professor Drumm described as the ongoing briefing meetings, I welcome this commitment but it has been slightly slow in bearing fruit. Professor Drumm might recall that at the Oireachtas briefing, which was an excellent and very positive meeting and well chaired by the Ceann Comhairle, I put it to him that my colleagues from all other parties and I read about the decision in respect of paediatric services in the newspapers. In the meeting, I mentioned the paediatric services in particular. I recall that Professor Drumm conceded that we should have been properly informed and briefed but we still have not been properly informed and briefed. No local briefings have taken place. We still do not know what is going on. Professor Drumm is aware from correspondence I have sent to his and the Minister's offices that it is an issue. I will not be any more politically sensitive than any of my colleagues and will take the knocks like everybody else.
The decision regarding paediatric services has been mentioned several times this morning. If Professor Drumm bothered to examine the publicity, he would see that the Tallaght Echo , which is received by the Minister, discusses the campaign every week. This morning’s headline was that people should fight for their hospital. Every political pamphlet states that the decision was political. I listened to Professor Drumm’s comments and I must repeat it a few more times because people are concerned about it. I sent Professor Drumm a cutting recently concerning someone who wrote to my local newspaper arguing that children in Tallaght will be in an unsafe position. This upsets many people. In my local newspaper this morning, Professor Ian Graham, a very eminent individual who is consultant cardiologist at Tallaght Hospital and vice-chairman of the board of the hospital, was reported as saying that the board learned a hard lesson about politics through the issue of the paediatric hospital. He is cited as saying that the board sat in a room for nine days preparing Tallaght Hospital’s bid. It was happy when it finished because it believed that Tallaght Hospital was the only site to meet all nine requirements to get the National Children’s Hospital. However, little did it know that the bid would hardly be read. These statements are a challenge to Professor Drumm, who must give his opinion on the matter. I live in Tallaght, was a member of the Tallaght Hospital board for a long time and am supportive of my local hospital. I have no problem in taking political hits, but I need to hear Professor Drumm’s reaction. What will he do to reassure the people of Tallaght and the wider area about their services?
Professor Drumm eloquently stressed that the issue of children must come first and referred to the Mater Hospital site, but he, his senior staff and the local people are not addressing a number of points. What is the local management doing? Tallaght Hospital is the only hospital that complies with the MacKenzie criteria. As Professor Drumm knows, co-location with adult services remains the right approach.
Many people say that the HSE process and report were flawed. I do not want to pick on the former chairman, Mr. O'Brien, for whom I have much respect. It is never mentioned that he was replaced during the process, which raised many doubts about it. People ignore the difficulties. Recently, Sinn Féin carried out a good exercise in which three public representatives gathered at Tallaght Hospital with families and used different modes of transport to go to the Mater Hospital. They found that travelling by bus, Luas or car was a nightmare. Professor Drumm must provide guarantees in this regard.
Yesterday in the Dáil, I asked the Minister for Health and Children about her meeting with the Taoiseach and church leaders. It is important that Professor Drumm answers the charge that the HSE is violating the terms of the charter that established the hospital in 1998. Recently, the Taoiseach confirmed the status of the charter a number of times. The people of Tallaght were promised a children's hospital, but there was no question of its only being there for a while. Tallaght is the third largest population centre in the country and has a young population. What commitments were given to permanently site the National Children's Hospital at Tallaght Hospital and what is being done in that regard? Tallaght Hospital is unique in that it is the last Protestant teaching hospital in the Republic and the removal of the National Children's Hospital's services to the Mater Hospital will have an important impact. We need to know the details of the specific services to be retained, which is the core issue. People clearly believe in the two-hospital approach.
Tallaght Hospital's catchment area is much larger than Tallaght alone, as it extends through parts of counties Kildare and Wicklow. Professor Drumm has made the point that the change will remove children's services from the south side, but I am challenging him again. This issue will not go away. I am not politically sensitive, but the people of Tallaght, Clondalkin and elsewhere are being told to lobby their Progressive Democrats and Fianna Fáil public representatives to get the decision reversed. Professor Drumm must spell out that I am not in a position to reverse it.
Tallaght Hospital was set up in 1998 as an amalgamation of the Meath and Adelaide Hospital and the National Children's Hospital. Its future concerns many people. Reference has been made to the hospital's cancer services, which must remain when the review concludes next year. I hope the HSE ensures that the five academic hospitals in the Dublin area retain their cancer services. The people of Tallaght are of the opinion that they are not being fairly treated by the HSE. What will Professor Drumm, his staff and organisation do to correct that impression?
Does Deputy Gormley have a question?
Yes.
Is the question for me or our guests?
My question is for the panel.
The Deputy must wait.
For how long must I wait?
Senator Feeney and Deputies Fiona O'Malley, Ó Caoláin and Cooper-Flynn are before Deputy Gormley. They have not spoken yet.
The Chairman is doing a good job despite the difficulties. My questions are for the Minister and Professor Drumm. According to reports, there are varying degrees of subvention in different parts of the country. As the HSE has a national basis, will the rates be made the same across the country? Professor Drumm has answered the question on medical cards.
The new cervical cancer vaccine of which we read during the week will come on stream at a price of more than €300. The women targeted will be between 19 and 26 years of age, the best group at which to aim the vaccine. Preferably, younger women who are not yet sexually active would also be targeted. Does the Department plan a national rolling out of the vaccine? Where women are at risk or have presented with worrying signs of cervical cancer, does it follow that their daughters could be in the same category?
I welcome the five new centres in respect of out-of-hours general practitioner services. Given what was highlighted on radio last week, are there talks between the Departments of Health and Children and Justice, Equality and Law Reform about doctor and patient safety?
I agree that the overall accident and emergency performance figures are alarming. Professor Drumm referred to the two accident and emergency units in the north west, namely, Sligo General Hospital and Letterkenny General Hospital. I have personal experience in this regard. On 21 July, my son was driving from Dublin to Sligo when he experienced a severe headache. He lost power in his right side, lost the power of speech and had a temporary memory loss. He dialled my number, but I did not know what he was trying to say. I phoned the emergency services at 999. I did not know where he was on the road, but an ambulance found him within ten minutes of my call and took him to Sligo General Hospital. Within two minutes of being admitted, he was brought to the resuscitation unit and was seen by an accident and emergency consultant. Within an hour, he had a CAT scan. He was given a lumbar puncture within four hours and an MRI scan within 48 hours. All of this was done through the public health system. He was one of the 5,000 people admitted through the accident and emergency unit to the ward that week. He received the best care and, sadly, is one of the 90% of people who have not told their story. He was very well looked after. The figures are alarming and misleading.
I regret that Deputy McManus has departed. She stated that she did not wish to be parochial but she was when she pointed to the lack of a hospital for children from south County Dublin to Wexford. She wondered how people could gain access to a site on the north side. When this was raised previously, Deputy Flynn and I pointed to the difficulty for people in the north west, such as Sligo, west Mayo or the Inishowen peninsula in north Donegal. I have sympathy with Deputy O'Connor's point that everyone would like to have the national children's hospital in his or her constituency. We must not confuse this with a Dublin hospital just because it is based in Dublin. We must tell people in Dublin not to play politics with it. I agree with the woman the Minister met last night that we must make progress on the hospital.
I read letters to The Irish Times from eminent Irish consultants working in the UK, whom we would love to have working in Ireland. They hear the debate and wonder why politics, religion and gender are being brought into this debate. This is wrong and it is time Professor Drumm buried this debate and continued working on the hospital for the sake of the sick children of this country and the parents who seek a hospital that will be the best in Europe. Whether one is coming from the south east or the north west, everyone will have access to it.
What is the state of BreastCheck in the north west? Will it be rolled out later this year or early next year?
I wish to continue the point raised by Senator Feeney. There are only two centres in the US equivalent to the proposed centre for Ireland. It is a centre for the care of children that is unique. Can Professor Drumm confirm this? It will help us to understand what will be built and why people are complaining about where it is located. We are fortunate to have it on the Continent of Europe.
Mr. Browne referred to statistics on orthodontics and I would be grateful if he could provide us with them. Having chaired the Sub-Committee on Orthodontics, I am disappointed that, at the end of this Dáil session, the two reports have not been reviewed. We gave a commitment that we would keep this matter under review. The report of the review group will be submitted to Professor Drumm but no timescale is provided. We need action on this matter. The statistics sound impressive but I seek the information behind them. Mr. Browne stated that waiting lists have been reduced by 16%, which sounds terrific. The report examined how patients are indexed. Are they being dealt with as categories A, B and C or is it proposed, as the sub-committee report recommended, to change to international standards?
I met an elderly constituent who recently had a stroke. She is waiting for a railing to be installed in her home. She was obliged to go through many hoops and was told it would take three months to install. I applaud the Minister's objective of allowing elderly people to remain at home. The woman in question wishes to remain in her home but it is difficult when she must wait so long for a railing to be installed. We must find a way to deliver more readily the minor services that facilitate people staying at home. This is a priority and it is totally wrong that bureaucracy in the local authority is costing so much. I plead with the Minister, who is keen to keep patients in their homes, to help those who cannot have their bathrooms adapted.
