Oireachtas Joint and Select Committees
Thursday, 23 April 2015
Public Accounts Committee
2013 Annual Report of the Comptroller and Auditor General and Appropriation Accounts
Vote 39 - Health Service Executive
Chapter 14 - Procurement by the Health Service Executive
Health Service Executive Financial Statements 2013
10:00 am
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I remind members, witnesses and those in the Public Gallery to turn off their mobile phones because they interfere with the sound quality of the meeting. I ask everyone to ensure their mobile phones are removed from the desks because if they are left sitting in front of microphones, interference can be picked up.
I advise witnesses that they are protected by absolute privilege in respect of the evidence they are to give this committee. If they are directed by the committee to cease giving evidence on a particular matter and they continue to so do, they are entitled thereafter only to a qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given. They are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against a Member of either House, a person outside the House or an official either by name or in such a way as to make him or her identifiable.
Members are reminded of the provision within Standing Order 163 that the committee should also refrain from inquiring into the merits of a policy or policies of the Government or a Minister of the Government, or the merits of the objectives of such policies.
I welcome Mr. Tony O'Brien and his officials to today's meeting. I also welcome Mr. Greg Dempsey of the Department of Health. I ask Mr. O'Brien to introduce his officials.
Mr. Tony O'Brien:
I thank the Chairman. I am joined by Mr. John Swords, who is the HSE's head of procurement; Mr. Pat Healy, who is the national director of social care; Mr. Stephen Mulvany, who is the chief financial officer; Ms Valerie Plant, who is an assistant chief financial officer; and Mr. Paddy McDonald, who is also an assistant chief financial officer.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I ask the officials from the Department of Public Expenditure and Reform to introduce themselves.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I ask the officials from the Office of Government Procurement to introduce themselves.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Thank you. You are all welcome. I call the Comptroller and Auditor General to make his opening statement.
Mr. Seamus McCarthy:
The appropriation account for Vote 39 indicates that the Health Service Executive gross expenditure for 2013 amounted to €13.87 billion. This was approximately €98 million more than provided for in the original Estimate for the Vote approved by Dáil Éireann. Approximately 10% of the amount spent was funded through a range of appropriations-in-aid of the Vote, which amounted to €1.37 billion in 2013, a shortfall of approximately €89 million compared to the amount of receipts forecast in the original Estimate. The net result was a requirement for Exchequer funding of €12.5 billion for 2013, approximately €188 million or 1.5% more than originally budgeted for. This budget overrun was met by a Supplementary Estimate in December 2013 which allocated an additional €219 million to the HSE. The €31 million unspent at the end of the year was liable for surrender.
While the overrun relative to the original Estimate in 2013 is relatively modest, it continued a pattern of such overruns that has extended over many years. In addition, the variance relative to budget is more significant in some spending and receipts areas than others. The HSE is one of a small number of Votes in respect of which a Supplementary Estimate is required annually. Notes 3 and 4 of the appropriation account provide explanations of significant variances in spending and receipts.
The Accounting Officer has included in the appropriation account a comprehensive statement on the system of internal financial control in place in the HSE. This reflects the complexity of the HSE as an organisation and the range of services and facilities it provides. I am keen to draw the committee's attention to certain key matters dealt with by the Accounting Officer in that statement. These relate to the extent to which the HSE does not comply with its own procurement procedures, based on national and EU procurement rules - I have reported separately on this matter and I will outline my findings in that regard presently; the development by the HSE of arrangements to enhance its oversight of the governance of section 38 funded agencies, a matter the committee has inquired into previously, in particular their adherence to national public pay policy; a comprehensive review by the HSE examining its compliance with tax rules - this review was ongoing when the account was being finalised and the HSE expected to settle any underpayment of tax during 2014; the non-collection of income in respect of services provided by the HSE to some nationals of other EU states who are visiting or resident in Ireland due to weaknesses in the data collection systems in respect of such cases; and measures and initiatives taken by the HSE to ensure appropriate control over medical card eligibility.
Chapter 14 deals with the issue of procurement by the HSE, in particular, the extent to which procurement is based on competitive processes that can potentially deliver significant savings to the HSE. To put the matter in context, excluding drugs paid for by the primary care reimbursement service, approximately €1.6 billion of the HSE's €14 billion expenditure relates to the procurement of goods and services directly by the HSE.
The chapter under examination today is not the first occasion on which we have reported on procurement by the HSE. Committee members may recollect that the 2010 report on the accounts of the public services contained two chapters dealing with aspects of procurement by the HSE. One dealt with procurement generally while the other examined procurement of external consultancies. These chapters were examined by the committee in June 2012.
Among the conclusions and recommendations in those chapters were that there was scope for the HSE to increase its use of procurement frameworks; procurement should be based on up-to-date contracts rather than on simply rolling over expired contracts; the HSE had not put in place an adequate system to track non-competitive procurement and, therefore, did not know the extent to which procurement was not compliant with procurement rules; and that out of a sample of 27 consultancies which cost the HSE a total of more than €41 million, the executive had tendered openly for only ten and that only ten had formal contracts or service level agreements in place to govern the procurement.
In the chapter under examination by the committee this morning, we report that non-compliance with procurement rules continued to be a significant problem within the HSE in 2013. We examined in detail a sample of 100 purchases in 2013 at six different HSE locations with a total value of €2.2 million. We found that more than one third or 36% had not been subject to appropriate procurement processes. In terms of value, these represented 47% or almost half of the value of the items examined.
The HSE is required to submit an annual report to my office and to the Department of Public Expenditure and Reform on any non-compliant procurement. The report for 2013 referred to 116 contracts valued at €17.6 million having been awarded without a competitive process. Our examination found that 31 of the 36 instances of non-competitive procurement identified should have been included in that report. In fact, only three were included. On that basis, we concluded that the HSE's internal assurance process is failing to highlighting the true level of non-compliant procurement that is occurring.
We found that, centrally, the HSE had increased the number of framework agreements in place from 52 to 83 in the three years since July 2011. However, the audit found a lack of awareness of the existence of those frameworks at the six locations visited during the audit.
The HSE has provided to the committee a copy of the management letter issued by my office following the 2013 audit of the HSE's appropriation account and annual financial statements. A draft of the letter was inadvertently released by the HSE some weeks ago. This has been mentioned previously at this committee. Normally, the management letter does not come into the public domain and, therefore, it might be helpful for me to explain the context.
The primary purpose of the letter is to formally alert management and the HSE audit committee of any matters of concern that come to our attention during the course of an audit. It does not aim to be a complete report on all control weaknesses or irregularities within the HSE. We simply could not undertake the amount of work necessary to provide such a report each year, and, in any event, the HSE's own internal audit examines and reports on the operations of HSE controls. The letter forms part of an overall feedback system to HSE management and the audit committee. We also communicate any matters of concern that arise in the course of regular meetings with management and the audit committee throughout the audit cycle. The management letter formally captures the salient issues as well as the response of management and serves as a key reference document for follow up by us in the next year's audit. Failure on the part of the HSE to address significant matters raised could result in future examination or possibly a report on the matter.
Our draft management letter for 2013 issued to HSE management on 30 September 2014. We sought HSE management's response to the points raised. I understand that while this was being compiled, the letter was inadvertently released around the beginning of March. Since then, the HSE has provided its final response on the points we raised and this is captured in the final version of the letter, which is before the committee today.
The table on screen before the committee sets out a summary of the key areas where we had findings and the priority classification we awarded these. Overall, there are 52 points in the letter. These can be conveniently categorised into 12 areas. Each of the 52 points is awarded a rating based on its perceived importance. A high rating indicates a significant weakness in the current control environment, financial management or governance that, in our view, requires immediate action by HSE management. A medium rating represents an opportunity to improve the effectiveness of the control environment, financial management or governance, and requires management attention in the near term. A low rating is a general opportunity to improve efficiency and effectiveness of the processes or controls. Further low risk issues may be identified by us. These are discussed with the relevant managers and we keep them under review.
Of the issues rated as high, a large number relate to the control over grants to outside agencies, the operations of the primary care reimbursement service and the nursing home support scheme, known as the fair deal scheme. We have highlighted many of these issues in reports in the past and in audit certificates relating to HSE financial statements.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Thank you Mr. McCarthy. Mr. O'Brien, will you make your opening statement, please?
Mr. Tony O'Brien:
Thank you for the invitation to attend today's meeting to discuss the Comptroller and Auditor General's 2013 report and appropriation accounts relating to Vote 39 - Health Service Executive and Chapter 14 relating to procurement by the HSE.
I wish to record my thanks to the committee for its kindness and sensitivity in rescheduling this meeting. We have submitted information and documentation to the committee in advance of the meeting and I will, therefore, confine my opening remarks to the following issues.
The first is the 2013 out-turn. The Revised Estimates volume provided a net vote estimate of €12.312 billion for the HSE, a reduction of €209 million from the final 2012 allocation. A net Supplementary Estimate of €219 million was passed by the Dáil on 12 December 2013. The Supplementary Estimate amounted to 1.8% of the original net Vote with €188 million or 1.5% eventually required and the balance of €31 million returned to the Exchequer. From the outset in 2013, the Department of Health and the HSE identified certain risks to the achievement of the very demanding savings targets in the 2013 service plan. Some of these risks materialised, including the delay in finalising and implementing the Haddington Road agreement, which was €70 million; the decision by the Government to defer the introduction of charging for private patients occupying public hospital beds, which was €62 million; and the delay in the introduction of regulations under the FEMPI Act to reduce fees paid to doctors and pharmacists which could not be introduced until the Haddington Road agreement was finalised.
Outside of these areas the HSE delivered a €25-million surplus made up of deficits on core services, primarily hospitals and surpluses on capital and other services. This was a considerable achievement in view of the very challenging environment in which the HSE operated in 2013 given the increasing demand due to demographic pressures, the need to ensure patient safety as a priority at all times and the very challenging targets for service delivery.
The draft management letter for the 2013 audit was issued by the Comptroller and Auditor General on 30 September 2014 on completion of the audit and certification of the HSE accounts. The purpose of sending a management letter in draft format is to set out the Comptroller and Auditor General's observations from the audit and to confirm the factual accuracy of those observations with the HSE. On receipt of the Accounting Officer's response, the Comptroller and Auditor General further considers his observations in light of the responses received before formally issuing the management letter to the Accounting Officer. The Comptroller and Auditor General has pointed out that his management letter should also be considered in the context of the audit certificate and any chapters in the Comptroller and Auditor General's annual report. The final management letter has been received by the HSE and a copy has been provided to the committee in advance of this meeting.
I have set out the actions which have been or are currently being taken by the HSE to address the control issues identified. These issues underline the imperative of specific and sustained focus on compliance at all levels of the organisation. The implementation of these recommendations by management will be co-ordinated by a national financial controls assurance group and progress will be monitored during 2015 by the national performance oversight group and the audit committee. The situation will also be reassessed by the HSE in the 2015 review of the effectiveness of the system of internal control.
The HSE established a compliance unit in 2014 to support the development of a strong and consistent compliance culture across all section 38 and 39 agencies funded by the HSE. A key role of the compliance unit is to safeguard the regulatory and governance obligations of the HSE through ensuring that all funded agencies are compliant with the guidelines and regulations as set out in the service arrangements.
The primary legal framework under which the HSE provides financial support to non-statutory service providers is set out in the Health Act 2004. In 2009, the HSE developed a formal national governance framework with national standard governance documentation known as service arrangements to manage the funding provided to these agencies and this came into operation in 2010. The service arrangements are to ensure a national standardised consistent application of good governance and eliminate the need for individual contracts to be created each time the HSE funds an agency.
In December 2013, the HSE sought to enhance its governance arrangements with section 38 agencies and also to strengthen the direct relationship between the HSE and the boards - as distinct from executive management - of each of these agencies. In particular, the HSE established a formal engagement process with the chairs of the boards, including formal meetings twice a year; introduced a new compliance statement whereby the chair and another director of the board signs and confirms on behalf of the board that the agency had complied in full or in part with eight key areas under its service arrangement; and defined best practice requirements for boards and corporate governance arrangements. The requirement for an annual compliance statement came into effect on 1 January 2014 and is applicable to each agency's 2013 annual financial statements with a requirement for agencies to have a plan in place to achieve compliance in respect of 2014. All section 38 agencies signed the annual compliance statement in respect of 2013.
The committee will have recently received the HSE report on the implementation of recommendations in the HSE's internal audit report on section 38 agencies' remuneration. As the committee will be aware, the internal audit report contained 22 recommendations which dealt, in the main, with issues of compliance with approved public sector remuneration levels for senior management in agencies funded under section 38 of the Health Act 2004. A total of 17 of the recommendations have been implemented in full, a further three are still in progress and it was not possible to implement two of the recommendations due to information gained or decisions made since the audit was completed. One of the recommendations, No. 9, relates to decisions in respect of applications to red-circle remuneration arrangements on a personal to post holder basis due to legal contractual entitlements. A total of 85 such cases have been submitted for consideration from 25 agencies. These applications have been made under section 7(4) of the pay policy and have been made by the agencies after they obtained independent legal advice to ensure that action taken by the agency as an employer is legally compliant. This mitigates the risk of future legal action to the greatest extent possible. The cases were submitted to the Departments of Health and Public Expenditure and Reform and we are awaiting their decisions.
This committee had a significant interaction with St. Vincent's Hospital Group. There remain serious outstanding issues concerning overall governance arrangements in this group, notwithstanding the clear commitments made here and to the HSE concerning "swinging around into compliance" by the then chair of the group board. To be fair to him, he had made some important progress on that before his removal from office by the group's shareholders.
Members have received an advance briefing document on chapter 14 of the Comptroller and Auditor General’s report dealing with procurement by the Health Service Executive. In the conclusion to Chapter 14, the Comptroller and Auditor General drew attention to a number of issues and made a number of recommendations. The HSE accepted the conclusions and the related recommendations and has over the past 15 months implemented actions to address them. It is also important to note that through ongoing work in procurement over the past number of years, significant savings have been achieved by the HSE.
In respect of the recommendations and the actions taken by the HSE, I highlight the following. In November 2010, an agreement was negotiated following an LRC process to implement a single integrated procurement function for the HSE. This implementation necessitated the re-positioning of all procurement staff to the head of procurement. In 2013, a further change was implemented and progressed following the Government decision incorporating the Office of Government Procurement, OGP, and "one voice" for health procurement. A health procurement plan 2016-2019 is under preparation in consultation with budget managers across the health system. A procurement programme management system, PPMS, is being developed to manage work in progress in regard to future multi-annual procurement plans and to provide up-to-date reporting on progress and outcomes. Since the audit, some frameworks have been combined on the basis of similar requirements and also some frameworks are transferred to the OGP. The HSE currently has put 80 national framework agreements in place covering the majority of its common expenditure categories and has in excess of 550 central contracts in place covering an annual expenditure value of €426 million. To improve the communications, awareness of framework agreements and contracts, the HSE has developed a procurement assisted sourcing system, PASS, from which budget holders will be able to access current contracts information.
The HSE is implementing on a phased basis the national distribution centre, NDC, plan which will consolidate stock holding across the HSE, improve contract compliance, increase stock management at the point of use and control and deliver efficiencies in transactional costs. Over the past 15 months, HSE procurement has achieved cost reductions of over €50 million. Since 2010, with the development of a centralised procurement function, total savings achieved to date have been €250 million. Work has commenced on a data warehouse and business intelligence system which will allow for information to be extracted for reporting, data analysis and comparisons across the numerous financial systems within the HSE. The HSE has commenced a new training programme for senior managers outlining the importance of being compliant with procurement rules and national financial regulations. Over 100 senior staff members have been trained to date. Arising out of the finance reform agenda, we are currently considering options to deliver an integrated financial and procurement management system.
These systems and enhanced processes will assist budget holders and procurement personnel in identifying areas where greater efficiencies can be achieved and will support compliance with procurement rules.
A detailed briefing note was submitted to the committee on the issues relating to the Waterford intellectual disability service. I will highlight several points in regard to this very serious and sensitive matter. The HSE has been involved in undertaking an inquiry into the standard of care provided by one foster family in Waterford over an extended period. This inquiry involved two distinct phases. The first, which commenced in 2010, examined the standard of care provided to a person with an intellectual disability who resided with that foster family. This report, the Conal Devine report, was completed in March 2012. A complex legal process followed the completion of the first phase of the investigation. Once that was resolved, the second phase involved a full tracing and look-back exercise in respect of all clients, living and agreeable to this process, who had contact with the foster family concerned.
In addition to the inquiry by the HSE, these matters are also subject to an ongoing Garda investigation, as well as civil proceedings. The matter has also seen the involvement of the Wards of Court office. In this context, the HSE is limited as to what it can comment on publicly. The service and policy issues have been the subject of discussion at the Joint Committee on Health and Children and the HSE has committed to providing that committee with a copy of the inquiry reports once clearance has been received from An Garda Síochána and the Office of the Wards of Court. The Data Commissioner has also been advised of the HSE's intention to publish the reports once clearance is received. In the meantime, the HSE is anxious to assist this committee in so far as possible in its consideration of the procurement issues involved in the process.
The appointment of inquiry teams is not subject to tender for several reasons. The nature of inquiries is that they deal with sensitive issues which it would not be appropriate or even permissible in some cases to discuss or publish for the purposes of conducting an open tender process. Inquiries are often urgent and the time periods for open tendering do not permit the conduct of a tender process in such circumstances. The scope and extent of inquiries often means there may be only one person or collection of persons with the technical expertise to deal with the matter. Professional experience and expertise are critical for the conduct of inquiries.
There are exceptions under procurement rules which mean the HSE is not required to tender in each of the above circumstances. The relevant regulation is Regulation 32 of the European Communities (Public Authorities' Contracts) Regulations 2006, which permits awarding authorities to engage in a negotiated procedure without a call for competition in these exceptional circumstances. In the briefing note that was submitted to the committee on this serious and sensitive issue, we set out the process that was followed in regard to the procuring of Conal Devine, who undertook the first phase of the inquiry, and Resilience Ireland, which undertook the second phase. Resilience Ireland appointed an inquiry team which consisted of two people who previously worked in the health system, and the briefing provides further detail in that regard.
It is important to point out that the expertise required to undertake this broad-ranging and sensitive work included expertise in conducting serious incidents, reviews and investigations, knowledge of the social care services, child protection knowledge and expertise, as well as knowledge and experience of safeguarding practice. This type of expertise is not readily available in Ireland. As a result, the local HSE area asked Resilience Ireland to undertake the review as it had available the specialist staff and knowledge, which included the former health care employees, to undertake the review within the timeframe available. It is important to emphasise that while these former health care employees have worked in the health system in the past, neither has ever held management responsibility for service delivery in the Waterford or south-east areas.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Thank you, Mr. O'Brien. May we publish your statement?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I will now take questions from members, beginning with Deputy Patrick O'Donovan.
Patrick O'Donovan (Limerick, Fine Gael)
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Thank you, Chairman. I welcome the witnesses and thank Mr. O'Brien for his presentation. Prior to my becoming a member of this committee, issues relating to section 38 agencies were examined in considerable detail here. I understand a total of 202 business cases were presented to the HSE relating to instances where the remuneration of individuals was outside of the accepted pay policy guidelines. Are there any other agencies where such applies and in respect of which a business case has not been submitted?
Patrick O'Donovan (Limerick, Fine Gael)
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Can Mr. O'Brien give us information on those cases?
Mr. Tony O'Brien:
They relate to two individuals who are employed at the National Maternity Hospital, Holles Street and in respect of whom a red circling is not being sought. The issue there is simply one of disclosure, and a process is under way involving the national director of acute hospitals. In other words, we are in process with Holles Street at the present time.
Patrick O'Donovan (Limerick, Fine Gael)
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Is the HSE aware of the total remuneration package in these two cases?
Patrick O'Donovan (Limerick, Fine Gael)
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How far outside of the cap are the remuneration packages in these cases?
Mr. Tony O'Brien:
Given that I do not have the full details, I am loth to speculate. It is important to stress that the argument being advanced is that these individuals are not receiving any additional public sector remuneration. Consequently, the process that is under way is simply seeking to establish the full facts in the matter. I am a little hesitant to say anything definitive until we have the full information.
Patrick O'Donovan (Limerick, Fine Gael)
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However, this has been going on for more than a year and we still do not have the full information. It involves only two individuals. When can we expect to have the full information in this regard?
Mr. Tony O'Brien:
My understanding is that following the airing of this matter at the recent meeting of the Joint Committee on Health and Children, the institution concerned has agreed to provide the information to the national director of acute hospitals. We will then be in a position to take a view as to whether the remuneration is inside or outside of pay policy. At that stage, we will be able to advise the two committees that these matters have been resolved.
