Ruairí Quinn
Ceist:37 Mr. Quinn asked the Minister for Health and Children the progress made with regard to implementation of the recommendations of the Hanly report; and if he will make a statement on the matter. [15596/04]
Amharc ar fhreagraWednesday, 26 May 2004
Ceisteanna (19, 20, 21, 22)
Eamon Gilmore
Ceist:85 Mr. Gilmore asked the Minister for Health and Children the progress in the work of the implementation bodies for the East Coast Area Health Board and Mid-Western Health Board area in regard to the Hanly report; if an assessment has been undertaken of the costs of implementing the Hanly recommendations in each area; and if he will make a statement on the matter. [15579/04]
Amharc ar fhreagra
Paul Nicholas Gogarty
Ceist:88 Mr. Gogarty asked the Minister for Health and Children if he intends to implement the Hanly report fully and the areas he intends not to implement; and if he will make a statement on the matter. [15719/04]
Amharc ar fhreagra
Bernard J. Durkan
Ceist:92 Mr. Durkan asked the Minister for Health and Children the aspects of the Hanly report that have been shelved, temporarily or permanently; and if he will make a statement on the matter. [15677/04]
Amharc ar fhreagraFreagraí ó Béal (171 píosaí cainte)
I propose to take Questions Nos. 37, 85, 88 and 92 together.
The Government is committed to progressing the implementation of the Hanly report for the benefit of all patients. I announced the establishment of implementation groups for the Hanly report in both the east coast and mid-western regions in February. The groups will carry out the detailed work on identifying what services should be provided in each hospital, in line with the Hanly recommendations.
Substantial progress has been made in developing hospital services which will support implementation of the Hanly report. In the mid-west, for example, 1,110 additional staff have been appointed to the region's acute hospitals since 1997. There has been a 77% increase in ambulance staff in the past five years. Some €80 million has been invested in major redevelopment of Mid-Western Regional Hospital. A new €5.7 million acute psychiatric unit opened in Ennis General Hospital. A design team has been appointed for further development of Ennis General Hospital, which I announced recently. A design team has been appointed for extensions in Nenagh General Hospital's X-ray department, laboratory and accident and emergency unit. A 24-bed acute psychiatric unit has been approved for Nenagh General Hospital and a health centre-community care headquarters will commence construction on the site of Nenagh General Hospital.
In regard to hospital services outside these two regions, I have announced the composition of a group to prepare a national plan for acute hospital services. The group contains a wide range of expertise from the areas of medicine, nursing, health and social care professions and management. It also includes an expert in spatial planning and representation of the public interest.
The group has been asked to prepare a plan for the interim Health Services Executive for the re-organisation of acute hospital services, taking account of the recommendations of the national task force on medical staffing, including spatial, demographic and geographic factors.
Neither the local implementation groups nor the acute hospitals review group has been able to meet due to the consultants' continuing industrial action. I again ask that all parties return to the table to progress the work of these groups.
In regard to the consultant contract, a number of meetings have taken place between officials of my Department, health service employers and representatives of the Irish Hospital Consultants Association and the Irish Medical Organisation. These talks are also affected by the current programme of industrial action by the Irish Hospital Consultants Association.
Negotiations with the Irish Medical Organisation regarding the reduction of non-consultant hospital doctors' hours are continuing in the Labour Relations Commission. A number of further meetings have been scheduled over the coming weeks and every effort will be made to complete these negotiations at the earliest possible date.
In recent weeks, a national co-ordinator and support team have been seconded to oversee the implementation process in the health agencies. A working group in each hospital is needed to implement these measures and to monitor progress on the reduction in NCHD hours. The urgent need to establish these groups at both national and local level has been discussed with the Irish Medical Organisation. To date, the IMO has not agreed to the establishment or operation of these groups.
The subgroup of the task force which dealt with medical education and training is still in place. It has been asked to examine, and to report to me on, the measures required to accommodate NCHD training in all postgraduate training programmes in a 48-hour working week and to safeguard training and service delivery during the transition to a 48-hour working week.
The essential recommendation of the Hanly report is that all hospitals providing emergency care must provide acute medicine, surgery and anaesthesia services on site. An irreducible minimum of 21 doctors will be needed to provide such basic on-site medical cover. What progress has been made in that regard? The Taoiseach and the Minister are trying to convince the public that accident and emergency departments across the country will stay open with medical cover. Will the Minister ensure that every hospital in the country will have an irreducible minimum of 21 doctors, and possibly more, in line with the recommendation in the Hanly report? Is the Minister unravelling the Hanly report in an attempt to fool people until the June elections are out of the way?
