James Reilly (Dublin North, Fine Gael)

In many respects, the Bill seeks to rationalise some health agencies. We do not have a problem with this, but I will discuss quangos later.

I will ask a few questions and raise a couple of concerns about the Minister of State's comments. In terms of the National Women's Council of Ireland, NWCI, some 300 jobs will move to the public service. Will this rationalisation save any money or reduce the amount of administration or rent on buildings? There will be no loss of employment, not that anyone would want to see someone out of a job in this climate. We must ask why the Bill is being introduced and whether we are using the opportunity to achieve real rationalisation and savings for the taxpayer.

The legislation will enable the Government to subsume five State agencies, including the NWCI and the Crisis Pregnancy Agency, into the Department of Health and Children or the HSE. I do not have an issue with the technicalities addressed by the Minister of State that ensure that people's rights do not suffer. However, the NWCI and the National Council on Ageing and Older People should not be subsumed in such a fashion as to neutralise their overall effect. For instance, the Bill does not propose a review mechanism to monitor or measure the change of policy direction against outcomes.

There will be a transfer of employees from non-established positions within the Civil Service, but what does "non-established" mean in the context of the Bill? The legislation might not safeguard the knowledge or institutional memory built by the agencies since their inceptions. The staff have built a high degree of competence and expertise in their fields and should be regarded as assets to the public service. What commitments have been made to ensure that the Department and the HSE will continue to work in partnership with civil society and other relevant sectors after the bodies enter the system, which were seen to have been outside it previously?

The NWCI has provided a board representative to the Women's Health Council on ministerial appointment since the latter's inception. The health council has provided a useful forum for representatives from the NGO sector, statutory bodies, the private sector, the medical profession and academia in tackling women's health holistically. In turn, the forum has provided independent advice to Departments. Will the good working relationships fostered by this direct participation be safeguarded? How can the continued commitment be protected under the terms of the Bill?

The NWCI and the National Council on Ageing and Older People can directly link with and provide an independent voice, but they are being subsumed. On the face of it, this rationalisation would save money, but will it have a net effect of quietening — I will not use the word "silencing" — necessary criticism, which can only be made when people are independent as opposed to being State employees? The Official Secrets Act does not apply to them currently, but will it apply to them when they assume non-established positions within the Civil Service?

The Women's Health Council has played an important role in the implementation of the National Women's Strategy 2007-16, particularly under objectives 8 and 18. Under this plan, the Department has undertaken to establish a gender mainstreaming unit. Will the establishment occur or is the Minister considering whether to use the staff of the Women's Health Council to fulfil the role? Many people would be interested to know the answer to that and I am interested to hear the answer to the question on the Official Secrets Act.

The National Drug Advisory and Treatment Centre has been in operation for 40 years and has developed a significant amount of knowledge and expertise. It is the type of organisation that should fall under the remit of the HSE, but only as long as its tertiary addiction service, the only one in the country, continues. As the centre is being funded by the HSE and works with it closely, joining the HSE makes perfect sense.

I have no problem with the inclusion of the National Cancer Registry, the proper place for which is in the HSE. It is a bad reflection on the country that the registry has only been running for a few years. Only certain parts of the country had one ten years ago.

In terms of hepatitis C, I welcome that the age limit for travel insurance has been moved, as the current provisions are out of date. It puts me in mind of another group of people seriously affected by an arbitrary age limit, namely, Patient Focus, which comprises the victims of mistreatment by Dr. Neary at Our Lady of Lourdes' Hospital. Unlike younger victims, many who suffered at his hands have been unable to avail of compensation because of their dates of birth. Ms Justice Maureen Harding Clark has ruled on the matter, but I am sending an apolitical message. The Chairman and Deputies Jan O'Sullivan and Ó Caoláin have been heavily involved in the issue. There has been cross-party support for the group. Perhaps the Bill is a missed opportunity for the Oireachtas to correct what we all agree is an unjust anomaly. On later Stages, will the Minister use the Bill to address this? I will not say any more, as all sides of the House are in agreement.

I will revert to the comments that I made at the outset. There has been much discussion of rationalisation and removing quangos. Yesterday, during the same week in which the Bill is before the House, the Minister issued a press release on the formation of another quango, an expert group on resource allocation in the health sector. The group comprises many excellent people, but what is going on? The Minister seems to be setting another group as a buffer between herself and her responsibilities. The clear implication of the press release is that the Minister, after four odd years — some would say that they have been very odd — in her portfolio, has finally admitted that she does not know how to allocate resources and wants to get an expert group to help her. She will move her responsibility to the group, which will report to her.