Patrick O'Donovan (Limerick, Fine Gael)
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If it is anticipated that a business case is due from Holles Street, can we not take it that the remuneration of the individuals concerned is outside the cap?
Mr. Tony O'Brien:
The issue here, and it relates to the totality of the subject matter, is that the individuals in question were receiving remuneration above and beyond the approved level of pay for the posts they held. In some of the cases we looked at, that was done by way of payments that were effectively coming from the public purse. In other instances, it was by way of pay that was coming from a separate source. In this particular instance, a business case has not been made to continue making payments from the public purse because it is contended that the pay was never coming from that source.
Patrick O'Donovan (Limerick, Fine Gael)
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The pay is coming from another source?
Patrick O'Donovan (Limerick, Fine Gael)
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Do we know what that source is?
Patrick O'Donovan (Limerick, Fine Gael)
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The National Maternity Hospital is funded through the HSE and it is important that we should know what its staff are being paid. Two years after this process began, it seems there are two people employed by it whose remuneration is outside the cap, but we still do not know how much they are being paid or from what source the pay is coming. That is not acceptable.
Patrick O'Donovan (Limerick, Fine Gael)
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When will we have that information?
Mr. Tony O'Brien:
As I indicated, following the recent airing of this matter and the publication of the update on the report, a process of engagement was initiated. I am given to understand by the national director of acute hospitals that he expects to have the full information within a couple of weeks.
Patrick O'Donovan (Limerick, Fine Gael)
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What if he does not receive that information? This has dragged on for years, with Holles Street still not in compliance.
Mr. Tony O'Brien:
Holles Street would contend that it is in compliance with public pay policy. We are saying that by not giving us this information, it is not in compliance with our process. While that might seem like splitting hairs, there is an important distinction. In some instances, throughout this process, we discovered that some of the returns that were made to us at the outset included arrangements which probably should never have been returned. For example, there were instances where people were receiving genuinely private income from legitimate private sources but, for reasons of administrative convenience, this was put through a singular pay roll and returned to us, which might not have been the appropriate thing to do. These issues are never completely black and white. I am conscious that whenever this issue comes up, two individuals in Holles Street may be feeling under particular pressure. I do not want to suggest that we have reached a view that they are in breach of public policy. We do not yet know whether or not that is the case.
Patrick O'Donovan (Limerick, Fine Gael)
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However, I reiterate that it is not acceptable to have an outlier in the case of Holles Street, two years after this process began. Did the HSE not consider the matter important enough to seek to clear it up before now? There are 202 other cases where issues have arisen in regard to red circling and so on, but this uncertainty in regard to the personnel at Holles Street cases is allowed to drag on.
Patrick O'Donovan (Limerick, Fine Gael)
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How much does Holles Street hospital get from the HSE every year?
Patrick O'Donovan (Limerick, Fine Gael)
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That is a considerable amount of money for an important institution in Dublin. After everything that has happened on the pay issue, was it not on the HSE’s radar to deal with this issue before now?
Patrick O'Donovan (Limerick, Fine Gael)
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This discussion relates to several individuals and what happened in 2013. If there were allowances made available to them from an outside source, do we know if they have been discontinued?
Mr. Tony O'Brien:
On the two individuals in question, my understanding is that they continue to be in receipt of the separate remuneration. It is contended, however, by the institution that it is not within the scope of public pay policy, in other words, there is not a breach of public pay policy in the case of these two individuals.
Patrick O'Donovan (Limerick, Fine Gael)
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Are they publicly funded for public work?
Patrick O'Donovan (Limerick, Fine Gael)
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Yet it is enhanced from another source.
Patrick O'Donovan (Limerick, Fine Gael)
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Does that not sound familiar?
Mr. Tony O'Brien:
It sounds familiar in that it is a case that was made by others and found not to be correct. If it is genuinely a separate set of exercises in which they are involved, after they have fulfilled their contract with the health service, there is no legal prohibition on their having external employment. If that is what it is and can be shown as such, we do not have an issue. Clearly, we are waiting for the evidence.
Patrick O'Donovan (Limerick, Fine Gael)
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Are these individuals in management or medical roles?
Patrick O'Donovan (Limerick, Fine Gael)
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There are two individuals in management roles in the National Maternity Hospital outside the pay cap in receipt of allowances from outside. For how long has this been going on?
Patrick O'Donovan (Limerick, Fine Gael)
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I did not ask that question. We have been down this road before and saw the damage these circumstances did to the charity sector and other health service providers. After all of this, we still have two individuals in the National Maternity Hospital which is funded to the tune of €40 million from the Exchequer who are outside the pay cap.
Patrick O'Donovan (Limerick, Fine Gael)
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What is the position on the former chairman of St. Vincent's University Hospital?
Mr. Tony O'Brien:
What came out of the committee’s engagement with St. Vincent’s University Hospital was a wide range of issues which had obviously started off with public pay policy. All of the unauthorised allowances, the subject of the discussion, were discontinued in line with the commitments made by the chairman when he attended the committee. It included some staff members actually leaving the public service altogether.
The outstanding issue relates to the relationship between St. Vincent’s Private Hospital and St. Vincent's University Hospital which are under the combined management of a board known as the St. Vincent's Hospital Group. The concern aired by the committee at the time - it is continuing - was that consultants whose contracts did not permit them to work in private hospitals were being permitted by the St. Vincent's Hospital Group to do so. The information I have available is that approximately 56% of the admitting consultants at St. Vincent’s Private Hospital are consultants whose contracts do not permit them to work there. We have been seeking to obtain full disclosure by the new board. There was a change of board-----
Patrick O'Donovan (Limerick, Fine Gael)
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For how long has the HSE been seeking that information?
Patrick O'Donovan (Limerick, Fine Gael)
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Is it the case that it will not give the information?
Patrick O'Donovan (Limerick, Fine Gael)
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How much does St. Vincent’s University Hospital receive from the HSE?
Mr. Tony O'Brien:
It receives €206 million. It is citing spurious issues such as data protection. I am seeking to know exactly how much work is being done by each consultant in the private hospital. Any one of us could log on to its website and pull down a full listing of all the consultants who work there in one form or another. Funnily enough, I have a copy in my bag. It does not, however, give me the level of detail that I need. My concern is that, in effect, the private hospital is being run on the back of the public hospital. I am concerned for the public hospital, but I am equally concerned for the private hospital. Given its bed stock, number of theatres and parasitic dependence on the public hospital, it may well not be viable as a private hospital. It is a private hospital that was developed on the back of the tax investor scheme, which means that it has serious implications for health care in the area and those who invested in it. I want to balance this by saying St. Vincent’s University Hospital is an important part of our health infrastructure and has many fine clinicians, as well as fine national and specialist services. This should in no way reflect on the quality of care provided in it.
Patrick O'Donovan (Limerick, Fine Gael)
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If it is parasitic, is it Mr. O’Brien’s contention that the public hospital is, in some way, being put in a negative position? Is the service in the public hospital at a loss because of the private hospital?
Patrick O'Donovan (Limerick, Fine Gael)
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This has been going on for three years. Is it affected or not?
Mr. Tony O'Brien:
It is clear to me from the information I have available which does not yet amount to full disclosure that 56% of the consultants admitting to the private hospital have contracts which in the ordinary course do not allow them to do so. There were substantial commitments made at the committee by the then chairman of the hospital, a distinguished former Secretary General to the Government. He was very clear and pursued those commitments while he remained in office. He was removed from the position by the shareholders of the group. Since that time, while we have been given various assurances, we have not had full disclosure.
Patrick O'Donovan (Limerick, Fine Gael)
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Since he was removed or got rid of, less information has been made available to the HSE.
Patrick O'Donovan (Limerick, Fine Gael)
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What is the current chairman saying to the HSE?
Patrick O'Donovan (Limerick, Fine Gael)
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Is the current chairman obstructing Mr. O’Brien’s work?
Patrick O'Donovan (Limerick, Fine Gael)
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What is Mr. O’Brien doing about it?
Patrick O'Donovan (Limerick, Fine Gael)
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Has the chairman who is not being as helpful as Mr. O’Brien would like any role in the public hospital?
Patrick O'Donovan (Limerick, Fine Gael)
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Who appointed him?
Patrick O'Donovan (Limerick, Fine Gael)
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Who are they?
Patrick O'Donovan (Limerick, Fine Gael)
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Was the appointment made with the approval of the HSE or the Department of Health?
Patrick O'Donovan (Limerick, Fine Gael)
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He was appointed after the previous incumbent was got rid of. Since he has been appointed, he has not been helpful to Mr. O’Brien in finding out what is happening.
Patrick O'Donovan (Limerick, Fine Gael)
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Has the HSE engaged legal services on this issue?
Patrick O'Donovan (Limerick, Fine Gael)
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When was the information first requested?
Patrick O'Donovan (Limerick, Fine Gael)
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Has Mr. O’Brien met the chairman?
Patrick O'Donovan (Limerick, Fine Gael)
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Has he met the chief executive officer?
Patrick O'Donovan (Limerick, Fine Gael)
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Is he the CEO of both the private hospital and the public hospital?
Patrick O'Donovan (Limerick, Fine Gael)
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Is there an overlap? Is there anyone fulfilling a dual role at management level?
Patrick O'Donovan (Limerick, Fine Gael)
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Does he have a role in the public hospital?
Patrick O'Donovan (Limerick, Fine Gael)
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Is his pay in compliance with the cap?
Patrick O'Donovan (Limerick, Fine Gael)
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He is a retired public employee who has been recruited by the private hospital and Mr. O'Brien cannot get information from him.
Patrick O'Donovan (Limerick, Fine Gael)
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When will this escalate to a point where the HSE will state it will not accept it any more?
Patrick O'Donovan (Limerick, Fine Gael)
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What will Mr. O'Brien do?
Patrick O'Donovan (Limerick, Fine Gael)
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How many public patients are waiting for appointments in St. Vincent's University Hospital?
Patrick O'Donovan (Limerick, Fine Gael)
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Can I receive it?
Patrick O'Donovan (Limerick, Fine Gael)
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Are the consultants' roles typically across all surgical elements?
Mr. Tony O'Brien:
As I do not have the individual names provided by the hospital as per the request submitted, I am uncertain of the exact detail. However, there appear to be publicly appointed consultants whose substantive appointments are in the university hospital but who are working in most of the disciplines in the private hospital. It is important to be clear that a number of them have contracts that permit this, while a number do not. There are different categories of contract, what are known as category 2 contracts, B star contracts and so forth, but there appear to be a number of consultants with B contracts working in the private hospital. It is our view that their contracts do not permit this.
Patrick O'Donovan (Limerick, Fine Gael)
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Since this matter has been unearthed, have other consultants been appointed in St. Vincent's University Hospital who have a similar type of contract?
Patrick O'Donovan (Limerick, Fine Gael)
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Does the new contract provide that they must work exclusively in the public hospital?
Mr. Tony O'Brien:
Broadly speaking, but I would have to provide a full breakdown because there can be certain exceptions. There is also the option of having what is known as a category C contract, which is what is normally applied for where a consultant's specialty depends on him or her being able to work privately in order to maintain his or her skills. In current circumstances I am not in a position to consider any category C application from St. Vincent's University Hospital without full disclosure. There are no category C consultants at St. Vincent's University Hospital.
Patrick O'Donovan (Limerick, Fine Gael)
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Has it requested a category C appointment to be made?
Mr. Tony O'Brien:
As part of the agreed process with the former chairman, whereby the category C requirements were fulfilled - they are very specific in terms of the public interest being served and about maintaining skills - it was agreed that such applications would be made and that, on a phased basis, they would ensure appropriate compliance in the case of other consultants, that is, they would progressively ensure they were working in the public hospital. A number of category C applications have been made by St. Vincent's University Hospital. They require the approval of the hospital and the consultant and involve some other approval processes. They are referred to a type C committee and ultimately come to me for approval. In the absence of full disclosure and being able to truly assess the impact on the overall operation of the public hospital, clearly I am not in a position to bring these applications to finality. I have advised the consultants accordingly.
Patrick O'Donovan (Limerick, Fine Gael)
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What is the financial position of the public hospital?
Patrick O'Donovan (Limerick, Fine Gael)
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When was the last time a category C consultant was appointed at St. Vincent's University Hospital?
Patrick O'Donovan (Limerick, Fine Gael)
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How many applications has the hospital made to Mr. O'Brien?
Patrick O'Donovan (Limerick, Fine Gael)
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When was the most recent application made?
Patrick O'Donovan (Limerick, Fine Gael)
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The current chairman who will not provide Mr. O'Brien with the information he has requested has advanced an application to Mr. O'Brien for the appointment of a consultant?
Patrick O'Donovan (Limerick, Fine Gael)
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However, it would be approved by the chairman.
Patrick O'Donovan (Limerick, Fine Gael)
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Was it approved by the board?
Patrick O'Donovan (Limerick, Fine Gael)
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It would be an operational issue.
Patrick O'Donovan (Limerick, Fine Gael)
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I will return to overall section 38 matters. With regard to the 202 business cases to which Mr. O'Brien referred, 84 are in the red circle. What is the maximum payment? Who is at the top of that pile? I do not seek the person's name, but what is the payment at the top of the pile?
Patrick O'Donovan (Limerick, Fine Gael)
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A total of €1 million for two months.
Patrick O'Donovan (Limerick, Fine Gael)
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That works out at €400,000 per month and we still do not know to what extent the overrun relates to the parasitic element, as Mr. O'Brien called it, of the private hospital.
Patrick O'Donovan (Limerick, Fine Gael)
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Does Mr. O'Brien believe St. Vincent's Private Hospital is an entity that can survive into the future?
Mr. Tony O'Brien:
That is a difficult question to answer. If only those consultants whose contracts in the ordinary course allow them to provide services in a private hospital were to do so, it would radically change the landscape in terms of the level of activity at St. Vincent's Private Hospital. The particularities of its bed complement versus its theatre complement suggest it could be very challenging for it.
Patrick O'Donovan (Limerick, Fine Gael)
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Is Mr. O'Brien aware of the financial position at St. Vincent's Private Hospital?
Patrick O'Donovan (Limerick, Fine Gael)
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Given what he said earlier, is it Mr. O'Brien's view that the HSE should be made aware of its financial position?
Patrick O'Donovan (Limerick, Fine Gael)
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Has it been requested?
Patrick O'Donovan (Limerick, Fine Gael)
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Does Mr. O'Brien not think that it is all a little shambolic? This is a public hospital that is already way behind where it should be, regardless of whether the budget is appropriate, and by Mr. O'Brien's estimation of the relationship between the private hospital and the public hospital, the private hospital is potentially pulling down the public hospital.
Patrick O'Donovan (Limerick, Fine Gael)
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What would be required for it to stand on its own feet?
Mr. Tony O'Brien:
It would need to provide services using consultants whose contracts permit them to operate in a private hospital. It is unique. Other private hospitals bear the name of public hospitals such as the Mater Private Hospital, but they are distinct and separate institutions operating distinctly from each other in separate ownership, which brings its own transparency. It is less than ideal to have this intermingled governance on the campus in question.
Patrick O'Donovan (Limerick, Fine Gael)
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Are any of the people in the red circle working in St. Vincent's public hospital?
Patrick O'Donovan (Limerick, Fine Gael)
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They left.
Patrick O'Donovan (Limerick, Fine Gael)
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How many remained in public service employment?
Patrick O'Donovan (Limerick, Fine Gael)
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Is their remuneration still in excess of the cap?
Patrick O'Donovan (Limerick, Fine Gael)
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Is anybody outside the cap at this stage?
Patrick O'Donovan (Limerick, Fine Gael)
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What is the pay of the CEO of St. Vincent's University Hospital?
Mr. Tony O'Brien:
The approved salary for the CEO of St. Vincent's University Hospital would be in line with that for national director level 1 - €141,000. The post is vacant. It is being filled on an acting basis by the hospital's medical director who is being paid in line with the medical director scale. However, that is a temporary arrangement.
Patrick O'Donovan (Limerick, Fine Gael)
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To go back-----
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The Deputy is over time.
Patrick O'Donovan (Limerick, Fine Gael)
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I am nearly finished.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The Deputy can intervene again later.
Patrick O'Donovan (Limerick, Fine Gael)
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With regard to the service level agreements reached after the HSE had started its examination, has any section 38 organisation had its funding discontinued by the HSE?
Mr. Tony O'Brien:
No, but the possibility was used as a lever to ensure compliance. The Deputy may recall that at a certain point in 2014, when we wanted people to comply on the submission of business cases, it was made clear to a few institutions - I think the matter was discussed here - that if the deadline was not complied with, their funding would be at risk. However, we have not, to date, done this.
Patrick O'Donovan (Limerick, Fine Gael)
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How many are not in compliance?
Patrick O'Donovan (Limerick, Fine Gael)
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What organisation is it?
Patrick O'Donovan (Limerick, Fine Gael)
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There are 84 so-called red circle remuneration arrangements. How many of them relate to the 143 business cases the HSE received for senior managers? The total number of business cases submitted was 202, of which 143 related to people at grade VIII or higher. How many of those in the red circle are in that group?
Patrick O'Donovan (Limerick, Fine Gael)
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Will it be soon?
John Deasy (Waterford, Fine Gael)
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I will start with Mr. O'Brien's opening statement and the section dealing with procurement practice in establishing inquiries. He said "inquiries are often urgent and the time periods for open tendering do not permit the conduct of a tender process in circumstances where the establishment of an inquiry is urgent." The issue with which we are dealing concerns the alleged sexual abuse of mentally disabled children. It has been alleged that there were dozens of children involved. The allegations date back about 24 years. I have looked at this issue inside out and there was no urgency in dealing with it. In fact, it was the exact opposite. There was resistance to dealing with it, from start to finish, within Mr. O'Brien's organisation. To actually characterise any of it as being "urgent" in any respect within the organisation is false.
On the tender process, Mr. O'Brien said inquiries were related to sensitive issues which it would not be appropriate or even permissible in some cases to discuss or publish for the purposes of an open tender process. I wish to delve into that specific point initially with the staff from the Office of Government Procurement at the Department of Public Expenditure and Reform who are present. It might also be worthwhile seeking the opinion of the Comptroller and Auditor General on what Mr. O'Brien said about the reasons this was not put out to tender.
A couple of things really strike me. Mr. O'Brien has said the necessary expertise was not available in Ireland, but how does he know that if it was not put out to tender? Tenders are not just about cost, they are also about getting the appropriate person with the appropriate skills set, but there was no attempt to do this. When it comes to the rules on contracts, the relevant regulation is No. 32 of the EC (Public Authorities Contracts) Regulations which permit awarding authorities to engage in a negotiated procedure without a call for competition in exceptional circumstances. Was there a negotiated procedure when it came to Resilience Ireland and Mr. Conal Devine? Was the Office of Government Procurement involved in the negotiated procedure with the HSE in this regard? I ask Mr. Ryan and Mr. Bresnan to indicate whether that was the case.
Mr. Karl Ryan:
We were not actually involved in that process. The Office of Government Procurement was not involved in the tendering process which was handled by the contracting authority. The general position is that our guidelines require a competitive process. That should be the norm when purchasing or awarding contracts, except in duly justifiable cases.
John Deasy (Waterford, Fine Gael)
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Therefore, there was no negotiated procedure. Is that correct?
John Deasy (Waterford, Fine Gael)
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The other thing that really struck me about his opening statement was that Mr. O'Brien said the expertise required was not readily available in Ireland, but the HSE ignored the expertise available within the organisation. That is why we are in this position. The in-house experts were continually ignored. Senior social care officers were continually ignored, which is the reason we have ended up in this position. Frankly, the last line of the statement is insulting, where Mr. O'Brien refers to the two whistleblowers who had made protected disclosures and says, "neither has ever held management responsibility for service delivery"-----
John Deasy (Waterford, Fine Gael)
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Fair enough, but I put it to Mr. O'Brien that this has come about because the two individuals who blew the whistle were not in management. I believe there was a clique in the HSE for a number of years which shoved all of this under the rug.
I will go back to the issue of urgency. The two whistleblowers who made protected disclosures contacted their senior managers in September or October 2009, but they were ignored. They were then forced to go to the Department to make protected disclosures. A report was commissioned in March 2010, approximately four or five months after the protected disclosures had been made. It took two years to finalise the report, but at the time of its initiation, it was announced that it would take eight weeks. There was no urgency - absolutely none. We must remember that the allegations date back to 1992.
Regarding investigations, persons involved in the health care system and the health boards then in place reported what they felt were improper practices in the foster home mentioned by Mr. O'Brien. When he uses the word "urgency", I do not take him seriously because there is absolutely no evidence that urgency was shown in any of this. The report was then sent to An Garda Síochána. When was it officially sent to the Garda? When did it first get sight of the report finalised by Mr. Conal Devine?
John Deasy (Waterford, Fine Gael)
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I asked when the report was given to An Garda Síochána.