I appreciate the opportunity to participate but I think we will be interrupted by the vote on Private Members' Business. I did not intend to appear at this meeting because I was preparing to be in the Chamber as leader of my party in the House. I had been watching proceedings on the monitor since 9.30 a.m. and had to make a last-minute change with a colleague because I was incredulous at the remarks of Professor Drumm. His attempt to dismiss the extent of offence that his remarks have caused to Deputy Connolly and me is unacceptable. The remarks were outrageous, claiming that people were "scaremongering out of self-interest". Professor Drumm went on to state that the public should question the motive of these individuals. He then indicated to Deputy Connolly that the remarks were not attached to him personally but of course they were. Self-interest is a personal interest and he also referred to motives of these individuals. These comments are most offensive and, as an elected representative of Cavan and Monaghan, I must state that this is a slight on Members of the Houses of the Oireachtas and on those who have led the campaign for the retention and development of services at Monaghan General Hospital, specifically the County Monaghan Community Alliance. It is also a slight against those health professionals who have stood against the raft of reports commissioned with predetermined outcomes. One can get a report to achieve anything. That is the case in many instances noted over the years. Any one of us could commission a report from an individual with a particular outcome intended. If one's constant intent is the decimation of services at local hospitals, one will certainly get what one wants. That is my opinion on commissioning reports based on my experiences from the North Eastern Health Board through to the situation under the aegis of Professor Drumm and the HSE.
Professor Drumm should withdraw his accusations and apologise to all concerned. His remarks this morning were absolutely inappropriate for a person in his position. He should at least accord the people of our community the respect they deserve for the genuine, sincere and passionately held views they articulate. He should not think for one moment that 10,000 people as a representative number of our community could mobilise last Monday only if they were orchestrated or were acting out of self-interest.
The bottom line on self-interest is that we are here not only as public representatives. Those who champion the cause of the Community Alliance do not do so only in self-interest. They know it is in the interest of themselves, their families and the wider community that we retain the maximum services achievable and the basic essential services. I could not credit what I heard this morning on the monitor in my office. I sat patiently here for the opportunity to put it to Professor Drumm that his contribution should be expunged from the record because it is inappropriate for his position.
Regarding a number of other points made by Professor Drumm, drifting into Dublin——
We will suspend the meeting for 15 minutes. Is that agreed? Agreed.
I will return to this matter when the meeting resumes.
When we return, I will put it to Professor Drumm that he should formally withdraw his remarks. He will have had time to consider it over lunch.
Go ahead. Professor Drumm is a big boy. He is able to handle himself.
Committee members should be allowed ask questions before those who are not members of the committee.
I did state that but I found it difficult when the Deputy had been here since 9.30 a.m.
He was watching it on a monitor as I was in my office. It is not acceptable.
I apologise in that regard. Owing to the fact the member had been here since 9.30 a.m.——
We understand when we are not allowed to ask questions when we attend meetings of other committees.
I apologise.
Sitting suspended at 12.55 p.m. and resumed at 1.30 p.m.
I stated before the break that I would formally request that Professor Drumm withdraw his remarks which I and others deem to be deeply offensive. The people of Monaghan consider them to be offensive and I would imagine that every other public representative would agree. There were issues raised and statements made——
We will come to that later on.
The public should question the motivation of these individuals. This should be dealt with now. I gave notice that I would do this. The remarks will be taken as representative of the HSE.
The Deputy has made his point. Professor Drumm can deal with that issue later on. I wish to move on now and give other members the opportunity to contribute. Before doing so, I apologise to committee members. I allowed Deputy Ó Caoláin to speak when I should not have done so. Members of the committee should have been allowed to contribute first. I allowed him to contribute because he had been here since 9.30 a.m. I now ask Deputy Ó Caoláin to complete his contribution and from then on, members of the committee will be given priority.
I was not aware of issues of sequencing.
I made it clear at the outset but I broke my own rules and apologise for that.
I accept the opportunity to speak and thank the Chairman for it. To recap on the point I had made, I thought that what Deputy Connolly——
I ask the Deputy to try to continue. We understood his point.
I will be the author of my own contribution, with respect.
With respect, I will chair this meeting. We have heard the Deputy's submission already. If he wants to go back over old ground again——
I presume the Chairman will afford me, as a Member of the Houses of the Oireachtas, the same courtesy as any committee member.
If the Deputy is going to go back over ground again——
I do not intend going back over ground——
I ask the Deputy to please keep going.
I ask the Chairman to allow me to proceed.
The Deputy said he was going to recap and I do not want him to do that.
The Chairman might yet be given the job of Ceann Comhairle.
I do not want it.
Is he working towards that?
No, I am not. I am trying to keep this committee meeting going.
I was of the view that I had already asked Professor Drumm to withdraw his charges this morning. That is very important, if not essential, as they were deeply offensive.
I referred to the Teamwork and Carey reports. Professor Drumm and the Minister for Health and Children should note that these have been rejected unanimously by Monaghan County Council, which is made up of representatives from all political parties, and by the North East Health Service Executive forum. Eminent practitioners within the health care delivery area have also voiced their rejection of the thrust of those same reports and the real or bottom line intent of both.
It cannot have escaped the notice of many that the Teamwork and Carey reports give the impression that there was some cross-over or consultation between the authors of the two. It is quite incredible that the conclusions reached in the two reports feed into the view that local hospitals do not have a role to play in health care in the way we have traditionally enjoyed and appreciated. None of us is stupid enough to believe that we can have all-singing, all-dancing hospitals in an unlimited number of sites throughout the country. However, we have an understanding — not only as uninformed members of the community but supported by the professional opinion of eminent practitioners in health care delivery — that there is a basic level of service we should be allowed to enjoy and have the comfort of knowing is delivered, in the event of an emergency. That is what is critically important and what is absent from everything that Professor Drumm argues.
I could go on at length about many points surrounding the Monaghan issue. Rather than deal with the roller-coaster ride of all the other reports, from Hanly to Teamwork and Carey, let me deal with the policy of intending to see us bereft of services. This policy has particularly affected women and children because of the withdrawal of services from Monaghan. That is the reality of the displacement with regard to Monaghan and it should bring shame to all who have presided over it.
Professor Drumm made a remark on patients drifting into Dublin, as if people of the north east did not have confidence in the services with which they were provided in the past but I contend that is not the case. I brought my daughter to Professor Drumm when he was an eminent practitioner at Crumlin hospital and I have nothing but the highest praise for the way in which he conducted his engagement with us. However, I did not know about the professor or the services he provided and we did not go to the hospital by choice but were referred there.
The overwhelming majority of people in the north east who present at Dublin hospitals or to eminent specialists are referred through the hospital system or by their GPs. We are not drifting but are being sent, possibly because of the dearth of services in the north east. It continues to be the case that the north east is not considered to be on a par with other areas, despite the fact that its population is expanding at a significant rate. For example, we are not in the running at all with regard to the proposed roll-out of radiation oncology, even though our population is at the level recommended for coverage in other areas. People of the north east are not second-class citizens in this country or on this island and it is not acceptable to say we are drifting into Dublin. Perhaps we have all drifted into Dublin in one way or another but we have certainly not done so in respect of health care needs.
What is the genesis of the opinion articulated by Professor Drumm? On what grounds does he base his charges of scaremongering and self-interest or his recommendation that people should question the motives of the individuals concerned? I have no doubt the people at the helm, including medical practitioners involved in the Community Alliance, will reflect on the serious response I have offered today.
Given that I rarely have the opportunity to participate in the deliberations of the Committee on Health and Children, there are several other issues I wish to raise.
In fairness to others who are members of this committee and are waiting their turn to speak, I ask the Deputy to limit his intervention.
I intend to raise a couple of issues in the limited opportunity available to me.
In that case, the Deputy should seek a seat on the committee.
I did but was not successful. Professor Drumm made reference to the delays encountered in answering parliamentary questions. I have tabled questions which were referred by the Minister to the HSE prior to the summer recess and have not yet received a response. They were not the most difficult questions to answer and, given that questions were not flowing into the HSE's parliamentary response unit during the recess, one would think there would have been adequate time for it to catch up. That has not happened. It is not acceptable that I have not received any response to the questions I tabled.
I welcome the distribution of documents pertaining to Leas Cross and the opinion of counsel. However, with regard to the difficulty experienced in publishing the Leas Cross report, I suggest the Minister and Professor Drumm should consider the approach taken on the Barron report, which was referred to a sub-committee of the Joint Committee on Justice, Equality, Defence and Women's Rights. That mechanism allowed the series of reports produced by Mr. Justice Barron to enter the public arena and permitted the safe dissemination of the relevant information without fear that recourse would be taken to legal action. A similar approach could be taken in respect of the Leas Cross report if there were concerns about the actions which might ensue from its publication. The inventive solutions found within the Houses of the Oireachtas to other issues should be considered because it is crucial that the report be published.
