JOINT COMMITTEE ON HEALTH AND CHILDREN díospóireacht -
Tuesday, 6 Nov 2007

Business of Joint Committee.

Deputy Niall Blaney

I congratulate the Chairman on his election. While it is an onerous task, I have no doubt he is capable of it. I also congratulate Deputy Jan O'Sullivan on her election as Vice Chairman.

I agree with the Chairman's comments on groups attending the committee. Committees can get bogged down with yea or naysayers. While they must have an investigative aspect, they also must take tough decisions when the need arises. Some committees can get bogged down with inviting groups, some significant and others very insignificant, with argy-bargy about nothing. Rather than have a talking shop, I would like to see this committee play a cross-party strategic role in dealing with health care issues.

Deputy Rory O’Hanlon

I congratulate the Chairman and Vice Chairman on their appointments.

For a long time I have held the view that adversarial politics has not served the people well, particularly the ill. I am not against party politics or people arguing and debating. While this is important, considering how the health service has evolved during the years, we would serve the people better if we agreed on what we expect from the health service and analysed objectively what is happening in it. It does not matter who is in government or in opposition. It is easy for the Opposition to blame the Government or the Health Service Executive, although I am not sure they should take the blame for some of what is happening in the health service. We will not serve the people well if we cannot attempt to objectively identify and address the issues to be dealt with in the service.

This is a good time to raise the matter. In the cut and thrust of politics we all try to promote ourselves and our parties in the best possible way. With the level of debate devoted to the health service in the past ten years, one would have believed the Government could not have survived the last general election. For the first time in 30 years, a Government has been returned to power, which suggests the debates on the health service are not having the impact we imagined.

During the committee's lifetime we must take a more objective view as to what is happening with the health service. I hope we will all work together to identify the real issues that need to be addressed, make recommendations and, perhaps, travel abroad and examine the best health services around the world and write a report on which we can agree. In that way, we would do a great service to those who are ill.

Senator Geraldine Feeney

I congratulate the Chairman and Vice Chairman on their election and wish them both well. I hope they will be able to put up with the committee when matters get stormy. I note some members of the previous committee have returned. I welcome what the Chairman said about the Minister coming before the committee on a quarterly basis, accompanied by Professor Drumm. This is an excellent arrangement and it will be more necessary than ever in the coming parliamentary term.

In regard to delegations appearing before the committee, it was often the case during the last term that, because of other commitments, as few as two or three members might be present to hear the views put forth by groups attending meetings for two or three hours on a Thursday morning at 9.30 a.m. For each of the delegations in question, there was nothing more important than the issue it wished to raise. It did not create a positive impression when only two or three members were in attendance to hear delegates voice their concerns. I propose, for the coming parliamentary term, that we select those delegations that will gain most from coming before the committee and vice versa.

The Chairman mentioned two matters on which this committee focussed during the last term. I echo his comments on one of these, the issue of suicide. Another issue I propose we should examine is the report of the Commission on Assisted Human Reproduction. During the last term, we discussed the lack of regulation of fertility clinics. This is an urgent issue that we should examine comprehensively.

Deputy Bernard Allen

I congratulate the Chairman and Vice Chairman on their election. I agree with Deputy O'Hanlon that as representatives of the public, we must be positive in dealing with the many and complex issues we face in delivering an efficient and effective health service. However, we also have a responsibility to reintroduce the element of accountability that disappeared with the demise of the health boards and the corresponding insulation of the Minister in terms of parliamentary accountability. It befalls this committee to ensure some degree of accountability in respect of the health service. We should embrace this role rather than functioning simply as a forum for research on various issues. Ministers and chief executive officers of State bodies have questions to answer and this is one of the few fora in which those answers can be obtained.

Chairman

Before calling Deputy James Reilly, I will respond to members' comments. I failed to mention that the Minister for Health and Children, Deputy Harney, has agreed to come before the committee on Thursday, 22 November. I also took the opportunity to ask Professor Tom Keane, interim national cancer control director, to attend a meeting as soon as he takes up his appointment.

I agree with Deputy Allen that the function of this committee is to provide a forum for accountability. We must also focus on teasing out policy strategy. In other words, we should be involved in the roll-out of policy rather than being merely a research committee. If we go the latter route, we will have little to report upon in the coming years. I am keen that the key personnel within the health service should come before the committee on a regular basis. Such meetings should simply not be routine; if an important issue develops, we should have the right to ask the Minister, relevant Minister of State or HSE official to appear before us.

Deputy James Reilly

I echo the previous speakers' congratulations on the election of the Chairman and Vice Chairman. I look forward to working with them both in the coming years.

