I would like to agree on the times for the speakers' slots.
Business of Select Committee.
I would like to raise the right of members on this side of the House to have advisers approach them with notes. The Minister has experts from the Department of Health and Children beside her and her advisers behind her and they can communicate freely without disrupting the meeting. At the last meeting my PA had information that I could access only through an usher, which delays things. I ask for the same courtesy to be given to all sides.
The Deputy wants a PA to be able to come in and hand over notes. I see no problem with that.
Thank you.
The proposed timetable for this meeting has been circulated. It allows for opening statements by the Minister and the Opposition spokespersons followed by an open discussion on the Estimate through a question and answer session. Is that agreed? Agreed.
How much time is allocated?
The Minister will have 15 minutes for her opening statement while the Fine Gael and Labour Party spokespersons will have ten minutes each. The question and answer session will be from 5.35 p.m. until 6 p.m. As the Minister is due to leave at 6 p.m. I will continue as quickly as possible.
For new members I will give the background to this meeting. No decisions can be taken by the committee based on its consideration of the Estimates. This committee is empowered only to consider the Estimates, not to alter, amend or vote on them. Such powers belong to the Dáil. The committee cannot recommend increases or decreases in the Estimates. The committee must send a message to the Dáil when it has completed it consideration of the Estimates and cannot decide not to do so.
Under Standing Order 87 the message must be to the effect that the select committee has completed its consideration of an Estimate referred to it by the Dáil. There is no provision for the expression of opinion by the committee on the Estimates in its message and as the Standing Order prescribes the nature of the message to be sent, the content is not a matter for decision by the committee. Standing Order 86.2 provides that the message sent to the Clerk of the Dáil is deemed to be the report of this committee on the Estimates. If that is understood and agreed I propose we ask the Minister to make her presentation.
Estimates for Public Services 2007.
Vote 40 — Health Service Executive (Supplementary).
I am glad to have the opportunity to address the committee and bring the Supplementary Estimate for the Health Service Executive before it. As Minister for Health and Children, with overall responsibility for the health group of Votes, I seek the approval of Dáil Éireann for a Supplementary Estimate of €1,000. My Department has already provided members with background briefing on the Supplementary Estimate which is before them. I propose that the Supplementary Estimate be approved to increase the provision for a number of subheads to meet necessary expenditure across a number of health programmes. The Vote subheads requiring this additional funding are: A, corporate administration; B1, eastern regional area; B2, midland area; B3, mid-western area; B5, north-western area; B6, south-eastern area; B8, western area; B9, grants in respect of certain other voluntary and joint board hospitals; B10, medical card schemes; and D, appropriations-in-aid. The gross additional spending requirement for these subheads is €255 million. However, this is reduced by savings of €249.999 million within other subheads of the Vote. This results in a net additional requirement of €1,000.
In proposing this Supplementary Estimate I am, as always, conscious of the need to ensure that public funding is applied most effectively for the delivery of services. However, against a background where Dáil Éireann has voted specific funds for the HSE it is more important than ever to set out clearly the reasons for additional funding requirements.
The Supplementary Estimate in 2007 is primarily a technical matter involving the transfer of savings between subheads of the Vote to other areas to support additional expenditure on core services in excess of the budgets allocated. However, the underlying causes of where increased service pressures and costs have driven spending to unanticipated levels need to be set out clearly. There is a requirement for an internal transfer between subheads amounting in total to €255 million or less than 2% of the overall HSE total. While this percentage may appear relatively modest I do not seek to minimise its significance. Whilst the prime objective remains the adequate funding of accessible high quality health services, we must acknowledge the need for improved budgetary monitoring and control processes. This means ensuring the total resources are deployed correctly across the health system to meet existing and new obligations and also for maximum effectiveness.
I propose the Supplementary Estimate be approved to increase the provision for aforementioned subheads to meet necessary expenditure committed. The areas within which expenditure exceeds budgets are community drug schemes, the cost of contracted beds in private nursing homes to relieve pressure in the acute system and the acute hospital system.
Expenditure on the statutory drug scheme has been increasing at a significant rate in recent years. Within the OECD, Ireland is among the countries with the lowest drug costs per head of population. In 2007, the HSE has seen significant increases in the costs in drug pay schemes, high-tech medicines and long-term illness schemes. The higher spending is driven by a combination of volume and type of drugs prescribed rather than price inflation. Growing use of statins, anti-depressant drugs, Tracleer for respiratory illness, prescriptions for the treatment of arthritis and multiple sclerosis are some of the main drivers of costs. A new agreement with the pharmaceutical companies will result in a 35% reduction in the cost of some drugs from 2008 onwards.
The 2007 service plan included additional funding for the purchase of contracted beds for patients awaiting transfer from acute hospital settings and to alleviate the accident and emergency bed pressures. Due to these pressures on the system, it was necessary to contract more beds than provided for in the HSE service plan. Again, this was successful in continuing to alleviate the accident and emergency pressures in early 2007, but it required greater funding than that available in the service plan.
Inpatient and day-case activity have recorded consistent increases in 2007. When measured against the service plan to October these increases have been some 3% to 5% above the targets for 2007. This is despite efforts by the National Hospitals Office, NHO, to contain activity to the service plan targets. While this is good news for patients and the system generally it is not sustainable within the approved funding levels.
The latest HSE performance monitoring report of October 2007 indicates activity levels within the NHO exceed the targets outlined in the national service plan as follows: inpatient numbers are up 3.1 %; day-case numbers are up 5%; outpatients numbers are up 9.8%; and birth numbers are up 10%.
In light of the emerging funding pressure, the Health Service Executive put in place in September a breakeven plan which is now delivering results. Pay expenditure is down €18 million per month when comparing August and October spending levels. Non-pay reductions have also been achieved but are being overtaken by growth in community drug schemes and the primary care reimbursement service. This is having the net effect of non-pay remaining static when the average spend from August to October is reviewed. The HSE has pulled back on all discretionary spending, such as overseas travel, hotel usage and training costs.
The HSE breakeven plan also envisages delivering the contracted service levels as per the service plan for 2007. We are now close to achieving community-based services, however activity in hospitals continues to grow and drive costs.
There are projected savings arising in the following subheads at the end of the year. Subhead B4, north-eastern area, has projected savings of €2 million. Subhead B7, southern area, has projected savings of €9 million. Subhead B13, dormant accounts, has projected savings of €6 million. Subhead B14, long-term repayments scheme, has projected savings of €216 million. The hepatitis C insurance scheme has projected savings of €1 million and information and communications technology capital has projected savings of €20,999,000.
The original project plan prepared by the scheme administrator for long-term repayments predicted that 13,240 offers and 11,538 payments, estimated at a value of €230 million, would be made in 2007. However, these projections proved to be overly optimistic for the following reasons. The level of rejected claims is far higher than anticipated at 40%. There is a low uptake of the scheme. The return of application forms by estates where certificates of entitlement to claim have issued has been slow. Complex and numerous deficiencies in a large number of applications received have to be resolved prior to offers being made. Also, legal and technical standards required for appropriate governance of the scheme must be applied.
As of 30 November, repayments totalling €99 million have been made to 5,007 applicants. Offers totalling over €155 million have been issued in over 8,000 cases. The HSE expects that further payments will be made to bring the total value of repayments for 2007 to €119 million. The projected total amount repaid under the scheme up to 31 December 2007 would be €132 million, and this includes €13 million in repayments to 604 people made in 2006.
The report projects that 6,082 payments will be made by the end of December. Overheads and up-front costs associated with the scheme will amount to an additional €11 million. This will result in the utilisation of €143 million out of the €360 million originally made available for the scheme in 2007.
An allocation of €150 million has been provided for the scheme in 2008. However, all eligible applications received prior to 31 December 2007 closing date will have to be repaid and appropriate provision made to meet these costs. Savings on ICT capital expenditure have arisen due to a focus during 2007 on the reorganisation of the HSE's ICT directorate, development of a new ICT strategy and associated planning for future years.