The final issue I wish to raise concerns accident and emergency services. Despite the fact that we experienced one of our best summers in many years, there was a failure to overcome the accident and emergency crisis of people waiting on trolleys and in other inappropriate overnight accommodation. The numbers of such people are on record. If we cannot completely prevent that problem from arising during the lowest period of presentation to accident and emergency units, what are we going to face over the coming winter months? It is incredible.
I read the HSE's daily accident and emergency bulletin of Tuesday, 26 September, which, I suppose, is the HSE's response to the INO's trolley watch and, with regard to the computation of the figures, it is interesting to look at the breakdown of the waiting times. During the 24-hour period reported, there were a total of 152 patients waiting for admission, of whom 13 were waiting longer than 24 hours. A breakdown of the figures for patients waiting longer than 24 hours reveals that three patients were waiting Mayo General Hospital, six in Our Lady of Lourdes Hospital and eight in St. Vincent's Hospital, for a total of 17 patients, not the 13 indicated in the table. Therefore, even the explanatory note and the tabular presentation do not add up.
These may be small matters to some minds but we should acknowledge the valuable service provided by the INO's trolley watch. I have no problem with the HSE presenting its own figures but I would hope they are accurate. The HSE is happy to include Monaghan General Hospital in the list of accident and emergency departments with no waiting lists, even though we are told the hospital does not have such a department. The results for the summer are damnable and I do not know what we will face during the coming winter. The circumstances in which ordinary people find themselves when they seek to access hospital services matter to them.
Over the past two years, I have been highlighting the issue of subvention. A situation has arisen since last spring with regard to enhanced subventions in the west of Ireland. On 7 December 2005, the Minister announced that a total of €20 million would be allocated to subventions for residents of private nursing homes, a figure which represents a 14% increase on 2005. She stated that the money would be spent on supporting an increase in the numbers of patients entitled to basic nursing home subvention as a result of a substantial upward revision in the means test, on reducing waiting lists for enhanced subventions and on bringing greater consistency of enhanced subvention support throughout the country. In County Mayo and most other parts of the west, the maximum amount of subvention currently paid is €190.50 per week. This compares with €850 in the eastern part of the country. In the counties of Galway, Mayo and Roscommon there are 2,000 patients in non-public beds. There has been an increase of 800 patients between 2001 and 2006. Some 70% of those residents receive subvention, with an increasing number requiring the maximum level of dependency. All of them are medical card holders. Owing to the shortage of public beds they have no alternative but to try to avail of the non-public beds. A significant number have only the non-contributory old-age pension of €182 and the maximum subvention of €190.50, a total of €382.50, despite the fact that as public patients they are entitled to public care.
Owing to budgetary constraints the enhanced subvention has been discontinued from spring 2006 for new subvention applicants. This information has come from the community welfare officer in the area. This has resulted in public patients, despite their appeals of hardship, being long-fingered or ignored. Geography should not be an issue. If the same level of need exists, people should be entitled to the same level of subvention. I call on Professor Drumm and the Minister to reintroduce enhanced subvention with immediate effect in County Mayo and the western region. This discrimination cannot be allowed to continue.
The last time Professor Drumm attended the committee I mentioned that Mayo received five of the 500 home care packages. I note from his contribution that 550 additional home care packages are to be provided and I wonder how many of those have come into County Mayo. Irrespective of the number of home care packages in the county, they are no substitute for providing people with the means to access a bed in a private nursing home if there is no public bed available. People who have paid for a bed in a private nursing home with their own resources for a number of years are left in the unacceptable position of having to vacate a place they have called home and try to find a bed in a public facility. They have no choice of location and could be 30 or 40 miles from home, with the result that people cannot visit them, causing upset at a time in their lives when they need certainty. The €20 million was not enough. I do not know the answer. However, a maximum dependency patient who lives in County Mayo should be entitled to the same payment to cover his or her costs. When subvention was introduced in 1993 it covered 60% of the cost of care. Today it covers only 30% of the cost. Even taking into account the fact that the cost of a bed in a private facility in County Mayo is lower than in Dublin, the figures do not add up. I have evidence of many cases, which I can provide through my office. I want this issue sorted out.
My next issue is BreastCheck. The last time I raised this with Professor Drumm I asked three times for clarification on when BreastCheck would begin in the west of Ireland. Professor said it would begin in early 2007 and I asked him to clarify that it was early 2007, not late 2007. He replied that it was always to be early 2007, but I now understand that this is not the case. Could he clarify that once and for all?
What progress has been made on the localisation of services for people with cystic fibrosis and rheumatology? Professor Drumm will be aware that the committee has met cystic fibrosis sufferers. I particularly want to know what is happening in the west. Could I have figures for the number of contract beds in Mayo and the west?
On the consultants' contracts, representatives of the consultants who appeared before this committee in June left us with the impression that they were not holding up any negotiations. This surprised the committee because it contradicted the feedback we had received from the HSE at a previous meeting and we questioned them vigorously. If misinformation has been given to this committee, we intend to invite them back again. Could Professor Drumm tell us what is delaying the consultants' contracts and why nothing is happening when they have told us that they are willing to enter into meaningful negotiations?
I apologise that I could not be here this morning. I was attending the Order of Business.
I also apologise for my late arrival.
The former Tánaiste is sadly missed. She will have to teach the new man a few lessons. I would like to ask Professor Drumm and the Minister about health promotion. We have the health promotion unit, and the HSE also spends money on this aspect. How much money is spent on health promotion and how is it spent? Should it be significantly increased? Do they share my concerns, particularly on alcohol consumption? Statistics tell us that it costs billions of euro each year through absenteeism, anti-social behaviour and accident and emergency services. Do they feel it should be tackled urgently? Would the Minister agree that it is time for the alcohol products legislation, which has been postponed indefinitely? This is an urgent priority.
Many of the issues I wanted to raise have been addressed and I will listen to the answers on the monitor. Professor Drumm mentioned cases of people who have died in which scaremongering was involved. I want to raise a tragic case outlined to me last Monday that was owing not to living too far from a hospital but to misdiagnosis. I will not mention the name of the person until I have cleared it with the family. A young woman reported to accident and emergency, was told that she had food poisoning, was given antibiotics and sent home. However, the problem became worse. It turned out that she had a perforated bowel and she died. Can Professor Drumm tell the committee what recourse the family has in a case such as this? This is not an isolated case. If I gave Professor Drumm the details, would he carry out an investigation? Will the Minister initiate an investigation? It seems to involve a litany of errors. The junior doctors are put in the front line and on occasion they do not have sufficient experience. What can the family do to find out what happened? It is a serious and tragic case.
Most of the questions were for Professor Drumm but I will deal with some of them. I will start with the case to which Deputy Gormley referred. I do not know the facts but, in the first instance it would be a matter for the coroner to deal with in an inquest. I am keen to ensure we do not force families or patients who have such experiences to take the legal route for answers or remedies. I have learned much in the past two years from attending a number of patient safety events, both during the UK Presidency a year or so ago, during which Sir Liam Donaldson, the CMO in England, had interesting and strong things to say on the matter, and elsewhere, and my Department is working on the patient safety agenda. If Deputy Gormley makes the information available, I will look at it. If there is to be an inquiry, I will ask the HSE to look at the matter.
Many families and patient representatives have asked me why we force them to go to lawyers for basic answers. Sometimes the legal system encourages that. With enterprise liability, where families and patients will not have to deal with different doctors with different insurance companies and different teams of lawyers, it should be easier. It is usually families who are faced with such situations because the patient has often, tragically, died. Not everybody wants to sue, nor is everybody interested in money. They want to know what happened and a guarantee that it will not happen to anybody else. Professor Drumm will deal with issues surrounding health promotion, etc.
Deputy Flynn asked about subvention, which this year will be €160 million. She is correct that when it was first introduced it funded between 60% and 75% of the cost of nursing homes. I am very unhappy with the present situation in the public system where the only thing we require of residents is that they pay up to 80% of the amount of the non-contributory pension, whereas in the private system 80% of the cost must be paid by the resident. That is not fair. Just over a year ago an interdepartmental group was put together and it has now completed its report. I hope to bring a memorandum to Government shortly on all the issues surrounding long-term care. In particular I am anxious to ensure there is equality between those who are allocated a bed in a public institution and those who are required to stay in a private institution.
We work on the basis of a co-payment, a principle supported by the social partners in the recent social partnership agreement, which I very much welcome. I am concerned about the huge difficulties that exist for families and the huge uncertainty and incoherence in the current system.
On nursing home subventions I hope that, with the establishment of the HSE as a new, single, unified entity, we will have uniformity across the country. I accept that market conditions vary and that it is more expensive in some places than others. Higher dependency patients are far more expensive than those with lower levels of dependency, though it is difficult to get facilities in the private sector for high dependency patients. Notwithstanding those differences, an average of €850 in the east and €150 in the west represents a huge discrepancy. We allocated an extra €20 million to the HSE but, to be fair to the HSE, it can only do so much with such an amount. There is a huge demand and we need to do something at a national level to bring about a more coherent policy.
BreastCheck will start early next year. The directors for both the west and the south west have now been recruited and I understand they are currently recruiting staff.
