SELECT COMMITTEE ON HEALTH AND CHILDREN díospóireacht -
Thursday, 4 Dec 2008

Vote 41 — Office of the Minister for Children and Youth Affairs (Supplementary).

Chairman

On behalf of the select committee I welcome the Minister for Health and Children, Deputy Mary Harney, to the committee. We are meeting to consider the following Supplementary Estimates: Vote 40 — Health Service Executive;and Vote 41 — Office of the Minister for Children and Youth Affairs.

An indicative timeframe has been circulated to members by the secretariat and it sets out the possibility of us concluding our discussions at around 3 p.m. Members have discussed this matter just before commencement and we would be very happy to conclude around 1.30 p.m. if that were possible. I ask members to attempt to keep their questioning as direct and concise as possible. I invite the Minister to make her opening remarks.

Minister for Health and Children (Deputy Mary Harney)

I have a 17-page script and clearly I will not read it but rather deal with the salient points or otherwise we will be here for quite a while.

The additional sum of money being sought for 2008 is €345 million. The receipts from the UK are down by €350 million. For more than 40 years we have been receiving money from the UK for those who are entitled to a UK pension and who come to live in Ireland and use the health services. The view was taken by the UK authorities that they were overpaying in recent years and therefore there is a reduction of €350 million effectively for 2008. In the Estimates for next year, €250 million will be the amount of the receipts from the UK and we intend to reach agreement on that issue. A saving of €123 million was achieved in 2008 essentially as a result of timing factors. One saving of €85 million was to do with the fair deal scheme, the legislation for which is very complex. It was only published recently and is currently going through the Dáil.

A saving of €38 million was achieved through new developments all of which are now under way. They began later in the year than was anticipated. They are mainly to do with recruitment of staff and so on. I am sure members of the committee will have questions about the UK receipts.

The next issue I will deal with is the decision of the High Court on the wholesale margin for the supply of pharmacy products. The High Court decision in October was that although we were entitled as a matter of principle to reduce the margin, the appropriate process had not been pursued and therefore the pharmacists were entitled to be paid from that time. Therefore, a sum in the order of €34 million for 2008 is required to pay the pharmacists the relevant margin from October.

With regard to benchmarking and pay issues in general, there was an arbitration between the HSE and doctors on the issue of emergency doctors not being able to charge private fees in casualty departments. This is binding arbitration and €4 million is to be made available to the 55 emergency consultants as back payment and compensation back to 1998 and this will be paid. The other sum of money relates to the new consultant contract. Although we are providing money for this in these Estimates, it is not to be paid and cannot be paid unless the new changes are put into effect. I will be frank and say that the clinical directors have not been appointed. I do not anticipate that that money will be paid in 2008 because it is for change, longer working days, structured weekend cover and clinical directors. It is about doctors working differently in the interest of our public hospital system. As a matter of good faith we are providing the money. It is not a money issue. It is an issue to do with whether the changes have been implemented. The sanction that will go to the HSE is that it cannot be paid unless we are assured the changes are put into effect in 2008. Given that we are almost at the end of 2008, I do not envisage that those moneys will be paid.

There is also 5% for the review body. Again that is in the same position. All of those issues are tied in together. There is the issue of benchmarking, which amounts to €5 million for approximately 4,300 technical staff, including directors of nursing, assistant directors of nursing and so on. Again we are making provision for that. Some wider issues relating to public pay need to be addressed. That is a matter for the Government and for the Minister for Finance in particular.

There is an underspend in the dormant account moneys that go to some social inclusion projects in the health area. There was an overspend of €4 million. Much of that goes to voluntary organisations that are in deficit. In 2007 there was an underspend. We provided for €10 million and I believe €3.6 million was spent. However, in 2008 we provided for €10 million and €14 million was spent. There are timing issues and we are making provision in that regard.

Those are the relevant opening comments and I would be happy to take questions from members of the committee.

Deputy James Reilly

I welcome the Minister and her team. Have changes in work practice that have been measured taken place and an increase in productivity occurred as a consequence of benchmarking awards? The Minister might like to bank the questions — if she will pardon the pun. The briefing document states that the agreement involved additional costs for medical consultants that would fall to the HSE to pay in 2008 and that these costs were not and could not have been budgeted for in the 2008 Estimate. Why could they not have been budgeted for? Was there no PC sum at all? That does not sound reasonable or appropriate. The Department might not be able to speculate as to the precise amount, but it should have put some sum aside.

The Minister explained the breakdown of the €72 million she put aside. This is for existing consultants with new work practices. The Minister has already informed us that no new clinical directors are in place. Even though people have signed up since 1 September, clearly much of this work cannot have been taking place. I do not know how the Minister will address those difficulties with individuals who have signed those contracts. However, that is not my main concern. My main concern is where are the 2,000 new consultants we were promised. There does not seem to be any mention here of new posts that will be filled in the coming year. Have any new posts been created and if so when will they be filled? Have they been approved? What is the cost? Will we need a further Supplementary Estimate to achieve that?