I have recently approved the 2008 service plan submitted by the HSE. In doing so I emphasised that the board and the executive's management should pay particular attention in 2008 to the absolute necessity for the HSE to operate within the limits of its voted allocation in delivering, at a minimum, the levels of service activity specified in the service plan. This is an essential requirement that must be met if the HSE is to retain the confidence of the Dáil and the Government in its stewardship of public funds. This means that the evident links between the voted allocation, approved employment levels and service activity, within the HSE itself and in HSE funded agencies such as the major voluntary hospitals, need to be planned and actively managed from the very start of the year with the appropriate action being taken in the event of any divergence from profile.
During 2007 the HSE concluded a number of major reviews including the bed utilisation study, the bed capacity study and the laboratory review. These reviews have been discussed with the Government and will be considered in the context of the health forum established by the Government. The recommendations of these kinds of report are key to driving long-term value in the health sector. Their implementation is now a matter for the HSE in partnership with the Government and the stakeholders in the wider health sector. The effective implementation of these reports will drive long term value in the health sector.
For its part the HSE has informed my Department that it has developed a new budgetary process for 2008. The following are the reasons for developing the new budget process. Every budget owner is now registered and budgetary responsibility has been clarified and enhanced in a new budgetary process. The budget process has been made more clear and concise. Funding has been directed to particular areas of service pressure making 2008 budgets more achievable and realistic, linked to service level. Greater links have been established between the development of the Estimates submission, the service plan and the subsequent distribution of allocations to business units. All available funding is allocated at the start of the year, with no in-year budgetary review, as this removes any possible lack of clarity and any expectation of additional funding to resolve service pressures.
As I mentioned at the outset, the net additional requirement of €255 million for Vote 40 isfully offset by the savings arising within the Vote. In conclusion, I recommend the Supplementary Estimate to the committee and would welcome questions.
Rather than make a presentation I will make some comments and ask questions as I proceed. There was a supplementary budget only a few weeks ago and I wonder whether the Minister was aware that these Supplementary Estimates were coming at the time. If so, why did she not take the opportunity some weeks ago to make us aware of this?
Can the Minister confirm the administrative costs of the nursing home repayment scheme, from which the bulk of this money is coming? According to Drury Communications the figure was €15 million but I was told in answer to a parliamentary question that the figure was €23 million and I seek clarity on this.
People are surprised at the low level of uptake. Is the Minister happy that only 32,000 applications have been received when 70,000 were anticipated, as Deputy Seán Power stated on 30 March 2006, with an estimated cost of €1 billion? Is she satisfied that the scheme has been advertised appropriately in the right newspapers? The advertisements have appeared in the broadsheets but have they appeared in what are known as the red-tops, which have a different type of readership?
On the same topic, is the application form simple enough? The Minister mentioned that those involved in estates are particularly slow in seeking information and may not fill out forms properly. We all understand the difficulties surrounding probate and estates and once one enters the legal realm things can be very slow. How many of the 32,000 applications received so far relate to living people and how many to estates?
The scheme has been running since August 2006 and it is intended to cease taking applications at the end of this month. Given the low uptake I wonder whether the Minister would consider extending the period. Less than half of the anticipated number of claims have come in and this is a matter of concern for people. While there are some legal cases in this respect I do not want to see many people forced to use the courts because they did not have sufficient time to address the issue.
What is the estimated projected cost of completing the scheme and why is the initial cost of €1 billion so far in excess of the estimated cost mentioned today? Is €294 million the estimated cost or will there be payments in 2009? Will all payments stop in 2008? If the current cost of the scheme is maintained it could cost as much as €559 million but only €294 million has been allocated. How can these figures be squared? Some €48 million is owed for the repayment of interest on the accounts of elderly patients. From what budget will this be taken? Given that the Department is facing more than 400 legal proceedings because people are choosing to bypass the repayment scheme, where does the Minister envisage costs will be offset?
Did the recruitment ban, with all the pain it caused patients, not result in savings? Where are the savings recorded and to what have they been allotted? It is stated that €2 million will have been saved in the north-eastern area by the end of the year. If this is the case, why was it necessary to close the orthopaedic unit in Navan? Why was no locum obtained for the anaesthetist who went on holidays, causing the cancellation of operations in Cavan? It does not make sense.
Could I have an explanation of what, precisely, are the dormant accounts mentioned by the Minister? In addition, I am not clear, although perhaps I did not catch the Minister's explanation, on the nature of the ICT capital saving of €21 million. Is the Minister happy that this saving, which relates to capital funding, be transferred to current expenditure? Could the Minister elaborate on the hepatitis C insurance scheme? Has it been cancelled? The Minister mentioned again today something she mentioned on "The Week in Politics", namely that she would like to see a 2% efficiency saving in the HSE. Has she done anything about this, such as issuing instructions? How is this to be achieved, or is it just wishful thinking?
We were told there would not be cutbacks this year but there were. I asked the Minister about the savings made in this regard. The situation with trolleys in accident and emergency departments was mentioned. On 10 December this year there were 268 people on trolleys. Yesterday there were 284 and today there are 252. These are INO figures which I know will be disputed by the HSE. However, I am comparing them to INO figures for the same time last year. On 10 December 2006 there were only 123 people on trolleys. On 11 December there were 246, compared to 284 today, and on this day last year there were 225, compared to 252 today. I cannot see how things have improved in any real sense. Furthermore, if the Minister wishes to dispute the INO figures, she should bear in mind that this organisation provided the figure of 500 used by the Minister when she declared a crisis in accident and emergency departments, as she may recall.
I would like to obtain greater clarity on the figures mentioned, such as €43 million for the HSE regional areas. This goes to the core of the problem with the HSE. We do not have clarity on where large sums of money are going. They are pigeonholed into broad areas. There has been considerable concern about the money going into the HSE and the lack of return from the patient's perspective. This is a political forum and I make no excuse for saying what I am going to say. I am not here to have a row, but I must point out that the Minister cannot say the cutbacks are not hurting people when home care packages are being removed from children with disabilities, when home help is being taken from the elderly, and when people's operations are being cancelled throughout the country. I would like to get some answers to the questions I mentioned and to obtain greater clarity. I would also like to know specifically what these large sums of money being added to the budget are for.
Many of the Deputies' questions were about the nursing home repayment scheme. A company was contracted to deal with the administrative aspects, which seems to be working well. The company's contract runs out some time in the middle of next year when, it is to be hoped, all of the administration will be completed. I hope all the money will be paid during 2008. It is difficult to give estimates of the amounts involved because there is a six-year statute of limitations applying to estates, while those who are alive are paid back the money for the entire period. It was always hard to obtain accurate figures in terms of how many payments would be to estates and how many to living people. I do not think we have that breakdown today, but I will try to obtain it. The priority in the first instance was to pay people who were living so they could have the benefit of the money during their lifetimes and that remains the priority.
There are many people who did not apply for refunds. I have personally met quite a few families who said the care was fantastic and they would not be seeking the money back. In fact, I had this discussion only last week at my clinic. I asked a family whether they had considered claiming the money and giving it to the institution in which their father had been cared for, but they said they were happy with the care and they would not do that. I do not know whether this accounts for the discrepancy between the large numbers that were envisaged and the numbers that did apply. It may well be that many applications will be made over the next few weeks because many people are making applications through legal forums. Many of the applications came from people in the private nursing home sector, which was not affected by this, so there may have been some confusion and misunderstanding.
We considered extending the scheme and decided, for a host of reasons, not to do so. The scheme received widespread publicity. We established an oversight group, chaired by a geriatrician, Dr. Bernard Walsh, and including people such as Sylvia Meehan, who were involved with the whole process, including simplification of the application form and ensuring that it is easily usable by older people. We discussed with this group whether it would be a good idea to extend the application period. These are always fine decisions. Should the period be cut off after six, 12 or 18 months? We decided when we were establishing the legislation that we would set quite a long period for applications, from the time the legislation was passed until December of this year, which is almost two years. We also engaged in a widespread publicity campaign and had a roadshow that visited local communities. Thus, we felt, for many reasons, that we had given adequate notice.
