Defence Forces Medical Services.

Dáil Éireann Debate, Wednesday - 21 April 2010

Wednesday, 21 April 2010

Ceisteanna (17, 18)

John Deasy

Ceist:

54 Deputy John Deasy asked the Minister for Defence the number of recommendations of the Defence Forces Medical Services Review that remain unimplemented; the number of recommendations in the process of implementation but not yet fully implemented; the number of recommendations yet to begin the process of implementation; the number of recommendations that have been fully implemented; the specific timeframe in which the recommendations will be implemented; and if he will make a statement on the matter. [15669/10]

Ciaran Lynch

Ceist:

88 Deputy Ciarán Lynch asked the Minister for Defence the position regarding the establishment of the new centralised medical corps for the Defence Forces. [15615/10]

Freagraí ó Béal (5 píosaí cainte)

Deputy Tony Killeen

I propose to take Questions Nos. 54 and 88 together.

The PA report assessed the current arrangements for the provision of medical services and proposed a model for future delivery of those services. The consultants recommended a programme of major change. The high level recommendations include a centralised command structure for the Medical Corps and the creation of a medical services management and administrative function. This structure will provide strategic planning, resource allocation and overall responsibility for the management and delivery of the medical service and for the development of medical officer-led care teams, together with a refocusing of medical staff on appropriate clinical tasks. The structure and systems recommended have been designed to meet the demands and needs of the modern Defence Forces at home and overseas and provide medical officers with a fulfilling and rewarding career. The implementation schedule follows the recommendations made by PA. Many of the recommendations made in the PA report are of a high level strategic nature.

The governance structure proposed in the report for the delivery of change in this area has been put in place. A dedicated programme group with civilian and military representatives is co-ordinating a range of projects. Progress has been made on implementation of the PA recommendations including, alignment of Defence Forces and medical corps strategies, redesign of the medical care model in the Defence Forces, a centralised command structure, informed service provision through strategic and operational demand and capacity planning and the making available of accurate and timely health and business information. Also included are a performance-based approach to managing demand and ensuring efficient use of resources and support to sustaining and developing the medical service within the PDF.

As recommended, working groups have been set up to progress the various projects identified. These continue to meet regularly and all have submitted reports. The steering group has considered all of these reports. While none of the seven recommendations from the PA report has been completely implemented, the programme of implementation is progressing. In particular, the steering group has approved the high level organisation for the unit, which now includes a line officer at the rank of colonel commanding the medical corps. It has also authorised the immediate introduction of an annual medical for all Defence Forces personnel and directed, following the findings and recommendations of the future medical information system working group, that all medical corps personnel will use the personnel management system medical module. Formal links have been established with the Medical Council, the Health Services Executive, the Royal College of Surgeons in Ireland and other relevant bodies to explore external training for doctors in the Defence Forces medical services.

Final reports from a number of the working groups including those on the future medical information system, organisation and establishment, training and education, and financial arrangements and outsourcing are due to be delivered by 30 April 2010. The clinical review working group is not due to submit its final report until 30 September this year with monthly reports to be submitted in the interim. It is only following completion of this phase that full implementation of the recommendations can be achieved.

It is expected there will be substantial progress before the end of the year in implementing recommendations. Some issues will be resolved quickly while others will require significant consideration and will, for example, require negotiation with the representative associations.

Deputy Jimmy Deenihan

The first question I asked the Minister's predecessor back in October 2007 was about establishing a review of the medical corps in the Defences Forces, to which the then Minister responded. The consultancy group was taken on in 2008 and reported last year. It is very important that the report is implemented and I have concerns about the speed of implementation. The PWC report of the late 1990s suggested there was an establishment requirement of 46 medical doctors for the Defence Forces. I understand that at present the number is 23, some of whom are non-nationals. Will the Minister confirm the number?

Due to the nature of their work, the health and fitness of our Defence Forces is paramount. More than any other occupation, they are exposed to physical challenges and stresses that people in other occupations would not fully comprehend. This is why a proper well resourced medical corps is paramount. We are failing badly in many respects with regard to providing that support to the Defence Forces. The report stated quite clearly that current demand for medical assessments is not met. It also stated that the medical corps delivered 7,222 medical assessments in 2007 against a requirement estimated at more than 18,716. This is grossly inadequate.

A key recommendation of the report was for the immediate creation of one centralised medical command structure. It is now six months later and one would think it should have been possible for that to have been put in place immediately. Will the Minister respond on the inadequacy of what is available at present? Will he give us more direction and a timeframe for the implementation of the recommendations made by the PA consultant group? Will he be more specific with regard to the centralised medical command structure because it strikes me that it will be the structure which will drive reform?

Deputy Tony Killeen

I will take the final point first. I agree with Deputy Deenihan that the single medical command structure with a line officer at colonel level will have a positive bearing on the quality of service provided. As I stated in my reply, it is already being done with regard to the appointment of the line officer. Deputy Deenihan also made the point that some of the recommendations could be implemented more speedily. It is important to bear in mind that there are a number of review groups, some of which reported recently and others which will not report until the end of the month. Without knowing the detail of the work it is doing, it seems the report of the clinical review working group, which is due in September, will have a considerable bearing on the direction, notwithstanding the fact that it is making interim monthly reports.

Last week, I visited the Galway office of the Department and the barracks. I got a very good close-up view of the work undertaken there in support of the medical services for military personnel. I was very impressed with the manner in which it is organised. With regard to some of these changes, it is also important that there will be elements on which the representative organisations will have views. I have had the opportunity to meet two of them and I will meet them while I am in the job. It is important that we take on board any concerns or recommendations they may have.

I will have to come back to the Deputy with information on the numbers of personnel in specialisation. I know some are non-nationals but that is the case across all of our health services and I do think anything negative could be taken from it.

Deputy Brian O’Shea

In answer to a question tabled on 24 February, the then Minister of State at the Department of Defence, Deputy Pat Carey, told us it was planned that the new centralised medical corps would be established prior to the end of the year. In his response today, the Minister was not as definitive as that with regard to when the corps will be established. It seems the date is moving back. In essence, many processes are under consideration at present and some have been put in place to some degree. Is there any improvement, even at this stage, in the provision of medical services within the Defence Forces? Realistically, when does the Minister consider that we will see major and worthwhile improvements to a situation described in the not too distant past as being a shambles?

Deputy Tony Killeen

The agreement reached at steering group level is an important development. It is very hard to ascribe a timeframe in a situation such as this where a steering group and various sub-groups are reporting. However, the fact that it has approved a high-level organisation unit to include a line officer at the level of colonel is very important because it is central to delivering on many other concerns. The introduction of an annual medical for all Defence Forces personnel must be welcomed because one would have thought this was the case already. With regard to a peer review group and access to best practice, the links being established with the HSE, the Royal College of Surgeons in Ireland and other bodies must be a positive move. However, I understand the frustration, if that is the right term, of Deputy O'Shea about the fact that many recommendations which appear to be required in common sense seem to take a bit longer to implement than one would hope. I will try to encourage as much progress as quickly as possible in this regard.