There is a staggering sum for the UK-Ireland reimbursement agreement. How could we possibly get it wrong by €350 million, which is out by 75%? That cannot be construed as a miscalculation. It is as if there was an entire misread of the situation. Why are we only doing reviews every three years rather than using up-to-date yearly information? There has been considerable talk recently about the HSE, accountability, transparency and Mr. Fitzgerald's report. Who is responsible for this miscalculation of €350 million out of €450 million? This is a vast sum of money. Just as nobody ever took responsibility for PPARS, we are now told there will be €78 million to replace PPARS. I ask the Minister to comment on that. Is it contained in this Supplementary Estimate or will she be seeking new money for a new computer system?

Regarding the budget overall, would the Minister like to take this opportunity to reconsider removing the cap on discretionary medical cards for the terminally ill? It is not a vast sum of money.

Deputy Jan O’Sullivan

I welcome the Minister and her colleagues. In previous years money was given back to the Exchequer, including in 2007. Can the Minister give an assurance that she will not give any money back this year? The issue of the consultants is the one on which I have most questions. Along with Deputy Reilly, I do not understand why some money was not allocated this year for that purpose. Money was allocated for the fair deal legislation and because it did not happen in the time we expected it was not spent and is coming back into the pot. However, we would have expected the consultants' contract to have been agreed some time this year. Why did the Minister not have an estimated figure in that regard? Did she not expect to get such a bad deal? Did she expect she would have enough money? I thought the purpose of the consultants' contract was to get better value for the taxpayer and patient. I am concerned about the amount of money involved here.

How will she monitor compliance? I know this came up when the Minister appeared before the joint committee last week. From reading between the lines of what she has said and from what is contained in the briefing document, I wonder whether there is co-operation regarding the different work practices that will be expected in terms of consultants delivering rather than just leading, being available for the extra time and taking the kinds of responsibilities they are supposed to under the new contract. Is the Minister getting the kind of co-operation she needs on that?

I ask about the back pay that was agreed under arbitration. It appears from a report in today's Irish Independent, and was just confirmed by the Minister, that the emergency consultants cannot in effect have private patients because of the nature of the work they do. However, the amounts they are getting through arbitration are up to €200,000 each. Is there a longer-term implication? The report states, “It is expected that academic consultants will be among those who will also sign up before the December 31 deadline.” I understand that academic professors of medicine will be paid considerably more than professors of other disciplines in universities. Has the Minister had any discussions with the universities in this regard? Is it an issue? I believe this consultants’ contract is not half as good from the State’s point of view as I would have expected it to be. Considerable money is being paid out to people who are already pretty well paid under the old contract. I know they will need to do more work under the new one. It appears that more consultants will remain with the old contract than originally expected. Can we expect some monitoring to ensure they give the appropriate amount of time to their public patients and that they do not fill beds meant for public patients with their own private patients?

I refer to the issue of the receipts from the UK. At €350 million it is a vast sum of money. The briefing indicates that the UK has agreed to an advance payment of €100 million. Can I assume from that we will not have to pay the amount? It is taking an advance payment. There is a suggestion that there are ongoing negotiations. Will the Minister clarify what that means for the budget? If we end up not needing to pay the €450 million, how will it be dealt with in the figures?

Can I ask the Minister about the pharmacy ruling and the Hickey judgment? I am particularly interested in legal advice. Do the HSE and the Department get advice from a single legal firm? Do they avail of the services of different legal firms? Can the Minister put a figure on the kind of money the Department and the HSE spend on legal advice on an annual basis? I do not suggest that the legal advice in this case was not given in good faith, but the judgment went against the HSE, obviously.

I would like to ask a simple question about the moneys from the dormant accounts fund. The projects being financed from the fund this year will cost €14 million, but just €10 million has been provided under the fund. The discrepancy arises from the failure to draw down moneys from the dormant accounts fund in 2006 and 2007. Were those moneys returned to the Central Fund or retained within the health budget? I think I have covered everything.

Deputy Rory O’Hanlon

Some €4 million has been set aside to pay consultants for their private work. Does any of that work involve attending at road accidents? I understand that insurance companies might be concerned about liability in such cases. Has agreement been reached to get insurance companies to contribute to the emergency accident scheme? Consultants are not entitled to make claims under that scheme.

I understand the number of people who have made applications under the health repayment scheme is much fewer than the number who were entitled to apply. It is important to recognise that many people did not apply because they felt their parent or relative got a very good service in the hospital.

I would like to ask the Minister a question about the UK receipts. Is a similar arrangement in place for emergency hospital or family doctor treatment on either side of the Border? If such an arrangement is in place, does an issue arise in terms of trying to balance payments?

As the health service costs €16 billion to run, we always need to try to find savings by improving efficiency. It would be great to think that a Supplementary Estimate will not be needed next year, especially as money will be scarce. We should try to make savings, by means of increased efficiency in the service, to meet the cost of the supplementary payments that will be needed. We all have a responsibility to ensure a maximum level of efficiency is achieved on foot of the money that is spent.