This issue received widespread publicity due to its nature. It arose as a result of legislation that had been defective for many years and subsequently a Supreme Court decision with regard to the new legislation that was put in place. For all these reasons we have decided not to extend the period. In addition, if we extended the application period the contract with the private operator would have to be extended, perhaps at considerable cost.
I mentioned the application form. The oversight group, which included representatives from older persons' organisations, a geriatrician and a director of nursing, ensured that the form was usable by older people. On balance, the group has done a good job.
With regard to probate issues, a simplified procedure was again put in place in conjunction with the President of the High Court. However, these matters always cause difficulties and delays. As I understand it, although I am not a lawyer, a simple process has been put in place by the President of the High Court, who has responsibility in these matters. I understand this is running smoothly, even if it is taking some time.
The €1 million saved by the hepatitis C insurance scheme is due to the slow start-up of the scheme. An administrator was appointed and the council overseeing the scheme is very happy with it and with the coverage provided, which is currently life assurance but will be extended to include travel insurance. The sum of €1 million is a saving due to the fact that the scheme has taken longer than expected to be put into operation, although the take-up has not necessarily been slow.
In the matter of administration, I have sent a letter to the Chairman of the HSE in response to the service plan submitted to me. As was the statutory requirement, I approved the plan this week. The letter relates to value for money and savings within what is broadly called the administrative budget, and I hope to achieve the saving I mentioned publicly, which is of the order of 2%. It is not a matter for me to decide the individual areas where that can happen. It is a matter for the management, the chief executive officer, the director of finance and the management team in the Health Service Executive.
However, we must drive reform, not just through the allocation of new resources, which will always happen, but also through the better use of existing resources. That must happen whether it is in the area of travel, subsistence, the holding of conferences, the renting of hotels, providing services in a different manner or people working together differently.
In the 2008 Estimates we provided for an innovation fund to support the many pockets of innovation at local level that I see regularly in the health service. We want to support and develop that innovation financially and for those pockets of innovation to become cells that expand to the wider organisation. That is the reason we began the innovation funds.
We have also established the health forum, the whole purpose of which is to work differently. A major challenge for the system, as Deputy Reilly would be aware, is moving more activity into the primary and community care setting which is more expensive in the short term but better value in the long term. A total of 95% of our health needs can be met at that level if it is appropriately organised.
Regarding the accident and emergency figures, and there are disputes about figures, Deputy Reilly knows there will always be people on trolleys. The issue is the length of time they must wait on a trolley and whether they will be admitted to a hospital bed. Many people receive treatment only on the trolley because they are not being admitted to an acute bed. The issue is the length of time spent on the trolley.
Across the 32 accident and emergency departments there have been substantial improvements this year over last year and last year over the previous year. I will acknowledge that there are deficiencies in certain places and Beaumont Hospital is one of them, which I believe Deputy Reilly mentioned. Issues arise regarding late discharges where people who have completed their acute care can move on to a community setting. When the fair deal scheme is introduced, which will make long-term care affordable for the many families who currently find it unaffordable and are paying substantial sums every week — in many cases children, nieces and nephews are paying money they cannot afford and must borrow or remortgage — it will greatly assist people in making long-term care affordable for every older person and their family.
On the question of dormant accounts, after the DIRT inquiry by the Committee of Public Accounts one of the issues that came to light was money left lying in accounts which had not been claimed. That happens in the insurance sector as it does in the banking sector. The Government established legislation to allow it claim that money. If somebody claims it and they are entitled to it legally they get it back but substantial moneys are made available each year from those dormant account funds administered through a board established by the Minister for Community, Rural and Gaeltacht Affairs and some of that money goes into worthwhile projects in the health area. During 2007, not all the money allocated has been drawn down. I understand the projects identified will move into next year. There is a saving of approximately €6 million, although it is not an actual saving; it concerns projects that will proceed next year as opposed to this year.
On the embargo on the recruitment of staff, Professor Drumm established a national group that had to give approval where new staff were to be employed or where existing staff were to be replaced. Up to three weeks ago they had made a couple of hundred exceptions. It was not a question of every post not being replaced or not recruiting any new staff. In the context of some of the examples the Deputy mentioned, including the anaesthetists in Cavan and Monaghan, and there are Deputies here from Cavan and Monaghan, there is a team of nine across those two hospitals and it is incredible that if one anaesthetist went on holidays, half of the procedures could not take place. I understand that was investigated by the HSE which found that did not happen. Likewise, some of the issues that came to light in some hospitals showed that the ratios of staff in different hospitals varied a great deal. Much useful information has been gathered by the HSE regarding some of these issues. We want to ensure that when staff are allocated to hospital, community or primary care facilities it is on the basis of best practice.
With regard to the issue of administration, approximately 16% of those who work in the health system work in what is called management-administration. Some people call them unnecessary bureaucrats; others see them as vital support staff. There is no doubt that we cannot run any services without support staff. I do not know whether we have the optimum number. There is an exercise under way in the HSE which will be completed shortly and issues will arise for the health service in that regard. If there are people who are superfluous to requirements in certain areas and there are shortages in other areas, it does not make sense to maintain those levels of staffing and the issue of a voluntary redundancy programme would arise, which we would discuss with the stakeholders. I am very open to that happening because it is unusual that we would amalgamate so many organisations and not have a restructuring financial package around voluntary redundancies. It was felt at the time that would not be appropriate, that we had to put the new organisation in place and then examine some of these wider issues.
I have comments to make but to be fair to other speakers I will not make them. I would like the questions I asked answered. In particular, were advertisements placed in the tabloids? Can the Minister confirm the cost of the administration?
Sorry, I can do that.
How many dead and alive-----
I do not have the dead and alive figure. I cannot give that to the Deputy today.
Did the Minister know three weeks ago about the need for this Estimate?
We have known the financial issues in the HSE since September but it would not be appropriate to bring forward an Estimate until we knew the situation and the amount of money that needed to be transferred. The HSE would not have known that. If the Dáil was sitting on 31 December we would be doing this at the latest date on which we would have the most accurate information about savings on one subhead and overruns on others. It would not have been appropriate, therefore.
I answered a parliamentary question on 17 October in which I mentioned some of these issues. It is clear we knew there were overruns in the HSE. We did not know about the potential reductions as a result of the new measures put in place during September, October and November. I gave the Deputy some data on that today but we cannot bring in a Supplementary Estimate until we have the maximum amount of information on the way the allocations will be changed. We would not have had an accurate figure at that stage regarding the repayments either.
Will the Minister answer the other questions?
I knew we would have to make some adjustments. I did not know the scale of them.
Were advertisements placed in the tabloids at any stage?
This was all done by the HSE and the steering committee. We are trying to check that for the Deputy.
On a point of order, Chairman, with respect to Deputy Reilly, he asked so many questions other members may not have a chance to contribute. Would it be possible for the Minister to give all the answers in writing to the Deputy and allow other members contribute before 6 p.m.? There are only 20 minutes left.
It is-----
Deputy Reilly is asking more questions now and he has gone well over ten minutes.
Our spokesman did not take up his allocated time, which he was entitled to do.
He did by one minute but we will not waste time on that. We will try to move on quickly.
All his questions were not-----
I want to move on now to the Labour Party spokesperson. All the questions will be asked by the end of the meeting.
I am trying to get the information.
I understand that.
I do not have the precise-----
I give an assurance that if questions asked cannot be responded to immediately, they will be before the end of the meeting. I call Deputy O'Sullivan, the Labour Party spokesperson, who has ten minutes. I am aware four other members are offering also.