Senator Feeney asked about the cervical cancer vaccine. We will ask for that to be assessed by the cancer screening committee. There are a number of issues, such as whom we should target and what age group. The Senator mentioned 19 to 26 year olds and I have read articles in publications mentioning 11 year olds. She also raised the issue of the daughters of women who had cervical cancer. Neither I nor my officials are in a position to decide whom we should target, or where the benefits and risks are. We need experts to advise in that area and we will ask them to do so.
Senator Feeney also made a point about good experience. We arranged for some analysis to be published last year by the health quality association which showed that in 91% of cases the experience of patients was a good one. Of course that does not make the news because distinguished members of the Visitors Gallery who cover health stories do not generally write about the positives. I see they are smiling but it is a fact. One never sees a headline, either in the print or the broadcast media, on all the good things about which I hear every single day and by which I am very encouraged. For as long as we have difficulties, challenges and deficiencies the focus will be on them. The reform is designed to address them and ensure we receive more for what we spend on the system. It is not designed to maintain the status quo but to change the way we do business with a view to improving services for all patients.
Deputy O'Malley asked a number of questions. Professor Drumm will respond to her question on orthodontics. She made a point about the bureaucratic nature of administration. There is no doubt that when families want to access appliances there can often be, for a whole host of reasons, a long gap. Some families have told me they wanted to take their loved ones out of hospital and asked whether, if they bought their wheelchair or stairlift, they would be reimbursed afterwards. Our system is not amenable to that approach at the moment but requires an application and subsequent approval, involving the inspection of one's house, etc. Being an operational issue, it is not really a matter for me, but I know Professor Drumm and his team want to be as flexible and realistic as possible. If a person spends a long time in an acute hospital, it is very expensive and unsatisfactory. The more we adopt a flexible approach to the provision of appliances, the better. I accept that with home adaptations, for example, in the bathroom, two issues arise, one of which is the cost. The State generally does not meet more than three quarters of the cost, with a ceiling of approximately €20,000, if memory serves me right, and that often does not cover the cost of the adaptation. That represents a real issue which I have discussed with the Minister for the Environment, Heritage and Local Government. He has informed me that to spend €8,000 costs €8,000 in administration. It may well be appropriate to consider a better way to give resources to people for adaptation rather than putting a huge number of requirements in their way.
Our system has to be supportive of those under the age of 65. The wife of a younger man — I think he was aged 58 — attended my own clinic last Saturday. Her husband has had a severe stroke and she said she had been told by a hospital that, because of his age, the process would take longer. I have not taken this up with the HSE but I do not believe it is or should be the case. Perhaps some people work to an age agenda when we need to work to a patient agenda.
I am not surprised Deputies Ó Caoláin and Connolly articulate the cause of their constituents in Cavan-Monaghan, and that of the hospitals there. As Senator Henry said, Deputy Connolly was elected to help maintain and enhance existing services in Monaghan. We have to go beyond that. I do not say that because I do not represent Cavan-Monaghan, because my constituency hospital is Tallaght Hospital. The vast majority of sick children in my constituency, if they have what is known as an "urgent care case", attend that hospital. Others who are more seriously ill attend Our Lady's Hospital for Sick Children, Crumlin.
We all have to think outside the box on these issues. I will repeat what I said. If patients can be treated safely as near as possible to where they live, the Government and the HSE would want to support it. We recognise that geography is a factor in the provision of such services, which is why we have regional hospitals so that not everything is based in the big cities. If patients cannot be treated safely, the opposite has to happen. We have to avoid that because it puts lives in danger. I do not want to see another Pat Joe Walsh, baby Livingstone or others of whom we have heard from the regions. It does not make anybody feel good. We all have a responsibility to lead our constituents around the change agenda, because change is never easy. I will not speak for Professor Drumm because he is more than capable of speaking for himself.
However, sometimes we all act as if we were a vested interest. Sometimes we become accustomed to the way we always do things. Generally we get up at the same time every morning and perhaps go to bed at roughly the same time every night and do approximately the same things. If somebody challenges us to change that, it can often present a difficulty, and we may not like it. Perhaps we would not believe it to be the right thing.
I do not subscribe to that agenda. We have had people with much expertise, international and domestic, look at the north east. They have included clinicians from outside the region and clinicians I have spoken to privately. I have come across clinicians who have stated one thing to me privately and one person made a statement diametrically opposite on the radio. I wondered if I had imagined the incident. Occasionally that happens, although it is not a common practice. It is unfortunate when it does. It would be better if we were all consistent.
The regional forum consists of local authority members. The county council is another elected body. Our role as politicians is to hold the executive or the authorities accountable and ask questions, put forward a case for our constituencies and be involved in policy-making and legislation. Our role is certainly not to say to outstanding clinicians that we know better than they. I worry about a health care system where the decision is made by elected people rather than by people who have enormous expertise in the area.
Senator Henry made a number of points which are mainly operational. She reiterated the view that is often expressed that we have the FitzGerald report, etc. We want to provide services as near as possible to people. At the moment we are very heavily dependent on services in the bigger cities. These are Cork and Dublin mainly, and there is also Galway. We need to beef up regional services and have components working together. Perhaps we need doctors travelling from one place to another where there would be joint operations for a single department of surgery, for example, between two or more hospitals. That is when one can provide the best possible services for the patients.
In my own experience of speaking to seriously ill people or their families, they want access to the best possible level of care above all else, wherever it might be. If somebody thought going abroad was necessary, which happens occasionally because we do not have the expertise here, that has been supported also. If it means people with serious cancers have to come to Dublin because the necessary facilities cannot be made available to a small population base in every region, I believe that is what patients would wish for.
I stated at the outset that the only area of cancer care where we compare favourably with other European countries is children's cancer care. That is because the service is centrally operated from Crumlin, although it can be delivered in all nine to 13 hospitals around the country. It is centrally planned and organised and all quality is assured. We do not do this with adult cancers, and as a result we do not perform as well as we could do.
We must all do better, and that means a reconfiguration of services is essential in order to ensure that we can perform to the highest possible standards of patient care.
I have a comment on Deputy Harney's statement. The safety issue is of course paramount in all our minds. What does the Minister think the contributory factors were to the death of Bronagh Livingstone and Pat Joe Walsh, the two cases that she cited? Both of them were as a direct consequence of the withdrawal of services and the introduction of protocols outside the ambit of the professional and highly thought of practitioners based in our hospital.
We had no safety issues prior to that direct interference, with the closure of the maternity wing and all of the gynaecological supports for women. That is why Bronagh Livingstone's mother was en route to Cavan and not receiving the support she needed, thus losing her child en route. Pat Joe Walsh——
The Deputy cannot start another speech, to be fair.
I am not, I am just making the point. Pat Joe Walsh——
The Deputy has made the point and should move on.
Pat Joe Walsh——
The Deputy has made the point.
Pat Joe Walsh died as a result of protocols introduced and the fact that the key was turned in the theatre at 5 o'clock.
Deputy Ó Caoláin, please.
This is very unfair. I am asking only to clarify a point because there is a peddling of a view.
Even I picked up the question asked by the Deputy long ago.
There is a peddling of a view that there are safety issues.
There is a further point of information——
The safety issues are a direct consequence of the actions of the Minister-----
Will the Deputy let the Minister answer the question?
-----and those at her behest in the HSE.
I am trying to intervene and I cannot.
That is where the problem rests.
Deputy Connolly has a point of information.
The Minister for Health and Children has mentioned that we all want the best level of care.
Before the Deputy moves on, may I allow members——
We do not have any difficulty in the world with travelling for any level of care. That is not the issue. It is in the area of emergency care that people's conditions are stabilised. There is no point in mixing up a person who wishes to and will travel to Cork for a hip replacement——
Deputy Connolly——
It is very unfair——
——I am trying to intervene. Other members are here——
Is Deputy Fiona O'Malley the Vice Chair of this committee?
I am not.
I will suspend or adjourn the meeting in a minute if this continues. There are other issues outside of the Monaghan hospital. I will ask Professor Drumm to deal with the issues outside of Monaghan hospital for the relevant members, and we can then return to the issue. Is that fair enough? Perhaps Professor Drumm will address the other issues and we can then return to the Monaghan hospital matter.
Professor Drumm
Senator Glynn has left but he raised the matter of the NTPF. He stated that it was scandalous that it is not being used more widely. As an organisation, we are also frustrated that a significant number, if not all, of the hospitals that have extremely long waiting lists or waiting times in accident and emergency departments do not refer patients or refer only a minute number of patients to the National Treatment Purchase Fund.
It creates a significant question as to how we have people waiting in accident and emergency departments when we have another mechanism for dealing with people accessing the services. The two matters overlap to a large extent. Mr. O'Brien and I are taking the issue up with the NTPF, a separate organisation. We hope to take it up with individual hospitals, which may well describe how they have experience at another level in terms of getting referrals. We need to clarify this.
I suggest that Professor Drumm could address the questions of the individuals currently present and then return to any outstanding questions. We all have meetings to attend and I am just trying to be helpful.
That is fine.
