James Reilly (Dublin North, Fine Gael) | Oireachtas source

I did not talk about staged payments at all. There is no question that anybody would be denied legal representation. What I did say, however, was that I wanted to ensure that any funds we could procure in order to compensate for the pain, hardship, hurt and distress caused would go to those who suffered and not to members of the legal profession. That is one matter about which I am very clear.

The next point I wish to make is that it would be very wrong of any member of this committee or others to mislead people into believing that the awards they might obtain would be at the very top end of what was obtained by a woman who has indicated, in very clear terms, that she had an open-and-shut case but who was obliged to go through several years of proceedings and who nearly lost her house. The woman in question stated that during the final appeal she woke up one night in a cold sweat and realised that she could lose her house. She had an open-and-shut case but there were several legal points which could have derailed matters. The matter was eventually settled by the Supreme Court not after one, four or nine years but rather after 11. I do not want many more of the people who suffered as a consequence of what occurred pass away before we get to rectify the position for them. That is why I am taking the most expeditious approach possible. Judge Murphy is an individual of considerable repute who has form in this area and who was also involved in dealing with matters relating to childhood abuse. She is very skilled, knowledgeable and full of compassion. With the agreement of the women concerned and their representatives, she will do her best to come an arrangement that will help bring about some sense of closure for them.

A great deal of concern has been expressed about a number of recent incidents involving the national ambulance service. I am also concerned about this matter. HIQA was due to carry out a review of the ambulance service in the second quarter of the year. I have spoken to both the chairman and the CEO of the authority and they have agreed to expedite matters carry out the review as a matter of urgency in order that all relevant matters might be investigated. I appreciate the concerns of Deputy Ó Caoláin, who inquired about the use of Sat Nav. The HSE does not operate Sat Nav devices because they are not sufficiently safe and do not contain maps for Irish townlands. The HSE ambulance services operates GeoDirectory mapping combined with digital automatic vehicle location, which allows control to direct a vehicle to the scene of an incident. The HSE can probably elaborate on that matter for the Deputy. We must accept, however, that much and all though we strive for perfection, it is something which eludes us. Things sometimes can happen, the wrong information can be transmitted and vehicles can be directed to the wrong location.

I am very concerned about instances outlined to me of four ambulances parked outside accident and emergency departments, especially on days when TrolleyGAR and Trolley Watch indicated that there was no particular issue with regard to trolleys. We all serve the public best by insisting on transparency. When there is transparency, it is then possible to have accountability and, with that, we may get some fairness. I am very happy for HIQA to carry out a very thorough review of the situations in question and of the entire service and to indicate where the problems exist. We will address those problems because the safety of citizens must be paramount.

Deputy Healy referred to the boards of the hospital groups and appointments thereto. Those appointments are in train at present. I wish to make my position clear in respect of this matter. The Tallaght report threw up a great deal of material, some of which is being dealt with in a neighbouring committee room in the context of other issue. I will make one comment on that matter and I assure the Chair that I will not cut across the matters with which the Committee of Public Accounts is dealing. On foot of the Tallaght report, it was determined that we needed a uniform approach to appointments to the boards of hospitals and that such appointments should be based on competency and should not be made on the basis of on with whom one went to school. The relevant competencies would be legal, human resources, HR, financial, managerial, etc. That is what we are doing. We have a grid in place in respect of appointments to boards and we can look at this in respect of any individual and assess which boxes they tick. I agree with Sir Keith Pearson who made the point that no member of staff should be on a hospital board because that is counterproductive. Staff can be members of the wider board of governors but they should not be on the board which supports the management and the executive.

In the context of the issue to which the Tallaght report gave rise in the context of a second stream of payments being made to senior executives in hospitals. There is only one instance of which I am aware where the same individual is the CEO of both the public and private hospitals. I am of the view that this is a conflict of interests and that it is unsustainable. Knowledge of that situation by no means confers acceptance of it. That goes for many other things that have been happening and of which we may have had some knowledge. Those things to which I refer are now being addressed by means of a cogent and coherent mechanism which has regard to due process. I am sure Mr. Tony O'Brien will not want to say too much on that matter because it is being dealt with by the Committee of Public Accounts.