I welcome the Minister and her officials. I want to focus on the last part of the Minister's presentation regarding the outlook for 2008. The Minster said that each manager will have ownership of a budget, that it will be carefully controlled and so on. That is welcome but there are issues around that which I want to raise with the Minister. For example, in the case of people in beds in acute hospitals, if the funding is running out for either home care packages or for the purchase of beds in private nursing homes to move people on, is there some flexibility in those areas? Would it makes sense to use the money in those types of areas rather than have people in acute beds? A case was brought to my attention today of a person who was in an acute bed in St. Vincent's Hospital for nearly ten months and was ready to be moved to a nursing home where a bed was ready for the person, but it was found the funds from the relevant budget subhead had been used up. That acute bed is still being taken up even though the person concerned could be moved to make way for somebody who needs it. In such instances, to what extent is there flexibility to expand the budgetary allocation where it makes sense? Similarly, where a person is well enough to go home but there is no funding in the home care packages budget to provide for that, flexibility to expand the budgetary allocation would make sense. Is there flexibility in that regard?
Some female Members of the Oireachtas were lucky enough to have a meeting with Professor Drumm earlier.
What about the male Members?
I do not know how that was the case. We were told a matrix will be developed to provide for comparisons in spending in different areas. Has the Minister any further information on that? I understand this will mean that where a certain number of patients are being treated by a specialist in one area, a similar number should be treated in another area. It would be helpful if the Minister would clarify if that will be the case.
I wish to ask about spending in HSE areas in particular. It appears that some HSE areas have overspent while others have underspent, and some have overspent more than others. If an area has underspent or worked to the limit of its budget, it seems it is still subject to the embargoes. For example, would the southern area, which appears to have handed back €9 million, if I am reading this briefing correctly, have been subject to the same embargoes as other areas? I am aware that the level of spending in my area of the mid-west was pretty much within budget. Are areas, effectively, punished for working within the parameters of their budgets and are they still subject to the embargoes, which would seem unfair?
The embargo will throw up many problems in the new year. A locum registrar was not replaced in my area. A specialist in the Mid-West Regional Hospital — I do not want to identify his specialty — said that in excess of 2,250 patients are currently waiting to be seen as new patients. He contacted GPs earlier to highlight that this issue would arise because the locum registrar was not replaced under the embargo. Are there many such cases of professionals who were not replaced because of the embargo and a result of which waiting lists have lengthened? To what extent does the Minister envisage that will be a problem in 2008?
I wish to raise specifically the issue of accident and emergency departments, which Deputy Reilly also raised. The extent of the problem in the accident and emergency departments appears to be increasing again. I am aware that in hospitals in my constituency a significant number of people have been treated on trolleys in the past two weeks. I spoke to the daughter of an 83 year old yesterday afternoon. Her mother, who needed to be admitted, had been in an accident and emergency department from 8 p.m. the previous evening waiting for a bed to become available. As of yesterday afternoon when I received the telephone call, she had not been assigned a bed. I assume she has since got one because I did not get a call back. The number of people being treated in accident and emergency departments seems to be becoming more of an issue again. This is the position in an area where there has not been a significant level of overspending. How does the Minister intend to respond to this issue, which appears to be becoming more acute?
I wish to ask the Minister specifically about the nursing homes repayment scheme. A reply to a parliamentary question I tabled on this matter indicates that as of 9 November only 4,721 payments had been made. That number of payments had increased slightly to more than 5,000 as of 30 November. When I tabled that parliamentary question, 31,000 claim forms had been submitted. I am not sure if the Minister referred in her speech to the number of claim forms submitted. There appears to be a delay in making the payments, although that may relate to the checking of estates and so on. I am concerned that there is a delay in the payments being made to people who filled in their forms properly. I share Deputy Reilly's concern about the need to inform people as fully as possible in this regard. I am aware that some people are not claiming payment because they consider they received good care for their relatives. While that is good, I would not like to think there are others, who have a genuine claim and whose family perhaps suffered some hardship, who are not aware of the scheme. I support Deputy Reilly's comments. To what extent has the Minister tried to get the message regarding this scheme out to all corners of the country? Local radio is a particularly good medium to use. Has the Minister used local radio to raise awareness of the scheme?
Deputy Reilly asked some questions I intended to ask. Regarding drugs and medical surgical devices, these are what used to be known as demand-led schemes in the former health boards. Generally, if expenses were incurred as a result of a demand-led scheme, the money was generally paid at the end of the year because the schemes were demand lead. To what extent does that flexibility still exist? We all know that medical inflation is higher than ordinary inflation. If there are genuinely extra demands on services, it makes sense that there should be a facility to pay for that. I would like the Minister to clarify that aspect.
On the issue of administrative costs, the Minister indicated in a reply to a parliamentary questions I tabled that she had approved 24 grade 8 plus people in the HSE last year. Since December 2006 when her Department specifically had to approve those categories, there was an obligation on the HSE to seek approval from the Minister and her Department for the appointment of any persons at grade 8 or higher. I understand that 24 of those appointments were made in the past year. To what extent will the Minister continue to allow the HSE to appoint people at those high levels of administration when, for example, 2,250 patients are on a waiting list in the Mid-West Regional Hospital for outpatient appointments?
There is a still a major concern among the public that it seems a simple matter to appoint people at higher levels of administration, resulting in a drain on resources, but that it is much more difficult to get approval for the appointment of people to work at the coalface. The Minister might address that matter. It is a widespread perception and I believe it is based on the figures we have been given in the replies we received.
While funding of the cancer strategy may not be strictly within the remit of what we are dealing with, the Minister spoke about 2008. While I note that Professor Tom Keane will appear before the committee next week, I want to ask the Minister a question he will not be able to answer. Given that he must complete the programme by 2009, as I understand it, and that he has not yet received all the facts and figures from the centres providing cancer services around the country, if he identifies that he will need more than the €29 million — although I have since heard it is €31 million, which the Minister might clarify — that has been allocated for 2008, will the Minister be able to allocate additional funding for the cancer strategy next year?
After the Minister responds, I note four members wish to speak.
Deputy O'Sullivan asked if there was flexibility to move resources from one area to another. Clearly, there is. The HSE is organised on the basis of two pillars, however: a hospital pillar, and a primary, continuing and community care pillar. Professor Drumm is reviewing that because essentially it means that if a person is in an acute hospital and requires community or continuing care, the budget responsibility moves to people who have separate responsibilities. That probably does not make much sense in terms of trying to make things happen in an integrated fashion. Professor Drumm is giving serious consideration to how that can be brought together better so that we do not end up with these difficulties.
Earlier this year, when I visited the Scandinavian countries for St. Patrick's Day, I found that local authorities there become responsible for patients when they finish their acute phase. They have a system of severe daily fines if a local authority leaves someone in an acute hospital. The introduction of that system had a dramatic impact on local authority funding for patients in the community system. I am not suggesting that one section of the HSE would fine the other, but we do need to marry that piece together so that it works better in the interest of patients.
The embargo was generally on non-frontline staff. All sections of the HSE were asked to make a contribution when the issues arose at national level because the chief executive officer must live within his budget. He is the Accounting Officer with that responsibility.
As regards locums, we have an over-dependency on non-consultant hospital doctors in our hospital system. We have 6,000 doctors working in our hospitals, of which about 2,000 are consultants and 4,000 are non-consultant hospital doctors. I accept that many of them — I think it is about 800 — are senior registrars. We need to switch that balance around in favour of having twice as many consultants as non-consultant doctors. The consultant contract negotiations are coming to a conclusion and it is crucial that we can recruit consultants rapidly. Nowhere is that more important than in some of the areas where there are long delays in obtaining a consultant appointment. Very often, the treatment cannot happen until one has had an outpatient appointment to assess whether one needs treatment and the nature of it.
Three hospitals in the country account for more than 30% of the long waiting lists: Sligo, Letterkenny and Tallaght. I have been in discussions with the National Treatment Purchase Fund about the need to refer patients from those three hospitals. The NTPF has the resources to treat them, including the capacity to provide outpatient appointments and treat them in other places. We need to ensure that happens quickly because there is no excuse for the delay.