Professor Drumm
Senator Henry has left. Deputy O'Connor asked about the quality of answers. As we have stated before, it is an issue we are auditing and we are putting much work into it. I hope it is improving, although it may not be perfect. With regard to the Millbrook Lawns issue, I will ask Mr. Browne, who would deal with it, to comment on the matter.
Mr. Browne
I know where Millbrook Lawns is, having lived beside it.
I have received calls asking me where it is.
Mr. Browne
It is a priority, as I stated the last time I was before the committee. It is in the current capital plan and will receive attention.
It needs it.
Mr. Browne
Agreed.
Professor Drumm
As Deputy O'Connor pointed out, Mr. John O'Brien was central to the process of the children's hospital. I should clarify the reason the change took place. It is well known to everybody that the two applications short-listed were the Mater Hospital and St. James's Hospital. Mr. O'Brien was previously CEO of St. James's Hospital and he wrote to me requesting that in that situation it seemed unreasonable for him to continue, and he felt it would be unfair for him to do so. He asked that the change be made. It was at Mr. O'Brien's request that the change was made. He may want to comment on the issue of Professor Graham, and on the fact that Tallaght ticked all the boxes.
Mr. O’Brien
In the first instance I will deal with the notion that submissions from Tallaght Hospital were hardly read. I would have to take issue with that. The period of my chairmanship of the group would have covered that particular issue.
Six submissions were sought from academic teaching hospitals around the city for this purpose. They were to indicate to us how they might meet the criteria that had been set out by McKinsey in the report. All of those six submissions were read by every member of the joint Department of Health and Children and HSE task group. Each submission was subdivided into segments for expert and very detailed review by selected members of the committee, who in some case took external support and systems for the process.
For example, the site itself and details on the site submission would have been given to the architectural and engineering expertise on the subgroup. The extent to which the co-location clinically could be met were dealt with by the clinicians on the group with some external support. Every submission was examined in detail. The group went to all six proposed sites, including Tallaght, and any outstanding issues regarding the sites were dealt with on those visits.
Each of the hospitals was then given an opportunity to meet the committee, at which point any further outstanding issues were raised by us. This gave them an opportunity to submit further information pertinent to the process. Professor Graham attended one of those meetings. Tallaght had two opportunities, in that it was represented separately by the Adelaide and Meath Hospital and also by the National Children's Hospital. Having assembled all this information, the group began to decide how to proceed. There was no question of submissions not being given due and equal consideration.
Professor Drumm
The issue of the hospital charter has been raised with the Government and Department of Health and Children and I would not be the expert to comment on it. Mr. O'Brien stated that two hospital sites were acceptable, but that could quickly become three. We informed all the hospitals on the first day that there should be one hospital site and they accepted this. When the hospital site was chosen it became two. We may well move from one to three at this point.
The issue of cancer services will be dealt with by a major programme of reform on which Mr. O'Brien may wish to comment.
Mr. O’Brien
There is confusion over the notion of a hospital having a cancer service and being a comprehensive cancer centre. The existence of a cancer centre providing all cancer services does not mean that other hospitals do not deliver cancer services. However, they need to be delivered within a network framework of single protocols. That any of the Dublin hospitals under the aegis of the cancer programme would not deliver cancer services in some form would be remote, but they will not all be the same.
I asked if there was a future for the National Children's Hospital.
Professor Drumm
The McKinsey report planned for one children's hospital and two to three satellite centres that would deal with children coming with acute problems on a daily basis. Very few children are admitted, a tiny number compared to adults. Thankfully, few of them get that sick. The proposal was that any children needing admission would be transported to the centre. The centres would probably be run on existing acute hospital sites. They would be very comprehensive in terms of out patient services and day-care services and they would be run from the paediatrics centre. It would be a completely co-ordinated system.
There will be comprehensive children's services in either two or three satellite centres.
Mr. O’Brien
The transition group is progressing through an exercise that will deal with that issue. It includes issues such as what precisely will be in these centres, how many there should be and how they should be distributed across the city.
Professor Drumm
These centres will play a critical role in secondary care provision to children who do not have life threatening illnesses. This role is evident in the fact that the National Children's Hospital is down to 380 beds from the previous plan for almost twice that number. The centres will provide services at a community and out patient level. This includes significant emergency department input on those sites.
Deputy O'Malley and Senator Feeney raised the issue of a centre of excellence. This question of alcohol abuse and the preventative approach has been raised before and I do not think it was dealt with adequately. Dr. Pat Doorley has worked hard on this matter and I suggest he meet with the committee. I am conscious of the fact that it is a huge issue. I am not satisfied that we have done as much as we should have as a health promotion organisation. It would be useful if the committee's views were relayed to the relevant people. We are taking on the health promotion role and it is something into which we want to put a huge effort.
Misdiagnosis can occur and Mr. O'Brien might comment on the protocol in such cases.
Mr. O’Brien
Generally hospitals have provisions for addressing this issue with the family involved, including internal and external reviews. That is usually the initial response to a misdiagnosis and as a hospital chief executive I have dealt with several to the satisfaction of the families and others involved. My office is happy to meet with the families concerned.
Professor Drumm
We have a consumer affairs division, which is led by Mary Culleton, and it may be useful if families involved could approach the situation through it. We will get that information in the next day or so.
Health promotion should be dealt with through this committee, not exclusively. It is an issue that is relevant to us all.
Professor Drumm
I am perfectly happy to do so if the Chairman wishes to include it as an issue for the committee to address.
The centre will be very large by international standards. Many operate on a smaller basis in America, but Canada has at least two large centres. There are at least five or six in the United States. However, by European or American standards this is a very positive development. In the UK children's hospital services can be quite divided, so this is a significant development with enormous potential. It relates not only to in-hospital health care but to health and protection issues for children in society. A broader role can be developed with that kind of power on one site.
There were specific questions relating to orthodontics and categorisation.
Mr. Browne
We can make the statistics available to the committee. They were recently given to Deputy Catherine Murphy in reply to a parliamentary question. There is no standard of categorisation in the country at the moment. The objective of establishing a review group was to move towards standardisation. There are many different views among experts and practitioners on what should be done. The sooner we get a result from the review the better. I anticipate we will have it before the end of the year.
Professor Drumm
The subvention issue keeps coming up.
Mr. Browne
Substantially it is the same issue. The Minister has dealt very fully with the policy aspects of it. As the HSE came into being and the risk assessment was being carried out, one of the key realities identified was that there was a huge differential in how resources were allocated, particularly between east and west. This was strongly the case in the care of the elderly. There are a couple of issues in that, the first of which is a standard setting approach. We have to identify the standard and put that in place. That work is in process and almost complete. There is also a cultural issue in terms of how the old boards operated, priorities they gave to particular areas and how they rationed their finances across a whole range of services. There are particular issues in that respect in the west. Then there are the pure budgetary issues — the amount of money available for allocation. Clearly, the catch up between €180 and €850, if those are the figures, is substantial and will obviously be a significant drain on a budget in one year. While I do not think it will be done in one year, we have certainly started the process of working our way along it.
The Deputy raised other issues that are contradictory. Some of the information she has raised is contrary to the information that I have. I would be anxious to deal with her directly on that.
That is the information regarding the subvention.
Mr. Browne
Yes, and about enhanced subvention. My information and understanding is that people apply for subvention and an assessment of their requirements is made. There should not be another gate which they have to pass through to get enhanced subvention. It should be based on need. I am advised by sources in Mayo particularly that there is no issue of exclusion from enhanced subvention.
I had a copy of that letter the last time this was before the joint committee. It was issued in spring 2006 and specifically laid out that enhanced subvention for new applicants — not existing applicants already in receipt of it — is discontinued due to budgetary constraints. Things have worsened since I was last here. When I last raised this, one could have received €230 per week, now one can only get €190.50. Despite the injection of €20 million, things have gone backwards.
Mr. Browne
I certainly intend to deal with those issues.
If I could get an undertaking that enhanced subvention based on need — even though it is much worse than what can be got on the east coast — would be reintroduced immediately, that in itself would be a step forward.
Mr. Browne
I am not sure I can give that commitment at the moment. I need to assemble more information as to what exactly is happening. I will respond to the Deputy directly.
I thank Mr. Browne.
Mr. Browne
As regards the home care packages, the current number for Mayo is approximately 40, with 20 in assessment. Assuming those in assessment come through, that would be 60 all told and is equivalent to the average in every other county. There is no intention to discriminate against any county over another in this regard. Whatever about looking at the legacy issues, since the PCCC directorate and the HSE have been established, we have made a significant effort to ensure that all new money is allocated on the basis of assessed needs and identifying the gap between what is there and what should be there.
Professor Drumm
The other issue the Deputy raised was that of contracted beds in Mayo. I am told 24 have been put in place for the mental health services. Under the winter initiative, negotiations are ongoing with nursing homes to contract a number of beds for older persons. All I am allowed to say is that we believe some of those negotiations are almost complete, but we do not want to say what the numbers are as we believe that would put us in a negotiating-----
The HSE is currently negotiating for contract beds.