How does the Minister intend to implement the European working time directive? The implementation bodies have not met, even though the directive is due to come into force on 1 August next. The Minister has admitted that just 60% of doctors are in a position to comply with the directive. I assume this means that 40% of doctors will be unable to comply. How does the Minister propose to meet the deadline required of him by law?
I am conscious that the debate on the Hanly report in recent weeks has taken place in the context of the forthcoming local elections. Having examined many of the leaflets that have been distributed, it seems to me that people are saying "I will get elected on Hanly, or I will get elected on the hospital". I am conscious that it is pointless and fruitless to try to have a rational debate on the Hanly report at this point in time.
Especially when the Minister keeps changing his line.
There is a clear political agenda.
The Minister is not being very complimentary to some of his colleagues.
The main consideration is not best survival or outcomes——
The Minister should answer the question.
The only outcome that seems to be considered in this debate is the best electoral outcome——
What about recommendation 356?
——for those who are making contributions.
The Minister does not have to go far if he wants to meet people who are doing that.
I asked about recommendation 356.
Regarding major trauma in accident and emergency——
Fianna Fáil is looking for——
——I have already made my position clear.
I am sorry——
May I reply?
It is not——
With respect, I have listened to the Deputy.
The Minister is deliberately misleading the House.
I have heard what she has to say.
The Minister is in possession.
I did not ask about major trauma.
I have heard her.
I asked about basic medical cover.
I know what the Deputy asked about.
The Minister should be allowed to speak.
He should stick to what I asked about.
The Deputy will not dictate my reply. I will reply in the manner I see fit.
If I ask a question, I expect it to be answered.
The Minister should be allowed to proceed.
I expect to be allowed the opportunity to reply.
The Minister should answer the question he has been asked.
I have appointed local implementation groups in the mid-west and east coast areas. The national hospitals review group has not met yet because of the industrial action by the IHCA. The group has not examined anywhere outside the mid-west and east coast areas. We have appointed local implementation groups to suggest solutions to the issues that have been raised in respect of the Hanly report. Nobody said the Hanly report would be implemented in one or two years. In the interim, the health boards in both areas have come forward with their responses to overtures from the Medical Council and other regulatory bodies. Deputy McManus refuses to acknowledge in any debate in the House that the regulatory bodies have a significant role to play in deciding whether hospitals or accident and emergency departments continue with accreditation for junior hospital doctors.
Is the Minister going to blame them now?
That is consistently ignored. The Mid-Western Health Board has responded.
He has found somebody to blame.
Everyone is getting up on their high horses to condemn the response of the Mid-Western Health Board. I thought it was a rather practical immediate response to the problem with which the board was presented. That was clearly articulated by the health board at the time, but people chose to ignore it because of the forthcoming local elections. It seems that the only people who cannot make announcements about health in advance of the local elections are members of the Government parties. The Opposition parties can put up any placards they like.
What about the working time directive?
It seems that it is fine for them to engage in scaremongering and to put up whatever banners they like.
Will the Minister stop?
The man is suffering from some kind of obsession.
Order, please.
I wish to speak about the working time directive.
Can we have an answer to the question?
I have answered questions on the directive in the House, including in my formal reply some moments ago. It is a simple and straightforward matter. We have endeavoured to engage the social partners on the implementation of the working time directive over a sustained period of time as part of the social partnership process. That 60% of doctors are in a position to comply with the directive represents significant progress on the issue. I am concerned and surprised that the IMO does not seem enthusiastic about the proposal to reduce the number of hours worked by non-consultant doctors. We agreed a major financial package three or four years ago to compensate doctors for the number of hours they were working. At that time, the campaign was waged on the basis that doctors were working too many hours in hospitals.
Perhaps the Minister should reform them.
The pendulum has swung fully now, however, because it seems that there is resistance to the idea of reducing the number of hours worked by non-consultant hospital doctors.
What is the Minister doing about it?
I will review the situation on an ongoing basis.
The Minister cannot expect them to give up money he granted to them two years ago.
It is a matter of regret to me that the present industrial action is slowing things up.
It has to be implemented by 1 August.
The industrial action is being pursued because of the clinical indemnity scheme. The Government is acting properly on behalf of the consultants and the taxpayer in dealing with a body that is saying it cannot meet its obligations. The consultants have taken limited industrial action on that basis. I find such a position to be untenable, in light of the role of the Government and the Department in trying to resolve the problem in the interests of consultants, etc.
Will the Minister look for a derogation?
No, that does not arise. The law will apply.
It will apply from 1 August.
Yes, the law will apply.