I am not familiar with any situation where a locum may not have been replaced, but the group Professor Drumm put in place at national level was keen to ensure frontline services were not adversely affected by any embargoes. It can often be a question of time.
I am familiar with the matrix and, as I said earlier, there are pockets of fantastic innovation everywhere. If we can get every health setting within the country to operate to best practice we would alleviate greatly many pressures. I am familiar with two hospitals that have broadly the same number of beds and the same catchment, yet their performances vary greatly both in terms of the number of nurses and the level of activity. Professor Drumm and his team are examining the data on these matters to try to ensure the best innovators drive the performance of others too. In some cases, it is not about punishing people but about helping them by sending experts in. Foreign expertise has been sought to help a number of hospitals to readjust their processes and improve performance. That is what the matrix is about — trying to establish what is best and make it happen everywhere.
As regards applications, individuals have 28 days to decide from the time they are made an offer. Obviously they take legal or family advice, but they are given 28 days. I have not yet got the answer on the red-tops but I hope to have it before the committee rises as somebody has gone to check on that. There was widespread advertising through the post office network, for example, and around places where people collect their pensions. Since the beginning of this month, we have begun an aggressive advertising campaign involving local and national media. I have heard the advertisements on quite a few occasions. Anyone who makes an application before the end of December, even if it is somewhat incomplete and has to be adjusted, will be facilitated if they qualify.
As regards cancer services, we have made an allocation of €35 million but €6 million of that is for radiation oncology and therapy provision. Professor Keane has not yet said what he estimates he will need by way of additional resources during 2008. The only way I can get additional resources is through a Supplementary Estimate or by reallocating resources within the overall health budget. I will be more than happy to do that if he requires resources. When we were making the allocation we had some preliminary discussions with him. If, for example, we are recruiting consultants, it takes a while from the time one begins the recruitment to the time one gets somebody new into a position. We have given reasonable resources for 2008, but if additional resources are required by Professor Keane I will be sympathetic in seeking to reallocate them from some other subhead within my overall Vote because cancer is a priority. Otherwise, I would have to go to the Minister for Finance, which is not an option. There are options within our own Vote, however. We reallocated resources within our Vote this year for the repayment scheme for victims of Dr. Neary.
The Deputy is right about demand-led schemes but we are also able to anticipate what there may be in any given year. It is important the HSE anticipates that as accurately as possible within its budget allocation. If we know that there will be roughly X% during 2008, we need to allocate it now based on that, rather than finding at the end of the year that the scheme has run out of money owing to demand. If that demand can be anticipated, and we believe we can anticipate it fairly accurately in some respects, then the money must be allocated from the beginning of the year.
My first question was about whether people were being punished for being good.
No, on the contrary, I mentioned about the two pillars. The purpose of the innovation fund and the 100 consultants Professor Drumm is allocating on the basis of accident and emergency performance is exactly the opposite. More consultants and more staff will go to places where they can provide better services or where we can get more value from the allocation of additional people. Performance must drive budgets as it does in every other activity. In the outside world, performance is always rewarded. That is what needs to happen, and is happening, in the health system.
Deputies O'Hanlon, Neville, Blaney, Allen and Kathleen Lynch have indicated they are interested in contributing. I call Deputy O'Hanlon first.
My first question is about savings in the north-east and southern areas. How did those savings come about? Will the bed utilisation and bed capacity studies be published? The Minister mentioned some of the trends, but perhaps she could elaborate on some of the other trends that are emerging. What work is being done to ensure we get best practice into all our hospitals?
The Minister spoke about various services in different areas. No mention was made in the course of the Budget Statement, however, of an increased allocation to psychiatric services or a commitment to implement the report entitled A Vision for Change. The Government has accepted the report as policy but is slow to provide the resources to implement it.
What increased provision has the Minister made for the National Suicide Prevention Office? Word is coming back that she is only giving the same provision as for the previous year when inflation is applied. There is an urgent need for comprehensive extra resources to reduce the levels of suicide. I ask the press not to report this but there is much concern that cocaine might be being used as a new method of suicide. If that is reported it would be suggestive but there is concern nonetheless, given what has occurred in recent days.
I refer to the renal dialysis unit in Limerick. In June the Minister gave me a comprehensive answer to an oral question on the provision of a new dialysis unit but last week when I tabled a written question to her, she said it was none of her business and that it was the business of the HSE. Why was my oral question comprehensively answered but not my written question?
Planning permission was recently refused for the extension of that unit. Why did the HSE not consult Limerick County Council before it applied for planning permission? It was obvious it would be refused under the Limerick county development plan. It was in the middle of an industrial estate with articulated trucks everywhere. There were places in that industrial estate which the director of services for planning told me would be acceptable. Any first term county councillor will tell one to consult the council before applying for planning permission. There is a view in Limerick that it was an excuse to postpone the establishment of the dialysis unit and to shift the blame to the county council.
Has the Minister read the report of the Mental Health Commission published a couple of months ago? It was damning of the mental health services.
I ask the Deputy to keep to the agenda.
Are my ten minutes up?
Members do not have ten minutes; they have less time. Those who behave well are punished the worst.
The Minister said that within the OECD, Ireland is among the countries with the lowest drugs cost per head of population. Why is there such a row about the level of drugs costs if that is the case?
I do not believe many people, if any, are unaware of the nursing home reimbursement scheme. It was probably one of the hottest topics for the last Dáil. It received much media attention, particularly when the Minister took on the issue and announced the new scheme. If people missed it then, they will not hear about it in any re-advertisement of the scheme. The Minister has given ample time for people to apply. A number of families in my constituency have not applied for reimbursement for the reasons the Minister mentioned. They have buried their dead, have moved on and do not want to dig up the past.
I commend the Minister's efforts on budgetary reform. I was a member of the North Western Health Board from 1999 to 2003 and I remember when little attention was paid to budgets. Those responsible for budgets would keep spending and leave it up to the Minister to provide the extra funding at the year end. That was the trend back then, but reform of the health service is taking place now.
The Minister referred to the National Treatment Purchase Fund and a number of hospitals, including Letterkenny General Hospital. I would like more detail on hospitals not moving patients on to the National Treatment Purchase Fund. I have tried my best to highlight the benefits of that scheme on the airwaves and elsewhere. It is a shame if it is not being taken up and I would like to raise it with the hospital managers.
Deputy Rory O'Hanlon asked about the €2 million and the north east. The budget estimate for the north east for 2007 was €2 million over what was required. There is no area of which we are aware where there were reductions or there was underspending. It was an over-allocation based on the level of activity.
We have rising drugs costs because of innovation in medicine, more people being treated and the ageing of the population. That trend will continue. I do not know if the Deputy had a specific question on the trend. There is a trend to move more to day activity.
It was more on the trend in terms of the use of beds, a comparative analysis between the different hospitals in terms of value for money and how we will ensure best practice in all the hospitals.
The HSE's work in this area has shown huge divergence across the country. If we take the country generally and compare the top 20 procedures for which people end up in hospital, we have, on average, twice the length of stay they have in Australia for the same procedure. Within the country, there are enormous variations. Professor Drumm has said on a number of occasions that the if we could get every hospital to have the same length of stay as the best performers, a couple of thousand acute beds would be made available each year in the health system.
Equally, we must try to get the level of day activity up to between 60% and 70%, which I understand is the best practice internationally. We are somewhere around 50%. The percentage has risen considerably in a short period but if we could move it further, there would be enormous potential savings. If we could do what they do in Denmark over the next couple of years, our reliance on acute beds would be greatly reduced.
The report the Deputy mentioned will be made public. The intention is to discuss it with the stakeholders — in other words, those who work in the laboratories, who are directly affected, and those who work in the acute system. The intention is that, through the forum, these reports will be put into a process for action. They will be made public when they are given to the forum and, hopefully, they will be the subject of good discussion here on the reform agenda.