Professor Drumm
Yes. I gather that negotiations will be complete in the near future. The number of those beds will depend on commercial issues and how we deal with the different people who are contracting to supply them. Given the experience in the hospital in Castlebar, it is important that we get them in place.
Is the figure confirmed at 24 contract mental health beds?
Professor Drumm
Yes, it is 24 for mental health services.
Are they acute or long-stay beds?
Professor Drumm
I have a note here in response to the Deputy's question.
Mr. Browne
They are continuing care beds, not acute beds.
Are they nursing home beds, for example?
Mr. Browne
They are beds in appropriate locations and facilities. They may be nursing home beds.
I just want to clarify this to see if it is happening elsewhere. They have been removed from psychiatric services and put into nursing homes.
Mr. Browne
There is no question of beds being removed from psychiatric services. It is about finding an appropriate location for people.
Is this happening in other areas of the psychiatric services?
Mr. Browne
Is what happening?
That contract beds are put in place for mental health services.
Mr. Browne
It depends on the need, particularly for people who are in long-stay care and are highly dependent.
Is it an issue in other counties?
Mr. Browne
I do not know.
The last time the executive met with us it said there would be a new consultant provided for in its budget and also raised the issue of cystic fibrosis.
Mr. O’Brien
The HSE fully recognises the deficits in cystic fibrosis services. It has set up a working group within the HSE to address this issue. In evidencing its view of the priority of this issue, before the group has even reported it has proposed increasing staff numbers quite significantly both this year and next. The price tag is approximately €10 million. Approximately €4.8 million has been put forward for that purpose and more than 57 staff are in the process of being appointed within that round. In terms of the distribution of those staff, approximately 37 of those are in the greater Dublin area and the others are distributed across the country. We will seek a similar sum of money next year to do the same again.
The working group will recommend that cystic fibrosis care be delivered from specialist centres with other centres working on a network basis. The report confirming and articulating that position will be published shortly. The other set of recommendations likely to come from it will be that each of the hospitals involved in this process would submit and develop infrastructural requirements to accommodate the service. We expect 57 people to go into position this year, and probably something similar next year. The distribution of staff next year has not yet been determined.
It will be rolled out countrywide and a special centre will obviously go to Galway.
Mr. O’Brien
Cork, Galway, the mid-west region, covering Limerick, and Waterford will be the primary areas of focus and will have significant centres.
Professor Drumm
There was also a question about rheumatology. We have got caught up in the question regarding consultant contract negotiations. I will endeavour to answer both. The appointment of consultants is a huge challenge. The contract negotiations broke down because we made a decision that we would not appoint any more category two consultants. For anyone who is not clear on this, a category one consultant is a consultant who only works within the public sector, albeit they may see a significant number of private patients in the public sector. The split between the categories is approximately 70% category one and 30% category two. Category two consultants work to a large degree, but not exclusively, in Dublin. These consultants can work for a full salary in the public sector, but also have the right to work in private hospitals once they have discharged their work in the public service. We have decided that this is not the way to provide services in the public interest going forward. We did not believe that was breaking a contractual commitment because the giving out of category 2 consultant posts was always within the remit of the employer. One was not allowed to say one would have a category two contract under an academy one. It was up to the employer to say he or she would look for a category two, as against a category one, appointment. It was actually the authority of the Health Service Executive saying that it was no longer going to exercise category two appointments, which was within its remit.
The unions have taken a different view. We did offer a compromise some months later, which was for the period of the negotiations which was to be ring-fenced for two months, that we would appoint category 2 consultants during that period but we would not backdate it for the previous eight or ten months during which we had not made those appointments. That was not acceptable to the two bodies involved and, therefore, we are in a position where we are outside of official negotiations. I am hopeful this problem can be overcome given the positive submission in one of the newspapers the other day from one of the representative bodies, the IMO, suggesting that there could be a significant amount of common ground.
Does that include the roll-out of rheumatology?
Professor Drumm
In terms of the whole appointment, we are still putting them out as category 1 posts. I would need to check what is happening in the west and whether it has advertised for rheumatologists.
Mr. O’Brien
I will check the details with the rheumatology unit as I do not have them with me, except to say that the development of consultant rheumatology positions is based on a Comhairle na nOispidéall report which has recommended a number of additional posts nationally. The focus this year and next will be on dealing with that issue outside of Dublin rather than inside Dublin. Where precisely that is I cannot say.
I wish to raise a point of clarification concerning the appointment of consultants who work for the public contract only and who can work outside of those hours. I would have thought that if a person who does one job effectively was to moonlight it would make life difficult for the level of service he or she would provide to the public service and to the patient. Is this a question of value for money? Is it in the public patients' best interests that this consultant be allowed to moonlight afterwards?
Professor Drumm
I do not think Deputy Connolly will find anybody in the consultant organisations who will claim that I am their champion. One of the reasons we removed category 2 as an option was precisely to reign in the concerns the Deputy has expressed. We believe we need people who are fully committed to their job in the public hospital. Obviously, professional organisations have taken a different view on that but the view we have taken would be the one the Deputy has expressed. It has not gone down that way.
May I deal with the Monaghan issue?
Yes.
Professor Drumm
I will deal with the first issue which is what I read into my report this morning and which was accurately quoted by Deputy Ó Caoláin. I have no objection to what he has quoted. What he is asking me to do is to say I will remove it. To do so, would be to say that it is responsible to say that the maintenance of what I have been told in two reports is an inappropriate service. There is no way I am accepting that is responsible. I am absolutely adhering what those two reports state. I will come back in a moment to whether the two reports were in any form of collusion. I absolutely believe it is responsible to say only that this service is inappropriate. I am not in a position to say anything other than that. I fully believe it is irresponsible to suggest that those two reports are in any way colluding together to actually decide that the people of the north east and Monaghan, should get an inferior service.
When we talk about drift into Dublin our figures can clearly distinguish between people who come to Dublin for tertiary services in terms of looking at the numbers. The numbers coming from the north east are way out of line with the numbers coming from anywhere else in the country. The Deputy hit the nail on the head when he said the services have never been optimally developed. What we are saying is that a regional hospital is needed but one cannot have a regional hospital with what one has at present and neither can any other place in the country dealing with the same issue. I do have a significant concern, obviously, about the issue of saying that the reports, as I said earlier, need to be torn up, and that they are in some way a collusion of people against the people of the north east. I can assure the committee that the people involved in these reports, whom I have not met, although I met some of the teamwork people at their presentation, could swear on bibles that they have never met one another, or, if they have, they have not spoken to one another in terms of the north east. It is completely wrong.
I suggest it is irresponsible to suggest to the people of the north east that there was a collusion to bring together a report that would undermine the services for people in the north east. I think the terminology the Deputy used was that we were decimating the services. I can assure the Deputy we have no role in deciminating services in the north east or anywhere else.
You have already done it.
Professor Drumm
We have not done it. In fact the first advance nurse practitioner outside of Dublin, where are very few, has been appointed to Monaghan to start to build up the services there. What is needed there is four or five more of those people and not junior hospital doctors who, as alluded to earlier, have not got the training to provide a front-line service.
I am extremely concerned that we continue to talk about collisions in terms of reports. I have to refer back to what I said to Deputy Connolly earlier who outlined the cases of people who died, which has no bearing whatsoever on giving us information on whether a hospital should be open or closed.
I have to take issue with this. This is a core point. I outlined three people who were alive when the services reached them but who were dead on arrival at the further hospital. I also quoted the cases of three people who were brought to Monaghan General Hospital while it was off call and whose lives were saved. These are people who suffer heart attacks. It is a known fact that the sooner one can get the needle into the vein to administer antithrombotic medication the chances of survival are massively increased. We do not have that service in Monaghan. That is the issue.
After one suffers a heart attack one is at least one-and-a-half hours away when taken to Drogheda or wherever, if one can get a service while there, and provided one does not have to listen to a radio appeal such as, "please do not to come to our hospital, go to your GP". This is what the core issue is about. What the patient wants is the very best treatment but he or she wants to be alive to receive that treatment. They do not want to be dead on arrival. Anybody who requires heart surgery, hip survey or any form of surgery, will travel. However, I am speaking about basic life-saving services, such as the mother with the child who is dangerously ill, or an asthmatic attack, where one can get into medical care immediately. That is what I am speaking about and it is not to be confused with anything else.
Professor Drumm
This is absolutely what would be provided. This is what we need to provide and this is why we need advance nurse practitioners who are trained to do-----
We have one in Monaghan.
Professor Drumm
Monaghan General Hospital has got the first one and it also has doctors working in its emergency department as we sit here today who are highly paid.
Of course there are doctors in Monaghan General Hospital and we want them to stay there.
Professor Drumm
They are there.
Will they stay there?
Professor Drumm
No. Ultimately, when the advance nurse practitioner cohort is trained not only in Monaghan but in many other parts of the country there is an overall acceptance everywhere that will be a level of service that is significantly above what is provided in most of our accident and emergency departments at present. We need to move away from the idea that doctors, most of whom are junior hospital doctors and trainees just out of medical school, are in some way superior to skilled advance nurse practitioners who provide our communities with a superb service and who, as Deputy Connolly said, give thrombolitic therapy immediately at the point of contact. We do not have them currently but we have begun that process.