I gladly endorse the comments of Deputy O'Hanlon. Membership of this committee offers us an opportunity to rise above political differences in investigating why the health service is not functioning. As to whether we should be policy or research orientated, it is my view that the greatest crisis we face in terms of the health service is its inability to deliver timely care to those in need. We should keep politics out of it. Meetings with HSE officials should take place on a far more regular basis than once a quarter. It is not always necessary for the chief executive officer to attend but rather those officials with responsibility for different aspects of the health service. I would like this committee to work somewhat along the lines of the Committee of Public Accounts to find out where all the money has gone, why decisions were made, who made them and what the consequences were.

The purpose of the committee should not be in facilitating a witch hunt but rather in finding out where things are going wrong and how to correct them. The Chairman might anticipate that we may not be here for a full five-year term, but if we achieve that goal in the next few years we will have performed a significant service for the Irish people. It will be much more than we would do roaring and shouting at each other across the Dáil. That is where I see us in future, and I hope members on all sides will join in trying to examine where things have gone wrong. The one irrefutable point is that we are not delivering at the moment and we must find the reason.

Deputy Dan Neville

I wish to discuss the groups coming before the committee. We found it very frustrating in the last session that they would have a half hour for a presentation and questions but we would still be in the meeting an hour and a half later. Groups would come in with long statements, sometimes given by four or five people. As we met at 9.30 a.m., the Order of Business would begin soon after and many of us were obliged to go to the Dáil.

Is there any way of informing such groups prior to their attendance of the time allocation and directing them to stick strictly to it? This would create the precedent of allowing groups a certain length of time to speak. The length of meetings in the last session was very unsatisfactory. Some of us would have been waiting around for an hour and a half to ask two or three questions and the information in presentations was written down on most occasions anyway if we wanted to read it later.

It is very difficult to get hold of the HSE when its officials make representations, as four or five of them could be making presentations. The Chairman then groups committee members' questions together and the officials choose what to answer and how they do so. We do not have the opportunity to ask follow-up questions as the Chairman has to move on in order to include everybody in questioning the officials, which can take up to an hour. Officials can avoid answering and we cannot do anything about it.

It would be extremely helpful to find a way around this. It was sometimes very frustrating when officials did not answer satisfactorily, although in fairness to the Minister, she was much more direct in answering questions than were some of the HSE officials. I am not necessarily referring to Professor Drumm either, as I found him quite direct. Others often avoided our questions or answered only the parts they wished to. We did not have the opportunity to follow up on it.

Senator Frances Fitzgerald

I share in congratulating the Chairman on his appointment, and Deputy Jan O'Sullivan on her appointment as Vice Chairman. The public clearly wishes to see effective health services which can be accessed in a timely way. My thoughts sitting at this committee this morning are of the women in Portlaoise who did not find this to be their experience, and it is hard to meet this morning without thinking of the trauma being faced by their families.

People are talking about being non-political on this committee but we must acknowledge that political decisions all over the world drive health services. I would like to see us rigorously analysing the political decisions driving health policy in this country and having a good cross-party discussion on them. I immediately think of the co-location decision, the establishment of specialist centres and the resource implications for current and future services.

We should consider these cutting edge issues and we are required to do so in a way which brings people together across parties, while still being rigorous. These types of decisions require such rigorous political assessment.

Chairman

I support that view. From what I am hearing we are moving to a position where committee meetings will not be a talking shop. That approach would be similar to other committees that have been forensic in dealing with issues. Other members wish to contribute but we will try to come to a position at the end of the meeting as to how we see ourselves going forward.

Deputy Kathleen Lynch

I congratulate the Chairman on his appointment and I hope the committee will have a successful term and manage to do some good work. I also congratulate Deputy Jan O'Sullivan.

I do not wish to diminish the trauma certain women in Ireland are experiencing at the moment but, thankfully, the matter is being addressed. Whether people have confidence in how the issue is being dealt with is an argument for a different day because if we were in the same position as these women we would be as traumatised. People who have been given the all clear must now be wondering whether the diagnosis is correct, given what has come to light.

The dispute involving pharmacists will have a greater impact in a shorter period than any other foreseeable issue. I know many elderly people, which I am sure is the case with everyone at this table, and they are terribly worried by what will happen on 1 December. This committee should spotlight the matter and bring people together to bring about a resolution to the issue. People are worried by this and dealing with it would represent a good day's work for us. Last night I received two phone calls on this matter, one from a bedridden woman in her eighties who said she would die if she could not get her medication. This decision will affect many people, as Deputy O'Hanlon knows better that most of us, and it is to be implemented in three weeks. I suggest we address this matter immediately.