Deputy Dan Neville

I want to ask the Minister a question about savings. I am looking for clarification in respect of the money that was spent in 2008 to implement the report of the expert group that compiled A Vision for Change. Some €50 million — €25 million each year — was provided in 2006 and 2007. When this committee considered the Supplementary Estimates last year, the Minister told us she did not intend to allocate any money in this area in 2008 because the moneys that had been allocated had not been spent. It is obvious that €27 million of the budget of €50 million had been spent up until this time last year. How much of the rest of the €50 million was spent in 2008? Can the Minister confirm something that Professor Drumm said last week? He said that an additional €1.75 million had been allocated to the National Office for Suicide Prevention. On the basis that the office's current budget is €4.55 million, does the additional allocation now bring the office's budget to €6.3 million? Can the Minister clarify the matter?

Deputy Mary Harney

I will deal with the broad headings. I was asked about the agreement with the UK. The error that was made was not on our side. The UK authorities paid us €450 million. They then reckoned they had paid us €150 million more than they should have. That will have a double effect in 2008. They will pay us €100 million this year, instead of the €450 million they were paying us. That is the issue that arises in this context. Although final agreement has not been reached on next year's figure, it is estimated that approximately €250 million will be payable by the UK to this country. If we do not get the €450 million we were getting, we will have a shortfall. That is the issue that arises. There was no miscalculation on our side. The UK authorities formed the view that they were overpaying us.

Deputy Jan O’Sullivan

I would like to seek some clarification on that. Do I understand correctly that the final figure is €100 million?

Deputy Mary Harney

The UK authorities have decided they overpaid us by approximately €150 million last year. They think they should have been paying €250 million. It is clear that we are getting €100 million this year. It has a double effect. Not only are we not getting the money, but we will also have to make up the difference.

Deputy Jan O’Sullivan

It is described in the documentation as an advance payment.

Deputy Mary Harney

Yes. It is an advance payment.

Deputy Jan O’Sullivan

Does that mean we might get more money?

Deputy Mary Harney

We will not get any more money this year. There was an over-payment. I am being honest with the committee. It is not finalised. We reckon we will reach agreement for payments in the order of €250 million to be made in respect of each of the coming years. That is the approximate cost to Ireland of giving health treatment to people who have UK pension entitlements but now live here.

Deputy James Reilly

Could I mention——

Chairman

Does the Deputy wish to speak on the same point?

Deputy James Reilly

Yes. It is obvious that we are talking about a huge sum of money. It is worth spending some time on it, with respect. The Minister has said that there was no miscalculation on our part. It seems that there was a miscalculation on the part of the UK. Does that not imply we have no involvement in the calculation of the moneys owed? Surely we do not take the UK's word for it? We have to do our own calculations to check that we are getting what we should be getting. I suggest that somebody on our side must have let it pass because he or she knew we were getting more money than we should have been getting, or else that somebody on our side was not doing his or her job properly. That is my point. If our officials demonstrate such a level of attention to detail when they are dealing with vast sums of money in this aspect of the health service, which we know about, God help us when they are working on budgets and proper financial controls in the rest of the health service. We need to get to the root of this very serious issue. I do not accept that the Government should not be represented by civil servants from this country's health service when decisions are being made on the amount of money to which we are rightly entitled for providing care to UK residents. My point is that there is an onus on us to do our own calculations.

Deputy Jan O’Sullivan

I would like to come in——

Chairman

Is the Deputy making the same point?

Deputy Jan O’Sullivan

——on the same point.

Chairman

Perhaps we should take all the questions on this before the Minister responds.

Deputy Jan O’Sullivan

The Minister said that we will probably get €250 million from the UK next year. Why did we get just €100 million this year? Surely one would expect a similar figure.

Chairman

Does any other member have a question on this matter? No.

Deputy Mary Harney

There has been an agreement between Ireland and Britain in this regard for the past 40 years. Following periods of emigration, people with pension entitlements tended to flow from Britain back to Ireland. Under the agreement, the UK authorities agreed to pay us a sum of money in respect of health treatments. The agreement is reviewed every three years by both pension administrations. When such a review took place recently, it was found that the amount of money due to Ireland was being over-estimated. The three-year review of this agreement by both pension administrations — the social welfare authorities of both countries — involves a survey of pensioners, followed by a determination of what the accurate figure should be. The recent survey established that even though we got €450 million in 2007, we probably should have got just €250 million. Therefore, there was an over-payment. As Ireland is not getting the expected moneys, and will also have to make up a shortfall, there will be a double effect this year. The UK authorities are giving us €100 million for 2008. We believe we are about to reach agreement on annual payments of approximately €250 million for the next three years. It will be reviewed again in three years.

Deputy James Reilly

Is the Minister happy to let it go every three years when there are such fluctuations?

Deputy Mary Harney

This bilateral agreement was entered into 40 years ago by whoever was the Minister at the time.

Deputy James Reilly

It could be timely to review it on its 40th birthday.