John Deasy (Waterford, Fine Gael)
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Come on - do not start the "I don't know" business. Mr. Healy is the one in charge.
John Deasy (Waterford, Fine Gael)
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This is very serious stuff.
John Deasy (Waterford, Fine Gael)
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In the past couple of weeks Mr. Healy was well able to tell An Garda Síochána that the report would be published "soon" and asking for its comments. This issue has been hanging around for years and when Mr. Healy knew he was coming here and that this issue was going to come up, he was well able to contact An Garda Síochána.
John Deasy (Waterford, Fine Gael)
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Can Mr. Healy tell me in what year An Garda Síochána was given the report?
John Deasy (Waterford, Fine Gael)
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I said that.
Mr. Pat Healy:
There was engagement between the chairman, Mr. Conal Devine, and the Garda on the issue of whether the report could be completed.
The reason there is confusion is that during the undertaking of the investigation, the Garda Síochána asked that there be a pause on it because of the work it was undertaking. There was ongoing engagement between the chair of the investigation team and the Garda Síochána and, subsequently, he was able to continue his review. He sought and received clearance to complete the review and publish the report. Subsequently, in light of additional information that became available to the Garda Síochána, an investigation was opened and continues today. In that context, there has been movement over time about whether there was clearance to publish the report. In relation to the current position, we have-----
John Deasy (Waterford, Fine Gael)
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Can I stop Mr. Healy there? This is a question for both witnesses. I am going back to the opening statement.
John Deasy (Waterford, Fine Gael)
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Hang on now. I want to get to the bottom of this as far as I can. I will encapsulate it. The process began in September 2009. Two weeks ago, the HSE contacted the Garda Síochána to ask for its comment before publication. It is now April 2015, almost six years on. Where is the urgency with regard to the protected disclosure that was made? Why has it taken so long to get to where we are now? How can Mr. Healy possibly characterise this, in any sense, as urgency?
Mr. Tony O'Brien:
My comments about urgency in the opening statement are clearly addressed to the issue of procurement at the time of the investigator and the exemption from procurement requirements that attached to it. My comments relating to urgency do not extend back to 1992 or forward from the point of view of the procurement time. My comment about urgency is very specific.
John Deasy (Waterford, Fine Gael)
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When did Mr. Healy find out about these allegations?
John Deasy (Waterford, Fine Gael)
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What position was Mr. Healy in at that time?
John Deasy (Waterford, Fine Gael)
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Mr. Healy did not know anything about this when he was in that position and was not aware of these allegations dating back to the 1990s?
Mr. Pat Healy:
I was not aware of the allegations. They became known at corporate level. There were protected disclosures in late 2009, but there were three disclosures over a period from late 2009 to early 2010 and they were notified to our authorised officer who deals with this. Immediately after it happened, engagement took place with those who had made protected disclosures and the work in establishing an investigation commenced immediately. In the note submitted to the committee, I mentioned that the preparation to undertake an investigation commenced immediately. The discussions with Mr. Conal Devine were undertaken by the authorised officer.
John Deasy (Waterford, Fine Gael)
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They were not started immediately. The people who brought this up were ignored for months before anything was done. They had to go and make a protected disclosure because the HSE ignored them and stonewalled them.
John Deasy (Waterford, Fine Gael)
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No. This started with a particular senior social care worker who was employed in 2007 and started looking at the cold cases. He started going back to old files and found certain issues that concerned him gravely. He brought up these issues and the HSE management ignored him. Then he felt compelled to make a protected disclosure, and he was not the only one. Six years later, here we are, and the report has not been published. I will keep going with the people contacted to do these reports, one of whom is a former HSE employee. Mr. Ger Crowley certainly is. Does Mr. Healy know Mr. Crowley?
John Deasy (Waterford, Fine Gael)
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At a workshop held by Mr. Crowley in September 2014, he said that Mr. Healy had phoned him directly in May 2014 and asked him to write the policy.
John Deasy (Waterford, Fine Gael)
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That is what I am talking about-----
John Deasy (Waterford, Fine Gael)
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Does Mr. Healy know Mr. Crowley professionally and has he known him for years?
John Deasy (Waterford, Fine Gael)
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Is it appropriate to ask a colleague to deal with something as sensitive as this - someone who has worked in HSE apparatus?
John Deasy (Waterford, Fine Gael)
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Is it appropriate that the HSE commissioned someone who was a former employee to deal with something like this?
John Deasy (Waterford, Fine Gael)
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That is a real bureaucratic answer if ever I heard one. I will start with the taxpayer. How does the taxpayer get value for money when someone contracts individuals he is familiar with to do the work? I will repeat that we are dealing with allegations of the rape of mentally disabled children in a foster home. The allegations centre around not one but potentially dozens of people. How does the HSE continue to contract people who had worked in the organisation for years, knew the people who were in management in the south east region and had had contact with them over years? Who in their right mind would consider that independent? I have nothing against Mr. Conal Devine but I have been dealing with the families who dealt with Resilience and the process was appalling. I have never come across anything like this and I have been a public representative for 16 years. The process is a sham.
John Deasy (Waterford, Fine Gael)
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I asked Mr. Healy a question about the appropriateness of hiring people who are former HSE employees to deal with allegations that go back to the 1990s. There must be an answer for that. Mr. Healy cannot just sit there and say that they are in compliance.
John Deasy (Waterford, Fine Gael)
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Stop. Mr. O'Brien must be kidding me. He worked in the HSE. This is absolutely absurd and Mr. O'Brien cannot stand over it, given the gravity of the allegations made over the course of 20 years. These people were contracted not because of sensitivity but because HSE management was potentially sensitive to the findings of the investigation and there was comfort in the fact that they hired people who had worked in the HSE previously.
John Deasy (Waterford, Fine Gael)
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I am not sure I am going to get one, but I ask Mr. O'Brien to go on.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I want one.
Mr. Tony O'Brien:
I thank the Chairman. I can speak with an independent mind about what happened in 2009, because I was not in the HSE when any of this was done in 2009. Given the range of requirements, it is not appropriate to automatically suggest that someone who worked in a different part of the system for most of his career, not in the HSE at all but in its predecessor bodies-----
John Deasy (Waterford, Fine Gael)
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That is what I thought Mr. O'Brien would say. I am talking about the appropriateness of the HSE doing it in the first place and not the individuals and their professional integrity. I am talking about the concept of employing people and tendering contracts as sensitive as this to people who are former HSE employees. It is absurd. I do not believe Mr. O'Brien's assertion in his opening statement that the expertise does not reside in Ireland. I do not think the HSE tried.
John Deasy (Waterford, Fine Gael)
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The reason they were picked was because nobody else at work in the HSE had that expertise.
Mr. Tony O'Brien:
I understand that the purpose of having witnesses is that they can answer questions. The Chairman wants to hear my answer. I understand that the Deputy is unhappy about the situation and I understand why, but the reality is that the particular set of skills required to carry out an investigation like this are not widely available and when-----
John Deasy (Waterford, Fine Gael)
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How would Mr. O'Brien know if he did not tender it?
John Deasy (Waterford, Fine Gael)
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I have asked Mr. O'Brien this before and he did not answer the question. How could he possibly know that the expertise did not exist if the HSE did not put it out to open tender? He would have absolutely no idea whether the expertise existed if it was not publicised. Notwithstanding the sensitivity he just mentioned, how would he know? The reason Mr. O'Brien and the organisation did not make an attempt to do this was because there was a comfort factor in finding individuals known by the senior officials in the HSE to deal with this. This stems back to 1992. It was 17 years previous to this commissioning of the report, in terms of Mr. Conal Devine, that these issues arose. Surely there was an urgency within the HSE to take it out of the HSE and deal with this independently. There was never an attempt to do that - it remained in the fold and the fold got stronger.
Mr. Tony O'Brien:
To reiterate, I was not involved and I was not in position so, I hope, I am taking an objective view. Conal Devine was not part of the HSE. His piece of work was directed specifically at the specific allegations. The secondary decision was to have a broader look back. The skill sets that the individuals have is an appropriate skills set and I told the committee what the exemptions are under EU procurement. Clearly, the Deputy is not happy with that situation. I am simply putting forward the rationale for the decisions that were made at the time and I do not believe there is any basis to question the integrity of the individuals concerned, particularly those whose names have been mentioned today.
John Deasy (Waterford, Fine Gael)
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Mr. O'Brien is the one putting those words in my mouth. I am not questioning the integrity of any individuals, I am talking about HSE procedures. This is the Committee of Public Accounts. Surely we are allowed to ask about procurement procedures and whether it is appropriate to hire people who are former HSE employees - Mr Crowley, as was said, and not Mr. Devine. Is it appropriate to do that in cases like this? It is not and Mr. O'Brien would have known that. He would have known the history of this issue going back to 1992 and, institutionally, people would have understood the allegations that had been made back in 1992 and 1993.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Deputy Deasy, allow Mr. O'Brien to answer the specific questions that you have put to him.
Mr. Tony O'Brien:
What I can tell the committee is that those who were charged with making these decisions at that time would have been aware that there was no basis upon which they could exclude persons merely because they were former employees of the health system, particularly in circumstances where they never, ever held an operational role in that part of the country.
John Deasy (Waterford, Fine Gael)
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In other words, Mr. O'Brien does not have an answer to the point I raise which is the inappropriateness of employing people when it came to Resilience Ireland. It was not just Mr. Crowley, but Mr. Drohan and Mr. O'Dwyer. There were plenty of former HSE employees involved in this. This is endemic. It is just unbelievable. In terms of investigations, one name that comes up is a Mr. Tennant, who is recommended by HSE staff when it comes to section 39 bodies. It is par for the course - that is what the HSE does and has done for years. It employs former employees to deal with these issues. It was not once or twice. I am not questioning their integrity but am talking about the HSE's unbelievably, incredible, illogical procedures when it comes to procurement and tendering these contracts when it comes to issues like this.
I remind Mr. O'Brien of a couple of things that occurred. In the case of one girl who was placed in placement, there were significant concerns of abuse back in the 1990s which led to a number of Garda inquiries. Files were submitted to the DPP. After a decision was made that it was in her best interests to be removed owing to allegations of sexual abuse, the child was left in that foster home for 13 years. That was in the 1990s. Nobody has ever been sacked or disciplined. The decision was reversed. The senior care worker - Mr. O'Brien knows his name - arrived on the scene ten years later and went back over the files, making his disclosure in 2009. Here we are six years later. There have been news reports about this but they have been scant. As Mr. O'Brien knows, it has been on RTE's "Prime Time Investigates". The big finger of the HSE points at people who try to air this, which is worrying when it comes to an organisation like the HSE.
There are other questions regarding the costs involved here which are directly related to the Committee of Public Accounts and the case of that girl. A fully funded residential bed, held open for two and a half years for the client in question at a cost of €120,000 per annum, was never used. The costs with regard to Mr. Devine and Resilience Ireland came to a couple of hundred thousand euro. There were five legal firms involved, also. I believe the committee should be given the amounts involved in the costs of those legal firms.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Has Mr. O'Brien got those costs?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Can Mr. Healy give them to the committee now?
Mr. Pat Healy:
I do not have the specific detailed costs here but they can be provided. Two firms were involved. From a corporate point of view, Arthur Cox was involved in more recent times. Local firms were used by the local team when involved in this. In any investigation of this order, the investigation team itself has to be provided with legal advice separate from the HSE, so we use our own corporate lawyers, Arthur Cox. When the investigation was undertaken and the completed report was circulated for due process and fair procedure, there was correspondence from lawyers of some of those who received extracts, and that had to be engaged with.
To correct the record in respect of two names mentioned by Deputy Deasy, Mr. Tennant and Mr. Drohan. They have never been involved in this in any way. It is important to clarify that.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Deputy Deasy was referring to general work done for the HSE.
John Deasy (Waterford, Fine Gael)
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They are directors of Resilience Ireland.
John Deasy (Waterford, Fine Gael)
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I am not talking about Mr. Tennant, I am talking about Mr. Drohan and Mr. O'Dwyer. They are directors of Resilience Ireland. Is that correct?
John Deasy (Waterford, Fine Gael)
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Mr. Healy mentioned two people. The people I mentioned were Mr. Drohan and Mr. O'Dwyer as directors of Resilience Ireland and they are former staff of the HSE.
John Deasy (Waterford, Fine Gael)
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I am not talking about Mr. Tennant being involved in this at all. He is just hired for investigations.
John Deasy (Waterford, Fine Gael)
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I did not say he was, so Mr. O'Brien should not mix it up. I said Mr. Tennant was involved in investigations and he is referred by HSE staff to other investigations. The two people I mentioned in respect of Resilience Ireland are directors and are former HSE staff. Is this correct?
John Deasy (Waterford, Fine Gael)
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Mr. Healy does not know.
John Deasy (Waterford, Fine Gael)
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Does Mr. Healy not know Mr. Crowley or Mr. Drohan?
John Deasy (Waterford, Fine Gael)
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Mr. Healy does not know many people in the organisation of the HSE when it comes right down to it, an organisation he worked in all his life. I mean, this is-----
John Deasy (Waterford, Fine Gael)
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I think this is unbelievable and Mr. Healy is having a laugh. I think he knows all these people. In many respects, the witnesses are the ones who actually hired these people. They knew exactly what their backgrounds were. They knew them intimately, in my opinion.
John Deasy (Waterford, Fine Gael)
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Mr. Healy is giving us the impression that he does not know these people. Of course he knows them.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Yes.
John Deasy (Waterford, Fine Gael)
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Mr. Healy was the head of HSE South when Mr. Crowley was hired and he is saying he was hired-----
John Deasy (Waterford, Fine Gael)
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Was Mr. Healy head of community care in the whole of the country or what was he?
John Deasy (Waterford, Fine Gael)
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This is relevant. Is it not?
John Deasy (Waterford, Fine Gael)
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Mr. Healy did not know that this guy had been hired at all, did he?
John Deasy (Waterford, Fine Gael)
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Did Mr. Healy know Mr. Crowley?
John Deasy (Waterford, Fine Gael)
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How long has Mr. Healy known Mr. Crowley?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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If Mr. O'Brien allows me to chair the meeting I will arrange for that.
John Deasy (Waterford, Fine Gael)
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Mr. Healy really has no interest in answering these questions whatsoever.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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That is my job.
John Deasy (Waterford, Fine Gael)
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The connections I have are like that.
Mr. Pat Healy:
I have looked at the file in relation to the decision-making around the appointment of Resilience Ireland and Mr. Crowley and it speaks, in particular, to the point in relation to section 32 of the EU regulations in relation to the expertise that was required, the expertise that was identified as necessary. It is quite a complex and difficult situation.
John Deasy (Waterford, Fine Gael)
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Is Mr. Healy referring to the prolonged discussions that took place with the office of procurement?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Deputy Deasy should allow Mr. Healy to answer.
Mr. Pat Healy:
I am saying that in relation to the look-back exercise, the expertise that was required was: number one, senior management experience of running inquiries and that capacity; number two, a detailed knowledge and expertise in relation to disability and child care services; number three, a knowledge of safeguarding, which has significantly changed over recent years; and number four, an actual professional expertise in relation to social work. Now, it is the rare individual who actually has all of those capacities. In this individual, one has someone who actually led the Madonna inquiry in Ireland, which gave rise to the basis of the establishment of the social care inspectorate. He has been involved in, and led, on behalf of the regional health boards at the time, the child care guidelines, Children First. He was a key player in implementing that. He is currently a registered social worker. He was a head social worker for the mid-west for 12 years.
John Deasy (Waterford, Fine Gael)
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I know this. I have gone through all of that.
John Deasy (Waterford, Fine Gael)
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But I-----
John Deasy (Waterford, Fine Gael)
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The funny thing is that the question I asked Mr. Healy was: does he know this man and does he know him well?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Yes, please do, Mr. Healy.
John Deasy (Waterford, Fine Gael)
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I know plenty of people with great CVs.
John Deasy (Waterford, Fine Gael)
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I know tonnes of people with wonderful qualifications. It is not the point I am making. It is not the question I am asking.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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What is the question Deputy Deasy is asking?
John Deasy (Waterford, Fine Gael)
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The question I am asking is: how familiar was Mr. Healy with Mr. Crowley when he was hired?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Let us take that question then.
John Deasy (Waterford, Fine Gael)
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I did not ask Mr. Healy-----
John Deasy (Waterford, Fine Gael)
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Did Mr. Healy know Mr. Crowley well when he was hired at that time?
Mr. Pat Healy:
I know Mr. Crowley and his reputation. I am just outlining for the Deputy, he is well known within the health service. His reputation is very significant. The point I was trying to make was that a key piece here was that a clinical team had to go to meet very sensitively and in line with a protocol from the gardaí, in line with data protection and in line with legal requirements, all of these families. He supervised, and had the professional capacity to supervise, that work.
John Deasy (Waterford, Fine Gael)
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The witnesses all knew these people. That is my point. They should not have been hired for that reason considering what we were dealing with here. It was inappropriate. It was wrong. I know plenty of people with good CVs and great qualifications. It was completely wrong for the HSE to hire former employees to deal with something that had existed since 1992. By the time they made their protected disclosure it was 17 years later. Surely, one would have copped on by that point that there was something wrong.
John Deasy (Waterford, Fine Gael)
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In my opinion-----
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Is Deputy Deasy finished?
John Deasy (Waterford, Fine Gael)
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No, I am not. Over the course of 23 years, the HSE failed to deal with this issue. Over the course of many years in the 1990s, the HSE failed to protect these children. Mr. O'Brien may not have been in the health board but the organisation that he is head of now failed to protect these children and I think it is incredibly serious. I think it is a dereliction such as I have never seen before. It is absolutely amazing stuff. Management that presided over this case had left by the time this inquiry had been completed; they are gone to places like Tusla, the Child and Family Agency. I think everybody who was involved in a senior management position between the early 1990s to date needs to be investigated. I think that, considering what I know, and what I think the Chairman knows, and considering the interaction we have had with the families, the social care workers who were involved in this and the gardaí, this needs to be taken out of the HSE's hands completely. I do not think the HSE has a role in this whatsoever any longer. I do not think the HSE can be trusted to actually look at this independently. I think the HSE has failed miserably when it comes to the review of this and the investigation of it, regardless of the reports the witnesses have commissioned by their friends. I think there needs to be a commission of investigation conducted under the appropriate legislation and I think the Minister for Health should look at it immediately with other members of the Government, and I think it should be taken out of this completely now. The HSE has mishandled this for 23 years. It is astonishing. That is it for now.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I thank Deputy Deasy. I will reflect on this just for a minute. The central concern is the 30 to 40 young adults, at the time, who were in care. That is first and foremost. For the work of this committee what is important is the governance issues, the cost and so on, and the investigation itself, whether that was good governance practice or management practice. The other issue that I find in this report, which I have read, is the issue of protection for the whistleblowers. I will start by asking if Mr. Healy can tell me, from the date of the reporting, which was 2009, the funding graph for the following five years for the agency that employed the whistleblowers. Will Mr. Healy tell us what that agency received in, say, 2007 onwards?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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While Mr. Healy is looking for that I will ask the second question, in relation to public accounts, which is about the cost of legal fees. I note in the accounts in note C that legal fees amount to €44 million, I think. Could we check that figure?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Note 6.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Note 6.2. Will Mr. O'Brien talk us through that figure of €44 million?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Yes.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Is this directly to the agency in question?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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How much?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I can take it that this is a significant organisation which is respected by the HSE and which receives from it a considerable amount of work given the amount of the allocation each year.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I did not ask that. I know what it is. It is a significant player given the level of funding.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Is it a significant player?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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It is an important agency, thank you Mr. Healy. This important agency came to the HSE in 2009 with regard to the protected disclosure. Prior to this it has been reported to the South-Eastern Health Board in 1995. Is this correct?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The foster home.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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A "Yes" or "No" answer will do fine.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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That is what I am trying to do. I am being fair to you. Yes or no, was it reported in 1995?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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No, you are going off-----
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Mr. Healy, I am asking a straight question and if you co-operate with me we can get through this very quickly. I just want to know was it reported to the South-Eastern Health Board in 1995.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Thanks. Forget it. You are not answering the question.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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No, answer the question. Was in 1995 or was it not? That is what I want to know.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Good, so the health board knew back in 1995 of this home.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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It knew that there were issues with this home from the early 1990s onwards.
John Deasy (Waterford, Fine Gael)
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It was investigated by Pat Donaghy of the HSE in the early 1990s. That is the answer. Correct?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I never mentioned the report.
John Deasy (Waterford, Fine Gael)
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The Garda does not say that.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Hold on, Deputy Deasy.
