Matt Shanahan (Waterford, Independent) | Oireachtas source

For many months now, at various stages of the coronavirus pandemic, the Government, the Department of Heath and the HSE have continually been asked what is the plan. It is fair to say that the master plan often appears to be hidden and the perception is that Government health policy and leadership have been reacting to events. One recent decision that could be so described is the announced pending appointment of a new Secretary General of the Department of Health. The decision to award an almost 50% salary hike for this position appears to be both reactionary and rushed. A Government backbencher told me the reason for the decision is that the Department of Health management is dysfunctional.

I have sympathy for this narrative having seen at first hand. I refer, for instance, to the Department's influence in the development of a national cardiac care standard, as set out in the Herity report. This is a clinical standard that exists nowhere else in the world and one that describes travel times between two hospital centres for the treatment of emergency coronary blockage. This is a meaningless clinical measurement. Effective coronary unblocking treatment depends directly on the time envelope between the onset of symptoms and a patient's arrival into a cardiac catheterisation suite. I point also to the funding approval that was delayed by the Department of Health for 14 years to build a new mortuary at University Hospital Waterford, UHW. That funding was only secured in the end because of journalistic endeavour which highlighted the corpses decaying in the unit because of a lack of refrigerator space and capacity. Let us not mention the four-year calendar schedule, which is elapsing, for the delivery of a build tender award for a new catheterisation ward at UHW.

I can indeed believe that dysfunction in the Department of Health may be a reality. If it is, rather than just changing personnel, does it not indicate a need for a real strategic and structural change in the Department? During the banking crisis, it was recognised that the scale, complexity and oversight of the Department of Finance had become too large to be managed by the existing Civil Service structure. As a result, a new Department, the Department of Public Expenditure and Reform, was created. Given the significant scale and wide remit of the Department of Health today, surely now is the opportunity to look at strategic restructuring and a separation of responsibilities, such as the hospital and acute care sector being separated from social and family care services. What about reform within the HSE structure and its remit?

Instead of any strategic review of our health governance, it appears the Government has again taken the decision that an overwrought situation can be solved by a new appointment and a 50% pay hike. It is ironic that the preferred candidate for the position has been leading the Department of Public Expenditure and Reform for many years and, one presumes, has supported the policy to oppose increased appointments and pay increases across medical, nursing and allied grades during the Covid crisis. One might also ask whether this ambition extends to the Civil Service structure.

As a Covid-19 response strategy, there are a number of aspects to this appointment that require clarification. What evaluation has taken place on the need to provide a 50% pay rise to the salary scale of the existing Secretary General position? The appointment decision appears to favour a possible panel interview, yet how can that be the case for a fair interview process when the candidate is holding the position on offer, conferring significant advantage in final selection? What discussions, if any, were had regarding the waiving of future pension entitlements on the additional salary proposed, considering that this position attracts the top level Civil Service pension plan? The pay rise by my calculations, and I stand to be corrected on this, is a liability in excess of €1 million to the State. Was any discussion had as to the candidate agreeing to waive the benefits of this salary increase in respect of pension roll-up? If not, given the total employment costs involved, should the Government not have considered a move to create a contract role with the possibility of allowing private sector health management professionals to apply? It appears also that other Cabinet members were not made aware of the additional salary increases to be offered and neither was cognisance given to the pressure that this will cause in promoting further payouts across the Civil Service and public service at a time when so many private businesses and employees are facing potential ruin.

My personal disquiet on this issue has led me to write to the Comptroller and Auditor General and the Committee of Public Accounts to have this matter reviewed. At a time when Covid-19 mitigation strategy forces hard-pressed taxpaying businesses and individuals to close down and to depend on State subsistence - which for many is completely inadequate to cover their needs - Government leadership should be seen not to be reacting to individual crisis points nor to creating inflationary precedents, but should be, rather, planning strategically based on known deficits that can be overcome.

Regarding the high rates of Covid-19 infection at present in Ireland, which continue to rise and may potentially rise further given the new variant, I also point the Department to the risks around the oxygen supply and I highlight that we are dependent on the UK for the importation of medical grade oxygen. I have written to the Department on this point.

Can the Minister at some point also clarify what is happening with the vaccinators? We have a panel of up to 2,000 additional vaccinators made up of community medics, nurses and retired healthcare people. Will they be trained and when will this happen? The Pfizer vaccine requires 30 hours of online training. If that is the case, have these vaccinators begun this process yet?

There is no doubt that we are now in the throes of a third and probably the most significant wave of Covid-19 and we need every single hand at the pump.

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