Deputy Mary Harney

When pensioners come into accident and emergency departments, etc., we do not distinguish between those who have returned to live here in recent times and those who have been here for a long time. The acquisition of timely data is important in the health system, in general. That is why there is such a focus on technology issues, such as the electronic storage of patient records. We do not get all the information in a timely fashion. Both countries will agree that the system in place is fair. The sum of money that is paid by the UK is an appropriate one, notwithstanding the over-payment that took place in 2007, which came to light when new data were received. That is the issue there.

We could not have made provision for the consultants in the 2008 Estimates, clearly, because the agreement was not reached until May or June of this year. We also need to know how many consultants will sign on for the new agreement because the money will not be paid if they do not do so. The indications are that more than 70% of serving consultants will opt for the new contract, which fundamentally changes the way in which our hospitals work. Until now, consultants have worked as lone rangers — a phrase I have used previously and which I do not use in an offensive fashion — and do their own thing which means there is no teamwork or team boss. From now on, a clinical director, with the new management tool devised by the HSE, will be responsible for ensuring that the 80:20 ratio of public to private care is maintained, structured cover is provided by consultants in hospitals at weekends and consultants work longer days. Rather than working in 11 sessions in our public system, consultants will work on the basis of hours. There will also be a one-for-all list for access to outpatient and diagnostic services. The new approach will fundamentally change the way in which our hospitals function.

The new money is in respect of the new working arrangement and will not be paid if the arrangement has not been put into effect. I do not apportion blame because this presents major challenges but we will not pay for something that has not yet been provided. I am optimistic, however, that the arrangement will be put into effect quickly. I understand the process of recruiting clinical directors will also be completed quickly.

We are recruiting 189 new consultants on the new contract, many of them in the area of cancer. It is intended to pay for consultants by shrinking junior doctor overtime and numbers. Of the 6,000 doctors working in our hospitals, 4,000 are non-consultant hospital doctors and junior doctors and 2,000 are consultants. We want to reverse this ratio. While we have a sufficient number of doctors, we do not have sufficient consultants and we have too many non-consultant and junior doctors. The overtime bills arising from the manner in which the latter group works as well as the deficit in the number of consultants mean we pay as much as we would pay to have consultants. The cost of reversing the ratio will come from changing current practices.

As members will be aware, the Department has allocated €15 million to Professor Keane next year to recruit the multidisciplinary expertise for eight cancer centres. Not all of this money will be used to cover the cost of consultants. Some of it has been allocated for recruiting nurses and other staff required to make the centres fully operational as quickly as possible.

Benchmarking or review payments have not been made in the health sector. Benchmarking moneys are paid for changed practice, which must be verified before payment proceeds. Specific changes are required before the benchmarking money will be paid.

Professor Drumm and his team have circulated to the trade unions several suggested changes in the working practices of clinicians, nurses, doctors and other health care professionals in the public hospital system. Deputy O'Sullivan has been well briefed on this issue as she referred to many aspects of it last week. The sum of money in question, which affects 4,300 people, is tied up in the restructuring under way in the Health Service Executive. While provision is made in the Estimates, the Department of Finance will only sanction the HSE to pay these moneys when change is effected. They will not be paid otherwise.

On the issue of pharmacy, the Department takes advice from the Office of the Attorney General which occasionally outsources advice or secures external assistance. As a separate corporate organisation, the HSE has legal advisers. I am advised that the approximate figure for legal services is €30 million.

Deputy Jan O’Sullivan

Does the figure relate to the Department or HSE?

Deputy Mary Harney

It is for the HSE. A large portion of this money is expended on issues related to child protection, child care applications and so forth.

Also on the pharmacy issue, the HSE and Department were engaged in negotiations with the wholesalers when the latter produced legal advice suggesting the negotiations should not proceed as they contravened Irish and European competition law. That is how the issue came to light. This advice was subsequently confirmed by the Office of the Attorney General and the HSE's legal advisers. A number of pharmacists won a case in the High Court, as a result of which we were required to begin paying the higher margin from October onwards. The issue of whether payments should be made retrospectively to March last is before the courts. We await their determination.

It is intended to put in place a process over the next few days to deliver savings in the wholesale margin. A margin of more than 16% to deliver pharmaceutical products from producers to patients is twice that paid in other countries. Any savings we can make in these areas will be invested in patient services.

In response to Deputy O'Hanlon's question, payments are made to general practitioners in the North in respect of the treatment of patients from the South and vice versa. Such payments are made in two specific areas.

Insurance companies are charged the full economic cost of admissions to public hospitals arising from road traffic or other accidents.

On Deputy Neville's question on A Vision for Change, 94% of the €51 million figure will be spent by March. I am not in a position to state what will be spent by the end of this calendar year. The money has been sourced from elsewhere and will be spent.

Did Deputy O'Sullivan ask a question about the fair deal?

Deputy Jan O’Sullivan

No, I noted that money has been allocated for the fair deal despite the Government's failure to introduce the relevant legislation.

Deputy Mary Harney

The Deputy is correct. The Department knew how much the fair deal would have cost if we had been able to introduce it. We did not know what a new consultant arrangement would cost as we did not know what agreement would be ultimately reached or how many current consultants would opt for the new contract. We understand more than 70% of consultants have indicated they wish to move to the new contract, which is very encouraging.