It would be laughable, were it not so serious, and goes a long way towards explaining the reason, after countless billions of taxpayers' money has gone into the health service, that we have been left with an unholy and real mess. It is real for the 12 people with brain tumours who await lifesaving brain surgery and who are on a waiting list to get into Beaumont Hospital's neurosurgical unit. One 34-year old woman with two children from west Dublin was diagnosed on 18 January and it now is April. Although she could walk when diagnosed, she now is confined to her house and awaits a telephone call and our modern health service of 2009 is unable to look after her. Her husband is unable to understand how the health service can do this or how the Government can preside over a health service in which this is the position. She is not alone, as I have been informed that 11 other people await lifesaving brain surgery in Beaumont.

Another man who sent an e-mail to me has gone blind while waiting for an outpatient's appointment because of his diabetes. He was diagnosed with diabetes and was told he needed to visit an eye clinic. While he made an appointment, it was subsequently postponed. He then went to England to work for a while and awoke one morning blind in his left eye. Had he not been able to attend the Moorefields Eye Hospital to receive urgent treatment, he would have lost the sight of that eye permanently. Although he has managed to regain some sight in his left eye, he is permanently visually impaired in that eye as a consequence. He was told in no uncertain terms that had he received treatment before this happened, it would not have happened and he would have full sight.

The frustration that led him to send that e-mail to me arose because he is aware there are hundreds of others like him. The Minister of State will be aware of the debates that have taken place in this House on diabetic retinopathy, the need for screening and that €750,000 which was set aside in 2007 and 2008 was left unspent. It is now at last being spent in the west. What about the rest of the country and the other diabetics? There are 140,000 such people and there is a 10% incidence of this eye problem. Consequently, 14,000 to 16,000 people may go blind. The cost of 100 people going blind equals the cost of a countrywide service that would prevent thousands from going blind.

One is found out in a time of tight budgets. That is when priority decisions are made. It is when decisions are made on whether people in the HSE get bonuses or those needing them receive eye-saving services. It is when one makes a decision to spend money on hotels and meetings or on people, in order that they may have life-saving brain surgery. These are the hard decisions that must be made.

This also relates to the issue regarding cystic fibrosis, which will come before the House next week. Young people in the Republic are dying ten years younger than their cousins in the North of Ireland. At a meeting of the Oireachtas Joint Committee on Health and Children, I heard Professor Drumm making the point that there are 600 people with cystic fibrosis in Toronto and the system there is managed with six beds. He neglected to state or perhaps did not know, although he must know now, that Ireland has the most severe mutation for cystic fibrosis and consequently has the sickest group of people with the condition. They are not suitable for outpatient home treatment and need inpatient treatment. This issue will come before the House and there will be an opportunity for all Members to vote on it. While people can talk the talk, they will be asked to walk the walk.

I now wish to speak briefly about some of the agencies that are not being rationalised but which should be. The figures published in 2008 in respect of the National Treatment Purchase Fund show that 20,000 adults and children are on waiting lists, half of whom have been waiting for treatment more than six months. This does not include the patients waiting for three months before being entered onto the NTPF waiting lists. When such patients are included, the figures double to 40,000 patients. As for outpatient waiting lists, the figures do not take into account the thousands of patients waiting for outpatient appointments. There are estimates of up to 200,000 such patients, some of whom have been waiting for as long as up to seven years for an appointment.

In 2002, the Government promised an end to waiting lists by 2004 but everyone knows this has not happened. Moreover, people were informed that the problem associated with accident and emergency services, which was to be considered as a national emergency, would also be solved and a ten-point plan was produced. However, in recent weeks, there have been figures of 387 and 380 people lying on trolleys nationwide. As a result, 216,000 bed days were lost last year because of delayed discharges. This is taking place at a time when the Minister of State, who has responsibility for older people, will have been made aware by Nursing Homes Ireland that between 240 and 250 beds around the greater Dublin area are available for use. I visited St. Vincent's Hospital this morning and there were 62 people whose discharges were delayed while they awaited placement in the community. The figures for Beaumont, St. James's and the Mater are worse. Unless patients can be moved out of hospital back into the community, such beds will not be made available to those people in accident and emergency units who require admission. I refer to those who, having been assessed by doctors, need to be in hospital but who cannot be admitted.

The consequence is that the problem backs up onto the ambulances. Last month, I learnt of two ambulances which were held up in Beaumont Hospital's accident and emergency department for seven hours and five hours, respectively. They comprised two out of the 13 Dublin Fire Brigade ambulances that are available for the entire city. In itself, that number is extraordinary, given that 20 years ago, when half a million fewer people lived in the city, it was served by 12 ambulances. In other words, a single additional ambulance has been provided.