John Deasy (Waterford, Fine Gael)
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I have talked to the Garda and it is not the case.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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From the perspective-----
John Deasy (Waterford, Fine Gael)
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Mr. Healy is making it up.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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-----of adding up the costs I am asking was it known to the South-Eastern Health Board in 1995 and I think the answer is "Yes". Did the HSE receive an indication from an agency in England pointing to the fact there were concerns about this home?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Not in relation to the costs.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I am trying to establish when the costs began.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Okay, that is fine.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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We will move on.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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In 2009 the HSE got a whistleblower's report, correct?
John Deasy (Waterford, Fine Gael)
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Sorry Chairman, Mr. Healy is telling the committee the Garda has asked him not to publish this report.
John Deasy (Waterford, Fine Gael)
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Just to clarify it I am asking the question. That is fine.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I ask Deputy Deasy to allow me. I want to get to the point, and I understand the Garda investigation. The whistleblowers made this known to the HSE formally in the disclosure in 2009.
Mr. Pat Healy:
They wrote to the authorised officer and there were three components to it, at the end of 2009 and the beginning of 2010. There was ongoing engagement from the end of 2009 and the beginning of 2010 and all of these disclosures actually formed part of the terms of reference of the Conal Devine review. It was on the basis of those disclosures. All of them formed part of the terms of reference.
John Deasy (Waterford, Fine Gael)
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Are they the terms of reference done up by Arthur Cox, the solicitor's firm?
Mr. Pat Healy:
Arthur Cox was not involved in the Conal Devine review or its establishment. The terms of reference were put together by the authorised officer, and the authorised officer identified, in consultation with people nationally, Conal Devine as the most appropriate person. They identified him because of a history he had in dealing with cases, particularly those going back over years with a look-back component. That is why he was picked.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I understand that. I am only trying to piece together here where the costings start. In 2009 the HSE got the report and then it entered into getting someone to investigate the allegations. I ask people to check their mobile telephones because there is interference.
From 2009 the agency had this information and it acted upon it by appointing people to investigate. That is where the costings start.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Who investigated that case?
Mr. Pat Healy:
Conal Devine was assigned to undertake it. The authorised officer who received the protected disclosures arranged for that. The local assistant national director in the area at the time was given the responsibility to link with the inquiry team and receive the report in due course. In putting the terms of reference together the national incident management policy at the time was used to set the terms of reference.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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That is the agency's serious incident management team, is it?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Who was on the team?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Was Mr. Crowley on it?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Would he have been aware of this? From what Mr. Healy has said he was aware in 2009.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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He was aware of the details of that.
Mr. Pat Healy:
I am not sure to what extent. At the time, given the rules on protected disclosure the authorised officer was the person who dealt with the protected disclosures. The only input from the incident management team at the time would have been to guide the establishment of the inquiry to ensure it was established appropriately. The key person in setting up the inquiry at the time was the authorised officer responsible for receiving protected disclosures.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I understand that, but the point I am making here because Mr. Crowley's name was mentioned is that he was a member of the serious incident team in 2009.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I know it was not; I am just saying it had knowledge of it.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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And he was on that.
John Deasy (Waterford, Fine Gael)
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Mr. Healy does not know whether he had knowledge. Does Mr. O'Brien think it is appropriate that someone like Mr. Crowley, who was on the national serious incident management committee, was asked to involve himself in something like this with his prior knowledge of the individuals he had been managing?
John Deasy (Waterford, Fine Gael)
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That makes all the difference.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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It is down to cost. Did the HSE pay for legal advice on the position that it took when one of the individuals intended to go to court to be appointed the committee of this person?
Mr. Pat Healy:
Did the HSE or local area take legal advice? It would have had legal advice. The legal team-----
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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You stalled that process. Your advice was not do this.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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How much did the legal advice cost?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Yes, and what was the cost?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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No, for all of the advices received. I asked the question earlier and I draw Mr. Healy's attention to the note of €44 million.
Obviously, therefore, the HSE spends significant amounts of money on legal advice. Can someone give me the breakdown of the cost of legal advice regarding this case?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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It relates to 2009 onwards.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Obviously the HSE still has legal representatives in place, so is it fair to ask how much has been spent up to now on the legal team for this case?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Why?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The reason I ask that question is that it seems that from 2009 onwards, when there were various reports, the HSE contested the issue of the committee appointed to represent this person, in that it was of the view that it should not happen. Then, when various requests were made under freedom of information, it went to considerable lengths not to give the information. In fact, there were cases where the individual seeking information had to remind officials of the timeframes involved. It was only under continued inquiries, almost constituting harassment, that the HSE decided to give the person some of the information, even though the person involved was part of the committee for the individual who was intellectually challenged and allegedly suffered sexual abuse.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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To this date, the results of those investigations have not been given to that person. There is a cost factor involved in respect of legal representation which continues to mount. Mr. O'Brien specifically raised this issue in his opening remarks and went into some detail about it and yet, because we are the Committee of Public Accounts, he did not see fit to bring that figure here although he might be asked about it. That is what we are doing here. This is totally secondary to how these 30 to 40 individuals were treated, but it is the work of this committee and it is important that we know the answer to that. The information should have been brought to us today-----
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I know that. I have it all here. I have the names and how they were selected. I support Deputy Deasy in his remarks that this is an effort by the HSE to cover up what went on. Referring it to the Garda is just a method of prolonging it. In the correspondence I have here, the HSE refers to "the final report". The HSE has never published that final report. It has never even gone to the whistleblowers and discussed the final report. As I understand it, one of those whistleblowers had to raise the issue publicly at a meeting on Áras Attracta and ask what stage it was at. That does not show an organisation which is concerned about this and which will deal with it. Meanwhile, as we discuss facts and figures, there are 30 or 40 individuals who may very well need assistance and support because of what happened. Finally, in terms of-----
John Deasy (Waterford, Fine Gael)
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Can I break in there? There is also another point.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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One second.
John Deasy (Waterford, Fine Gael)
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Sorry, I will wait until the Chairman is finished.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Individuals or families are being interviewed and the report I have had from one of the families on how they were treated is shocking. I must ask about the professionalism of the HSE's approach to this, about the fact that it has gone on since 1992, the legal costs, the costs of stonewalling the whistleblowers, and the cost of stonewalling the release of information through the freedom of information system. These are all costs that I would like to see being put before this committee. The answer the witnesses have given Deputy Deasy regarding the procurement process is nothing short of a disgrace. I know it did not happen on Mr. O'Brien's watch and that it dates back to the 1990s, but it appears to me that there was no standard in place and that as soon as the HSE found the problem, there was a rush to ensure that no one else found the problem. The individuals who blew the whistle were the ones who came forward and persisted with this. It is all down to costs. Where are the figures that will identify for us the cost of this investigation from start to finish? The answers have not been given here this morning. I am interested in the overall case, but we must be interested in the costs. Can we go back to the figures?
John Deasy (Waterford, Fine Gael)
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To add to what the Chairman is saying, one critical element of this cannot be forgotten. The Chairman has mentioned the 30 or 40 potential victims in this case. Many of those alleged victims are non-verbal. In some cases, it is 22 or 23 years since these alleged crimes took place. In many cases, the witnesses or perpetrators have passed on. The urgency required by the HSE to deal with the matter as time moved on was absent. There was no desire to deal with this and no attempt was made to do so, because as time moved on and decades passed, reports were issued, it was prevaricated upon and the long finger came out at every juncture. The Statute of Limitations does come into this.
In my opinion, part of the reason this has been put on the long finger is that there is an attitude that time will deal with this and that prosecutorially it may not be possible to bring some of these people to justice. That is appalling. The HSE was aware of the gravity of these alleged crimes, going back to the 1990s. It was reminded of them in 1999 and surely at that point, when those protected disclosures had been made, there would have been a requirement within the organisation to deal with it and, as Mr. O'Brien said, some urgency. This urgency was not there. There are legal issues around the duration between when a crime is allegedly committed and when it is brought to a court. In this case, it could be 23 years. There was no urgency whatsoever here.
Mr. Tony O'Brien:
We will provide the detailed breakdown of costs to the committee as soon as possible. We do not have that level of detail with us today, but we can extract it from our systems and will do so. Regarding the impression that may have been gained that somehow the involvement of the Garda is a recent thing, or is designed in some way to shield us from providing the committee with this information, I just want to be clear that following the protected disclosures and the establishment of the inquiry there has been ongoing involvement and liaison with an Garda Síochána. There is no basis for any suspicion or concern that this involvement is recent or related to these proceedings. We do have written correspondence from the Garda asking us not to put that report into the public domain at this time. The committee will understand that we feel obliged to co-operate in that respect. There is no suggestion that we have sought to involve the Garda in regard to this meeting. There has been an involvement with it over an extended period.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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For the record, I want to make it clear that a protected disclosure was made to me as a Member of this House with all the supporting documentation. On 18 February 2015 I went to Pearse Street Garda station and made that disclosure. I have not heard a single word from the Garda since then, even though I was given a story involving these young adults who could not verbalise, as Deputy Deasy said.
John Deasy (Waterford, Fine Gael)
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The Garda has been involved since 1992.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I am shocked that this has not been brought to a conclusion by the HSE. So many matters regarding the funding and everything else have been raised here this morning that I want to ask for a complete report on costings dating back to the beginning, with an indication as to who approved the various reports, who authorised them, how they came about and so on, so that we can clearly understand how we arrived at the cost.
The use of former employees of the health service in this instance and in other instances is not best practice and it should not continue. If there had been an independent inquiry into this the matter would probably have been resolved a long time ago. It would not have been going on since 1992, with the lives of people who need further counselling and assistance being put in jeopardy. I agree with Deputy Deasy that we need to move the matter on significantly for those concerned.
I ask the committee to agree that we request a commission of inquiry of some kind, possibly instigated by the Minister, but it must be taken out of the hands of the HSE because as far as I can see it will never be resolved if it is left there. That is a recommendation we can make at the end of the meeting.
John Deasy (Waterford, Fine Gael)
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It is worth putting on the record again that when this was dealt with initially in the 1990s, the Garda was involved and files were sent to the DPP, but there were never any prosecutions. It was investigated. This is the second time around with this. Time badly limits the effect of a criminal prosecution. For the sake of justice and getting answers for the families involved, I am beginning to think that because of the effect time will ultimately have on these criminal investigations and potential prosecutions, the only recourse that these families will ultimately have is an independent investigation from which the HSE is completely removed. At this point, it deserves the HSE's removal from the issue completely. That is the only way these individuals and their families will have any recourse to justice and fair play.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I ask the HSE officials to record also that a complaint made by the whistleblower to the Department of Health about individuals at local level was actually sent back to those same individuals. From start to finish, there have been serious problems of governance affecting families and resulting in financial cost.
John Perry (Sligo-North Leitrim, Fine Gael)
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I welcome Mr. O'Brien and his team. Is there precedent in the British NHS of inquiries being carried out by employees who have left the NHS?
John Perry (Sligo-North Leitrim, Fine Gael)
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With the amount of staff who leave the health system, there could not be a corporate ban on any involvement by a former employee in any work once they have left the service. Any civil servant or any person who leaves the State services is not prevented from partaking in any other aspect of life afterwards. That is an important point given the number of people involved. I do not know the background to this story but I have listened very actively today. If we were to take this rule as a rule of the public service, it would mean that anybody who worked for the State would be excluded from doing any consultancy work in any other Department.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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That is not what is being suggested.
John Perry (Sligo-North Leitrim, Fine Gael)
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The interpretation----
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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It is not an interpretation; it is just factual. Deputy Deasy has suggested that because of the delay from 1992 to date and because there are serious issues from a health perspective and a financial perspective there should be an independent and immediate inquiry to conclude what needs to be done. That is the point in that regard. Does Deputy Perry have another matter to raise?
John Perry (Sligo-North Leitrim, Fine Gael)
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Yes, I have. Several members got discretion on time. With regard to the point about having been in the chair, it is very important that we do not have an execution and trial here on the spot over a case with which I am not familiar.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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That is not what happened.
John Perry (Sligo-North Leitrim, Fine Gael)
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It is important we just have-----
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Sometimes it is difficult to extract information.
John Perry (Sligo-North Leitrim, Fine Gael)
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That may be so, but we have to be very conscious of the role of the Committee of Public Accounts. There is a middle ground beyond which we should not travel with regard to the facts that have been put on the record.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Deputy Perry might take that up with his colleague.
John Perry (Sligo-North Leitrim, Fine Gael)
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I am just making the point. I am newly appointed to the Committee of Public Accounts, but I know the line of balance that has to be taken which represents integrity and fairness and the ends that are mentioned. At the opening of any meeting we state very clearly that we should make no reference to any individual by name such that it would prejudice the outturn of any case.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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These are directors of companies that were employed by the HSE at considerable cost. Some were directors. Some were used to provide reports and the reports cost money. We are talking about the cost of those reports.
John Perry (Sligo-North Leitrim, Fine Gael)
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I am just taking the point of a neutral observer who has been listening since I came in here. I congratulate Mr. O'Brien on his appointment since he assumed his role in the HSE. It is with the Garda Síochána. I think we have concerns with the reporting of the matter to the Garda Síochána. It should be addressed directly to the Garda Commissioner. That is what I would suggest. I make the point that there should be balance in all debates, regardless. I would respect the integrity of the individuals present today, given their comments on the case.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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As we all do.
John Perry (Sligo-North Leitrim, Fine Gael)
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I refer to the new HIQA requirements with regard to mandatory inspections of hospitals and nursing homes. We are talking about the disability sector. There is a massive requirement for on-the-spot audits, which are essential for homes that cater for the disabled sector and nursing homes. Given all the regulations that came in, which are very much necessary, is the HSE budget adequate to cover that? I know there was a recent query regarding the HSE and HIQA and the requirements. I ask Mr. O'Brien to go through that with me.
Mr. Tony O'Brien:
I think the Deputy is referring to the coming within regulation of the registration of the residential disability sector approximately 18 or 19 months ago, which required inspection followed by registration of those facilities and ascribed certain standards to be met. First of all, I should say on the record that those standards are appropriate and in the round are to be welcomed. However, one of the challenges the HSE faces is that the cost of compliance is quite considerable.
John Perry (Sligo-North Leitrim, Fine Gael)
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Yes.
Mr. Tony O'Brien:
When such regulation came in for the nursing home sector, both public and private, it was done on a phased basis.
Although there were still some outstanding issues, there was an opportunity for the health sector to catch up with the required standards. That opportunity is not currently available as regards the disability sector and, consequently, the cost-increasing recommendations from inspections are not capable of being met within our current budget. Having regard to our obligations relating to how we use the budget provided to us within a service plan that is approved under specific headings, when costs arise from a separate set of regulations from another agency whose parent is the same Department as ours but where their requirements and our budget do not match completely, it is a significant in-year challenge for us and it is something we are discussing at the moment.
John Perry (Sligo-North Leitrim, Fine Gael)
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Given the need for registration, compliance and other exacting obligations which are rightly in place, what will the shortfall be?
Mr. Pat Healy:
We set up the national summit following Áras Attracta and a six-step programme is now in place. Some of that requires additional resources, such as for our new quality improvement teams at a cost of €750,000 this year. The teams have already visited 50 of the centres and we want to support those centres as they aim to meet HIQA standards. The service improvement team approach is in line with the service arrangements and we are trying to link funding to quality and put the focus on outcomes.
In the disability sector, the congregated settings report of 2009 identified the fact that, in the transition to the new person-centred model, significant capital investment was required in moving from old, long-stay institutions and nightingale wards to person-centred independent living. We are trying to develop mechanisms to support that and discussions are ongoing involving the Department of the Environment, Community and Local Government, the Department of Health and the HSE to see how the housing component can be supported by local government. We are looking at developing a reform fund for the transition.
The costs in 2014 for the implementation of standards and the new approaches for the disability resource were between €12 million and €15 million. That had to be managed by ourselves, the community health care organisations and the individual voluntary sector agencies. There is a significant capital requirement but training and staffing also need to be addressed and we are working with organisations to do that within the existing resource, which brings challenges. A further dimension is the fact that in trying to transform a sector, taking on new capacity, new referrals and new places becomes more challenging for the existing voluntary sector organisations, meaning we face a bill for private placements. These places are not there now to the same extent as in the past because organisations coming to grips with the implementation of the new standards are not able to take on new referrals to the same extent.
As the director general said, the service user is at the forefront of our minds at all times and safeguarding vulnerable people through our safeguarding teams is fundamental to that, which means cost issues arise.
John Perry (Sligo-North Leitrim, Fine Gael)
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The exacting standards in place at the moment are mandatory because of the anomalies that we saw in places like Áras Attracta. Are the plans due to be included in the next voted Estimate?
Mr. Pat Healy:
We have a value for money policy review, which involves a national implementation framework chaired by the Department. It reports to the Minister and the HSE is leading its implementation. We are identifying the costs involved and working closely with the Department and others to ensure we bring forward those costs and plan for them properly. The key, as we try to bring about the fundamental change that is required, is to do it in an organised and systematic way over time and in a way which assures the standards but also can be delivered within the resources provided.
John Perry (Sligo-North Leitrim, Fine Gael)
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When the figures are available perhaps the witnesses will forward them to the Chairman.
Another area was the recovery on income from other states when people come from other European states into Ireland. Is the reimbursement of funding an issue?
Mr. Stephen Mulvany:
That remains an issue for us. The Comptroller and Auditor General has flagged it and it is one we are working on. We have made significant progress on the community side within the primary care reimbursement service, PCRS. We will be able to record and eventually bill for those costs, other than for those in the pharmacy area where we have a data issue which we are trying to get through with the help of technology.
On the acute side our recording has improved significantly but again we have an issue to get to full billing. While it is a relatively small part of the total, representing as it does approximately €10 million out of €1 billion, it is nevertheless important.
John Perry (Sligo-North Leitrim, Fine Gael)
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What does the figure of €1 billion represent?
John Perry (Sligo-North Leitrim, Fine Gael)
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Can this money be repaid retrospectively?
John Perry (Sligo-North Leitrim, Fine Gael)
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This is the €10 million that is outstanding.
Mr. Stephen Mulvany:
It is the total recorded cost - I can get the outstanding figure for the Deputy. A good chunk of it, some €4.5 million, is covered by bilateral waiver agreements whereby we have agreement not to bill a state, for example the UK, specifically. The Deputy will see in the appropriation account a large amount, some €220 million, which is the annual payment in recent years from the UK to the Irish health system. These agreements, which the Department of Health manages, mean we do not have to chase individual states with bills for a large chunk of people. For the rest, however, we do need to improve our processes to bring the collection period up to date. We have done significant work on this but we have not finished.
John Perry (Sligo-North Leitrim, Fine Gael)
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This is for patients who do not have private insurance.
Mr. Stephen Mulvany:
It is irrelevant in this case whether they have private insurance or not. This is for members of the European community primarily though not those from the UK, with whom we have the bilateral agreement which we work out annually. It is for individuals who come to Ireland, though they might not necessarily live in Ireland. If they present their European health insurance card we are entitled to recoup from their parent state.
John Perry (Sligo-North Leitrim, Fine Gael)
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Can the Secretary General give an overview of the fair deal scheme?
Mr. Tony O'Brien:
I am the director general of the HSE. The Secretary General of the Department is Mr. Jim Breslin.
The fair deal scheme was a significant concern in the early part of this year for one simple reason - the level of demand exceeded the level of supply of cash. Consequently, a waiting list developed, generally made up of people in hospital waiting to get out or people in the community seeking fair deal and ending up in hospital as their ability to be cared for at home diminished. The Government recently agreed traditional expenditure of the order of €44 million as part of an overall €74 million package to bring waiting times on fair deal down to four weeks, post-financial approval, which is back to where it was when the scheme originally began. That will help to bring equilibrium back into our system. It is taking us approximately 18 weeks to see the excess demand that had built up move from waiting time to actual beds.
That enables us to release transitional care bed stock, which usually turns over multiple times, from temporary long-term usage to enable the acute hospital system to work more effectively. With this recent allocation, our concerns about the fair deal scheme in terms of its current operation have been addressed. That is particularly important to those waiting for fair deal placements, many of whom felt they were under pressure to privately fund their nursing home care. That was a significant challenge and it led to a degree of inequality for society generally. Longer-term issues arise for the fair deal scheme. Thankfully, the population aged over 65 years is growing by 22,000 per year. This country is now successfully ageing to a greater extent than heretofore. That in turn will present a challenge for the Exchequer in terms of what it does with the fair deal scheme in the future but for now, the scheme will be stabilised by this change in the financial regime, which is welcome.
John Perry (Sligo-North Leitrim, Fine Gael)
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The scheme is financed by the sale of assets through probate on estates. How much income was received from the sale of assets in 2014? Is the HSE encountering difficulties with next of kin in arranging for the sale of property?