The Deputy is correct that in addition to the contract, the Department can take other measures on the mix of public and private care available in the public hospitals. I am considering this matter.

Deputy Jan O’Sullivan

I asked about academic consultants.

Deputy Mary Harney

It has always been the case that academic clinicians earn more than other academics or professors. The reason is that it is a challenge to get clinicians to enter academic medicine. To be fair to academic clinicians, they earn far less than they would earn if they were not involved in academic life and had the average public-private mix of consultant colleagues. While they earn more than their academic colleagues, under the new contract the margin will not differ from the margin they currently earn over category one contractors.

Deputy Jan O’Sullivan

I asked how compliance with the new contract would be monitored.

Deputy Mary Harney

Clinical directors will be responsible for ensuring compliance in their teams. The HSE also has a new technical measurement tool for the 80:20 mix, which is not enforced at present. In some hospitals, some consultants on category one contracts may have a 60:40 private-public mix and I understand there is one case of 30:70 public-private mix. Such cases will not be possible under the new contract which will be enforced because without enforcement, public patients will not be able to secure access to publicly funded facilities paid for by the taxpayer. None of us wants that to occur.

Chairman

Do members wish to make any final points of clarification?

Deputy James Reilly

Yes, on some of the responses——

Chairman

Do we need to go over answers which have been given?

Deputy James Reilly

While I do not propose to have a row, it is impossible to accept that no projected or provisional cost was made for the new change in the consultant contract. When building a house one may not know how many or what type of windows one will have but one makes a provisional cost for windows, even if it may increase or decrease. It is unbelievable that a provisional cost for the consultant contract was not made.

The Minister indicated that 189 posts were created. Have these posts been approved, advertised and filled? How many have been filled and how many will be filled next year?

Newspapers recently reported on a case involving a firm of solicitors which worked for the health board and had vast sums of money stashed away on which it did not pay tax. The Minister said she uses the Attorney General so it is more a question for the Health Service Executive. Is it satisfied that the solicitors it is using are tax compliant?

Deputy Jan O’Sullivan

I seek clarification on the 189 new consultants. Two years ago an incentive scheme was put in place to ensure the better functioning of accident and emergency units. Hospitals were to be allocated extra consultants on the basis of how well they dealt with that issue. In my area the Mid-Western Regional Hospital was top of the list in terms of the extra consultants it was supposed to get. I do not know if it got any of them owing to a shortage of money and because the contract was being negotiated. Will the Minister include those posts in plans for the coming years in terms of extra consultants?

Deputy Alan Shatter

I understand we are dealing with the Estimates for the Office of the Minister for Children later but I wish to raise a specific issue with the Minister about which I have a great concern. There have been dramatic developments in the area of stem cell research. I have no doubt that the work being done in that area will transform medical care and medical intervention as we know it in the next 20 years.

Chairman

That is not relevant to the matters before us.

Deputy Alan Shatter

It will be. That was an introduction to my question for the Minister. A company has been licensed by the Irish Medicines Board for the collection of cord blood from the umbilical cord of babies. As I understand it, there is no cost to the State. Does the Minister perceive there is any cost in the State's involvement in this regard? The Health Service Executive effectively is blocking parents who want cord blood collected at the time of the birth of a child, which could have profound health benefits.

Chairman

What relevance does this have to the matters before us? Will Deputy Shatter make a connection please?

Deputy Alan Shatter

I am about to make a connection. In the context of the likely treatment in the coming year of treating a small group of children who may need intervention, it is crucial that the issue is addressed properly by the Department. We are in breach of a European directive in this area. The matter is one of great distress to many parents and no cost is involved for the Department.

The critical point is that a decision has been made in the United States. The American Medical Association has ruled that cord blood banking should be discussed with all parents before the birth of a child in the event of it being needed in the future, either for the treatment of the child or for other family members. The critical point in the context of next year's Estimates is that the State is in breach of a European directive in this regard and the HSE is obstructing hospitals from co-operating with parents in the collection of cord blood. That is exposing the State to substantial legal claims in the future should a child or an adult lose his or her life in circumstances where it could be established that if cord blood had been collected, proper treatment might have been afforded through some of the new medical techniques that are developing.

As I understand it Professor Colin McGuckin met departmental officials to discuss the issue in the summer. On 11 December a major event will be held in the European Parliament to address the issue of cord blood banking. I am concerned that the Department is not keeping up to speed in this regard and that neither is the HSE. Apart from the absolute obligation we have to ensure the best possible care is provided to people in the State and their children and that they would have a facility to collect cord blood, the obstruction by the State of parents who wish to so do is exposing the State to substantial financial liabilities in the future. This issue needs to be addressed urgently and with a degree of coherence that has not been shown so far.

Deputy Rory O’Hanlon

On that point, we agreed at a previous meeting of the joint committee that we would go back over the report done by a previous committee on stem cell research. It is a broad debate because there are strongly held views, including my own, that we should avoid stem cells from embryos. While I do not disagree with Deputy Shatter——

Deputy Alan Shatter

This has nothing to do with embryonic stem cells.