I was asked why there is an issue with the cost of drugs. By volume, we use few drugs compared to other countries but we pay a hell of a lot more for the small volume we use than people in other countries because of the margins. We have had very successful negotiations with the producers of medicine and we will save roughly €100 million per year over the coming years as drugs come off patent, in particular.
The HSE has also announced wholesale margins. Basically, we were paying around 17%, which is twice the margin paid in other countries. We want to move to paying pharmacists a dispensing fee for the professional service they provide and not a small dispensing fee and a very large mark up by way of the cost of the commodity because, as drugs costs rise, if we pay a 50% margin, it will be incredibly expensive. I do not believe there should be a link between the cost of the product and how somebody is remunerated. To the best of my knowledge, that does not happen in other sectors. It is better to pay pharmacists a dispensing fee for their professional expertise — obviously, it would have to be appropriate — rather than pay a combination of a fee and a mark-up.
The pre-budget outlook, published in October, gave an almost 8% increase to health. Inflation next year is anticipated to be 2.5%. After the budget allocation, there will be a 9% increase in health spending which is one of the largest, if not the largest, in all the OECD countries. That would be more than three times the rate of inflation.
Specifically on mental health services, in the service plan letter I draw special attention to A Vision for Change and the priority of mental health because I was not satisfied with what has happened in that area in the past two years. I am in discussions with the Minister of State, Deputy Devins, on the specific allegation surrounding the Office for Suicide Prevention. He discussed that matter with me in the past couple of days.
It is wonderful we now have a Mental Health Commission which is effectively a watchdog or standard-setting inspectorate of mental health services—
Which was there previously.
—and HIQA will be the same for the rest of the service. No doubt there will be real challenges as these bodies identify undesirable levels of management of how things happen. There will be a painful exercise as HIQA and the Mental Health Commission do their work, but it is great that we have these independent statutory bodies that will be able to review the performance of the providers. That is really welcome. Difficult as it is to read some of it, I have read it.
They are being ignored.
They cannot be ignored because they have the ultimate authority to set and enforce the standards in these settings.
I asked about dialysis.
I know a little about dialysis because I met the Irish Kidney Association recently. As I understand it, the application was from a private provider in Limerick to put a facility into an industrial estate.
No. It was from the HSE.
As I understand it, it was to put a facility into an industrial estate. Is that correct?
Yes.
I am operating from memory and I do not know the answer to Deputy Neville's question.
The Minister might give it to me subsequently. It was totally incompetent. Anybody building an extension to his or her house would consult the county council about the viability of the application and a body like the HSE could not undertake that simple task—
A pre-planning meeting.
—of seeking a pre-planning meeting.
I am very familiar with such meetings. I set them up for people all the time. I agree with Deputy Neville.
I accept that.
My understanding is that that service will be in Limerick next September.
The Minister told me that previously.
I must check about the question with my office.
I understand that too.
Clearly, I find it hard to defend that and, frankly, I will not even try.
I understand why the Minister cannot do so.
I am sorry about that. In answer to Deputy Blaney, I have had discussions with the National Treatment Purchase Fund, which is very concerned. It has resources, capacity and patients on whom it cannot get its hands. I have asked the NTPF what can we do with these hospitals. I told them that we should discuss it with the local public representatives, among others, because the patients need to be informed. I do not want to be unreasonable with any hospital, but it cannot be satisfactory.
Many of these patients can be treated in the region. We are not talking about all the patients coming to Dublin, in case that is the view. Many of these patients can be treated in the region.
I will ensure that the National Treatment Purchase Fund connects with the public representatives of all parties for the regions that I have mentioned, and with the hospitals. It has been in dialogue with the hospitals, of that the committee can be certain. I already raised this matter with Professor Drumm and the HSE.
We are all here to serve patients and if there are patients who need an outpatient appointment and a procedure subsequently, we want to make that happen as quickly as possible and there is no reason it should not happen if the fund is there.
On a point of information, I do not wish to delay the meeting because there are other members wanting to contribute.
Other members are offering.
I will be brief. The NTPF only treated 80 patients last months and it will only treat 80 this month, as opposed to an average of 1,400 to 1,700 and a supplement of €10 million. It has run out of money. That is the reality. In addition, the Minister has cancelled all international travel.
I want to be fair to the other members.
I just wanted to correct that.
Deputy Allen will be followed by Deputy Kathleen Lynch.
When tabling questions I am used to the HSE fobbing me off, not giving me information and sometimes never coming back with information promised, but it is strange coming into a meeting where the Minister is present and finding gross figures without supplementary information. I want to get that information. If the Minister does not have the information she should give it to us before the Dáil rises tomorrow. Otherwise, there is no point in us merely rubber-stamping gross figures.
For example, in Cork women must wait until 2010 to get a mammogram. I am aware that a gentleman facing a nine-hour surgical procedure, who had been given the pre-operation sedative and was ready to go to theatre, was told to go home and return in two weeks because there was no nurse available for intensive care after his operation. The multimillion euro accident and emergency unit in the Mercy Hospital is closed and is still lying idle, and the Minister speaks of the accident and emergency services improving. I will take the Minister to Cork and show her where the health service is in chaos.
At the same time there is €9 million in savings in the HSE southern area. Where exactly have these savings been made and at what cost to the patients? Until I get that information I would be unhappy about rubber-stamping any gross figures.
I will try to be as brief as possible. One of the most magnificent hospitals, the new maternity hospital, was recently opened in Cork by the Minister. One could not but say that from a design and facility viewpoint, it is an incredible hospital but four of the theatres have never been opened. A maternity hospital is not only about delivering babies, but about all the complications attached and about the gynaecology service for women in Cork because there is not another hospital that delivers that service — all the services have been combined into one, which is a good idea that I favour. Is that where the €9 million returned from Cork was saved? I am told that the hospital's computer-operated robotic da Vinci surgical system, a marvellous piece of machinery costing €1.5 million, not including the cost of training operators, with which everyone is thrilled and which was announced by the Minister on the opening day with Professor Drumm, has been used once and that was for a publicity shot. That machine is unused in an operating theatre because we are supposed to be looking for a cohort of patients, which is complete rubbish. The patients are there waiting to have their procedures. Is that from where the €9 million came?
I will ask the Minister one other question on an issue in which I have an interest. Who exactly is entitled to apply under the hepatitis C insurance scheme and how do they do so? Insurance companies, in my experience, are the greatest predictors of how much a scheme will cost. It is difficult to argue with the figures they produce because we all know their job is to forecast how much it will cost, who will be affected, where the largest pay-outs will arise etc. How could the Minister possibly save €1 million on an insurance scheme unless, of course, there are women — not all are women, but those affected are mainly women — who have not applied because they do not know about it or have not been informed that they are entitled to apply? Who exactly is entitled to apply under this scheme, who will be covered under this scheme and why was there that much of a saving? In addition, can the Minister tell me how the €9 million savings returned by the services in Cork were made?
First, I will take up the issue of the insurance. As Deputy Lynch will be aware, the National Haemophilia Council has been very much involved in that and so too has the Irish Kidney Association, Positive Action, Transfusion Positive and the Irish Haemophilia Society. It is their members, all the people in that category affected by contaminated blood products, who qualify and not all of them will wish to avail of the insurance products. Essentially, the State has decided — we are the first in the world to do this — to make up the difference between what somebody who had not been so affected would have to pay and what the person would have to pay because of their illness.
It is not that there is a €1 million saving but that the establishment of the scheme did not happen as quickly as anticipated. The scheme is now up and running. Deputy Lynch may have been there, as a number of Deputies were, when I launched it some time ago.
We are engaged in a technical exercise. It is not the case that someone handed back a cheque for €9 million, while someone else returned one for €2 million. Estimates were made in respect of what services would cost at different locations. Some of the figures were overestimated, while others were underestimated. We are, therefore, taking this action to comply with the accounting requirements of the State and with the procedures of the House.