Mr. Tony O'Brien:
That part of the scheme is managed by the Revenue Commissioners and any recoupment goes back to the Exchequer. It is not part of the internal arithmetic of the fair deal scheme and the HSE has no role in it. Our role is restricted to the current contribution that people make from their income.
John Perry (Sligo-North Leitrim, Fine Gael)
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The revenue from the sale of patients' assets does not go into the HSE's budget.
John Perry (Sligo-North Leitrim, Fine Gael)
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Does Mr. O'Brien know the percentage coming back through sale of assets? I understand that it terminates after year three and people may be in nursing homes for a period of six years.
John Perry (Sligo-North Leitrim, Fine Gael)
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What is the cost difference of keeping an individual in an acute hospital in contrast to a nursing home? Is there sufficient capacity in private nursing homes to allow people to be discharged from acute hospitals?
Mr. Tony O'Brien:
That is a relevant question. When the fair deal scheme was introduced nursing home developments were what could be described as very bankable because commercial funding was readily available. The development of capacity slowed down in the intervening period because of increasing waiting times stabilising the supply of customers to nursing homes and due to the loss of bankability. Particularly in the north east, where there has been a significant mismatch between demand and supply, I am hopeful that the recent commitment on ensuring people do not wait longer than four weeks, which has increased the overall number of beds, will encourage those who wish to get into the business of developing private nursing homes and persuade potential bankers to look upon those schemes more favourably. We need that stock to be developed.
John Perry (Sligo-North Leitrim, Fine Gael)
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Making nursing homes a bankable option would require a commitment in respect of the fair deal system. Is it a challenge for the HSE to give such a commitment?
Mr. Tony O'Brien:
We cannot give commitments to individual proponents of projects. The rate paid per bed is determined by a process managed by the National Treatment Purchase Fund, NTPF, which is a separate statutory agency under the aegis of the Department of Health. The NTPF takes account of a range of factors in determining the price. We recognise, however, that increasing numbers of people will be able to avail of the nursing home scheme and for this reason the level of demand for beds is only going to increase. That in itself will make projects bankable. The reason we cannot give a specific commitment on any nursing home is because the resident makes the fundamental choice as to the nursing home in which he or she wishes to stay. We do not send people to particular homes.
John Perry (Sligo-North Leitrim, Fine Gael)
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A nursing home provider on the east coast will get significantly more than one on the west coast.
Mr. Tony O'Brien:
I am not sure that is universally the case. A range of weekly rates is payable and one will find different rates paid within counties as well as across the country. That is a function of the NTPF. The functions of setting prices and paying the costs have been segregated. The HSE has the payment function.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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We will resume our meeting. Deputy Costello, did you want to contribute?
Joe Costello (Dublin Central, Labour)
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Yes. I welcome the witnesses to the Committee of Public Accounts. I have a number of questions. One of the issues I am concerned about is the cost of drugs. We seem to be the most expensive country in the world in terms of drugs purchase. The drugs bill for the Health Service Executive, HSE, is approximately €2 billion. Have we any clear indication as to the reason we have not been able to manage better with generic drugs or be in a better position to put together some block purchasing? The drugs bill is astronomical, and that is extended to the consumer in terms of the cost of drugs and to the Exchequer, etc., in every format. Could we get some answers on that issue?
Mr. Tony O'Brien:
I thank the Deputy. The overall drugs spend is in the region of €1.8 billion. In the past couple of years significant inroads have been made to the individual cost of medications. This has arisen from two sources, one of which is what is known as the IPHA agreement. This is the agreement between the Department of Health, the HSE and the Irish Pharmaceutical Healthcare Association which has reduced the cost of patented medications on an agreed basis.
Separate to this, in 2013 reference pricing legislation came into effect, which is of relevance where there are interchangeable medications. In other words, molecular equivalents. As a result of this, and the powers given to the HSE at that time, we have been, on a continuous basis and starting with the highest volume and, therefore, the highest cost medications, referencing down in accordance with the legislation against the European average. We are in the process of completing a second round in regard to some of the higher value medications which are enabling the overall cost of medications, both for the State and individuals, to be reduced. We are required to proceed with a degree of caution. We must take into account the impact on supply and also the risk of co-payments. This has not been a significant issue so far and the reference pricing approach has proceeded very effectively. At the end of this year we will be in a position to provide a retrospective report.
Joe Costello (Dublin Central, Labour)
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Can Mr. O'Brien give us an idea of the success in terms of percentage decrease?
Joe Costello (Dublin Central, Labour)
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That figure relates only to generic drugs.
Joe Costello (Dublin Central, Labour)
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That is a drop in the ocean, out of €2 billion.
Mr. Stephen Mulvany:
The Irish Pharmaceutical Healthcare Association, IPHA, agreement related to patented drugs signed in October 2012, which will run until October 2015, was targeted to allow us to reduce costs by agreement by €400 million. Again, our sense is that this will largely be delivered. This has facilitated us-----
Joe Costello (Dublin Central, Labour)
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These are all still patent drugs. It is not that the patent has run out.
Joe Costello (Dublin Central, Labour)
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Is it not the case that the majority of drugs have gone off patent at this stage? There was a huge dip in terms of exports last year because so many of the drug companies had gone off patent.
Joe Costello (Dublin Central, Labour)
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Has the HSE tracked that in an effort to determine whether that has been channelled into the reduction achieved?
Joe Costello (Dublin Central, Labour)
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No, this is not reference pricing. That is the deal that the HSE has done with the pharmaceutical companies.
Joe Costello (Dublin Central, Labour)
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Let us keep the two separate for now. Reference pricing is about generic drugs.
Mr. Tony O'Brien:
No. Reference pricing references the branded price, broadly speaking, down to the generic level also but not where there is no bio-similar. In the case of a brand new drug, in respect of which there is no capacity for anybody else to produce something that does the same job pharmaceutically speaking, then reference pricing is not an issue. Once there is a capacity to reference against bio-similars it is beyond the protected patent period. Even in respect of the branded drugs we will only reimburse at the reference price level.
Joe Costello (Dublin Central, Labour)
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Yes but that is only in cases where there is a generic drug of the same quality available.
Joe Costello (Dublin Central, Labour)
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On the deal which the HSE did with the pharmaceutical companies in regard to the patented drugs that are not being dealt with in that fashion, has the HSE followed the track of the patents? The vast majority of those drugs have come off patent in the past two years and this has been reflected in the markets. A major concern for the IDA and Enterprise Ireland is the effect on employment of all of these companies coming off patent.
Joe Costello (Dublin Central, Labour)
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Perhaps Mr. O'Brien would answer my question in regard to whether the HSE has tracked the patent cliff to see how it affects the deal which it did with the Irish Pharmaceutical Healthcare Association?
Joe Costello (Dublin Central, Labour)
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I am not happy with "fairly sure". Perhaps that could be confirmed to the committee at a later date. I would like to see the curve that has already occurred in relation to the patent cliff and the amount of savings made, which would illustrate whether or not that deal is in tact. Perhaps the witnesses would forward a note on that matter to the committee.
Joe Costello (Dublin Central, Labour)
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When I was Minister of State with responsibility for trade and development, I sought to establish a depot in Shannon to deal with disasters. There is such a facility in Italy, which is the only one in Europe. Shannon has the capacity for all sorts of transport required to deal with tsunamis, earthquakes and other unexpected events throughout the world. One of the reasons cited for our not being able to have a base in Ireland was the cost of drugs, given the many drugs associated with all of these major events. There was a substantial survey done on this in 2012. The problem was that it was not possible to get the quantity of generic drugs required at the right price. It was possible to get them anywhere else in the world but not in Ireland. Has the HSE tackled this problem?
Mr. Tony O'Brien:
I would not use the term "tackled". We are in the process of tackling it in line with the intent of the legislation. We are sequentially, by volume and cost - which is where we would expect to start - referencing down against the European average basket as provided for in the legislation. We are not yet at the levels achieved in the UK, where this has been done for a considerable period now. By revisiting the reference pricing we are moving further in that direction. We are obliged under the legislation to take into account the impact of what we do on continuity of supply. Consequently, we are proceeding with a degree of caution. The targets that have been set, in terms of the reductions to be achieved, are being met. It is a longer journey than we have currently travelled.
Joe Costello (Dublin Central, Labour)
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It was only in 2012-13 that the HSE began to address the issue in a serious manner. Has the HSE ever considered bulk buying with our neighbours in, say, Northern Ireland or the United Kingdom, or with other countries of the European Union? Mr. O'Brien stated that we do not have the buying power of other countries like the United Kingdom and Spain. Could we not associate ourselves with those countries in terms of bulk buying rather than trying to purchase as an island?
Mary Lou McDonald (Dublin Central, Sinn Fein)
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The North is part of this island.
Joe Costello (Dublin Central, Labour)
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Absolutely. Could we not have an all-Ireland approach to this? There is a need for a little creative thinking in that respect.
Mr. John Swords:
There are issues. That has been discussed. There has also been discussion around possibly purchasing drugs outside of the country and engaging in parallel trading in relation to drugs but that could work out more expensive because of the effort required, including bringing in expertise to the companies and then bringing the drugs directly into the country. We have a national distribution centre in Tullamore. Within that we have a licence for distribution. We looked at this issue in the context of what the costs would be as distinct from what the distributors charge us but they were not comparable in terms of effort and the amount of money required. Even ensuring we were getting the right drugs, in terms of ingredients, and not spurious drugs was a risk. It has been discussed. The costs are quite high so we have to look at different ways of doing that.
Joe Costello (Dublin Central, Labour)
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It is hard to understand how linking up with the authorities in Northern Ireland would result in a major extra cost given it has been already stated that bulk buying is a major feature in the cost of the drugs that the HSE is purchasing.
Joe Costello (Dublin Central, Labour)
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Is Mr. Swords saying that there are two different sets of regulations on the island of Ireland and that they are out of kilter with each other?
Joe Costello (Dublin Central, Labour)
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Before moving on to Europe, what is the position on the island of Ireland?
Mr. Tony O'Brien:
There are differences. The regulatory approaches to pharmaceuticals operate in some respects at European level and in other respects at national level. The Health Products Regulatory Authority, which is an Irish entity, is the licensing body for any pharmaceutical that can be supplied or sold in the Republic of Ireland.
Their requirements are specific, which is why the packaging of products sold here meet these standards, as do information leaflets. The indications approved are sometimes different in different member states and it is the HPRA which determines whether products are interchangeable for the purposes of reference pricing. The net effect of what we have done in terms of the IPHA agreement which, as Mr. Mulvany said, is performing against its objectives and reference pricing is to implement the policy parameters determined by the Government and legislation. We are giving effect to the policy intent of the Government and the legislative process.
Joe Costello (Dublin Central, Labour)
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We are taking all of that on board and I have no doubt that there have been improvements. However, given that Mr. O'Brien has identified bulk buying as a major factor and the fact that Ireland is too small in that context, could we not nominate the Northern Ireland or UK authorities to conduct it on our behalf, even if there are different regulations operating here? Is it not possible to bypass things to get the authorities to state we are all in the European Union?
Mr. Tony O'Brien:
That would not be consistent with the current agreements in place or our current implementation of the 2013 legislation. I do not think I referenced bulk buying and I am not sure where that came from. When I referred to volume, I simply said - I may need to clarify - that when we were beginning the process of reference pricing, we started with the most prescribed and highest cost items in order that as we gained the benefit of reference pricing, it was related to those which had the greatest financial benefit. However, we do not bulk buy as such. We have national agreements on pricing and the way medicines are prescribed is obviously not in a bulk buying context but in the context of individual patients and prescribers.
Mr. Stephen Mulvany:
What we do buy in bulk are the drugs hospitals and community services utilise. The costs about which we are talking largely are those which are reimbursed by the primary care reimbursement service. It is people going into individual pharmacies. The pharmacies require the drugs and what we have, in effect, is a bulk agreement on price with the IPHA which, as the director general mentioned, has delivered €400 million in savings since October 2012. This has allowed us to invest €210 million in new drugs which we would not otherwise have been able to afford. That is the bulk element. That is us dealing with the entire market in terms of the reimbursement of drugs where individuals go into pharmacies. Obviously, we do not buy the drugs directly but reimburse patients through the primary care reimbursement service.
Joe Costello (Dublin Central, Labour)
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On the sample of 100 payments to suppliers which were examined, the determination was that in 35% of them appropriate procurement processes had not been followed. Can the witnesses give the committee some indication as to whether they agree with that figure?
Mr. John Swords:
We accepted the audit findings with thanks because they allowed us to improve our process to eliminate the weaknesses within the system. Clearly, there was an issue around the 40/02 report. The audit report stated the 40/02 report had been late and incomplete in that these instances were not reflected in it. We redoubled our efforts and have introduced a training programme that we are rolling out across all appropriate staff. We say "appropriate staff" as we used to do so by grade. We have stopped doing this as staff in many of the grades referenced in the 40/02 report were not actually in charge of expenditure but staff in grades below them. The training is across procurement directives and national financial regulations which incorporate the 40/02 report requirements. In doing this we have trained more than 107 senior managers. We have it on the web as a reference point for them and are continuing to roll it out in quarter 2. By the end of June, we will have completed the training programme across the HSE. It is inclusive of the voluntary hospitals and section 39 bodies which are now part of One Voice for Health which we have also introduced as part of the Government's decision in April 2013 that the public sector will talk with one voice. Specifically in health, One Voice was required to incorporate the voluntary sector and section 39 bodies. It included the TUPE of a private company in the voluntary sector which moved over on 1 January this year. We acknowledge that there was a shortfall which we put down to a lack of communication and awareness of the frameworks in place. Since the report was produced, we have introduced-----
Joe Costello (Dublin Central, Labour)
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Was there a lack of communication on or awareness of the framework agreement?
Joe Costello (Dublin Central, Labour)
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If there was a framework agreement in place, it must have been agreed to. As such, there is no excuse for not being aware of it.
Joe Costello (Dublin Central, Labour)
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The figure in the sample showed that only six framework agreements were actually in place. One might as well not have had a framework agreement at all. There was a sample of 100.
Joe Costello (Dublin Central, Labour)
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Is this what has been followed up since the sample was reviewed? Is that what Mr. Swords is saying?
Mr. John Swords:
No. There were 53 at the time and now there are up to 80. If I can take a step back, I will explain how the central procurement process came into being. In 2010 we had an agreement with the unions to introduce central purchasing across the HSE. It came to life in 2011 and, as the Deputy will appreciate, required the establishment of offices of central procurement and logistics to bring it into being. It took time to bring it into play. At the time we also had austerity hit us quite hard. In fact, we were sent the savings figures and asked to take money out of the system. When one goes that way and chases savings, one moves away from putting more of an effort into compliance and building one's number of contracts to cover all expenditure. One looks at areas where one can negotiate through agreements already in place to take money out of the system. We were very successful in taking out €250 million since 2010. That is a significant amount of money. It works out at an average figure of €50 million a year, which sum is not collective. When I refer to a figure of €50 million, I am referring to €50 million in cash.
Joe Costello (Dublin Central, Labour)
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I am really confused. If there was a sample of 100 and it was found that 36% were in breach of the standard procurement process, no matter how much money one saved, one did not have an effective process in place.
Joe Costello (Dublin Central, Labour)
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It was further found that only 6% of those engaged knew anything abjout the framework agreements. No matter what, that is not an effective process. To address the actual issues involved, how could it happen that such a breach of the normal procurement process could take place?
Joe Costello (Dublin Central, Labour)
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It is not communication but process.
Joe Costello (Dublin Central, Labour)
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There is a process in place for procurement. Either the procurement process is followed or it is not. Communication does not necessarily come into it. It might be communication on the framework agreement but not on following the proper process.
Joe Costello (Dublin Central, Labour)
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That is not what was found.
Joe Costello (Dublin Central, Labour)
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I really-----
Mr. John Swords:
Let me say what we have done about it as that might help. It is important to recognise that we have taken action on the report. There are four elements to what we have done. We have put in place a procurement management system to identify the pipeline of contracts on which we are working. It also gives us information on what is in place and its achievement by way of savings and statutory reports which we are required to give to the Office of Government Procurement, our partner in this process. Our procurement assistant system identifies contracts which are visible on a web portal which has been live since March this year.
We have 124 users and over 100 contracts on it.
We have also put in place a national distribution centre which I mentioned briefly. That is being rolled out. It is reducing our stockholding arrangements within the hospital areas. We are operating using a hub and base process in which we have hubs in Letterkenny, Sligo, Galway, Limerick, Tralee, Cork, Wexford, Dublin and County Louth, from which we will distribute all of our products. It will have the effect of consolidating all of our stock purchases, which will greatly assist in dealing with the compliance issue raised in the audit. We have statistics to support this. We reduce the inventory first time out, increase productivity, put our staff at point of use and reduce the clinical time nursing staff spend on stock management. It is measured in the format of four to six hours per week, which is per ward.
On top of this, we have also changed the culture of spend. We will easily meet the industry standard of 7%. On an amount of stock of €400 million, one can work out the figure of 7%, which is annualised. We will save approximately €30 million per annum in those areas.
With regard to compliance, we are working with the Office of Government Procurement and have segregated all of the work that will come to us, as we move into the new structures for hospitals, with the seven groups, and the CHO areas, of which there are nine. We are actively engaged in all of these areas to build a three year rolling plan. We are workng actively with the hospitals and the community health organisations to establish what is required across the entire HSE. This includes, for the first time ever, the voluntary sector. I consider this to be good progress.
Joe Costello (Dublin Central, Labour)
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That is extraordinarily impressive and underlines the fact that there was an incredibly poor, or non-existent, system in place. This is what is reflected in the audit report and the report of the Comptroller and Auditor General. We will not know whether the package Mr. Swords has outlined is effective until the next report is presented. Can he give us an assurance that this is working on the ground?
Joe Costello (Dublin Central, Labour)
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Is there the awareness and communication that he thought was missing about compliance-----
Joe Costello (Dublin Central, Labour)
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What supervisory system and mechanisms are in place to ensure Mr. Swords will get regular feedback on it?
Mr. John Swords:
I will start by speaking about whether we have traction and visibility. In the past two years, as we grew into a centralised procurement function, our requests for procurement support have increased threefold. That is a fair indication that awareness of the obligations of our budget holders is taking hold.
The second aspect is the 40/02 report. This year has seen a large increase. The Deputy might say it is bad, but I believe it is a good indication that there is awareness on the ground that people should state with what they have not been compliant. One might say it is bad, but it can be turned into a positive in the sense that it allows me to implement it in the procurement plan as we move forward. With the assistance of and collaboration with the Office of Government Procurement we will have more coverage than ever, which will make a significant difference.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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I apologise for my absence for most of the meeting. In his opening statement and making reference to the management letter and the observations and audit of the Comptroller and Auditor General Mr. O'Brien referred to the establishment of a national financial controls assurance group. Will he elaborate on this? Who is in it and when was it established?
Mr. Stephen Mulvany:
It is a recently established group. The aim was to bring together senior management team level people from each of our divisions - the five service divisions, including mental health, primary care, acute hospitals and so forth, as well as the finance, ICT, procurement and shared services divisions - in order that we could have a central senior team to lead the process of ensuring we could problem resolve some of what were, in fairness, long-standing issues that had come up over a number of years in internal audit reports, reports of the Comptroller and Auditor General and internal reviews. They are issues we need to tackle and include procurement, tax, cash handling and salary overpayments. The aim is to provide national leadership and engage the organisation fully in dealing with them. At one of its first meetings there was a significant conversation about tax. It is unusual for a service-----
Mary Lou McDonald (Dublin Central, Sinn Fein)
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When was its first meeting held?
Mary Lou McDonald (Dublin Central, Sinn Fein)
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Last month.
Mr. Stephen Mulvany:
Yes. It would be unusual for a conversation on tax to be held at a senior level, but clearly some of the issues we are trying to address require both service and function personnel to be involved. That is what the group is about. The aim is to commission pieces of work or research, if necessary, to try to get behind some of the more systemic issues which arise either in our reviews, internal audit or external reviews.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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Is this envisaged as a permanent structure?
Mary Lou McDonald (Dublin Central, Sinn Fein)
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On the issue of procurement, figures have been set out which indicate that, for one reason or another, not all of which are entirely clear, tenders were not subject to the normal procurement requirements and processes. In his statement Mr. O'Brien referred to the "outs", as it were, in respect of non-compliance with what would be considered to be standard procurement procedure.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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Yes. What I am seeking is reassurance that it is the position of the HSE that there be full compliance with standard procurement processes and rules. Is that the objective?
