Colm Burke (Fine Gael) | Oireachtas source

I apologise for not being here for part of the meeting. I was dealing with the Minister for Justice and Equality on a Commencement matter in the Seanad. I would like to ask the Minister about Project Ireland 2040 and the Sláintecare report. It has been identified that additional hospitals are needed in certain locations, including Cork. I understand that a group of people from various agencies in Cork, including Cork City Council, Cork County Council, UCC, the voluntary hospitals and the HSE, has been put together with a view to identifying a site for a new hospital in Cork. The identification of a site is a crucial issue. There have been 25 years of delays in developing a new children's hospital in Dublin. Even though all of the people who should be on this group were identified six or eight months ago, I understand the HSE has made no effort to call the group together. I am a little concerned about that. The first issue is identifying a site. The next issue is going through the planning process. These issues have to be dealt with before budgetary commitments are made. It should be simple to identify the pros, cons and disadvantages of a number of sites. I will explain why I am concerned to ensure this is treated as a priority. The population of Cork city and county has increased from 410,000 to 542,000 or by 130,000 over the past 30 years. It is growing at a phenomenal rate. Within the next eight years, there could well be a population in excess of 700,000 in the area in question. For that reason, I this serious issue is a priority. I would like to know whether the Department of Health can communicate with the HSE on this issue. We are talking about building additional units. At what stage do we start looking at sites? I am a little concerned about that.

I would like to raise a second matter. Over the past three years, the HSE has taken on more than 12,000 additional people. The number of staff in the HSE has increased from over 99,000 to over 110,000. I have concerns about the number of people being taken on in administration and management. I accept fully that they need support. If one looks at the entire staff of the HSE, more than 17,600 people work in administration and management and a further 7,500 are in nurse manager roles. Technically, there are more than 24,500 people in these positions. In fairness, nurse managers also provide nursing services. We seem to have a management structure everywhere. One of the problems I find with the HSE is that I cannot get anyone to make a decision. I recently dealt with a case in which 12 people from the HSE and Acquired Brain Injury Ireland were summoned to a meeting to make a decision on one person. Just 24 hours before the meeting was due to happen, one person announced that he or she had moved to a new job in the HSE and would not attend the meeting but did not set out who would attend in his or her place. As a result, the meeting was cancelled. I find that astonishing. I have come across many cases in which a medical practitioner who is trying to make a decision about a particular patient reports to management the issues he or she is dealing with, only for three different groups of people in administration to tell him or her how he or she should manage the patient in question. This is causing significant morale problems for nursing and other staff in hospitals. It seems that no one can make a decision on a particular issue. I raised this last week when Dr. Holohan came before the committee to speak about the proposed patient safety Bill. Doctors and nurses are being held accountable for every step they take, but we do not have any accountability on the managerial side. I refer not only to the decision-making process on the managerial side, but also to the delays in making decisions. When was the last time a HSE manager was disciplined? It is right that doctors and nurses are held accountable when errors are made. I wonder what process we can set up to deal with this issue if we want to have reform. There is resistance to reform. How do we propose to deal with this issue in that context?

I would like to mention a final issue. We met Professor John Higgins from Cork last week to discuss gynaecological services. A second theatre needs to be opened in Cork to deal with such services. The HSE ended up renting space from the Mater Private Hospital in Cork and the consultants moved to that hospital. Public patients were dealt with there in an organised way. More than 1,500 people were taken off the waiting list as a result of an initiative led by management and consultants. It seems that problems have been encountered in opening the second theatre in Cork University Hospital so that this service can be provided. We have the space and the theatre, but we seem to have a problem getting it opened. If we want to implement Sláintecare, how do we deal with all of the issues that will arise? We are trying to get people to accept that change must come about, that they must take responsibility for the decisions they are making and that they must take the people around them into account.