Equally, until they are in place, that service is being provided by doctors. Such a service should not have to be provided in a hospital but should be provided by people in our ambulance services at the point of contact with the patient in his or her home or on the street. In the South we have quite a few people trained and we have significant training programmes up and running. We have to get out there——
On a point of interest, if these services are in place in the South, why does the executive not attack those hospitals with such changes rather than focus on an area where it does not have such trained staff?
Professor Drumm
As to idea that we are attacking hospitals anywhere, the point is that a major opportunity exists for the north east. That is why I am saying it is irresponsible to knock it. This represents the biggest opportunity to get a comprehensive health service anywhere in the country. The Deputy's constituencyis the first place in the country to seize a modern health service and to seize the opportunity to get a major new development of a hospital allied to a massive change in the way we provide our services both at a community level and across the different acute units that currently exist in the system. In areas such as the mid-west and others there will be a huge interest in seizing that opportunity, but our——
I would like an opportunity to contribute. These are fine words from Professor Drumm——
Has Deputy Connolly finished asking his questions?
I am not finished yet because I cannot understand——
Will I not have an opportunity to get responses to my questions? The Chairman relegated these questions to last for a response and now I cannot ask a supplementary question.
I prioritised them until last for a response.
No. The Chairman relegated——
The Deputy should not start——
The Chairman has not treated my presence here today with the courtesy a Deputy deserves in coming to another committee. We are encouraged to do so but the Chairman have made it very difficult for me to participate here today. I have waited patiently for almost four and a half hours to have the replies to questions I put. They have not been answered by Professor Drumm. On the specific points, he is confirming the accuracy of the quotes I made, but he has made no specific reference to these and I want to have them addressed.
When the Deputy has finished giving me a lecture, I wish to make this point. There are 15 members of this committee and I give them equal priority. Members who are not on the committee must wait until members of the committee have contributed.At this point Deputy Connolly, a member of the committee, is in possession. I ask Deputy Connolly to continue.
I have been here for five hours and 25 minutes, as have the other members.
I want to make a point and I will be as brief as possible. First, Professor Drumm said that the Teamwork report is laced with grades of staff that do not exist and are unlikely to exist for a very long period in the north-east region.
Professor Drumm
I did not say that.
Second, as I understood Professor Drumm, he said he had pilot projects with the type of staff, to whom he referred, trained in other areas of the country. If he has those staff in those areas, why not develop these changes in that part of the country first where the back-up staff are in situ?
Professor Drumm
There is no place we have faced the challenges we faced in the north east in terms of the quality of care we provided to people, and I do not believe Deputy Connolly or anyone in the north east or elsewhere will deny that. There have been huge problems with the quality of care there. We have faced major challenges in terms of events that have occurred in the north east and there is a huge impetus to try to address that. These challenges are and were greater than elsewhere in the country and it is right that they should be prioritised. I hope the people in the north east will see this as an opportunity rather than as a challenge. We are trying to sort out what are significant problems with the service as it is currently provided.
To return to the position from where Deputy Ó Caoláin is coming, it is irresponsible to say that this is in some way wrong. It is irresponsible to say that the safety issues are the result of mistakes or the input of the Health Service Executive. There have been problems in the north east long before the HSE existed when the health boards were in place and the democratic deficit that has now been identified was not a factor. We inherited those problems. If the Deputy wants to obtain another independent report to examine services in the north east, I am sure it is within everybody’s right to agree to obtain it, but somewhere I have to grasp the nettle of the responsibility. The Deputy said that in my position I should not be commenting. My position, when I took it up, was to ensure that the health service that was implemented was to the highest quality that could be provided. I take seriously any suggestion that what I am doing is not focusing on absolute quality of care for people in Monaghan, as it does for people in Manorhamilton or Castletownbere.
May I have the opportunity to speak?
Yes.
The primary reason I attended this committee today is that Professor Drumm made specific charges. He has confirmed the accuracy of the quotations to which I have referred. In those he referred to scaremongering for self-interest and that the public should question the motive of these individuals. I again ask Professor Drumm to withdraw those charges and, if he is not prepared to, to be specific at whom he is directing them. These are serious charges. I emphasise that I do not see anybody acting out of self-interest or whose motive in placing an alternative before the system should be questioned. An alternative needs to be heard to that promoted by the Government prior and subsequent to the Hanly report and continued on in the raft of reports produced during the period since. It is outrageous and inappropriate to Professor Drumm's position for these charges to remain on the record, and that is the reason I attended here today. I put it to him that he should withdraw those charges.
I will go further and say that Professor Drumm said in the course of his contribution that the executive will not remove services until better services are in place. He inherited the situation in the HSE from the former health board system that applied. Nobody would pretend for a moment that the service provision that was in place previously was the be all and end all, but unquestionably we had a better and a safer service in place prior to the interference, as I see it, from wherever the genesis of it came, that resulted in the decimation of services the people, who depend on Monaghan General Hospital, enjoyed generationally, through the worst economic times to a time of time plenty when those services were taken from them. They include maternity, obstetrics and gynaecology services all the way through to acute surgery and with acute medicine definitely to follow. That was stated by the executive's network hospital manager locally.
A six-bay treatment room that was commissioned and fully kitted is not open because the necessary staff are not in place. This is insane. This treatment room has been lying idle for two years owing to the lack of the appointment of a small number of additional nursing staff.
The hospital has a two-bay, two-bed area, separated by a curtain. I had to bring one of my daughters to that area one evening and while we were there, a most unfortunate event was taking place in the adjoining cubicle, with only a curtain separating the two cubicles. Thankfully, my child's injury was minor and could be treated, but the case was much more grave and distressing for other family. It had an immediate impact on my child. That is the experience people continue to suffer in that small little so-called two-bay cubicle, while a proper six-bay treatment room facility that should be used as an accident and emergency department has been lying idle for the past two years.
What is Professor Drumm doing to improve the service delivery at Monaghan General Hospital and for the people who depend on that hospital facility? How can he for a moment say to me that if the maternity unit at Monaghan General Hospital had been open, baby Bronagh Livingstone would not be alive today? There is every chance she might be. That is certainly the belief of her mother, her family and many in the community. The professor has robbed us of the joy of birth in our midst and relegated the facility to the most difficult and colder end of hospital provision. I see a hospital as something more than just the response to ill health and in terms of preparation for death. I had the joy, at least, of the birth of four of my children in the hospital. That is what Professor Drumm has taken from us over the period. He relegated our hospital to the saddest memories in people's lives when he took away those critical elements. He has left our community vulnerable.
We do not have the ambulance service that is required to ensure safe access to hospitals either in Cavan or Drogheda. The professor does not take into account the reality of the topography and the roads system. To get from Monaghan to Cavan one must travel north of the Border. It is only now that the condition of the roads is beginning to be addressed. The professor does not take into account the weather conditions in the area, which are severe. Coming from a neighbouring county, Professor Drumm must know that the first and last snows will fall in that area and the topography brings it upon us, unfortunately. That is the sad reality.
All these issues are important. This is not a funny matter. To make a comparison, as the Minister did earlier, between the connection between Dundalk and Drogheda along a key motorway system and the link between Monaghan and Cavan does not compare like with like. No ambulance driver in the north-east region would dream of saying that the two were one and the same. They are far from it. Our community is left with dark clouds over our lives and there is no intention on the part of those who are in accountable elected life or those who have paid responsibility in the HSE of taking heed of the concerns of the community, as have been expressed and articulated by people as eminent as those who have prepared the reports. There are plenty who eloquently express the contrary view, yet Professor Drumm is prepared to roller-coaster on, so to speak, with his intent to decimate services further.
There is no doubt that Monaghan will be a template for the loss of services at other hospital sites throughout the State. Despite the responses in this forum and the tiredness of other Deputies of listening to talk of Monaghan, what we have experienced and what we continue to suffer could well be the reality in any other area. The people of Roscommon, Ennis, Mallow and other such sites would do well to heed what has happened or they will find themselves in the same situation.
I raised other issues with Professor Drumm regarding delays with parliamentary questions, the potential of addressing the Leas Cross report along the lines of the mechanism found through Justice Barron to deal with the Dublin and Monaghan bombings, and the accident and emergency figures, notably the advent of the Minister's daily bulletin as against the trolley watch operated by the Irish Nurses Organisation. There are many other issues but I appreciate the opportunity to address Professor Drumm on these matters.
Professor Drumm
The parliamentary questions are being handled and the Deputy can check that. The Deputy submitted 32 questions from January to June 2006 and 29 have been replied to. Two of the three remaining questions — I am not sure what the third is — required the gathering of information from all the HSE areas. They were national questions.
That related to the visually impaired. I know the detail of each of the three questions.
Professor Drumm
If there is a delay in two of the remaining three, it relates to the breadth of the questions.
This is the end of September and they were submitted in June. That is not appropriate.
Professor Drumm
I am not denying that. We will have to take that on board and see if we can constantly improve on it. Getting 29 of the 32 is a start. We were worse six months ago and I hope we are making headway. There have been questions about the quality of the answers and I accept that this also needs effort.