Deputy Rory O’Hanlon

It has to do with the whole question of stem cell research.

Deputy Alan Shatter

I am talking about umbilical cords.

Deputy Rory O’Hanlon

I believe we must have that debate to which we agreed at the previous meeting.

Deputy Alan Shatter

Could I just——

Chairman

No. I am sorry but Deputy Shatter has had plenty of leeway.

Deputy Alan Shatter

Deputy O'Hanlon was confusing embryonic stem cell research and the collection of cord blood, which gives rise to no controversy.

Deputy Rory O’Hanlon

I am not. I said I had no difficulty with the proposal.

Deputy Alan Shatter

It is a totally safe procedure that is to the benefit of people.

Chairman

Let us not have any controversy. We are dealing with the Estimates and we will stick to those matters. Are there any final questions relevant to the matters before us?

Deputy James Reilly

I forgot to ask the Minister a question to which I would like an answer. In her statement she referred to €38 million from a slower than expected roll-out of developments in the earlier part of the year. Can she list what they are?

Chairman

We will now have the final response from the Minister. I take it all Members who want to contribute have done so. I thank everyone for being concise.

Deputy Mary Harney

In regard to pay agreements or contract negotiations, it is never the practice in this or any other Department to make provision until we know what provision is required. It is always the practice to come back with precise details. I do not think the Minister for Finance or his Department would be happy if people were applying for sums of money they might not spend. That is common practice across the Departments in terms of public service pay.

Regarding consultants, 154 posts have been advertised, 41 consultants have been offered positions, and 47 candidates have been shortlisted for interview. Many of the posts relate to performance in terms of emergency care. Other posts are linked to the new cancer control plan.

I have not been briefed about the issue raised by Deputy Shatter It has not been brought to my attention. I have asked a person to speak to the medical team in the Department and I presume discussions have taken place at that level. I will come back to Deputy Shatter this afternoon. I apologise for not being in a position to answer the question. Clearly, he is distinguishing between cord blood banking and making that blood available and embryonic or adult stem cell research, which are different issues. I will talk to the medical team in the Department, the Irish Medicines Board and the Health Service Executive.

As to whether money not spent is handed back, the answer to that is "Yes". If, for example, the money for the new consultant contract is not used for that purpose, it must be handed back. The same applies to any other subhead where moneys are not paid, and to the dormant accounts money. That is why one year when we provided €10 million and only €3.6 million was spent by the voluntary organisations that were getting the money, the rest was handed back to the dormant accounts fund. This year €10 million was provided and we needed €14 million so we are providing an extra €4 million. That is normal practice.

Deputy Reilly referred to the sum of €13 million for cancer and disability services. The issue relates to recruitment and when people take up positions.

Deputy James Reilly

Perhaps the Minister would send me a written response outlining which services are affected.

Deputy Mary Harney

I will. One service related to childhood immunisation that began later than anticipated. The sum of €18 million was provided for that and we spent €14 million rather than €18 million in 2008.

Deputy James Reilly

At the outset, the Minister indicated that 189 new posts had been approved.

Deputy Mary Harney

A total of 154 posts have been advertised to date. I think they are advertised in batches to make a shortlist and do interviews.

Deputy James Reilly

A total of 41 consultants have been appointed.

Deputy Mary Harney

I understand 41 have been offered appointments.

Deputy James Reilly

But no one has been appointed yet.

Deputy Mary Harney

Some radiation oncologists in the cancer area have started working.

Deputy James Reilly

Rather than delay the meeting, the Minister might forward me the figures.

Deputy Mary Harney

I will get the breakdown for the Deputy.

Chairman

Are there any questions or issues relating to Vote 41, the children brief?

Deputy Alan Shatter

I want to raise some matters thereon.

Deputy James Reilly

Is the Minister happy that the HSE's current practice in respect of solicitors is such that the taxpayer is receiving his fair share in return? This was not the case heretofore.

Deputy Mary Harney

I know the firm about which the Deputy is talking. It is no longer the firm of solicitors used by the HSE. To be fair, it is not a matter for the HSE to examine how anyone deals with his tax affairs. The HSE goes to tender for legal services. There have been substantial savings in this area, if that is the appropriate phrase. Next year, there will be a further reduction in the cost of legal services. Over the past two years, since setting in train a national procurement process, the HSE has been obtaining better value for money. Unfortunately, the HSE is in the courts very frequently in respect of issues associated with child protection and wards of court for older people. Legal services are expensive and €30 million is a great deal of money. This is on a par with what is occurring in other jurisdictions.

Deputy Charlie O’Connor

I have a particular interest in the subject of children. The Minister will know my last real job was in the youth service and I have always retained an interest in this issue. I do not mean to mention Tallaght, but at the Tallaght drugs task force meeting——

Deputy James Reilly

That would never happen.

Deputy Charlie O’Connor

I am just saying where I was.

Deputy Mary Harney

It is nice to hear the Deputy was in Tallaght. It is a great shock to the committee.