If the Minister for Education and Science builds a new school, there will be the same number of students and teachers as before. If there are more students, additional teachers will be provided. If the Minister for Health and Children builds a new hospital and even if the number of patients remains the same, one thing is certain, namely, there will be a hell of a lot more staff involved. We must learn a lesson in this regard. That is why the revenue implications must be factored in when capital projects are being approved. This is to prevent us arriving at a situation where these implications have not been considered in respect of the funding to be provided three, four or five years from now.
The issue with the Mercy Hospital is that there is an ongoing row between those representing the employees and the authorities in respect of what should be the appropriate level of staffing for the new centre. It is a shame that we have a spanking new facility in place and that it is not being used. However, just because people demand more does not necessarily mean that what they are seeking is warranted. The reason many citizens ask me where the €16 billion is spent is because we may have people whose services are unnecessary in some locations, while there are staff shortages in others.
I provided an example earlier and I do not wish to name the hospitals involved because I have no wish to be unfair to anyone. However, there are two hospitals with which I am very familiar. These facilities have the same number of beds but their levels of performance vary to a very significant degree. I am not merely referring to their performance as regards levels of activity but also in the context of their respective staff levels.
Sometimes, many of these matters come down to old fashioned management. Unless we can manage this resource, the health system, regardless of who is in power, will break the country. If someone had sat here in 1996 and stated that the health budget, which then stood at €3.6 billion, would reach €16 billion in 2008, no one would have believed him or her. If we had convinced people it would be possible, everyone would have stated that, in light of the funding that would be available, the health service would be in fantastic shape.
There have been major improvements. Many more people have received treatment. In a great number of instances, the treatments provided in respect of cancer, etc., have proven much more successful. However, we face an ongoing challenge in the context of trying to extract more in respect of the existing level of resources rather than merely providing additional resources.
I am not familiar with the machine to which the Deputy referred. However, if what she says is true and if an item of equipment is not being used, I cannot stand over that. I do not wish to cast aspersions on anybody present. However, I faced a motion of confidence in the Dáil and during the debate certain patient facts were placed on record. I investigated each of these and I must inform members that most of them did not stand up to scrutiny. I do not want to be unfair to anyone and we have already communicated with the Deputies who raised these matters. We are not in a position to discuss the cases of individual patients. I do not know the facts relating to the item of equipment in Cork to which the Deputy refers but I will find out about it.
It is called—
I am aware of the position with accident and emergency services in Cork.
With respect, the facts I placed on record will stand up because they referred to a relative of mine who was placed under sedation and sent home.
I will come to that matter in a moment.
I am not making any allegations over which I cannot stand.
Is the Deputy referring to Cork University Hospital?
Yes.
That facility has a couple of thousand staff. A few weeks ago, I read in the newspaper that a patient in Galway, which has 2,600 staff, fell out of a hospital bed. I commented that with so many staff available, it should be possible to keep patients in their beds.
Cork University Hospital has a large number of staff. I could not stand over a situation where somebody was sedated and sent home because there was not one single nurse available to attend in the ICU. Again, this comes down to the management of resources. We need to get more from our existing resources and deploy staff properly in hospitals.
Issues have arisen in respect of the deployment of personnel. One unfortunate family was obliged to wheel their own child around because a porter would not come from the other side of the hospital to do so. These are the kind of practices which must be brought to an end. In light of the huge resources available to Cork University Hospital, there is no justification, unless an emergency had arisen elsewhere, for a patient to be treated in that fashion.
The senior manager at the hospital was in Dublin on the same day and he was aware of what happened. The blame should not be laid at the feet of the porter. Senior management was aware of what happened.
I am not blaming the porter. That is an issue to be dealt with by the management of the hospital, it is not one for which I have responsibility.
It is an issue for management and the Minister is responsible for management.
I am responsible for allocating resources for the system to be managed.
That is part of the problem.
No Minister for Health and Children would be expected to micro-manage the affairs of individual patients on a daily basis.
I merely provided an example of the chaos that obtains.
The example provided is not justified, particularly when one considers the resources available at that facility.
I could provide 30 such examples.
The facility in question is one of the largest hospitals in the country and it receives one of the biggest budgets. That particular example could not be justified unless an emergency had arisen.
With respect, the Minister is not comparing like with like when she refers to the accident and emergency department at the Mercy Hospital and its ultramodern counterpart, which is far bigger and at which far more facilities will be available. She cannot state that we should merely transfer operations from an old, overcrowded building to an ultramodern facility, at which there is far more space available and which will offer an increased number of services.
The Minister is making the point that resources are allocated. The Deputy cannot expect the Minister to run the hospital itself.
It took 18 months to build the new facility. With proper management at ministerial and local level, surely the crisis could have been resolved. One does not discuss problems when a building is ready to be opened. Proper planning is what was needed.
Does the Deputy accept that the resources are available at the hospital?
I am not an expert on management. I am merely stating that the unit has been lying idle since early this year. Almost 12 months have passed and this multimillion euro unit remains closed to the public. People are screaming out for treatment each night and a sum of €9 million has been returned.
It was not returned.
It was not used.
The Minister explained the position.
I accept what she said but the money was not used. This can only be described as total mismanagement.
I will return to the Deputy later. Deputy Kathleen Lynch asked the original question.
I was referring to the da Vinci operating robot.
I apologise. I saw that item of equipment.
Yes, the Minister saw it.
If the Deputy is telling me that was the only occasion on which it was used, I will be very angry.
We also applauded the lady who was trained in the operation of the robot.
That is correct.
As I understand it, the Minister stated that at the beginning of each year an estimate is made in respect of how much it will cost to deliver certain services. I also understand that no one wrote a cheque for €9 million and returned it to the Department. What I do not understand is how that estimate could have been off by €9 million when services are not being delivered at the hospital. I accept that the Minister is not getting €9 million back because it is Christmas week. However, I do not understand how the position was underestimated by that amount, particularly when services are not being delivered.
It is less than 0.5%.
We are not dealing with figures, we are dealing with patients.
We know that.
We are dealing with people.
Yes, we are dealing with people but we do not have infinite resources.
We should allocate those that we possess.
We are doing so.
We are not because €9 million was not spent.
This is a Supplementary Estimate which relates to the fact that the HSE was short of funding to the tune of €255 million. Most of the money in question arose because the repayment scheme relating to patients was overestimated by—
There is no detail provided. A blanket figure of €9 million is given. From where does that money come? Where were the savings made? What are the implications? I cannot be party to merely rubber-stamping this Supplementary Estimate. I want to know the details relating to the €9 million reduction in funding for the HSE southern area. I know many people who are awaiting services who could avail of this money, as could many of the Departments within the hospitals. Where were the savings made and what was the impact on patients?
I do not want to know about percentages, mismanagement or problems between management and the unions. Dealing with the latter is the Minister's job. My job is to protect the members of the public who voted for me to represent them. I will not vote the Supplementary Estimate through unless a breakdown is provided in respect of the €9 million.
There was no €9 million in savings.
It is listed under subhead B7 — HSE southern area savings.
I remind members that it is a matter—
We are allocating €255 million to services from either ICT or from repayments not being made.
It is stated under subhead B7 that savings—
Deputy Allen should remember that we are not here to vote. Our job is to consider the Supplementary Estimate.
In defence of my colleague, Deputy Allen is saying that this will probably arise in the Dáil tomorrow. I expect there will be a vote tomorrow and if Fine Gael is to vote with the Government on it then we need to be informed. That is the purpose of this meeting.
I am very unhappy with the manner in which we were given the information beforehand. I agree with Deputy Allen about the lack of clarity regarding the figures. What do the figures mean? They are just pigeon-holed into boxes of €9 million, €20 million, €5 million. Like Deputy Allen and others, I want to know where the money was saved, how it was saved and where it has been spent. I ask the Minister to make that information available to us tomorrow before the Dáil vote. If the Minister is interested in true reform, we must find out where the hole in the bucket is that is the HSE. How else will we find out unless we are given specific details about where money is being spent, who is spending it, who is making the decision and how this is impacting on patient care? Either we all take this seriously or we do not.