With regard to the trolley watch figures, I dealt with this in detail earlier but I am happy to refer to it again. We admit 5,000 patients each week and much hard work is done by HSE employees, including nurses, to do that. Of the 5,000, 90% are admitted without any wait. Five thousand is a large number. With regard to people waiting, we are referring to five or six units out of the 36 accident and emergency units in the country. This is a focused issue in units where we have to deal with a problem. In dealing with the problem, it seems unfair to me and everybody who works in the system that the massive number of more than 5,900 who are admitted quickly through the system is ignored.
That is not to say it is ever justifiable to have anybody waiting 24 hours on a trolley. For the first six hours one can often justify it being the right thing because things are being done. However, it is not acceptable. Equally, it is not acceptable to produce a global figure that ties somebody who is waiting 20 minutes on a trolley with somebody who is waiting 36 hours and claim that to be the figure. The person waiting up to two hours on the trolley might be perfectly appropriately and better treated in that situation, a decision even having been made to admit them.
Let us be honest with ourselves and the INO. That is not the way the public should get its information. It should get honest information and we have made that available. It has come to my notice from speaking here today, because it is clear people could not be aware of it, that we need to put out information for each of the units regarding the number of people who did not have to wait to be admitted. That is probably where we need to bring breadth of knowledge to the system.
Let us then focus on where we have problems, which is what we are doing. We are putting a big effort into that. We are the first to accept that it is summer and we face huge challenges heading into the winter. However, we also face huge challenges in, for example, the Deputy's own area in terms of the number of people who are admitted and why they are admitted to hospital at levels that are way out of line with what should be admitted. Those challenges must be taken on board. If they were not being admitted at that level, nobody would be waiting on trolleys. That is a challenge for us.
In terms of what I have said, the Deputy clearly has the view that I have undermined the service for the people of Monaghan. That is not an easy view for me to take on board. I hold firmly to the view that I have not. It is a difference between us and I will continue to proclaim that I believe that we are trying to improve services. The Deputy clearly believes that we are trying to dismantle——
I am referring to the charges Professor Drumm made this morning.
Professor Drumm
They are not charges. They are the same as what the Deputy said to me, that I have completely dismantled the service for the people of Monaghan. I do not accept that. I am not asking for that to be withdrawn.
Professor Drumm presided in that position. It is a position he inherited as it had already commenced. However, Professor Drumm is making charges that people are acting in self interest. That is grossly insulting to the integrity of Members of the Oireachtas and the people locally, including health professionals and other campaigning members of a group that has articulated the needs and fears of the community.
Professor Drumm
Is the Deputy saying there is no self interest on the part of a health professional locally expressing a view on the health service in the area?
I believe they are absolutely committed to what they are saying.
Professor Drumm
Is the Deputy saying that the opinions of health professionals throughout the country are always without self interest?
Is Professor Drumm identifying the health professionals as the people he is accusing of acting in self interest?
Professor Drumm
I am identifying statements that are scaremongering in relation to — and I tied it down honestly here — the death of a baby or individuals. That is totally unreasonable. The suggestion that we keep open a maternity unit because of a single death is unreasonable and unreasonable to that family. It creates-----
That is not the only reason.
Professor Drumm
It creates the sense that all this is avoidable by continuing to build hospitals here, there and everywhere.
Nobody is talking about building hospitals here, there and everywhere. That loose use of words is creating the problems. There must be greater exactitude. Professor Drumm has abused his position this morning.
The Deputy must withdraw that remark.
Professor Drumm cannot come here——
The Deputy must withdraw that remark. I call Deputy Connolly.
——and make charges as he has done. That is wrong.
Deputy Ó Caoláin should recognise the Chair. I call Deputy Connolly.
I am disappointed that Professor Drumm does not see fit to withdraw the remarks he made this morning. They were both heavy-handed and uncalled for. I interpret them as meaning that Professor Drumm has contempt for public representatives. I often wonder how high that contempt goes. Does it go above the HSE to the Minister for Health and Children, the Taoiseach and the President? That is how I think those remarks will be interpreted. Professor Drumm has said that he will not withdraw those comments, which is regrettable. They will be seen as driving a wedge between the HSE, public representatives and the people of Monaghan. As head of the HSE, his views will be taken as representative of the HSE's views, which is regrettable.
Earlier on this morning I raised two other issues to which I would like to have a brief response, although I realise that time is running on. The HSE north-east has rejected the recommendations in the Pat Joe Walsh and Teamwork reports. The county council has also rejected those recommendations. I do not think that can be ignored. A forum was set up but does one simply ignore what that body of people has done? I would like Professor Drumm to refer to that issue.
The other issue concerns the cross-Border and Working Together reports. Any report that sets out to undertake a review of services in Cavan-Monaghan, Louth or the north-east area generally, yet ignores Border communities, is not worth the paper it is written on. One cannot ignore the communities that live on either side of the Border. Some of them could be better treated on our side, while others may be better treated on the other side of the Border. Such reports demand credibility but this one cannot be taken seriously if it does not address those Border issues.
I was asked about the Leas Cross report and I forgot to mention it in my response. The HSE has been in discussion with Professor O'Neill and I look forward to hearing the outcome of those discussions. Professor Drumm has circulated the strong legal advice this morning. Clearly, for any Minister to use the privileges of this committee or of the House to publish such a report, I would first have to obtain the advice of the Attorney General. I am obliged to do so.
Second, we do not wish to interfere with the charter of Tallaght Hospital but the charter does not supersede every other development concerning paediatrics.
I wish to say the following to Deputy Connolly. If I am seriously ill and want an opinion, I will not go to any county council or to politicians for advice on where I should go. Some of the remarks that were made here recently concerning Professor Drumm were unfortunate. He is more than capable of defending himself but I think we are lucky to have someone of his standing, experience and determination as head of the Health Service Executive.
Professor Drumm
The views of original forum will be conveyed to the board. The board has taken the view that the north-east report by Teamwork would be the way along which we would proceed. We will inform them of the regional forum's input but somebody will have to come forward to clarify whether there is a proposal on the table that would stand up to scrutiny in terms of providing a better opinion on how the north-eastern services should be put forward. Perhaps there is or perhaps there is not, but we have conducted this as an independent review. Despite what Deputy Ó Caoláin said, there was no collusion. I would have no difficulty in producing these people to swear that they were not colluding, yet the same outcome emanated from two different sources. It is the same as anybody else telling me that it is not the right outcome, but there were two different sources and I had nothing to do with either of them. Neither had they anything to do with one another.
As regards the cross-Border issue, believe me, I know that countryside well. We have been told by the authorities in the North of Ireland that Enniskillen is going to provide the services they want for the Tyrone-Fermanagh area. I do not know if members know Enniskillen Hospital but I know it well. It is a tiny, under-developed hospital. They are very interested in taking work from the South to create the necessary critical mass for Enniskillen to survive. They are committed to that building. At a meeting between me and the chief civil servant involved, we took the view that in Cavan-Monaghan and the north east in general we need to build up our own services in the north east. At this point, we are not in a position to start looking at Enniskillen providing services for us because it could well undermine what we are able to do in the north east.
The fact is that the reports do not address this cross-Border issue.
Professor Drumm
If somebody has specific proposals concerning the cross-Border issue, they could certainly be examined. From my meetings on the matter, however, I suggest that it will be work from south of the Border going north of the Border.
That is okay. West of Enniskillen is where the new hospital is proposed. If one were to draw a 25-mile radius around that, it would look like they would cater for west Cavan, east Sligo and south Donegal. However, that leaves the Monaghan area out of that loop.
Professor Drumm
It will not. That is the challenge because Sligo is highly developed and more so than Enniskillen will be. I will take on board the Deputy's view that there is a cross-Border group. We should ask that body and I accept that it was not involved in the reviews but that does not prevent it even now engaging at the steering group level with the proposals.
I wish to draw the proceedings to a close at this point as we have been here for six hours. I thank the Minister, Professor Drumm and their officials for attending the meeting. I do not need to speak for Professor Drumm; he is well able to speak for himself. It is unfortunate that an allegation of any nature should be put before him of any of his officials. I think they are doing an excellent job. I wish to make that clear from the Chair. It is fair to make the point that over three months we have had an opportunity to hear from both the Minister and Professor Drumm. That is something the committee values and the more such meetings we have, the more information we will obtain.
We have all had problems with hospitals. For years in my area, I had to support the hospital in the next county. I supported Tullamore rather than Portlaoise. I know exactly what the depth of feeling locally is like. Nevertheless, it is about patient care, which I support. In particular, I support the Minister's viewpoint that it is not for local authorities or those who are not experts to give advice on this matter. I thank the Deputies from Cavan-Monaghan for having made their position clear. They uphold their position and Professor Drumm upholds his.
I will now suspend the meeting. I must ask the members to remain for a few minutes to deal with ordinary business.
The joint committee went into private session at 3.17 p.m. and adjourned at 3.30 p.m. until 9.30 a.m. on Thursday, 5 October 2006.