This raises the issue of the ambulance at Swords, which has been funded by the Dublin Fire Brigade and for which the HSE refuses to pay. The city manager now threatens to withdraw it. I have informed the House previously of an incident that occurred during the election, in which one of my patients fell ill outside a church and required urgent transfer to hospital. We waited for an ambulance for more than an hour and when I inquired as to the reason, I was told that five ambulances were tied up between Beaumont Hospital and the Mater Hospital that day.

Why do we not have spare trolleys, even stored in a portakabin, to allow patients to be left on such trolleys in the care of the accident and emergency staff, while the ambulance collects a spare trolley and heads back out onto the road to be available to save life and limb? It does not make sense as such a measure would cost very little. The real answer to the problem is to provide the community beds. The State has not built them yet, spare capacity exists within the private sector at present.

Previously, I have called for the putting in place of premodular units within six months that would contain rehabilitation facilities in order that people could continue the acute phase of treatment. One then can shorten the bed-stays about which Professor Drumm talks all the time. One will not achieve a shorter bed-stay by moving people out of hospital when there is nowhere in the community for them to go and when community supports do not exist. In that instance such patients will be readmitted directly.

As for the National Treatment Purchase Fund, €100 million has been spent plugging holes in a broken system and this constitutes throwing good money after bad and paying twice or three times as much. Patients were transferred from Cappagh National Orthopaedic Hospital to the Mater Private to have orthopaedic procedures performed. That cost a multiple of what would have been the cost, had Cappagh been given the resources to do it. Moreover, theatres in Cappagh were being closed down for one day per week. In other words, the public facilities were closed down so the public patients could not avail of them. They then were transferred to the NTPF, which cost three time more, while leaving idle the public facilities through nonsensical budgeting systems. I was astounded when the Minister informed me within the last two weeks that €4 billion is being spent on private health care in Ireland. When added to the €16 billion allocated to the HSE and the Department of Health and Children, one arrives at the enormous sum of €20 million. It is all going round in circles in the NTPF.

In the North of Ireland, the Minister for Health, Social Services and Public Safety rolled up his sleeves and became personally involved. He formulated a special delivery unit that visited each hospital to ascertain its waiting list problems and then returned every week until such problems were resolved. Heads rolled and there was accountability and transparency. People could see where there were problems and if those who were part of the problem were not prepared to get it fixed, they got the gate. Some people lost their jobs but that is what accountability is about. Accountability is difficult without transparency but that is what this unit did. The health service in Northern Ireland spent €36 million over 18 months and brought a 57,000-person waiting list down to zero. It costs very little money to keep it right. What are we doing? Multiplying by three their population of 1.7 million gives €5.2 million but we have only €4.2 million. Multiplying €36 million by three comes to just over €100 million, which we spend every year. They spent it once and fixed the problem. Why can we not do the same? It is because we are not addressing the problem and looking for solutions. We got lazy during the Celtic tiger period, throwing lots of money at problems. The NTPF is one quango I would get rid of because it is wasting public money and is not addressing the problem.

It is frustrating for those working in the public service to find they cannot carry out an operation in a hospital but can do so at the weekend and get paid for it. They do not understand it. Eminent surgeons such as Mr. Michael O'Keeffe have verified this. He is a man who does not mince his words and I ask the Minister of State why that doctor can do as many procedures on a Saturday as he can for the rest of the week in a public hospital. He gives reasons such as lack of organisation, people not being where they should be on time and various staff out sick or missing. There is no secondary line to replace a person who is ill. How many operations have been cancelled because the surgeon was present, the theatre staff were present but there was no bed in the intensive care unit? Perhaps there was a bed but no intensive care unit nurse available. These are management issues, not issues of medical personnel. Management should put in place a fallback position to fill the gap when a person is sick in order that the entire system does not creak to a halt. The system sometimes suits hospital management because of the crazy budgeting arrangements.

I have not said the following in the House before. If it costs €1,000 a week to keep a patient in a public bed and it costs €1,000 a day to have him or her languish in a hospital bed when the acute phase of treatment is over, it makes good sense to move that patient to the community. However, because there are two separate budgets, the primary and continuing care team does not allow the hospital to touch its money and the hospital team cannot access the money. The patient is locked in that system. There is a more sinister perversity in the system. From the hospital's perspective, if the patient is moved out, the next patient in the bed could cost €3,000 to €4,000 a night if acutely ill. This is costing the hospital money.