This committee can act in a positive way to help the HSE rectify what is clearly major dysfunction. I thank the Minister for attending this meeting tonight and giving her time. However, we need more than time; we need information. We are not getting it. We need information delivered in a clear, concise fashion which we can digest and understand and then be able to explain it to people.
The Minister must take responsibility for management. Who else will or should take responsibility? She is hardly suggesting the patients should do so. The HSE was set up by the Minister from a most bizarre starting point for any international merger or any merger where 11 companies are brought together to be the biggest employer in the State yet there are no job losses and no one is forced to move jobs. This was destined to be a mess before it even started. The hard decisions were not made. Professor Drumm was then presented with this fait accompli. I hope a serious attempt will be made to rectify what is wrong and to protect patients from the deficiencies in the service. Let nobody in this room cod themselves because the deficiencies exist and we all know about the cancelled operations. We were not given an explanation why the orthopaedic hospital in Navan was closed for a month when that north-east region of the HSE made savings of €2 million, but we may be given an explanation by tomorrow.
I hope the situation of last year where the HSE reported to the Department of Finance that it was €350 million short, will not recur and another supplementary budget be required near the end of the year.
I advise members that this is not the normal procedure for the Estimates. This Vote was only signed off by the Minister for Finance yesterday. The committee is normally in possession of the information two weeks before the meeting.
I remind members that the Minister is due to leave the meeting by 6 p.m. but I do not wish to curtail the debate.
I will be brief. I support my colleagues from the southern area and also people from the north-east who are not present. When I was a member of a health board, we went through estimates with a fine-tooth comb in public session. We discussed every detail, right down to the spending on laundry and on the toilet rolls. Yet all we have here is one big lump of money, even though this is the only forum available to us to examine the detailed expenditure of the HSE because it can no longer be examined at a local level. It is quite valid for people from an area to question the expenditure, especially where money is being saved and where there is need that has not been addressed. They are entitled to know where the money is being saved and they have my full support.
We need a public examination of how money is being spent on health. This is taxpayers' money and it is a significant sum. This is the only forum we have.
I accept the Deputy's point. In future we will not hold a meeting only 24 hours after the issue has been signed off. I make that promise to the Deputy and to the other members. We will ensure to have an explanation for the figures in advance of any meeting.
I despair when the Minister for Health and Children is here in front of us and she cannot supply the information.
That is not a fair comment.
I am not being unfair.
We have had clear recommendations on the Cork issue and the €9 million.
It is not just about Cork but also about Kerry. It is to do with a whole region.
It is to do with every one of these headings and figures.
On a point of clarification, we were discussing six headings on page eight of my script. I refer to the ICT capital which is €20 million. I explained in my script that the whole directorate-----
The Minister has referred to page eight but my copy of the script only goes as far as page seven and perhaps that is the problem. I am referring to the briefing document.
I will list the figures and headings. With regard to the ICT capital, there has been a new directorate and a re-evaluation of all the ICT expenditure. This is a figure of minus €20 million so there is a saving of €20 million. The issue of hepatitis C is a timing issue and that costs €1 million. The long-term repayments issue is also a timing issue because 40% of the applications are invalid. It was estimated that we would spend €216 million more in 2007 than we did. The dormant accounts is a timing issue. With regard to the north-east and the southern areas of the HSE I do not have the specific breakdown but I am informed by the HSE there is over-spending in one area and under-spending in another in what was anticipated and it is trying to marry the two within its Vote. The HSE monthly figures are available if the Deputy wishes to have them.
Yes, please.
There was an overrun of €21.5 million to the end of October on the southern region hospital side.
Cork is making a saving of €9 million one month later.
This is taking everything together, such as hospitals, community and primary care and all the different areas that make up the Vote.
I am more interested in the first list, the other services under the subheadings of B1, B2, B3, B5, B6, B8, B9. These include grants in respect of certain other voluntary and joint board hospitals. What does that mean? I am not in a position to give-----
If the Deputy wishes, I can supply him with a big document.
I would like that. We should have all the information and we should have it in plenty of time and then we will not have rows such as this. What is wrong with the HSE is the lack of transparency, the lack of accountability and this does nothing to address those deficits, I am sorry to say. I would like to co-operate with the Minister and I would like her to give me the information.
The chief executive officer of the HSE is accountable to the Oireachtas by way of the Committee of Public Accounts. He was due to give evidence at a meeting of the PAC two weeks ago but he had a family bereavement and the meeting was postponed. I do not know if the meeting has been re-scheduled for before Christmas.
I do not know if the Deputy is a member of the committee but that committee investigates the over-runs and under-runs, line by line. I can provide all the documentation the Deputy requires from that investigation. He can have every single piece of information and he is entitled to it in any case. I am more than happy to make any information available to the Deputy.
That information is key.
I remind Deputies that the southern area of the HSE does not just cover Cork and Kerry but also includes Wexford and Waterford.
I remind members that this committee must dispose of all this information by this evening to allow the clerk of the committee prepare it for the vote tomorrow. The Minister has stated she has this information available and it can be provided tonight.
I will ask my officials to talk to the Chairman after the meeting.
I wish to make a final point so that the Minister does not misunderstand what I am saying.
We have our ideological differences and our differences in how business has been conducted. I do not have an issue with money sitting in one place which is then brought over to be used somewhere else. I just want to know how it happened to be sitting in that place and I want to know what it will be used for in the other place.
This would not have happened except the Department of Finance only signed off yesterday. This would normally be done weeks ago and the committee would be able to have the information a week before this meeting. It is just the way things have happened this year. It has been a rush to put the Estimates through the different Departments and ours was the last to be done.
In the spirit of goodwill that is Christmas I hope that we can agree in the future—
I gave that commitment 20 minutes ago.
Not alone that, I would like this committee to be empowered in the same way as the PAC, to go through the HSE and find out what has gone wrong because it has gone wrong.
I wish to make the point that in January I will sit down with the Deputy and decide how we will proceed in that vein for future meetings, how to deal with how funding is spent by the HSE.
I agree with the Deputies. This committee is here to analyse what is happening in the health system.
Many people are of the view that we are rushing this issue. I promise that we will devote a half day to this issue for the next five years.
It might be safer to say six to 12 months.
We should scrutinise where the money is being spent.
We will sit down and take it five years by five years. We will agree to sit down and work this out rather than have time spent like at this meeting. I know it is right to do that but we will agree to bring members together at a meeting in January to work out procedures for investigating how money is spent.
I do not mean to be confrontational but I wish to ask a question. The Minister made serious allegations about the Mercy University Hospital, about a row being shameful. The committee should ask for details.
I was involved and I went to Cork recently.
Up to the end of June—
There is a difference of opinion between the management and those who work there on what additional resources are required. It is not unusual for that to be the case. I understand additional resources have been committed to make that facility a reality. There is a difference between what additional resources are necessary. This happened when the maternity hospital was due to open, as the Deputy knows. There was an unhappy saga there and it also happens in other places.
The problem with the Mercy University Hospital is that when people like me raised the issue up to June, there was an attempt by the HSE's propaganda department — that is what I would call it — to discredit the politicians raising the issue. It stated there were no delays and it was a question of fitting out the unit. All the time there was something else more serious behind it. I would like to get to grips with the money that has been spent on propaganda by the HSE to discredit politicians who raise valid issues. The ongoing behind the hand comments by people in senior positions—
The Deputy is well able to defend himself.
I will stand over that.
Let us not get away from the spirit of Christmas altogether.
The Deputy should not be so sensitive.
I am not sensitive.
The next meeting of the joint committee will be 15 January. I thank the Minister and her officials for coming in and giving two hours of their time. I also thank the members.