Chairman

We will try to deal with any matters that are imminent and of importance as there are some weeks left in this Dáil term. I take on board the Deputy's comments and agree that such issues should be addressed immediately rather than be seen as parked because they are controversial.

I will summon speakers in rotation and call on Deputy Paul Connaughton to be followed by Deputies Phil Prendergast and Jan O'Sullivan.

Deputy Paul Connaughton

I congratulate the Chairman and Deputy O'Sullivan and wish them both a successful period, though hopefully not five years. I had the good fortune to be a member of the Joint Committee on Health and Children some years ago and would like to share some points with this committee.

As Deputy Neville mentioned, we were damned during our term. It was not that we did not want people to come to us, because we must keep our doors open in that regard, but I found on that committee and on others that one must set down, long in advance, the ground rules for witnesses visiting committees. Witnesses must understand that each group receives the same amount of time before the committee. Time limits were applied in other committees and they worked as long as they were rigidly adhered to. There is a great deal of rivalry between many groups and they wish to demonstrate their professional expertise while here, so they are happy to spend an hour or two presenting their cases. This is good in a way but, as we are professional politicians, we should be able to acknowledge what they say through the written word. Witnesses should be given an opening ten or 15 minutes to address the committee before committee members are allowed speak. We are in these Houses daily and should be well able to question witnesses. Great inroads could be made if this issue were addressed and it is something with which the Whips could deal.

The area of intellectual disability is something the committee must take note of and it is a matter I intend to raise here, as I am sure many others will. This is not a political matter as it has been going on for years. I have a bee in my bonnet because every time I meet parents of children with intellectual disabilities they do not seem to be much better off than 25 years ago. With this in mind, it is clear that this committee has much to do. The committee has a very large brief and, from what the Chairman said, I have no doubt it will be interesting. We will give him every co-operation on this side and I hope it will have the desired effect.

Senator Phil Prendergast

I join with the other speakers in congratulating the Chairman and Deputy Jan O'Sullivan on their election.

When it gets to this stage in the speaking line up many points have been covered, but having worked in the acute hospital services for the past 23 years I know that many problems arose because of a layer of bureaucracy and administration where people were required to tick boxes. That led to the question as to who would make a decision. Clinical decisions can be made by clinicians in the heat of the moment but accountability is important and the accountability often stopped at 5 p.m. As we know, the health services do not stop at 5 p.m. or on a Friday evening and recommence on a Monday morning during office hours. One of the ways we could address that problem is to have an analysis of the issue.

Regarding the awful case in the news concerning Portlaoise, there were even more women diagnosed with breast cancer who did not have the disease. There is a case for a clinical audit of the work of consultants on terms that will be agreeable to any professional because if somebody becomes ill there should be no objection to a clinical audit of professional outcomes. That would be something of interest.

Deputy Jan O’Sullivan

I agree with those who said we should give some time to planning how we use our time in this committee because it will pay off. I agree with Deputy Connaughton about timeframes. If groups are given a specific timeframe and told their presentations will be circulated in advance it will not be necessary for them to read them out when they are before us. If we make that rule now, we will give ourselves more time for important work in the future.

I agree with Deputy O'Hanlon that we must examine the macro issues and comparisons with other countries but we must find time also for the urgent issues like the pharmacy one raised by Deputy Lynch. We should try to balance our time between more general systematic issues and the immediate ones that arise. I am interested in learning from other countries and because some countries have universal health insurance, others have a mix of public and private while others still have a largely public system, it is inevitable that the positions separate parties have on those issues will arise. However, we should try to learn lessons from the best of what is done in other countries. If that means we disagree on policy, so be it.

The issue of the consumption of alcohol is something the committee could consider if it has not done so already because it is becoming a crisis in our society.

Chairman

We had presentations from Alcohol Action Ireland and other groups and that is contained in the suicide report. We are meeting at 10 a.m. on Thursday to agree the work programme. I suggest the Whips meet me tomorrow at 4 p.m. and come back with suggestions for the committee on, first, the way we deal with the groups that want to come before us, second, the order of speakers from parties - Deputy Neville will confirm that the difficulty in the past was deciding who to call on first and whether it should it be the spokespersons - and, third, the length of time people should speak. I want to start this committee on the right foot. I do not want to come in here and say something should be done in a certain way because we have a majority. We will not go down that road. Is it agreeable to the Whips to meet tomorrow at 4 p.m. to decide the order in which members speak, the length of time they can speak and other priorities? I accept the positive suggestion from Deputy Kathleen Lynch to try to deal with the pharmacy issue within the next week or two. We will try to set a date for that. Is that agreed? Agreed.