For the first time, the Minister's press release referred to money following the patient, something about which I have been talking for 18 months. This is clearly the way to go forward, making the patient king or queen, where every patient that crosses the threshold is seen as a resource, not as someone to be left languishing on a trolley in accident and emergency units. If hospitals had a maintenance sum and any further budget was predicated on a per patient or per procedure basis, the efficient hospitals would be rewarded and would do more procedures. This is unlike the current situation where the hospital gets a budget whether it is efficient or grossly inefficient, and that is it for the year. As we have seen in Navan, operations can cease in October, which is a crazy set-up.

The Mental Health Commission is currently sitting on a report on a psychiatric institution in Clonmel. Stories in the newpaper refer to unreported fractures picked up on screening that are healing. There is a major issue of abuse of patients. In 2004 an investigation was conducted at St. Michael's Unit in St. Luke's Hospital on the serious concerns at the high level and frequency of fractures. Although the report has never been published, media reports reveal that between July 2002 and January 2004, 19 residents at St Luke's Hospital suffered fractures, 18 of which were unwitnessed by staff. There is serious concern that fractures were the result of non-accidental injuries.

The Inspector of Mental Health Services identified problems with the service at St. Luke's Hospital in the annual inspection reports of 2005 and 2006. These concerns were outlined repeatedly to the local health manager and senior management team, but nothing changed. The fracture report and the concerns raised in the annual inspection report led to the decision of the Mental Health Commission to establish an inquiry, only the second occasion on which the Mental Health Commission has used its power to set up an inquiry under section 55 of the Mental Health Act 2001. According to an article in the Irish Examiner, the Mental Health Commission was made aware in 2008 of the appalling conditions at the hospital. Rather than ensure that immediate action was taken to protect these patients and to promote their welfare, all of them continued to follow procedures. Nothing was done and patients were left in terrible conditions. The article confirms that none of the 145 findings and 11 recommendations has been implemented. The HSE has had the draft report since June 2008. Where is it? We still await it. What action was taken on it?

This is a recurring theme. One thinks of the poor people in Drogheda, Louth and Cavan walking around with tumours growing in their lungs. People knew there was a problem in September 2007 and did nothing until May 2008. The same ethos applied in Portlaoise, where the files of 97 women were left thrown in a corner. Any number of these women could have had breast cancer but nobody would do anything until a cohort of a round figure of 100 was reached. I do not know what a cohort is. The attitude is that information is available but we do not act on it. We await some official report before addressing the problem immediately to ensure patients are kept safe. This refers to the most vulnerable people in our society, who cannot speak for themselves. When made aware of it, people do nothing but sit on the report. When will the report be available?

I allude to another aspect of the NTPF, the co-located hospitals. Three or four years ago the Minister for Health and Children assured us this was the quickest way to bring public beds into our public health service to ensure sufficient bed capacity. Since then, 500 beds were taken out of the system last year, there are plans to take out 600 more this year and there is not a single co-located bed available, nor a sign of one. Not a sod has been turned on any site and, if one were living in dreamland, one might believe it would be a couple of years if they started building tomorrow. They will not start tomorrow, next month or next year because everyone knows this concept is dead. There is neither financial backing nor an operator who can get a bank to stump up money for this because there is no guarantee of a return, unless, of course, the hospital is guaranteed a return from the NTPF, which will send public patients, paid for by the taxpayer, to be treated privately.

The Minister should get off the fence, admit co-location is going nowhere and come back to the House with a realistic plan to address the health requirements of our people. The budget will include cutbacks next week but they should address waste. They should not hit capital projects.

The Minister has acknowledged that building costs have dropped by between 20% and25%. Why, therefore, was there a need to cut the capital budget as there was already an inherent 25% saving? Why cause all the upset to those poor girls with cystic fibrosis and their parents who were outside the House today? Why ask the very brave Orla Tinsley to put herself through all this media hype when she is not well? She thought the deal was done and the matter was closed. Last year, having received a person of the year award for her work for cystic fibrosis, she believed the unit in St. Vincent's was going ahead. Why are we putting these people through such an ordeal?

Why not look to more clever ways of financing, deferred payment models or the very competitive market where builders, just to be sure of work, will jump through hoops and accept all sorts of conditions and terms they would not have even considered two years ago? In that respect, I cannot see where this Bill is saving money, although I can see rationalisation in some respects. Are any jobs to be shed or efficiencies being achieved in administration, building or rent? I want assurances on the very valuable work of some of these groups — in particular the Women's Health Council, the Rape Crisis Centre and the National Council on Ageing and Older People — and a guarantee they will not lose their voice and independence when they are subsumed into the Department of Health and Children and the HSE.

The Government must ensure the Mental Health Commission report is published and action is taken. Even if it is not published, no delay should be allowed in the protection of patients if an issue exists.

See this speech in context