The Minister has accused the Opposition of playing politics, but he has not been behind the door in doing so. A new version of the Hanly report seems to emerge every time there is a public meeting. It is no wonder that we keep asking questions about it because we are at a loss. Those most at a loss are the unfortunate people who have to implement the report. Representatives of the interim Health Service Executive who attended a meeting of the Joint Committee on Health and Children a few weeks ago do not have the slightest idea of what they are implementing because it changes every day when they turn on the radio.
I want the Minister to clarify what is proposed in the specific instances of Ennis and Nenagh. When the doctors are appointed as medical cover, will they be in a position to admit patients? Will they have beds in the hospitals? Will they perform the functions of those in ordinary accident and emergency departments, or will they treat people before sending them on? Will they be able to admit patients in the normal way, as any accident and emergency department can? Will the same rule apply to other local hospitals in areas that are not pilot areas?
There is an air of unreality about the manner in which the Deputy has posed her questions. What happens in accident and emergency departments at present?
The Minister should not ask me the questions. I have asked him the questions.
I am asking a rhetorical question by way of reply.
What does happen? It is time for the Minister to answer his own question.
In the accident and emergency units in Ennis and Nenagh——
Will the physicians be able to admit people to Ennis and Nenagh?
——non-qualified doctors are in training.
I understand that.
Order, please. The Minister is in possession.
I do not doubt that they will be wonderful doctors.
Such people are staffing accident and emergency departments in hospitals up and down the country.
Will they be able to admit patients or will they put them in an ambulance?
The Deputy should resume her seat.
Which is it?
That is the position at the moment.
I ask the Minister to answer my question.
I say respectfully to the Deputy that the proposal that emerged from the Mid-Western Health Board in consultation with the medical people in the region is a superior provision, in terms of medical cover, than the provision that is currently in place.
I am sure the medical cover is wonderful.
That would be my argument.
Can they admit patients?
Yes. Has the Deputy asked the Mid-Western Health Board?
The Minister does not answer questions.
The Mid-Western Health Board came in with the proposal.
Is the Minister giving direction and leadership in respect of the Hanly report?
The Minister should be allowed to proceed.
The proposal was not made in the context of the Hanly report.
Will the Minister tell the people of the Mid-Western Health Board area if the doctors in question will have admission rights to accident and emergency units?
Yes.
Will they have beds?
Yes.
Is the Minister sure?
The bottom line is——
Is the Minister sure, or will I have to ask the Mid-Western Health Board?
I respectfully suggest that the Deputy should have consulted the Mid-Western Health Board a long time ago, if she is concerned about these issues. The health board announced this about three months ago. The advertisements were in the newspaper well over——
The Minister announced it in recent weeks.
I did not announce it.
Deputy Mitchell should resume her seat.
I did not announce it. That is an untruth which is deliberately articulated by those who——
Perhaps it was announced by the Minister, Deputy Michael Smith.
Did the Minister get somebody else to announce it?
It was the Minister for Defence.
The Chair has not called Deputy Mitchell.
I went down to announce the design team for a multi-million euro development at Ennis General Hospital. The accident and emergency doctor posts were advertised in the newspapers before I went there. They had already been in the newspapers. Did the Deputies not read them?
Was the Minister for Defence wrong when he said that the Hanly report had changed?
I call Deputy Cowley.
It suited the political agenda to merge the two——
Was the Minister for Defence wrong——
——but that is not what actually happened.
——when he said that the Hanly report had changed?
I call Deputy Cowley.
Confusion remains.
If the Minister, Deputy Martin, is wondering, I am wondering too. The debate on the Hanly report started with the Minister's proposal to have a nurse-led unit at Ennis. It is certain that the Minister has now made provisions for doctors there. Is it not the case that the doctors will not have any admission rights? The unit will close at 5 p.m. each day and people will have to travel elsewhere. The Minister has not made any provision for such people. He is crying crocodile tears about NCHD hours, but what about GPs? If I was in my practice, my locum would have to do 168 hours per week. How about us?
Not one penny has been allocated to the primary care strategy this year. If the Hanly report is implemented, people will have to go to their GP and then travel to a hospital that is far away when they look for services, but the Minister has catered for neither. Who is fooling whom?
The Hanly report is approximately six months old.
I am getting older.
It is probably ten months old at this stage.
I am not sure who is ageing faster.
It was not suggested, in the Hanly report or anywhere else, that accident and emergency units would close next week.
Tell that to the people of County Clare.
The Deputy has made his point. For a number of years, from time to time, various hospitals have come under pressure. It has nothing to do with Hanly but concerns the regulatory authorities.
It has to do with a lack of leadership by the Minister.