Mr. Stephen Mulvany:
Absolutely, that is the objective. We have a strong procurement function, although obviously responsibility for some of it was transferred to colleagues in the Office of Government Procurement. Within the limits of their overall capacity - we probably do not have enough - they engage in good procurement and produce good contracts. The issue concerns compliance with these contracts, an issue which Mr. Swords has covered to some extent. We have a distributed buying system. We have thousands of people who are buying product all the time; we do not have a single national system, either to facilitate this or to be able to readily track it. Some of what the director general outlined in his opening statement, in the brief we submitted and what Mr. Swords has covered is trying to deal with the awareness, communication and training aspects, but we can reassure the Deputy that procurement has a significantly higher profile as a control and reputational issue within the organisation in the past few years. We are clear that the public equates procurement with potential waste with the overall health service. It is a significant priority. We are not where we need to be yet, but the position is improving and must improve further in the next few years.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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Is there not a tighter timeframe for or a greater sense of urgency in addressing these issues? For example, of a sample of 100 cases with a value of €2.2 million, which represents just a proportion of the spend, 36% were not subject to procurement processes. A timeframe of how many years has been set?
Mr. John Swords:
Looking at the audit at the time we acknowledge that was the position.
With our colleagues in OGP, we are ramping up. The OGP has been resourced to take care of all the common areas across the public sector. It is a changing environment, for procurement but also for the health service, and there are moving parts here at all times.
How does one tap the situation into getting the best possible outcome? I think it is done by system. What we recognised is that we have done our training. We started our training programme - we are going to be finished by the end of June - to do that. That is awareness. The second part then is about visibility of the contracts, which, I think, was part of the overall failure on our part that led to the 36% figure referred to. On greater awareness, it should be that the first port of call is to go to the system and check is their a contract in place and then take a reference to one's procurement organisation. What we have right now is a combination of that.
We have 124 staff of whom we know are involved in the procurement function and who are now registered on this system. From there, we will now introduce that to the new system of the hospital groups plus the CHO areas. That, on top of the assistance we will get from the OGP, is the basis of how we are going to tackle this. I would think a rolling programme of three years will see change. It will take that time before we could say we will have full coverage on all of our contracts.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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In some of the document on Mr. Swords' checklist, he set out some of those. I am not trying to discount them.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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For the purposes of this committee, Mr. Swords is offering a three-year timeframe in terms of full compliance with standard procurement.
Mr. John Swords:
We will have contracts and frameworks in place for all of those areas. Full compliance is down to the system and the budget holders. We will have to ensure that they all are using our contracts. I do not know of any organisation, particularly of our size, in the world that would be 100% compliant but we will strive to achieve that.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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It was found that 36% of the sample I quoted was not subject to correct procurement procedures. I would put it to Mr. Swords that he might struggle to find an organisation that tells him it is serious about abiding by procurement standards and regulations that would have a figure of 36% for non-compliance. I do not want to get into a to and fro.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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I hear what Mr. Swords is saying in terms of the initiatives taken but I had directed the question to Mr. Mulvany because he is now the chair of this national financial controls assurance group. Would it be a fair depiction to state that he has a three-year target in terms of having the correct arrangements in place? I am asking Mr. Mulvany because he is the chair of this assurance group.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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Did the group discuss this at its March meeting?
Mary Lou McDonald (Dublin Central, Sinn Fein)
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Mr. Mulvany instanced procurement.
Mr. Stephen Mulvany:
Absolutely. It has not yet discussed procurement. What we are saying is we would expect to see significant improvement over the next three years. We cannot say we will have full compliance at the end of three years. Sitting here today, we are not in a position to say that for a variety of reasons but it will be significantly improved.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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Everyone in this room and beyond knows that there are few achieving 100% in anything in life but I do not feel assured that the chair of the assurance group has a more firm view in terms of achieving strong compliance with procurement.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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What did the group discuss at its first meeting?
Mary Lou McDonald (Dublin Central, Sinn Fein)
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When does Mr. Mulvany imagine the group will get to the procurement issues?
Mr. Stephen Mulvany:
In the next two to three months. To be clear, that does not mean there is not work under way. One of the reasons we did not discuss procurement at that meeting is because there is a very significant amount of work under way already in the organisation around procurement, which has already raised its profile very significantly.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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I understand all of that. Naturally enough, Mr. O'Brien made reference to the establishment of Mr. Mulvany's group and he is vesting a level of authority in and a level of expectation around this group to deal with a range of issues, including procurement. I am trying to get that sense of assurance from Mr. Mulvany that the issue features and that there will be targets. Mr. Mulvany is involved in the oversight, is he not?
Mary Lou McDonald (Dublin Central, Sinn Fein)
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None of us wants to be sitting here with audit report after audit report from the Comptroller and Auditor General, saying, "Here we go again, we still have a systemic issue around compliance with procurement standards, norms and procedures in the HSE". I want Mr. Mulvany to tell me that he does not want to be there either.
Mr. Stephen Mulvany:
I can absolutely tell Deputy McDonald that we do not want to be there. I just do not want to give her a commitment here today about something that group has not yet discussed or give her a particular target that we have not yet agreed or put in place. In terms of the principle and whether we want to be far more compliant around procurement, we absolutely do. We see the value of it, both in terms of reducing actual wastage and the perception around any health funding being used in a wasteful way because all of that damages our capacity.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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There are also two pieces to it. The notion of efficient procurement is waste reduction and minimisation and doing away with waste entirely in the ideal scenario.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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I am not referring to that goal in itself. Here I am referring to the HSE, if I could use the term, swinging into compliance with the procurement rules, regulations, standards and norms. That is what I am talking to Mr. Mulvany about. The raison d'êtrefor this approach is to minimise waste - we take that as read. The issue of reputational damage or the issue of concern when audited is when one comes across a phenomenon that seems to be persistent within the HSE, as the officials themselves have acknowledged, of non-compliance with the rules. I would have thought that Mr. O'Brien would have a much firmer message to give to the Committee of Public Accounts in terms of his determination and the timeline to reach full compliance.
Mr. Tony O'Brien:
Deputy McDonald is correct in saying that there is a persistence. I should say I have made reference to this oversight group. This oversight group is looking at compliance with all the national financial regulations and the reason Mr. Mulvany will not have had this on the agenda of his first meeting is because he would be aware of the significant work that the procurement function is doing to address the specific recommendations of the Comptroller and Auditor General which, in my view, has had a very substantive response. What we now need to do is ensure that all of the buyers who were not abiding by the rules have not more excuses left, such as, "I did not know about the frameworks", or "I do not have access".
There is an established pathway to follow in the literature as to how one achieves procurement compliance. Those steps are being followed and the function of the assurance or oversight group is to provide assurance across the whole piece. The fact that committee did not discuss procurement on that occasion was simply a feature of the fact that there is such a strong focus on procurement at present already whereas we do, unfortunately, have some other challenges as well.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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I noticed. Mr. O'Brien might let us know, perhaps by way of note to the committee. I do not know whether the following would be in order and the Chairman might guide me on this. As Mr. Mulvany's group takes shape and its members get their feet under the desk, is there a way in which he can keep this committee informed as to its work programme, agenda and progress being made on the various issues, including procurement. Would that be possible?
Mr. Seamus McCarthy:
If I could make a point, the statement on internal financial control, both in the appropriation account and in the annual financial statements, is comprehensive. It is one of the most comprehensive ones the committee will see. There is space, and an opportunity, there every year for the HSE to outline where it is at in that programme of development of controls. That would be one mechanism.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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I thank the Comptroller and Auditor General. That is useful. I raise this issue and zeroed in on the procurement one from a public interest point of view. This is something that has been the subject of commentary and criticism, not only by members within this institution but more broadly. A lot of documentation and information is trawled over, analysed and produced.
I am not gainsaying that. In order for the committee to fulfil our remit, it would be helpful if we knew that progress was being made not just annually but in a more systematic way and that the issue was being addressed and prioritised. Is that reasonable?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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That would be enough to go to the committee, the Comptroller and Auditor General and the HSE to share the information. I do not know if it is possible to get the minutes as they happen. Mr. Mulvany might send us the detail of the major points.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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In dialogue with the clerk to the committee, we might straighten it out. In the sample to which I referred earlier and the cases that were not subject to correct procurement procedures, who made the call on them? I apologise if this has already been covered.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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At what level in the organisation were the individuals?
Mary Lou McDonald (Dublin Central, Sinn Fein)
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What does that mean?
Mary Lou McDonald (Dublin Central, Sinn Fein)
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Does the Comptroller and General have all the details?
Mr. Seamus McCarthy:
Yes, we visited six centres, three of which were hospitals and three of which were local health offices. They were Cork University Hospital, south Lee and north Lee local health offices, Galway local health office, Galway University Hospital and Connolly Hospital in Blanchardstown. We took a sample and examined how they arrived at a situation in which they were paying for goods and services. As the witnesses said, there was a variety of authorisation for putting contracts in place or procuring services.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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And they were grade 4 staff.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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In Mr. O’Brien’s opening statement he set out the restrictions on comment on the Waterford intellectual disability services case. When he went on to speak about the procurement practice in establishing inquiries, he quoted the relevant EC regulation and the exceptional circumstances by way of explanation of how he engaged the services of Conal Devine and Resilience Ireland. He stated:
It is important to point out that the expertise required to undertake this broad-ranging and sensitive work included expertise in conducting serious incidents, reviews and investigations, knowledge of the social care services, child protection knowledge and expertise, as well as knowledge and experience of safeguarding practice. This type of expertise is not readily available in Ireland.
I am sure he has had a long conversation about this.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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We have covered much of this ground.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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I will not labour the point. Although, undoubtedly, those skills are not common to every Tom, Dick and Harry, I am surprised that Mr. O'Brien said they were not readily available in Ireland. I would not have thought that the HSE would have had to resort to proceeding as it did. I am not convinced by the assertion.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Neither were the members who were present, and we covered it.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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I picked up on some-----
Robert Dowds (Dublin Mid West, Labour)
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We discussed it for three quarters of an hour.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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Could Mr. O'Brien explain the increase in the costs of agency workers?
Mary Lou McDonald (Dublin Central, Sinn Fein)
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Why did the agency costs increase?
Mr. Stephen Mulvany:
It was due to a combination of factors, largely related to maintaining services, challenges around the market and the ability to get staff, which is particularly relevant with medical staff, and a moratorium whereby we have a requirement to maintain an essential service but are not allowed to recruit directly. While overall pay decreased, agency costs increased, and they increased again in 2014. They have stabilised somewhat but have not yet started to decrease significantly.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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In which posts or professions have there been the most marked increase in agency costs.
Mr. Stephen Mulvany:
The most marked increase has been in medical posts, meaning doctors. Given that the moratorium on recruitment largely did not apply to medical posts, the issue is not typically approval but availability, the capacity to find suitable people, particularly for smaller, more rural places and those with more challenging rosters. It is about being able to attract and retain staff, and the fact that in some hospitals we are under significant pressure consistently to field a team of directly employed medics, which is our preference. While it is not all down to salary, we hope the recent changes in consultant salaries should assist us in recruiting consultants, and there will be an obvious knock-on to NCHDs. This is our single most challenging area, and it is not related to funding availability, approval or the moratorium, but to the market and our ability to attract and retain medical staff. We are competing in an international market.
The other large areas are agency and support staff, which are subject to moratorium and approvals and the permission to recruit under the previous employment control framework. When it hits grades at which we are providing essential, often 24-7 residential services, there is a growth in agency costs, albeit overall pay costs, including agency, have decreased during the period. This includes nursing and support staff, such as porters, cleaners, domestics and health care assistants.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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Ironically, although the use of agency staff is posited as a more flexible, cost-effective choice, it is expensive.
Mr. Stephen Mulvany:
It can be flexible and cost-effective, particularly in medical. The premiums can vary very significantly and we are not in control of the market. The variations from direct pay for other grades are smaller and more standard. While there tends to be a normalised rate, the VAT cost creates a 23% gap between our costs, direct and agency. It is expensive overall. Approximately 5% of our total pay costs are agency and overtime whereas in hospitals approximately 10% of costs are agency and overtime. Overtime is also an issue, particularly in services that are over reliant on it.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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I return to the review and inquiry that was carried out in Waterford.
Without getting into the detail of that case, how many similar inquiries have been established over the last five years?
Mr. Pat Healy:
Within the disability sector, there would be a range of reviews under way. I do not have the figure across the whole of the health sector, across hospitals and so on. We track that and there is a national incident management process which takes account of all reviews currently under way. An important part of this which is relevant to Waterford is that one does not have to wait for the completion of a review. Significant action was taken immediately to start to address issues that were evident and to take the corrective action that was needed. That is a feature of the disability sector and applies across the system. Reviews like this are regularly undertaken although I do not have the exact figure for the whole of the health sector.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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What about the disability sector, Mr. Healy's area?
Mary Lou McDonald (Dublin Central, Sinn Fein)
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Not to nitpick, but are they reviews or inquiries? What are they called?
Mr. Pat Healy:
This was a formal inquiry. It depends on the issue being reviewed; sometimes it is a particular incident and we follow our national incident management policy. It may be an issue of a small order - relative to the scale of matters - but we follow the same type of process. In terms of the Waterford situation, it was a large inquiry.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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What I am asking is, were or are there other Waterfords? We will come to the reviews in a minute. How many inquiries of this type are there?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The number of inquiries generally in the disability sector is what is being asked.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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There are two major inquiries, but are there any that are less than major?
Mary Lou McDonald (Dublin Central, Sinn Fein)
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How many minor ones are there?
Mr. Pat Healy:
That is what I was saying. In line with our national incident management policy, there would be reviews in terms of serious incidents that may have happened. The HIQA inspections would reflect the fact that every HIQA inspection of a residential centre requires a response and all those are being responded to by those individual organisations.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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I am gathering that Mr. Healy and Mr. O'Brien do not have the information with them at the committee meeting today. I am presuming they have that information - the number of inquiries and the number of reviews, marking the distinction between an inquiry and a review?
Mary Lou McDonald (Dublin Central, Sinn Fein)
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I would like sector by sector figures, particularly for disability but generally also.
Mr. Tony O'Brien:
In the acute sector there would be numerous reviews, mostly into adverse clinical outcomes. They would not typically escalate to the level of inquiry but have some of an inquiry's characteristics in that they are root cause analysis type reviews, in which we typically use a formula that allows nominations from the forum of postgraduate training bodies and appropriately qualified clinicians from a different location to carry out an external review. It would not be of that inquiry standard, however.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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I think we understand the distinction.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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May we tie the witnesses down and just ask for general investigations and the more serious reviews that are going on across the sector rather than going into the finer details?
Mary Lou McDonald (Dublin Central, Sinn Fein)
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That is fine.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Mr. Mulvany mentioned a tax issue in reply to Deputy McDonald. Can he describe that for us please?
Mr. Stephen Mulvany:
As we have set out in the last couple of sets of accounts, the HSE is in a process of voluntary unprompted disclosure with the Revenue Commissioners in respect of our tax for accounting years 2011-2013.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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What prompted that?
Mr. Stephen Mulvany:
As I recall, although I was not there at the time, it was prompted by a review that our previous national director of finance commissioned back in 2012. That was a tax risk assessment review. One of its recommendations led on to where we are. I imagine when we engaged with Revenue, it asked that we start at 2011, which was the year before the review. That has gone on up as far as 2013. The process is not complete. We are now at the stage where Revenue is validating or auditing what we have given it. We would expect it to be complete in the coming weeks or months but we do not have control over it.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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What kind of money are we talking about?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Your process is complete.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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What is the total figure? I am not asking for details, I just want to know what the exposure might or could be.
Mr. Stephen Mulvany:
Over the three-year period we have paid tax of about €4.5 billion to the Exchequer. Any settlement - well, it is not a settlement - any amount that we pay is also going to the Exchequer. It is a very, very small fraction of that, well below 1%. We do not have a final figure because----
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Only the 1% is in question here.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Again arising from answers to Deputy McDonald, am I correct that Mr. Mulvany looks at the bad debts and procedures around debt collection?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I see there are private charges here. We have dealt with this before at the PAC. It goes into the details of Limerick Regional Hospital, names the hospitals and what is outstanding. In 2013, there was €5.5 million for that hospital, €3.1 million for Waterford and €2.2 million for Sligo. Is that improving or is it getting out of hand again? This is where consultants sign off on submitting claims.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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We have had this before so we are familiar with it.
Mr. Stephen Mulvany:
We would have the capacity to issue a bill for our statutory charge within a matter of five or six working days. However, the process that has been in existence for some time requires us to calculate and generate a huge amount of additional material, including around consultants' private fees and all those other costs, in order to submit that to the insurers, even though our only interest is the statutory charge. That causes significant delays in us issuing the bill to the insurers and there are also delays on their side. The reality is that the figure has got worse in terms of what is outstanding, just to get the bad news first.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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What is the total outstanding?
Mr. Stephen Mulvany:
At March this year the total figure was about €150 million. If I could just put that in context, which is important, one of the measures we use is how much of that outstanding debt is on our side, either in our processing or in our consultants not signing the forms, and how much is with the insurers in their processing, their delay or, to be quite frank, their "pending" of our claims. That is improving. The percentage of what is with the insurers has now increased, it is about 61% of the total.
Where this is going to end up is that we are in the process of negotiating - although no negotiation can be predicted until it is finished - to improve that collection process by seeking agreement with the insurers. We have three of them engaged in detailed negotiations and are nearly finished with two, I believe. This would involve us receiving a form of advance payment. It will improve the payment process so that we will be able to issue a bill shortly after discharge and will get paid upfront for a percentage of our cost while the rest will flow later.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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That happened before, did it not? The last time Mr. O'Brien was here he was explaining payment----
Mr. Stephen Mulvany:
No, what happened before turned out to be a once-off process which was not part of an ongoing agreement. What we are seeking now very clearly is an ongoing agreement which changes the payment term so that we get paid far quicker.
As soon as we can conclude that agreement, which we are targeting to conclude in the next couple of months, it should substantially reduce the level of debt between us and the insurers. It will also bring about a better process.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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As of now there is €150 million outstanding.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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How is the HSE getting on with the consultants signing off on their paperwork?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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It is still €150 million.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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You can explain it any way you like but it is still €150 million.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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That is not the point. The point here is every year we pass the health budgets in Leinster House. However, the same types of issues come up every year. In this case, this is €150 million.
Is it correct the balance outstanding from voluntary hospitals at the end of December 2013 was €11.1 million? In 2011, it is €1.8 million, in 2012, €2.5 million and in 2013, €6.8 million.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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If you were in business and €150 million were due to you, regardless of turnover, you would not be minimising it but chasing it.
Will you please deal with the other question on the outstanding €11.1 million?
Mr. Stephen Mulvany:
This relates to a national contract which was put in place for service contracts for imaging equipment. This is the HSE using its bulk capacity, so it is a positive development. Several hospitals had effectively not paid their share of the bill. Essentially, we are funding it. They are delaying in providing the money to us.
As chief financial officer, I have instructed this year that they will either pay us by the end of the year or we will take it out of their cash allocations.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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What will the figure be for 2014?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Will the same amount of money be outstanding?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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An entity within the HSE-----
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Okay, these are entities within the health sector that owe the HSE €11.1 million.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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They owe the HSE €11.1 million.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I know what the HSE is going to do. However, it did not collect it before.
I call Deputy Robert Dowds.
Robert Dowds (Dublin Mid West, Labour)
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I am shocked by what I heard about the Waterford disability case. It has the appearance of yet another powerful organisation putting itself before vulnerable people. As one who in the past taught children who had no verbal ability, I am aware of how vulnerable people like that can be.
How many whistleblowers were involved in the Waterford case? I am aware that whistleblowers can be badly treated. How have these ones been treated since they put this information out?
Mr. Pat Healy:
There were protected disclosures, which we spoke about this morning, between the end of 2009 and the beginning of 2010 which gave rise to the establishment of the Conal Devine inquiry. Two individuals working for a voluntary organisation made protected disclosures to the authorised officer. There was an original disclosure and then two further disclosures followed with letters and so on. That was between November and December 2009 and January 2010. On receipt of these, the matter was discussed with the individuals by the authorised officer. In February 2010, an inquiry was initiated and commenced its work in March. Within a short time of receiving these disclosures, an inquiry was urgently established.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Mr. Healy, I have to stop you there. I will not tolerate your attempt to rewrite what happened earlier on.
It is like this, Deputy Dowds. This dates back to 1992. The former health board knew in 1995. A protected disclosure was made in 2009. A further protected disclosure was made later and again in February. That is the history to it. The police are involved in it and there are ongoing investigations. The material is here if the Deputy wishes to look at it privately. It will shock him even further. So, let us not get into it again.
Mr. Pat Healy:
There was a second protected disclosure then by someone who worked with the organisation in March 2010. That is the point I was making. The Deputy asked how those who brought forward protected disclosures were dealt with. Two of the individuals were outside of the organisation and brought the disclosure to the authorised officer. Subsequently, as the investigation was commenced in March 2010, a further disclosure was initiated. The terms of reference for the inquiry were adjusted to encompass the totality of those protected disclosures to form part of the inquiry.