Deputy Rory O’Hanlon

I agree with the Chairman but I also think we should put a time limit on meetings. I suggest an hour, which is enough for a committee meeting, because that will concentrate members' minds and they will not go on for ten minutes if the meeting only lasts an hour. I found that to be a successful strategy as Ceann Comhairle, where meetings did not go on for longer than an hour.

Chairman

I agree.

Deputy Beverley Flynn

I do not think--

Chairman

We will speak in the specified order. We will go back to that grenade in a few minutes. Before I ask Deputy Margaret Conlon to speak, I reiterate that we are teasing out this issue. We will meet tomorrow and come back on Thursday with an agreement.

Deputy Margaret Conlon

As a newcomer to the Dáil, I am delighted to be here at my first committee meeting. I congratulate the Chairman and the Vice Chairman, Deputy O'Sullivan. I look forward to working with them and, particularly, to getting my hands on the suicide report, an area in which I have a keen interest due to my background as a teacher. I hope we can look at the report's recommendations and that procedures will be put in place so that when, as Senator Prendergast has stated, psychologists are off duty, there is someone for people to go to when they feel they have no one else to approach. I have listened to other members and taken the points on board but where issues arise that are so important, it behoves us as elected representatives to deal with them. I look forward to constructive debate on this committee.

Chairman

I will ask the clerk to circulate the report on suicide and members who want to join the sub-committee in a voluntary capacity can put their names forward at a future meeting.

Senator Mary M. White

The recommendations of the strategic report on alcohol are also very much part of the issue.

Chairman

Rather than nominating people, members can let us know later who wants to volunteer for the sub-committee.

Deputy Beverley Flynn

I congratulate the Chairman on his election and Deputy O'Sullivan on her election as Vice Chairman. I have been on this committee for ten years and while the idea of a limited time for meetings is appealing, the experience is that when the HSE comes before the committee every three months, everyone has questions to ask. There are many other issues, such as the national cancer strategy and the centres of excellence and their impact on the western region that must be forensically analysed at this committee. Glib statements are made in the public domain about improved outcomes and I want these outcomes to be examined by this committee. There is no way that can be done within an hour. We had meetings that went on for too long in the past but I want to make that point.

It is great to see the new members of the committee and I look forward to getting on with our work.

Senator Mary M. White

From my own experience on the committee, it is important that time is given to issues. Each person should be allocated six or seven minutes so he or she does not repeat himself or herself or speak for the sake of it. We should know from the start that there is a time limit.

Chairman

We will meet with the Whips tomorrow to work that out.

Senator Mary M. White

It will make it more interesting and will ensure people attend. I sympathise, however, with Dr. O'Hanlon's point. If there are no witnesses, meetings should not last longer than an hour and a quarter. Members can make their point in three minutes when push comes to shove. I have attended meetings in the last five years that have been very boring, where we go through a rota of people with some speakers repeating themselves over and over. We must make it interesting. As some Deputies and Senators, such as Deputies Conlon and Flynn, have stated, the committee must react to what is occurring. If there is a crisis, we must deal with it instead of what is on our agenda.

Deputy Bobby Aylward

I wish to be associated with the congratulations to the Chairman and Vice Chairman and I wish them the best for the next five years. As a first-timer, I am delighted to be a member of the Joint Committee on Health and Children, within which much important work can be done if resources are made available.

Members have addressed all the issues. The Department of Health and Children is large and spends nearly €15 billion per year. How far can the committee's investigations impinge on the Department's day-to-day running? Can we examine its financial spending? How much time can we devote to those investigations and what answers can we force out of the powers that be?

I look forward to our work. In the next five years, perhaps the committee can have an input into improving the health service. The system is not up to scratch and there are many related issues.

Chairman

We will go into private session. It will be seldom used - primarily to work on times and dates of meetings. I have listened to members' contributions and will take into account how they want the committee's work to be prioritised. I will meet the Whips tomorrow to work out the order of issues, the length of time given to speakers, the number of people making presentations and so on. The committee will resume at 10 a.m. on Thursday to agree the work programme and the decisions of the Whips. Is that agreed? Agreed.

We will try to move away from the committee of old, which spent too much time discussing reports. I ask that members bring their ideas on what should be prioritised with them on Thursday morning. We cannot take every proposal on board, but we can agree three or four priorities. For example, we could receive a presentation on the national cancer strategy because it is an issue into which people would like to delve. The committee should run in parallel with the Minister, that is, we should know what is occurring before we read about it outside the Oireachtas. We want to tease out policies, how they are working and what decisions are being taken.