Deputy Charlie O’Connor

I know some people would prefer if I were not there too often. At the Tallaght drugs task force meeting some days ago, concerns were raised over the changeover, which should be seamless. While we are not dealing with the whole issue here, I will take the opportunity to make the point that people are anxious that the changeover be smooth. There is a sense that there was expertise in the old system and that it worked well. It is expected that the Department will ensure that everything will be right. A very important role is being taken over by the Office of the Minister for Children.

Deputy Jan O’Sullivan

Was there full consultation with the National Youth Council of Ireland on the transfer?

Deputy James Reilly

I am sorry the Minister of State responsible for children is not present because my question is really for him. Does he still believe the vaccination of children against cervical cancer is not an issue for a Minister responsible for children? Will the Minister for Health and Children, Deputy Harney, comment on that?

Deputy Alan Shatter

In the context of this Estimate, which is just a technical mechanism to extend the youth brief formally to the Office of the Minister for Children, the speech of the Minister states the provision is to cater for the expanded role of the Office of the Minister for Children to include the transfer of functions and duties in respect of youth work. It also states the transfer of these functions to the Office of the Minister for Children will facilitate the strategic development of a more integrated, cohesive and effective approach to the needs of children and young people. For many years, I campaigned inside and outside this House for the establishment of a Department for children and a Minister for children.

I am aware there are several people in the Department and wider Civil Service with great expertise in this area and for whom I have a great deal of admiration. I do not want anything I say to be taken as a personal slight against them. I have grave concerns over the capacity of this Department, under the legal structure according to which it is operating, to fulfil the function and responsibility that is politically stated to vest therein. That is not to criticise the staff of the Department. We do not have an integrated, cohesive and effective approach to children's issues. I am not convinced the transfer of additional powers to this Department will provide it in respect of youth issues. I would much rather the Department had the legal capacity to exercise the function to cover children's issues that has been politically portrayed as being possessed by it.

I will ask two or three questions and draw attention to some matters to indicate what I am talking about. The Children First guidelines for the protection of the welfare of children at risk have been in place since 1999. It is blindingly obvious that we are not providing a uniform service across the State to protect children at risk and that, if anyone reports a child at risk to the HSE today or tomorrow, he or she cannot be guaranteed that the matter will be investigated properly. This is not simply an issue of there being an inadequate number of social workers, as some might wish to portray the matter. A considerable difficulty arises because social workers are not being given the training they require. Will the Minister state whether this is a question of resources for existing social workers?

It is absolutely clear that there are completely different approaches to child protection issues depending on the part of the country in which one lives and the HSE area that intervenes therein. In this context, the report published by the Office of the Minister for Children at the end of July confirms what I have been saying for some considerable time in that it refers to the absence of consistency in the delivery of child welfare and protection services across the country. More important, it refers to the absence of any standards against which the delivery of services can be benchmarked and monitored. What is the Office of the Minister for Children doing to ensure uniformity of services? Why are there considerable discrepancies in the delivery of services a decade after the Children First guidelines were issued? Does the Minister of State with special responsibility for children propose to put in place, within the Department, any real-time, modern, technical mechanism for monitoring the number of reported cases of children at risk of abuse or neglect and the number on the waiting list for full assessments? Are there any means whereby the Department can monitor the performance of the HSE in responding to reported cases of children at risk? I believe there are none.

Does the Minister know how many hundreds of files are gathering dust on shelves of different sections of the HSE that record reports of children at risk or awaiting a full assessment by a social worker to determine whether they require some form of family intervention or an application to be taken into care or to be placed in fosterage? Why is there no system in place ten years after the publication of the Children First guidelines?

In the context of the Office of the Minister for Children being given expanded functions, can the Minister explain the response I received to a very simple parliamentary question on 2 December asking the Minister of State responsible for children to explain the function of what has been described to me as the child protection notification system established by the HSE, the difficulties experienced therewith, the time for which it has been in operation and its cost to date? Why was the Office of the Minister for Children not able to furnish this information? I was informed the question related to the management and delivery of health and social services, which are the responsibility of the Health Service Executive, which was to write to me. If the Department has any functions, its most important is to ensure that the child protection services are working efficiently and have the capacity to monitor efficiency. The Department does not know how efficiently it functions, nor whether there is a child protection notification system in place. I understand a system was put in place that has proved to be unworkable and which cost a very large sum. What is happening in this area and how much public funding has been wasted? What is to happen this year and next year in the context of the Estimates, bearing in mind the relevant Supplementary Estimate for this year? The report published in July highlighted the necessity of ensuring proper information systems are in place. Is there any current financial allocation for this?

At the beginning of July, the HSE informed me, in a reply to a parliamentary question, that part of its remit was to start developing some form of information system in the second half of 2008. When I asked the Minister of State at the Department of Health and Children, with responsibility for children, Deputy Barry Andrews, about the progress made in establishing a fully integrated national communications system as recommended in the national review of compliance with Children First guidelines, he replied he did not know and would find out from the HSE.