In answer to the question, there were two separate disclosures - one from two individuals in a voluntary organisation and one separately from one who worked with the health service.
Robert Dowds (Dublin Mid West, Labour)
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Did any of those three people suffer adverse consequences as a result of their disclosures?
Mr. Pat Healy:
There is a clear rule set around protected disclosures. That is why a national authorised officer deals with them. It was the authorised officer who initiated the Conal Devine inquiry.
The distinction is that in this current review which is being undertaken by Resilience - the look-back review - will examine matters between 1983 and 1993. The South Eastern Health Board, the HSE and voluntary organisations have not placed anybody with the family in question since 1993. Resilience will look back at matters between 1983 and 1993 to identify all those individuals living and willing to participate in a study to establish what the details were. The particular focus is to ensure they have appropriate services and anything else that could be learned. That is a look-back and tracing exercise.
Robert Dowds (Dublin Mid West, Labour)
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Did any whistleblowers come forward in the 1990s?
Mr. Pat Healy:
When the Devine report, which we intend to publish, comes out, it will be clearly seen there were deficiencies and failures in that regard. Some of the findings will relate to information that was available at the time and whether it was followed up appropriately. It would be of great value from the HSE's point of view if we were able to publish both reports because it would be a comprehensive articulation of the issues. Unfortunately, however, we are precluded from doing that at present because of the Garda inquiry and the requirement for approval from the Office of Wards of Court to publish this documentation. At the earliest possible opportunity after clearance has been given, we will publish these reports and it will be evident to members of the committee and others that there were deficiencies but no cover-up.
Robert Dowds (Dublin Mid West, Labour)
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To go back to my question, were there any whistleblowers in the 1990s? Obviously there were three whistleblowers in recent years. Is Mr. Healy in a position to say whether there were whistleblowers in the 1990s?
Robert Dowds (Dublin Mid West, Labour)
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Did they suffer adversely due to having raised concerns?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The two whistleblowers are seriously concerned about the manner in which they are being treated and they are also concerned about their certification. I will go no further than that.
I do not accept some of Mr. Healy's remarks. I have read all the documentation and it is shocking. I do not want to go back into it; it is just a shocking report and it is available if one wishes to see it.
Robert Dowds (Dublin Mid West, Labour)
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The reason I am pursuing the question on whistleblowers is that I am aware of cases - and I am not just talking about the case of Sergeant Maurice McCabe - in which whistleblowers were excluded from further work, which is absolutely not the way they should be treated when they uncover something that should not have been happening.
Mr. Pat Healy:
I reassure the Deputy that last December we published a safeguarding policy and are rolling it out. A fundamental element of the implementation of the policy is that we have safeguarding teams and we support people who wish to speak out. We are trying to drive the no-tolerance approach throughout the sector. It is very clear that it is necessary. The director general established a confidential recipient as part of the process to encourage and bring confidence into the system so that people would feel encouraged to speak out. The message we are trying to communicate is that there is support for people who want to speak.
Robert Dowds (Dublin Mid West, Labour)
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Did anybody lose his or her job over malpractice? Was it the case that this particular foster family was not used any more?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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May I add that the lady who was abused the most was there for the longest period and had been left with the family?
Robert Dowds (Dublin Mid West, Labour)
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I support the Chairman's remarks on the need for an investigation of this case to be conducted by a body outside the remit of the HSE.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Thank you, Deputy.
Robert Dowds (Dublin Mid West, Labour)
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In regard to delayed discharges from hospitals. I see from the information we have been given that it is expected that delayed discharges will increase by 24% this year on the 2013 figures. Can somebody explain the reason for that increase? Are the new moves in regard to the fair deal scheme having a bearing on the numbers?
Mr. Tony O'Brien:
Once a period of eight weeks has elapsed from the announcement of new funding for the fair deal scheme, we believe the new moves will have a measurable impact on delayed discharges in acute hospitals. It was precisely the tapering upwards of the waiting periods for the fair deal scheme that could be correlated against the increase in the number of delayed discharges and the number of people on trolleys. An additional effect is that when there is no outlet to the fair deal scheme because of an absence of funding, the step-down or transitional care beds that many of the hospitals have access to are utilised by people who are waiting for the fair deal scheme. They would normally be turned over multiple times in an eight-week period, enabling staged discharge from the acute hospitals.
In our assessment, the core issue is the fact that the waiting time for a bed under the fair deal scheme headed out beyond 16 weeks at the end of last year, and if that situation had continued it would have reached about 20 weeks by this time, so the additional funding for the fair deal scheme, which amounts to €44 million, enables us to bring the waiting period down to four weeks and keep it at that point. Due to the numbers waiting and the pace at which people can be discharged and admitted into nursing homes, we see it as an eight-week process before the full effect of the new funding is experienced.
Robert Dowds (Dublin Mid West, Labour)
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Given that initiative, why does Mr. O'Brien expect the number of delayed discharges to increase so much this year?
Mr. Tony O'Brien:
Looking at the situation year on year, it is because the hospitals entered the year with 850 delayed discharges and that figure was unchanged for almost three months. By virtue of that, the overall number of days accounted for by delayed discharges in our system this year will be higher than in previous years.
Robert Dowds (Dublin Mid West, Labour)
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How does that impact on the finances of hospitals? Would there be a saving if people were discharged from hospitals earlier?
Mr. Tony O'Brien:
It has two effects, but they are not quite linear. Clearly it is better to have patients in the right place for the level of care they need. The typical cost of care in a long-term nursing facility or for the person to stay in their home with home care supports is considerably less that the rolled up cost of a hospital bed. When hospitals are overcrowded in emergency departments and it is necessary to use the full capacity protocol and place extra beds on wards in order to maintain safe care, extra staff must be brought in, and that increases costs in the hospital over and above that factor.
When we spoke earlier about the first two months in one particular hospital, I did at that point indicate that across the hospital system there were particular pressures at play in January and February which were pretty closely correlated with the pressures arising from overcrowding in emergency departments, which was a facet of the delayed discharge situation they experienced.
On the opposite side, it is also the case that patients are typically at their most expensive when they are being admitted for treatment as opposed to when they are in the bed awaiting discharge. A hospital that is more efficient is, generally speaking, in some respects more costly because of the costs of procedures, implants, hip replacements and so on. It is not all one-way traffic in cash terms, but overall it is a very bad situation when hospitals are clogged up to the extent that they were.
Robert Dowds (Dublin Mid West, Labour)
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Is Mr. O'Brien satisfied that sufficient step-down facilities are coming on stream in 2015?
Mr. Pat Healy:
The focus has been on the fair deal scheme, but I think an important initiative that is being funded now is the approval of 173 public beds around the country. We are opening an additional 65 short-stay bed community hospital in Mount Carmel. Some 24 dedicated beds were secured through the private sector for the Louth area to support Our Lady of Lourdes hospital. That is a good indication that there were not sufficient short-stay or long-stay beds in the Louth area to support the hospital. We are looking at creative ways of supporting hospitals. More will be required and, as Mr. O'Brien, the director general, said earlier, there are a couple of aspects to the issue. First, there is the direction of travel to the fair deal scheme, or the nursing home support scheme, which I hope will bring confidence to the private sector to engage in the development of further facilities. People have planning permission for nursing homes in various locations but the projects have not been progressing to capital construction. Equally, on the public side, there are locations around the country where additional capacity will need to be developed in both the private and public sectors, and obviously we will have to attend to that.
Robert Dowds (Dublin Mid West, Labour)
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Is the HSE largely relying on the private sector to provide those step-downs?
Mr. Pat Healy:
About 20% of the market is public. It is clearly stated Government policy that it is a necessity to have both public and private. We require to maintain the current public facilities and ensure that they are meeting the standards that HIQA set down. There is a discussion going on around that at present to ensure that happens. Additional capacity will also be required as the population age. The percentage of people in long-stay care will reduce but the volume or overall number will increase when one looks at the ageing population over time. One will have to provide for that. One will also have to provide for appropriate community supports such as home care packages, home helps and so on.
Robert Dowds (Dublin Mid West, Labour)
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I wish to raise another procurement issue. There was some discussion on it earlier so I shall try not go over that again.
There is still a considerable issue in terms of proper procurement processes and 36% was the figure that the Comptroller and Auditor General mentioned in his report. To what extent does the HSE have influence over procurement in terms of sections 38 and 39 organisations?
Mr. John Swords:
In compliance with the decision in April 2013, where the Government decided that public sector procurement would be dealt with as a collective, the breakout of that was as follows: the Office for Government Procurement would take common goods and services right across the public sector; there were four elements that retained, with public procurement health being one of them; and health within health would be One Voice. The actions that we have taken, and the description of services and systems that we have put in place to assist in compliance, have been put in place. In addition, we brought in One Voice for health in which negotiations took place with the voluntary organisations, both section 38 and section 39, since last year. Since 1 January we have used TUPE to move section 38 organisations into health so we are now speaking as One Voice to the market.
Robert Dowds (Dublin Mid West, Labour)
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Has all of that come together?
Mr. John Swords:
All of that has come together. With any of the contracts now that go in place, we put in a mechanism. The legislation is there from the point of view of the Government but in regard to voluntary hospitals with their own entities there was a complication within that. We took a model, a collaborative model, so we have agreement across health that we will work together. For example, if there is an organisation, such as a large hospital like Beaumont or St. James's and they have a specialty, they will take the contract on behalf of health as distinct from the hospital and, vice versa, the HSE will take the contracts. All of the contracts that we put in place from herein will represent health.
Robert Dowds (Dublin Mid West, Labour)
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To what extent does that bring about savings?
Mr. John Swords:
It will bring about savings. As I said earlier, we have brought about savings of €250 million to date. Our target this year is €30 million of which we have achieved €25 million, so we are on target this year. I caution against savings because savings come in different ways and also because the medical devices, and the medical area that we have charge of now across the public sector, will be affected by sterling, the dollar and currencies. We expect that will be a hard battle for us on which to hold the line. We have managed to do it to date but I think the savings are going to get harder.
In any procurement organisation, and particularly the transition that we have taken since 2010, the approach would be that one would harmonise the pricing across the organisation, put frameworks in place which we have done to a large degree, start working on one's contracts and from that one derives savings. From there one has to start looking at how one does one's work and that is where we will be concentrate our efforts from herein. We will look at the specifications that are there on current contracts and, thereafter, we might be made to make adjustments. Companies may come to us with difficulties, which they have already started to do, and say to us that they are suffering a cost increase on their costs and want us to absorb those. We are not funded for cost increases. We are funded for a delivery of service. Therefore, we have to look with them at bringing savings in different ways. The only way one can do so is by maybe looking at specifications.
Robert Dowds (Dublin Mid West, Labour)
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Last night, I received an allegation of failure to go through procurement procedures for a significant section 38 organisation. I do not want to name it here because I have not had a chance to check the details. If I give the director general the details would he mind checking it out and reporting back to me on the situation?
Robert Dowds (Dublin Mid West, Labour)
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I thank the director general.
Patrick O'Donovan (Limerick, Fine Gael)
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I shall briefly return to what I talked about this morning. I refer to the voluntary hospitals, mentioned by the Chairman, for 2013 with €11 million. Who are they?
Patrick O'Donovan (Limerick, Fine Gael)
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Who are they?
Patrick O'Donovan (Limerick, Fine Gael)
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Who is the third?
Patrick O'Donovan (Limerick, Fine Gael)
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I shall return to what I discussed this morning in regard to another voluntary hospital called St. Vincent's. Can the director general clarify what will happen if it continues to obstruct the HSE in determining where we are in regard to this matter? What remedies are available to the HSE to move the matter forward?
Mr. Tony O'Brien:
First, if I may provide a piece of information that the Deputy specifically asked me for earlier that I did not have, which was whether any of the red circled posts related to St. Vincent's Hospital. We have made inquiries and one post did. It was a nurse tutor post. It is not relevant to the issue of the private hospital but it is within the red circled group.
Patrick O'Donovan (Limerick, Fine Gael)
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What was the salary?
Mr. Tony O'Brien:
I did not ask that question but I shall provide it to the Deputy. It relates to a small allowance on top of the appropriate salary in respect of tutoring activities. We will get the information for the Deputy.
Ultimately, and this is where we do get into a difficult situation, the sanction would have to relate to our continued ability to fund the hospital at the present level, which would affect both revenue and capital. Of particular concern is that this is one of the hospitals assigned to the Ireland East Hospitals Group which includes other hospitals like the Mater, from Wexford through to Navan. Unless the governance on this campus is straightened out it is going to have an adverse impact on the ability of that group to be formed.
At the present time, I am holding on any approvals, or even considerations of approvals, for category "C" consultants. It may be that we will not be able to approve other types of consultants as those come up. We will have to consider all the issues of funding. At the present time, whatever their overall financial position, I can say categorically that unless this is straightened out, whatever deficit they may have, they will not get one cent above the amount of money that is specified for that hospital this year. Beyond that, I am not yet certain what I will do but it is a very serious situation.
Patrick O'Donovan (Limerick, Fine Gael)
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At what stage will the director general make a determination on that matter?
Patrick O'Donovan (Limerick, Fine Gael)
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Has the director general power to stand down the board of the hospital?
Patrick O'Donovan (Limerick, Fine Gael)
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What about the public hospital?
Mr. Tony O'Brien:
Section 38 hospitals come in two different types. This is a true voluntary hospital. There are other voluntary hospitals, or what we call voluntary hospitals, such as Beaumont and James's, which are actually in the ownership of the State and whose boards are appointed by the Minister or on the Minister's nomination. This is not that type of hospital. This is in the ownership of a private entity. It is one of the orders. I cannot recall offhand which one it is so I won't attempt to guess in case I get it wrong. We have no appointment authority in relation to the board of that group.
The governance structure of the group at present, which is also a cause of concern, and was something that the former chairman had agreed to address, was that there is a single board over three hospitals.
Patrick O'Donovan (Limerick, Fine Gael)
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Did the former chairman initiate actions to remedy the situation?
Patrick O'Donovan (Limerick, Fine Gael)
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Did the current chairman stop that?
Patrick O'Donovan (Limerick, Fine Gael)
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My following question on procurement may have been asked after I had to leave the meeting earlier. As Mr. Healy referenced, one of the other big issues that the HSE is examining at the moment is Áras Attracta. What is the framework for the investigation in Áras Attracta? Is it a HSE internal investigation? Was it put out to tender? Was it a point bid? Who is carrying out the investigation?
Mr. Pat Healy:
There are two processes in regard to Áras Attracta. The first is the formal investigation that is chaired by Mr. Christy Lynch who has a team with him.
Shortly after we initiated that investigation, the Garda, given that it is also carrying out investigations, asked us to pause our investigation for a period. Having got clearance from the Garda, we subsequently restarted the investigation and it is progressing very well. The expectation is that the work will be concluded by May and we will have a final report completed by July. This work is progressing.
The second process was an assurance process to look at, from a service and learning point of view, what happened. Dr. Kevin McCoy was asked to lead that investigation.
Patrick O'Donovan (Limerick, Fine Gael)
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Is Dr. McCoy a HSE employee?
Mr. Pat Healy:
No, he is independent of the HSE. Dr. McCoy is well respected and has carried out inquiries in Britain and Northern Ireland.
Patrick O'Donovan (Limerick, Fine Gael)
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Has he worked for the HSE at any stage?
Patrick O'Donovan (Limerick, Fine Gael)
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Does Dr. McCoy have a team working with him?
Patrick O'Donovan (Limerick, Fine Gael)
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How many members are on the team?
Patrick O'Donovan (Limerick, Fine Gael)
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Who are they?
Patrick O'Donovan (Limerick, Fine Gael)
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Are any of them former employees of the HSE?
Patrick O'Donovan (Limerick, Fine Gael)
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Did she retire recently?
Patrick O'Donovan (Limerick, Fine Gael)
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What was her previous role in the HSE?
Mr. Pat Healy:
She was in human resources. Her current role and the reason she was engaged for Dr. McCoy's team was that part of what was required was change management expertise. That is her role on the assurance group.
Deirdre Carroll has a long history of being involved with service users. She was a former-----
Patrick O'Donovan (Limerick, Fine Gael)
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Is she a former employee of the HSE?
Mr. Pat Healy:
No, she was involved with Inclusion Ireland, the representative body for those with intellectual disability in residential care.
Patrick O'Donovan (Limerick, Fine Gael)
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At what level of the HSE did Ms Ann Judge work?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Was she involved in the HSE's SKILL programme?
Patrick O'Donovan (Limerick, Fine Gael)
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Who selected the chairman of the group?
Patrick O'Donovan (Limerick, Fine Gael)
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Was it done by competitive tender or was the role advertised?
Patrick O'Donovan (Limerick, Fine Gael)
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Is Dr. McCoy based in Ireland?
Patrick O'Donovan (Limerick, Fine Gael)
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Is he based in this jurisdiction?
Patrick O'Donovan (Limerick, Fine Gael)
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Yes, but is he based in this jurisdiction?
Patrick O'Donovan (Limerick, Fine Gael)
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When Deputy McDonald corrected Deputy Costello on the island having two jurisdictions we were given to believe that there was none of this type of expertise available on the island to deal with the Waterford issue.
Patrick O'Donovan (Limerick, Fine Gael)
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What expertise do the three individuals who are joined by Dr. McCoy have that is not available in the HSE to carry out this investigation? Mr. Healy stated that Ms Judge was employed by the HSE in human resources in the west and I do not wish to detract from her previous role. How was Dr. McCoy appointed and how did he select his team for Áras Attracta?
Mr. Pat Healy:
In assessing that what is required is the task that has to be undertaken. For example, an important part of the assurance review is to have the voice of the service user and family central to it. It was in that context that Deirdre Carroll was identified as someone who would participate. As I stated, she is a former chief executive officer of Inclusion Ireland, which is a representative body. Dr. Bob McCormack is the chief executive officer of Dara Residential Services. He has experience but, more important, he is the chair of the quality and risk group of the National Federation of Voluntary Bodies and has considerable experience in the area of quality.
Patrick O'Donovan (Limerick, Fine Gael)
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Is the body of which Dr. McCormack was the former chief executive a section 38 or 39 organisation?
Patrick O'Donovan (Limerick, Fine Gael)
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Why would one need a change management consultant to investigate what happened in Áras Attracta?
Mr. Pat Healy:
It is not an investigation. As I mentioned, there are two processes and this is an assurance process. The first task is to look at what happened in Áras Attracta to identify why all of the significant training and other work that had been done to improve matters in Áras Attracta did not have the effect it should have had or that we expected. It is also specifically tasked with coming up with a plan for Áras Attracta, to look at each of the individual bungalows and come up with a plan. Probably the most important part is to take that learning and see how we translate it in a systematic way across the country. Dr. McCoy outlined to the national summit his plans in relation to that and we are using the national summit. There is also a whole process by which academics and others can feed into this so that there will be a rich learning that can be translated across the country.
Patrick O'Donovan (Limerick, Fine Gael)
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How much has this process cost thus far?
Patrick O'Donovan (Limerick, Fine Gael)
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Has a timeframe been established within which Dr. McCoy will report?
Patrick O'Donovan (Limerick, Fine Gael)
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Has a definitive timeframe been agreed by which Dr. McCoy must report?
Mr. Pat Healy:
We will have four national summits and Dr. McCoy will make an input into each of these. He will identify progress and learning, hear from the 200 or 300 participants and take that feedback and build it into what we are doing. He will also engage with academics and others. The work is clearly scheduled out and will be completed by the end of the year. That is the assurance element.
Patrick O'Donovan (Limerick, Fine Gael)
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The other process is being headed up by Mr. Christy Lynch. Is he an employee of the HSE?
Patrick O'Donovan (Limerick, Fine Gael)
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Which provider?
Patrick O'Donovan (Limerick, Fine Gael)
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Is he doing this work for the HSE on a pro bonobasis?
Patrick O'Donovan (Limerick, Fine Gael)
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Does he have a team?
Mr. Pat Healy:
Yes, he has a three member team. He is joined by Michael Brophy who is the senior investigator retired with the Office of the Ombudsman, Adrian Tennant who is an employee relations adviser, and Grainne Bourke, a quality and risk manager. The detail of that was all published and provided.
Patrick O'Donovan (Limerick, Fine Gael)
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Did one of those three names feature in the dossier presented on the Waterford case?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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There is no "may" in this case; it is the same name.
Patrick O'Donovan (Limerick, Fine Gael)
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Is it in relation to issues in Wexford?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Let us be clear about this matter.
Patrick O'Donovan (Limerick, Fine Gael)
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He has an involvement in respect of part of the dossier on services in County Wexford. Is that not the case?
Patrick O'Donovan (Limerick, Fine Gael)
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I did not dream it up. I read the dossier which we received by e-mail and Mr. Tennant's name jumped out at me.
