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

Fair play to Deputy Troy for getting as many questions in as he could. I can come back to Deputy Regina Doherty about scope and objectives regarding e-health and give her a very detailed answer. This is a hugely important initiative and we have nearly finished our ICT strategy, which will be ready in the next few weeks. It is critically important for the reform of the health service. I was astonished to hear the other day that there are 1,700 different IT systems within the health service. They do not all rate the pay but they are all different little systems that have grown up for different purposes. We must address that and are doing so. We will have a very cogent and coherent plan for that. It is important to say that there has been a history of near trepidation and fear of anything to do with IT ever since the PPARS fiasco but this is a nettle we must grasp. I am very pleased to say that very good people in the HSE and the Department are working on this. The new chief information officer will be critically important in this regard.

In respect of HIQA, it is not an investigation but a review. It was a standard review to be done in the second quarter but I want it done now with immediate effect insofar as that can be achieved. Obviously, it must make some preparations to do it. It should not take a long period of time. It will be comprehensive and will certainly focus on the areas that have been highlighted here such as the issues in Letterkenny, the issues mentioned by Deputy Catherine Byrne in St. James's Hospital and issues that have arisen in Drogheda and the north east. It will be right across the system to see why we have had problems. As I said earlier, it is certainly not acceptable that an ambulance should be held for an hour outside an emergency department. If nothing else, they should give them a spare trolley and let them go. The patient in need lying at the side of the road must be looked after and looked after quickly.

I will let Mr. Carter address the area addressed by Deputy Catherine Byrne in a more comprehensive fashion. Sticking with Deputy Regina Doherty, Mr. O'Brien can clarify the issue of the top ups but my position is that I am talking about best practice in terms of the management of a public hospital and any perceived or real conflicts of interest that might exist through being CEO of both a public and a private hospital and what that might mean. What Mr. O'Brien was alluding to was compliance with public sector pay but I can let him talk further about that.

In respect of Senator Crown's question, the graduate nursing scheme will continue. I was very much involved with and supportive of this scheme.

It offers job opportunities outside the employment control framework imposed by the Government and it gives nurses a chance to stay here while developing their skills. A range of areas, such as wellness screening and prescribing, as well as procedures like intravenous cannula insertion and catheterisation, would be invaluable not only in a community setting, whether a nursing home or general practice, but also in hospitals. While we cannot guarantee people jobs when their two-year term has been completed, if they are employed it will be at the full rate. In my view they will be highly sought after and, as general practice expands to cope with an increasing workload, much of the work will be carried out by practice nurses. I would like to see every GP employing at least two practice nurses to deal with the amount of work coming their way. I ask the chief nursing officer to address that issue in more comprehensive detail.

In regard to the current constitution of voluntary hospital boards, the comments from the director general preceded what we found in Tallaght and we have been addressing anything that has happened since then with the new competence based regime. The director general can address that issue more comprehensively. In regard to who is responsible, the trusts will be answerable to the HSE in the interregnum until the new health commissioning agency is established. At all times they are ultimately answerable to the Department of Health, the Minister for Health and the Oireachtas.

I do not have details on the mobile clinic in Crumlin and will refer the issue to the HSE. The roll-out in respect of children under the age of six years will take place in the middle of the year. A number of contractual issues have to be resolved and it will be necessary to consult stakeholders. Legislation is also required.

I apologise to the committee for indicating in my opening statement that planning permission for the new children's hospital will be dealt with by the end of this year. It will actually be spring of next year. That will not delay construction, however. We have appointed a children's hospital board which is working well. One of the key issues is to ensure that the mindset of the board, management and those who will staff the hospital regard it as a virtual hospital even before it is completed so that all the problems we encountered over 17 years in Tallaght and when Beaumont Hospital was set up will not arise in this instance. Even though there was a close relationship between Beaumont and the former Richmond Hospital, as a local GP I can attest that it was a long time before the hospital got its act together. We want to make sure the problems are addressed long before construction is completed in late 2018.

Deputy Troy asked about the money follows the patient model in respect of emergency departments. It was never intended that the money follows the patient model would apply to an emergency department because it would be too complex to achieve. Emergency services will be funded centrally. He referred to Mullingar in particular, which is a great hospital, and asked about the dermatology plan for the midlands. I will revert to the Deputy on that. We can examine the question of reinstatement and see what it throws up. I agree with him that it would be a useful exercise to investigate the funding and staff ratios of maternity hospitals, including Mullingar in particular, and I will revert to him on that. We continuously review what happens in our hospitals, particularly our maternity hospitals, and are actively considering the question of co-locating maternity and adult hospitals.

Members' questions on medical cards were addressed earlier. I acknowledge the concerns that have been expressed about the ability of those with lifelong conditions to access services. We will be putting in place a small review group within the HSE to investigate how we can best address the needs of such individuals. As Mr. Healy addressed that issue in some detail, Deputy Troy will forgive me if I do not rehearse his comments.