In the name of God, would the Deputy allow me to reply?
The Minister is now in possession.
Some 64 beds are vacant in Mayo County Hospital.
The world is terrible. It always has been so for Deputy Cowley and always will be.
It is not the Minister's job to empty wards and clear out casualty units.
May I comment?
The Minister is in possession, so please allow him to reply.
Some 64 beds are missing.
The money for Mayo was provided a long time ago.
The Minister should remove the embargo on health boards.
Please allow the Minister to reply.
We have employed an extra 8,200 nurses since 1998 in the health care service, which is something the Deputy will never acknowledge.
It is a big country and we need a lot more.
In the context of the Hanly report, over the last number of years various hospitals were under pressure. We had the Monaghan situation and others where various colleges said they were not happy and withdrew accreditation from non-consultant hospital doctors. The withdrawal of that accreditation had an impact on the provision of 24-hour, on-call emergency cover. We all know that——
No, we do not.
——so let us stop pretending that did not happen over the last four or five years. That was happening long before the Hanly report. It happened in Naas, for example, and at Tallaght Hospital.
A lot more needs to happen in Naas.
Deputy Pat Breen is the next to ask a question.
Tallaght Hospital had to take over the accreditation.
(Interruptions).
It is pointless for Deputies to make comments without giving me a chance to reply.
Is the Minister aware of the independent report commissioned by the national action committee and launched this morning in Ennis? It states that Hanly is not on. One would have to build a new hospital in Limerick if one were to transfer all accident and emergency cases there. As regards the Minister's announcement concerning Ennis General Hospital, will there be a 24-hour accident and emergency unit, as well as beds available there? When does the Minister expect to see work starting in Ennis General Hospital?
The design team has been appointed, it is up and running but will take some time to do its work. I can get the schedule from the Department's technical team and will give that to the health board. No one is saying, or ever said, that all accident and emergency cases should go to Limerick.
Hanly is saying it.
Hanly said it.
Up to 80% of all attendances will stay at Ennis.
What about the other 20%?
Deputies should examine the statistics. I looked at the figures for Nenagh and Ennis. One is talking about an average of two patients per night attending accident and emergency between midnight and 8 a.m. Let us get this debate into perspective. The vast majority of all attendances are between 8 a.m. and 8 p.m., or from 8 a.m. to midnight. We need to be practical and sensible as regards how we provide medical cover for the 600 or 700 patients attending hospital between midnight and 8 a.m., and we can do that. It should be within the capacity of the local implementation groups to come up with solutions to sort out that issue. What did the Hanly report say about the mid-west, for example? The mid-west should look at what is happening in the west today. We are now on the point of providing radiotherapy services for the people of the western seaboard for the first time. They will no longer have to travel to Dublin for such services.
Did the Minister not see the new report on that?
Likewise for cardiac surgery and a range of other services. That is what we are going for — regional self-sufficiency.
That is not the question we are asking.
Fianna Fáil and the Progressive Democrats have done more for regional self-sufficiency in health than any party opposite. It is about time Opposition Deputies realised that. They did very little for it in their time.
The Minister should answer the question.
Will the Minister confirm that he is now firmly skewered on the horns of the ultimate health dilemma? Having published the Hanly report, along with two other reports, he now finds himself acquiescing to the promptings of his party colleagues, and the Progressive Democrats, who have requested him to do nothing untoward until the 11 June elections are over. Will the Minister answer a straight question as to whether he has made his mind up at this stage? What aspects of Hanly is he going to ditch, or what aspects of the report has he been asked to ditch? If not, there hangs another question.
With respect to the Deputy, we are progressing with the implementation of the Hanly report.
In its entirety?
We have appointed two local implementation groups to deal with the report's recommendations.
In their entirety?
No. We have already moved in terms of providing an additionality of services.
It is flexible now, is it?
No, I referred to an additionality of services.
That is flexibility.
If there was to be a downgrading of Ennis Hospital, we would not be appointing a design team for a multimillion euro investment. Neither would we have put cardiac rehabilitation into Ennis, if we were about to downgrade it.
Will the Minister move it before the election?
We would not have increased staffing levels in Ennis or Nenagh to the extent we did, if we were about to downgrade them.
At the weekend, people were waiting five and a half hours for treatment in Clare.
There has been a significant expansion in staff numbers at all of these hospitals.
The time for questions has expired.
Naas Hospital, for example, has witnessed significant expansion and investment.
It is understaffed.
And underfunded.
The only agenda for the Opposition is how to turn this around for the local elections. It is politicising the issue.
Written Answers follow Adjournment Debate.