Mr. Ian Carter can address the problem with people on trolleys in hospitals in south Tipperary in a comprehensive matter. It is important to state, however, that overall trolley counts are down this year on last year. That is the case - believe it or not - even though there was a spike during the week. There will be pressure in the coming weeks but such pressure always arises in the first six to eight weeks of the year.

I fully agree with Deputy Healy in respect of the costs relating to agency doctors. This is a matter of serious concern for me, as is that which relates to the cost of agency nurses. That is why we introduced the concept of the "nurse bank", a matter in respect of which Mr. Tony O'Brien can comment further. We promised to obtain figures in respect of the overall cost for the Deputy but I do not know if it has been possible to do so. Mr. Tony O'Brien appears to be nodding to indicate that the relevant information has been procured.

The issue that arises relates to the recruitment and retention of non-consultant hospital doctors, NCHDs. This is also a matter of grave concern to me. Some time ago I informed the committee of my belief that it is both wrong and morally questionable for us to recruit doctors from the Third World, particularly when we train our own doctors here. I accept, however, that the latter can sometimes leave the country when they have completed their training. We undertook to discover why we cannot recruit or retain NCHDs. I am aware of anecdotal evidence of why the latter is the case. It is because NCHDs do not feel respected, are of the view that they do not have a clear career path and feel they are not treated with the dignity with which they should be treated. This matter is being addressed by Mr. Brian McGrath's group. Mr. McGrath has issued an interim report, which contains timelined recommendations, and will be bringing forward a full report later this year. I hope to address this issue because I am of the view that we have the finest and the best in this country and we want to keep them here. If anybody has any doubt about that, they should realise that when our doctors and nurses go abroad they tend to rise to the top of the very best institutions.

Deputy Conway referred to a consultant-led service. I do not wish to be difficult but we want a consultant-delivered service and that is what we are aiming for. In the past we had a consultant-led service. I have been examining the position with regard to consultant numbers and associated difficulties for the past two days. In that context, Mr. Barry O'Brien obtained an up-to-date report for me and it indicates that 93 new consultants have been appointed and that these are already in place. In addition, a further 71 posts have been approved for filling. If memory serves, approximately one third of those 93 consultants were employed at the new rate. I have discussed this matter with both Mr. Tony O'Brien and Mr. Barry O'Brien. When we introduced the reduction, it was never my intention that somebody who has spent ten years working as a cardiologist in Toronto would be expected to return here and commence work at the starting point on the salary scale.

That, clearly, does not make sense. It has to be modified and whatever needs to be done will be done to address that issue. In the main, there is not the great crisis chaos that the Irish Hospital Consultants Association would like to paint. There are many other reasons consultants do not wish to return, one of the main reasons in the past has been the lack of ability to do research - we are very lucky to have Senator Crown here who had led iCore, an Irish Cancer organisation, that does a lot of research in this country through a virtual grouping - but we want to address that through the hospital groups and through involvement of the universities in the hospital groups, etc.

The Deputy was concerned about the maternity hospitals' outreach services being ceased and that they are to start again, and Mr. O'Brien can go into that in greater detail. The claims owned by the private health insurance are obviously a concern for us and in the past we had an issue with consultants failing to sign off. That has not been a problem. That end of it is sorted in the main and Mr. Tom Byrne, as was said, has visited various hospitals and has been sitting in this room while somebody was in the other room signing forms before he got to them. That is not the issue. The issue now is with the insurance companies themselves and delayed payments and we are going to take them to task over that. The Deputy is right in pointing out that this money belongs to the public health system and should be in the public health system, and that it is badly needed by the public health system. I will pass over to the Minister of State, Deputy Kathleen Lynch.