Patrick O'Donovan (Limerick, Fine Gael)
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I was not referring to Waterford. The dossier circulated to us, which included issues in respect of Waterford, has an appendix on issues in Wexford.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The issue that arises in this regard is that it is alleged that a former employee of the HSE is being recommended by HSE staff to section 39 bodies and this could cost €1,000 per day. That is what is stated in this document in respect of that matter.
Patrick O'Donovan (Limerick, Fine Gael)
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Is that the case?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Do we know whether it is true?
Mr. Pat Healy:
No, I am not aware of any. Certainly, the HSE is not employing him as I understand it.
Patrick O'Donovan (Limerick, Fine Gael)
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There are five other such persons on Mr. Lynch's and Dr. McCoy's committee. Is it possible to find out how much they have cost the HSE up to now?
Patrick O'Donovan (Limerick, Fine Gael)
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As well as the number of man-hours put into their investigation.
Patrick O'Donovan (Limerick, Fine Gael)
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The only one is Ms Judge.
Patrick O'Donovan (Limerick, Fine Gael)
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She is outside the HSE.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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She worked on the HSE's SKILL programme and the SIPTU fund about which we spoke earlier, with a number of colleagues in the HSE.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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How long is Mr. Healy with the HSE?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Where was Mr. Healy before that?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Therefore, Mr. Healy has been involved in the health service since 1991.
Patrick O'Donovan (Limerick, Fine Gael)
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I am agog. I was not a member of the Committee of Public Accounts at the time, but I read about the issues raised. The Chairman can correct me if I am wrong, but I understand the SIPTU and HSE issue is still boiling in the ether in terms of who went where and what money was actually used. I am concerned-----
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The same names.
Patrick O'Donovan (Limerick, Fine Gael)
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Another name has cropped up of a person who was involved in that investigation. It was not a very pretty sight for the HSE or SIPTU.
Mr. Tony O'Brien:
On whether the name of the first individual was or was not included tangentially in the Waterford dossier provided for the committee, it was provided for the committee in February and the process was started in December. The committee provided a copy for us, but it could not in any way have been taken into account in the process.
Patrick O'Donovan (Limerick, Fine Gael)
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No. I am not suggesting-----
Mr. Tony O'Brien:
On whether an individual was or was not named among the many for the SKILL project, I am not sure if the committee ever made any finding that none of the people in question could ever be engaged in anything again. I want to be cautious, having regard to the injunction the Chairman read at the beginning of the meeting, because these individuals who had no idea their names would be mentioned-----
Patrick O'Donovan (Limerick, Fine Gael)
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I appreciate that and do not for one instance suggest anything to the contrary, but I find it remarkable that we have yet another investigation under way which includes a former senior agency official who is retired.
Patrick O'Donovan (Limerick, Fine Gael)
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An inquiry.
Patrick O'Donovan (Limerick, Fine Gael)
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But we do not know how much it will cost.
Patrick O'Donovan (Limerick, Fine Gael)
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The point I am making as a member of the committee is that, following the previous conversations about former HSE personnel becoming involved in processes - I use that word so as not to offend anybody by using the word "investigation" - we have come across another case.
Mr. Tony O'Brien:
To provide some context, in the past decade 150,000 people have probably worked in health service. From 2009 onwards there was a significant process to encourage people at a certain level to leave the organisation. They are now private citizens. There is no rule that states people who once worked for the HSE, the Department of Health or any other arm of government are precluded from being involved in various processes.
Patrick O'Donovan (Limerick, Fine Gael)
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I am not suggesting there is, but I am asking how it is one person in a particular group outside the HSE was chosen, apart from the doctor who heads it. Was the position advertised? Could anyone have applied to become a member of the panel? Was the person just plucked from obscurity? When was it decided to carry out an investigation at Áras Attracta?
Patrick O'Donovan (Limerick, Fine Gael)
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Was it on the day of the broadcast that it was decided to put a team in place?
Patrick O'Donovan (Limerick, Fine Gael)
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Therefore, a team had been put in place before the programme was broadcast.
Patrick O'Donovan (Limerick, Fine Gael)
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Who was appointed to make provisions for the team?
Patrick O'Donovan (Limerick, Fine Gael)
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Does the HSE have a database of names of appropriate people? Was Mr. Lynch the first person to be appointed?
Mr. Pat Healy:
The first step was to send a number of senior staff who had worked with our service to Áras Attracta to immediately commence a preliminary investigation. We pursued the matter in line with our safeguarding policy, even though it had not been published at the time. The approach we took was to establish two processes, namely, the investigation and-----
Patrick O'Donovan (Limerick, Fine Gael)
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When were they established?
Patrick O'Donovan (Limerick, Fine Gael)
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That is fine. Did Mr. Lynch and Dr. McCoy select their own team or was the team selected for them?
Patrick O'Donovan (Limerick, Fine Gael)
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Who selected the three people to work with Mr. Lynch and Dr. McCoy?
Patrick O'Donovan (Limerick, Fine Gael)
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Who put the names forward?
Mr. Pat Healy:
Ms Deirdre Carroll was identified through our disability services. Dr. McCoy came up with the names of some individuals. We had to find out who was available and how the group could be put together.
Patrick O'Donovan (Limerick, Fine Gael)
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Who put the other names forward?
Patrick O'Donovan (Limerick, Fine Gael)
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Did Dr. McCoy pick the people himself?
Patrick O'Donovan (Limerick, Fine Gael)
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Whom did he pick?
Patrick O'Donovan (Limerick, Fine Gael)
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I am sorry, Mr. Healy, but this is important. I would like to know who put forward the name of a former HSE employee who happened to be the only person in the team who would be paid.
Patrick O'Donovan (Limerick, Fine Gael)
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I might accept that point to a degree, but everybody on the side of the road knew that the issue in Waterford would be raised today. A natural progression involves what is under way at Áras Attracta. There is a suggestion that some of the persons investigating issues in voluntary organisations and other places are costing up to €1,000 a day. The HSE should, therefore, clear the air. Either they are or they are not charging €1,000 a day; either there is or there is not competitive tendering; people either have the proper skills set or they do not. Not in any way being disparaging towards the people involved on committees, in fairness to them, the HSE needs to clear up the issue of how they were appointed and indicate the basis on which they were appointed, how much they cost and who pays.
Mr. Tony O'Brien:
Of course, we will. My concern is that questions such as this which relate to individuals who, no more than the rest of us, had no knowledge that their names would be mentioned here are in the public domain before we can provide the committee with the answers. We will, of course, provide it with them, but we had no reasonable expectation that we would need to give the committee that information today.
Patrick O'Donovan (Limerick, Fine Gael)
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I do not accept that because the main thrust of the report of the Comptroller and Auditor General is procurement and the acquisition of external services by the HSE. To be fair-----
Mr. Tony O'Brien:
To be absolutely realistic, if our answer in the aftermath or in advance of the transmission by RTE of the programme had been that we would at some point have an investigation and put in place an assurance process but that we would first have to go through a procurement process of 40 days, it would not have been credible either.
Patrick O'Donovan (Limerick, Fine Gael)
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No, but what is not credible is that there are questions remaining to be answered in relation to whether or not people have been appointed to carry out work by the HSE on the basis that they were previous employees of the HSE. That has not been rebutted properly at all.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I will allow Mr. O'Brien, having heard the questions, to bring forward the information to us by way of a note. I think that is the easiest way to deal with it. Does Deputy O'Donovan agree with that?
Patrick O'Donovan (Limerick, Fine Gael)
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Yes.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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I am sorry I had to step out earlier, and if any of what I am going to ask has already been dealt with, I apologise, but I had to leave. One of the things I noted when Deputy McDonald was speaking to Mr. Swords about services and procurement was his comment that there were no contracts and that sometimes people at grade 4 and above would do that kind of thing. What kind of services are we talking about? I do not work in the HSE but I know that I could not walk into a place like that and order something without a proper contract - without doing it formally. I just wonder what kind of services are we talking about that those at grade 4 and above can do.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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What kind of-----
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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So if I got a job in the morning - for example, an administrative or secretarial job in a hospital - and I decided to pick up the phone and ring somebody and order paper, I could do that.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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It seems to me that everything that is being done is being done now and in the future, and that to me is very basic. I would have thought that nobody would walk into a job like that, at grade 4 and above, or any situation, and just pick up a phone and order without checking whether there was a proper way of doing it or a procedure to be followed.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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We are putting it into regulation now, but it has been done for donkey's years.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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It is obviously not right.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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Why is it only now that-----
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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-----it is happening? Why are we saying we will do it in the future?
Mr. John Swords:
One must look at the changes that have happened. For example, in 2010, we brought centralised procurement into the HSE. Before that it was health boards. So a whole culture is being changed. It is a change management issue. When one is bringing that in, one has to stage it in. Then, when one looks at the issues around austerity, what we were asked to focus on was actually saving money so that we could retain services. We had to go on that. Since 2010, we have had a further change in that the Government has made the decision that procurement will change again and it will move up a notch to address the public service issue overall, and what we are doing now, along with our colleagues, is changing in that regard as well. So there have been changes along the way, but there also has been progress. To give the impression that nothing has been done would be wrong, but I do think it is correct to acknowledge that the audit was right, and from the audit we will take the positive view in how we address it. What we have done to address it is to take contraction, and I think that is the point we should focus on.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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I do not buy it. I have a small office with three people working with me and none of them would go out and buy something randomly.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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No. Most people who work in a situation like that know that that is not the proper way of doing it. It seems to me that when it is Government money being spent caution is thrown to the wind and it does not matter because it is not real money. I think that is really wrong, and I think it should not have taken so long to start the process, so that we are only getting it right now. Can I go back to-----
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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I appreciate that.
Mr. John Swords:
If I could offer something as well: we do not just look at what we do internally but also externally - how it happens in industry. As I have said, I do not know of any organisation of our size that is fully compliant, so there will always be a variance, but it is the extent of the variance that we are addressing. In looking at compliance and non-compliance, should I say, one looks at different trends that are within industry and ourselves and they are no different, but we are addressing them, and that, I think, is the proper course of action to take.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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I think a memo could have been sent to people to stop doing this.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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Memos are sent to HSE staff all the time about holidays and about overtime and it gets out there directly. It does not take years and it does not take several reviews, so I think it is something that needs to be looked at.
Mr. John Swords:
One must also take into consideration that we are here essentially to deliver service for patient care - that is first and foremost - and value along with that and then compliance. Now, we want to be compliant. We want to always be compliant, but although people are not new to the system, because moratoriums have actually put a stop to new people coming in, there has been a drift of people out of the system. In my own division I have lost 100 people since 2010. That is a considerable amount of expertise to lose. So in addressing the areas of procurement, we would obviously like more numbers to get there faster.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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Yes.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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It seems that an e-mail could be sent to people to tell them what the procedures are. It would be a lot quicker.
Mr. Tony O'Brien:
If sending a memo or an e-mail was as effective as we would like it to be, given the number of e-mails and memos that the HSE has issued on its procedures, this would be a fantastic organisation. Unfortunately, that does not do enough.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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If one was in private industry, one would not order something from a company unless there was a purchase order number. If it was a privately run company it would have been shut down by now because of the amount of money that has been wasted.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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But there are managers in place to manage budgets, and that is their job.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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May I ask about the private health insurance? I know it was touched on earlier. Can I ask which hospital is owed the largest amount of money and what exactly the HSE is doing to recoup that money? I ask because I know Mr. O'Brien said that there was €150 million outstanding. Again, if that was a business it would have closed by now. I work with excellent people in the HSE - I have to give credit where credit is due - in the midlands and they do their damnedest to support me and to help me to provide services for people that I am looking after, but when I look in my constituency for a service for a person with, for example, intellectual disability and physical disability, nine times out of ten there are budget constraints. There is always a point at which someone will say, "We would like to do that for you, Deputy McFadden, but we cannot because we do not have the budget." Yet there is €150 million floating out there that has not been collected. I would like to know what urgency there is with regard to collecting that money, because if I went to an accident and emergency unit with my daughter I would get a bill for whatever it is - €100 - and I would be chased by the hospital for that €100. Why is the HSE not chasing private health insurance people and getting that €150 million, which could go towards helping with budgets for people with disabilities so that they can be kept in their own homes? I know a person who cannot get funding to go into a residential unit that he wants to go into. He is in a nursing home because there is no money for him, yet there is €150 million floating out there that is not collected.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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What are the books like of the hospital that owes the most to the HSE?
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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Yes, but it is coming back in to the HSE.
Mr. Stephen Mulvany:
It is Cork University Hospital, by virtue of its being the largest hospital. Again, I do not want to minimise it, but, as Mr. O'Brien said, that does not prevent the hospital from having a budget. It is an issue of cash and cashflow, a very serious issue, and we do chase the insurers. We are chasing the insurers. As I said, we are looking to reach an agreement with them which should improve that position, but it does not have an impact on the actual budget available to provide direct hospital services in the year.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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What is the figure for Cork University Hospital?
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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When there is a cashflow issue, it does affect it. If there is not cash coming in that is supposed to be coming in, there is a cashflow issue. Beds have to be closed on occasion because a hospital runs over its budget or whatever, so it does affect it.
Mr. Tony O'Brien:
I should point out that the service plan this year is built upon, roughly speaking, halving the outstanding amount in the course of the year. At any point in time, because the transactions are so big globally, there will always be a substantial sum of money outstanding in the ordinary course of business.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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I accept that.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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No; I was here for that.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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In financial terms, how much of the overall budget expenditure relates to management and staff salaries and pensions and how much relates to front-line staff?
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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I am conscious of the promise made to deliver nurses to the Midland Regional Hospital in Mullingar, which was not honoured.
Mr. Tony O'Brien:
It is a slightly harder question to answer than it first appears. The budget, or pay, is categorised into a number of categories, namely, medical and dental; nursing; health and social care professionals; management and administration; general support staff; and other patient and client care. In simplistic terms, the starting point would be to examine only management, administration and general support staff, and I will explain why that is not as precise as it might be. The proportions of staff in those categories have been changing. In 2007, the proportion of the workforce in all the front-line categories was 71.8% of all staff. It now stands at 75.4% of all staff. However, within the category of management, administration and general support staff are a wide range of staff who are in the front-line space, such as the clerks in hospitals who greet people at emergency departments or outpatient registration. While they are classified as management and administration, the distinction is not easy to make. Over the period, there has been a biasing of exits and recruitments in favour of the categories that are clearly 100% frontline.
Among the many staff in the management and administration category, a great proportion are also doing patient-facing work. I regard those who take care of hygiene on a ward as front-line staff. I regard those who perform civil marriages and those who answer the calls for medical cards and issue medical cards as front-line staff, although they are categorised as management and administration due to our narrow framework within which all pay must be classified. It is not very straightforward for me to say exactly which staff members are wholly or partially frontline or administration. The bias is moving in the right direction.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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Is the cleaning in hospitals done by private companies or HSE staff?
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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I would like that. Are domestic staff employed by the HSE?
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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What is the advantage of paying companies €38 million for cleaning compared with the old days when the HSE employed domestic staff to do it? In the old days there was no MRSA, and there were matrons going around with white gloves checking whether everything was clean. There was not as much MRSA and talk about hospital bugs as now. I accept that things have changed.
Mr. Tony O'Brien:
There are drivers of this. For several years, we would never have been allowed to employ a cleaner. As cleaners left, they were not in the categories that were exempt from the moratorium. The overall ceiling for the health services was coming down continuously during those years, due to the circumstances in which the country existed. In many instances, the only option was to procure from external providers because we would not have been in a position to employ. At times, it can have advantages in terms of flexibility of provision. I understand the Deputy's point. My wife, who was a nurse, often says we should bring back the matron.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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Bring back the matron.
Mr. Tony O'Brien:
The matron used to scare the living daylights out of her if she was seen off grounds in her uniform, for example. It is a slightly different discussion. In the circumstances in which the health service has been existing over several years, external provision was the only option available.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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Is the HSE going to stay with it?
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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It is a lot of money.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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I am not questioning any of the companies, which are all good and viable. I was just curious about how cost-effective it was. I refer to the community supports Mr. Healy mentioned when we talked about the fair deal. At Christmas, a huge number of people were on trolleys in emergency departments. When I went to visit one of them between Christmas and the new year, a huge percentage of the people on trolleys were very elderly people coming from nursing homes. I was told the reason many of them were there was that they were dehydrated and needed a drip or had chest infections and needed intravenous antibiotics, which could not be done in a nursing home due to governance issues. There was a question about employing community-based geriatricians. Now that there is no moratorium and no reason we cannot employ medical staff, will it happen? It could help alleviate the pressure on beds in emergency departments. Elderly people in their 80s and 90s should not be taken out of their beds in nursing homes to go to an emergency department just to get a drip. It should be done in a nursing home. It might help alleviate the problems and it might not cost as much money.
Mr. Pat Healy:
It is a very important question and we are very focused on it. One of the ways we are aiming to improve it is through community intervention teams whereby we will join up the work in the hospital, primary care team, something like a community nursing unit and social care. The community intervention teams have nurses who will go out and do the type of work the Deputy mentioned. Part of the initiative we implemented with Government support through funding was to increase the number of community intervention teams.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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Is it happening now?
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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It seems to be more humane as well as more cost-effective.
Mr. Pat Healy:
Absolutely. Together on the social care side we are working with Nursing Homes Ireland and our own community nursing units to develop the capacity and approach whereby people will have the confidence and capacity to hydrate and respond to a far greater extent to the needs of older people. Another important part of it is end-of-life care. We will support, in so far as possible, efforts to maintain people in their residences, whether in a community nursing unit or a nursing home, rather than transferring them to hospitals in an end-of-life situation. More and more, with palliative care teams and community intervention teams, we are trying to support such an approach.
Gabrielle McFadden (Longford-Westmeath, Fine Gael)
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Thank you.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Has the issue of Starline Management and the contract fees of €250,000 been resolved?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I have been asked to raise the DEXA scanner at Letterkenny General Hospital. A freedom of information request provided for the committee informed us that €29,250 was spent on outsourcing scans while the scanner was in storage.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The scanner is still in storage, some 20 months after the flooding of the hospital.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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It was bought by private charitable contributions and €100,000 went into it.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I will send on the photograph.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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It is not the way to store a machine of that kind and it might be important from the point of view of €29,000 being spent on an ongoing basis on scans.
I want to recap on what has happened. With regard to cost of claims to the HSE, without mentioning any names, can we get a list of them? We mentioned the legal fees earlier and they ran at €44 million this year and last year. Can we go through the procurement process and how many firms were involved? I refer in particular to the Waterford situation and the cost there.
A single financial management system was mentioned. I pester the Department of Public Expenditure and Reform about this issue all the time. It has been cropping up at these meetings since 2011, with no resolution in sight. Perhaps we can get a note on an update.
In cases like the Canning case, where reports and legal fees were involved, is it in order to ask for costs in regard to these reports? The document refers to various types of reports sought. I am interested in knowing how much these reports cost.
I posed the question on St. Patrick's in Kilkenny, the respite house and the opening of clients' accounts. I tabled a parliamentary question on this but the HSE must respond. Perhaps the HSE will examine the issues here.
There was an overview of section 38 bodies. Can we get an overview of the section 39 bodies? We went through the history to it before. There is a figure of €8 million for retired staff coming back and perhaps we can get a breakdown of that and the skills it covers.
Generally, a lot was asked today and the HSE committed to providing the facts and figures. Is it fair to ask for a timeline and is it possible to get it within a couple of weeks? Does the HSE have this information to hand? When the witnesses leave here, there is a whole lot of things to do but I am asking in the context of the information we have asked for.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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How is the budget going for this year? There are targets at particular times during the year. Is the HSE on target, behind or in front?
Mr. Tony O'Brien:
In the first couple of months of the year, particularly in the acute hospital sector, for reasons we discussed today, the hospitals were running hot and under our accountability framework we are in the process of bringing that back into line. The Government allocation in respect of the fair deal scheme, in particular, provides an opportunity for us to examine that in a different way. If the fair deal scheme problem had continued, we would have been in significant difficulties. The budget this year has two distinct components. There are demand-led schemes, which have rule sets based on eligibility, meaning certain costs arise on the basis of people accessing their eligibility. This is seen in one dimension as an acceptance and a monitoring process between ourselves and colleagues in the Department of Health and the Department of Public Expenditure and Reform. Then there are the things we have more direct control over.
We have some challenges in the acute hospitals and some challenges in social care that arise from the regulatory issue Deputy John Perry raised. The other divisions are performing in line with their budgets. It is relatively early in the year for us to make end of year projections so we do not but we know the challenges and we are using our escalation or accountability framework. It is a particular feature of this year's service plan and we are triggering the necessary responses to address the issues.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I thank Mr. O'Brien and his officials and officers from other Departments represented here.