Senator Fitzgerald and Deputy O'Sullivan referred to the Midland Regional Hospital at Portlaoise, my local hospital. I would like the right decisions to be made in the roll-out of services. I supported the then Minister, Deputy Noonan, on the national cancer strategy for the midlands, but we would not have the current situation in Portlaoise had everyone else supported him. Professor Jim Finlay was supported by the National Cancer Forum and the then Minister took the political decision to designate Tullamore as the lead centre for the roll-out of cancer services in the midlands. I supported that strategy rather than supporting my hospital in Portlaoise. It is unfortunate that, due to local political influence, the strategy was watered down and a breast cancer clinic was opened in Portlaoise. I do not want to see a similar situation arise.

I support members' comments regarding proposals being analysed to ensure the decisions are correct. I hope that the committee progresses along those lines and teases out matters properly. I take on board the suggestion that we should invite the Minister to appear before the committee once every quarter. Am I correct in interpreting the suggestion?

Deputy James Reilly

Yes.

Chairman

I will take into account the suggestion that the committee also be attended by the HSE and Professor Drumm every quarter. I take on board the suggestion that if day-to-day issues crop up, the committee should have the right to park the day's agenda and invite the relevant authority to attend.

The Whips and I will set out the parameters for the future and will try to return on Thursday to present a package to the committee in the hope of getting agreement. We must make the committee relevant and have it seen as a watchdog on health spending and, more importantly, policy.

Deputy James Reilly

I support the Chairman with one proviso, namely, urgent issues should be agreed by consent. It is self-evident that this should be the case.

I am concerned by the Chairman's comments regarding the Midland Regional Hospital. This hospital was designated the breast cancer service centre for the midlands and its failures are partly due to resourcing. There is no point having a plan and designating places as centres or as centres of excellence if one does not ring-fence funding for them. Funding is a major issue in Portlaoise. Why is there a 15 year old scanner? Why do radiologists work in isolation? Let us not abdicate responsibility for ensuring the final part of any plan is resourcing it.

Chairman

I differ with the Deputy by suggesting that the national cancer forum rolled out a central chemotherapy unit for all cancer services in Tullamore in 1996. Later that was changed to locate the breast cancer service in Portlaoise.

Deputy James Reilly

Having decided in 2000 that this was the place to provide the care, it was not resourced. The plan for centres of excellence leaves us in the same boat because the Minister cannot tell us where the funding will come from for these centres.

Chairman

I do not want to allow us to go in the wrong direction. The independent medical advice from the national cancer forum selected one centre. Today is not the day to differ on such matters.

Senator Geraldine Feeney

I was going to make that point. We should wait until an independent inquiry is held because there will have been faults in the medical and other areas, as Deputy Reilly outlined.

Deputy Rory O’Hanlon

Deputy Reilly has raised a fundamental issue for all of us about the role party politics has played, which we want to get away from. Decisions to locate services should be made in the best interest of the patient. I admire the courage of the Chairman who did not vote in favour of the Midland Regional Hospital in Portlaoise, which is in his constituency, because he believed it was the right decision. That is not easy for any politician. We must ensure the best decisions are made in the interests of patients. There will be different opinions on how to do that, whether through small or large hospitals, but we politicians must ensure we are properly informed. There are three priorities in the health service, namely, the patient, the patient and the patient. We must focus on their needs. I have had problems in my county because I will not support a service I would not use.

Deputy James Reilly

Deputy O'Hanlon misses the point. I concur with his comments--

Deputy Rory O’Hanlon

I said it was a fundamental issue--

Deputy James Reilly

I did not interrupt Deputy O'Hanlon and I ask for the same courtesy in return. I subscribe to the criteria outlined, such as that the patient comes first, but the best plans in the world are to no avail if there is no funding and they are not resourced. That is what happened in Portlaoise.

Deputy Niall Blaney

We are going off the agenda.

Chairman

I am not a doctor. I am listening to two doctors differing on this issue. Politicians are given independent medical advice, as we were in 1996 to locate one centre in Tullamore. As a non-medical person, the dilution of that advice down the line calls into question the merit of independent medical advice. We will not pursue these issues today. I am not avoiding them. There will be plenty of time.

Deputy Niall Blaney

We are going off the agenda and getting into arguments.

Chairman

I want to allow people to have their say on this, the first day of the committee. I now propose we go into private session to discuss dates and times of meetings. Is that agreed? Agreed.

The joint committee went into private session at 1.50 p.m. and adjourned at 2 p.m. until 10 a.m. on Thursday, 8 November 2007.