I appreciate the select committee is dealing with a nominal Estimate to technically and formally legally extend to the Department of Health and Children the power to call itself the Department for children and youth affairs. I am not criticising the departmental personnel. My concern is, because of the legal structure under which the HSE was created which is the responsibility of the Minister, Deputy Mary Harney, the Department is working blindly and has its hands tied behind its back.

Chairman

Could Deputy Shatter conclude please?

Deputy Alan Shatter

I have grave doubts as to whether any further functions should be extended to this Department until such time as it has the legal and political capacity to properly monitor our child care protection services and ensure the State does not have a repetition of the Baby P tragedy in England. I do not believe the Minister of State with responsibility for children understands what is happening.

Deputy Bobby Aylward

Deputy Shatter has repeated himself three times.

Deputy Alan Shatter

I cannot get a reply in the Dáil or from the HSE.

Chairman

Deputy Shatter, please.

Deputy Alan Shatter

It is a scandal that we have a Department masquerading as protecting children when it has its legal hands tied from doing so.

Chairman

Will Deputy Shatter allow the Minister to respond?

Deputy Alan Shatter

The Minister of State's main achievement to date has been photo opportunities with children. He is not even present at the committee today. He should be here for this discussion.

Chairman

Will Deputy Shatter allow the Minister to respond? He has been given considerable latitude.

Deputy Alan Shatter

It is a serious matter. When a child dies in this country in circumstances similar to those recently in the UK, people will ask the questions I am now asking.

Chairman

Deputy Shatter, we are aware how serious this matter is.

Deputy Alan Shatter

These questions must be addressed. So far they have not been addressed coherently.

Chairman

I ask the Minister to address the relevant issues.

Deputy Mary Harney

The statutory responsibility is with the HSE. Prior to that it was with the health boards and that was enacted in the Child Care Act 1991. It is not of recent origin.

I agree the welfare of children must be paramount to the Government. The quality of life of too many of our children was destroyed because of past failings, some within families, others from authorities that children and their parents were entitled to trust. Besides the damage to children, the taxpayer, through the redress scheme, is paying a high price for failings in the past. That is why a dedicated Office of the Minister for Children was established in the first place.

I heard what Deputy Shatter said about its staff. It is headed at administrative level by a wonderful public servant, Ms Sylda Langford, and a fantastic staff. We also have an Ombudsman for Children. Building on the success of the office, the Government recently decided to move youth affairs from the Department of Community, Rural and Gaeltacht Affairs and the Department of Education and Science, into this office, with staff being transferred to ensure continuity.

Although the National Youth Council was consulted on the budget for next year, I understand it was not consulted on the transfer of these responsibilities to the Minister of State.

Regarding the deficiencies that Deputy Shatter has indicated, the health service has ceilings in terms of staff recruitment. Next year, there will be floors as far as social workers are concerned. In other words, there will be minimum numbers that will be needed to provide services.

Recently, the Minister of State, Deputy Barry Andrews, addressed the HSE board on the child protection agenda. In the service plan for next year, one of the specific requirements of the HSE will be to deal with the deficiencies that exist in this area. I am not entirely on top of this as I do not deal with it on a day-to-day basis. The responsibility is delegated to the Minister of State, Deputy Barry Andrews. When I write the letter of determination to the HSE for its 2009 service plan, at the Minister of State's request, I will be including specific requirements on child protection.

The different regimes that apply in different parts of the country are not unusual in child protection. It is part of the experience of having 11 different structures in the past. It applies in other areas too. To be fair, we will be moving to a uniform and consistent system. The Minister of State made that clear to the HSE board, pointing out the areas with good practice and that other areas learn from this.

I am sure the Minister of State, Deputy Barry Andrews, will be happy to attend the committee to explain further the measures being introduced for child protection.

Chairman

I had discussions this week with him and he has indicated he will attend the committee at an early date to discuss children's issues. As there is a division in the Dáil, it might be appropriate for the select committee to conclude its deliberations.

Deputy James Reilly

I have one brief question.

Chairman

Very briefly.

Deputy James Reilly

Will the Minister remove the cap on medical cards for the terminally ill?

Deputy Mary Harney

There is no cap on medical cards for the terminally ill. There is a cap on the HSE's budget. Is the Deputy referring to the discretionary hardship fund?

Deputy James Reilly

Yes.

Deputy Mary Harney

That applies to a much wider group than the terminally ill.

Deputy James Reilly

The Minister in a response to me stated there is a cap on it.

Deputy Mary Harney

I would hope that terminally-ill people would be able to avail of the discretionary hardship fund.

Deputy James Reilly

It is not happening. We have two cases where we know it did not happen. We have more cases across the country. All it takes is a simple ministerial order to sort it out.

Deputy Alan Shatter

This meeting was scheduled to sit until 3 p.m. I insist——

Chairman

The committee determined before the Deputy arrived that we would conclude at 1.30 p.m. I have given the Deputy much latitude today.

Deputy Bobby Aylward

We agreed on the sitting times.

Deputy Alan Shatter

When a child dies, the committee will be in here discussing the circumstances. I hope we do not have to look forward to that.

Deputy Bobby Aylward

Deputy Shatter cannot come in and dominate a meeting like this.