Dáil debates
Wednesday, 4 May 2005
Leaders' Questions.
2:30 pm
Enda Kenny (Mayo, Fine Gael)
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In recent weeks the Taoiseach has given the House some indication of the way the Government proposes to deal with the appalling conditions that apply in many accident and emergency units throughout the country. The Government's response has been to hide behind the ten-point plan published last November, which the Taoiseach has admitted will not make any serious inroads until next autumn. We have also seen the spectacle of a number of Ministers flying kites such as the use of St. Bricin's Hospital and other issues.
We learned today that Tallaght Hospital was forced to suspend elective surgery between 13 and 22 April because of serious overcrowding in the accident and emergency unit. Yesterday, there were 21 patients on trolleys in Tallaght, 22 in the Mater and 32 in Beaumont Hospital and Naas Hospital. Throughout the country yesterday there were 237 patients on trolleys. The latest proposal from Government and the Health Service Executive is to instruct all hospitals to add an extra bed to each ward to deal with this problem. It appears the Government is continuously trying to invent a policy on the hoof, so to speak.
First, if this is such a good idea, why was it not included in the ten-point plan last November? Second, will the Taoiseach indicate the status of the report from the Health and Safety Executive in respect of an instruction to hospitals to move patients from trolleys into additional beds to be placed in existing wards? Third, was that proposal discussed and agreed at a Cabinet committee as reported last week? Fourth, has any risk assessment been done in respect of this proposed move from a health and safety and infection control perspective? What is going on? Is anybody in charge in respect of this matter?
Bertie Ahern (Dublin Central, Fianna Fail)
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I can go back over all the initiatives again if necessary but I will confine myself to answering the questions——
Bertie Ahern (Dublin Central, Fianna Fail)
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——raised by the Deputy. The ten-point plan the HSE has drawn up in conjunction with the Department is under way. The HSE has now put its own action team into the key accident and emergency departments to try to assist by talking to management and staff with a view to bringing this proposal to fruition as quickly as possible. Some of these matters can happen quickly, others cannot. There was a meeting of the health committee last week at which the HSE outlined to the members of Government on that committee the type of actions it is trying to implement. The proposals to put additional beds into wards or open up other beds are nothing new. In some hospitals additional beds are put into wards. That was the traditional way of dealing with accident and emergency crises. It tends not to be done now because of staff objections, which I can understand. Health and safety issues may arise also. Where beds can be made available, particularly those adjacent to accident and emergency departments, they are looking at trying to do that. In fact, they are examining all measures on the ground with the management of the hospital, the medical executives and the hospital executives of any area, that they believe can help the nursing staff. That is being done on a one to one basis in hospitals. The solution in one hospital may not be the appropriate solution in another. They are working with the staff to find solutions.
Deputy Kenny asked about the Health and Safety Authority, which has completed its programme of inspections. Everything the authority has recommended is being implemented as quickly as possible. While there are no further risks, there is enough to address in the current issues. All of the other measures I have outlined in recent weeks, especially the sourcing of suitable accommodation for people who do not need acute beds but who cannot go home, are being implemented as are the health care packages. While all of these initiatives are under way, it will take some time to complete the process. In Cork, Blanchardstown and other hospitals in which they have been provided, new facilities are operating fairly well.
Enda Kenny (Mayo, Fine Gael)
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I did not ask the Taoiseach about the report of the Health and Safety Authority, but will do so now. According to the report, wards, exits from wards and fire escapes were blocked with trolleys and other equipment in a number of cases. The report also stated that, in the context of overcrowding, consultations should take place in every case in which extra bed capacity was to be allocated to a ward. Is that being done in every such instance?
Will the Taoiseach comment on today's claim by the Irish Nurses Organisation that there are hundreds of empty beds nationally which could be utilised, of which approximately 150 are in Dublin alone, without adding to the pressure on existing wards? Is the Taoiseach happy that full use is being made of existing bed capacity, without adding to the risk of infection or compromising health and safety, by moving beds into existing wards?
I understand that approximately 25% of those who attend accident and emergency units at weekends are intoxicated or drunk out of their minds and oftentimes accompanied by hangers on. What is the Government response to such circumstances which arise every weekend?
Bertie Ahern (Dublin Central, Fianna Fail)
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I referred to the Health and Safety Authority in response to Deputy Kenny's question as to whether the authority was involved with the HSE in ensuring the executive's initiatives were in line with its requirements. The process is underway. I am told the HSA has acknowledged that hospitals are fully engaged in a process of addressing health and safety requirements in accident and emergency units.
We were told last week at a meeting attended by most of its executive team that the Health Service Executive was examining on a case-by-case basis hospitals with beds which were not open or which could be used to alleviate accident and emergency and other problems. The team went through a range of initiatives at different hospitals to tackle their different problems. The executive is working on the ground to find resolutions to the problems. Bed managers and other hospital staff have engaged last week and this week directly with those problems. Mr. Doran of the Irish Nurses Organisation has written to me in the last few days to provide records of beds the organisation believes could be opened. I passed the information to the Tánaiste and the Department of Health and Children and it will be examined.
Deputy Kenny was correct to indicate that a significant cause of major difficulties at accident and emergency units is alcohol. It is estimated by the experts in the field that between 25% and 35% of patients presenting are under the influence, which proportion rises to 75% during the peak hours of Saturday night and Sunday morning. I am not in a position to correct the figure, but the experts say alcohol is the key issue at accident and emergency units at peak hours. If it is anywhere between 25% and 75%, they are right. Short-term patients present with injuries directly related to the fact that they are heavily under the influence of alcohol which creates a problem. I do not suggest it is the only issue facing accident and emergency services as there are obviously problems at other times.
Alcohol abuse is a problem which cannot be addressed solely at accident and emergency level as it is a problem for society as a whole. Many initiatives have been put forward by many groups, including the task force on alcohol. I met the task force recently to discuss the 77 recommendations it has put forward, all of which are worthy of being acted on. It is no use to say the matter can be easily resolved, because it involves problems of society.
Pat Rabbitte (Dublin South West, Labour)
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Without warning on 5 March, gardaí took the five children of Padraig and Mary O'Hara into care on foot of a court order obtained by the HSE in the Kells area. Of the children, four are autistic and their separation from their parents and a well established routine was traumatic. The parents were required to submit to psychiatric examination despite the possession by officials of a clinical psychology report testifying to their good parenting and character. Since four of their children were diagnosed with autism four years ago, the O'Haras have been engaged in a struggle for basic services with the HSE, which threatened reprisals if the parents went public about their difficulties. More than seven weeks after the court ordered the immediate return of the children to their parents, no official at any level of the HSE has lifted a telephone to call the O'Haras, whose children had supposedly been at risk.
Why was this family treated brutally through an act of bureaucratic vindictiveness? This was a grossly excessive abuse of authority. The O'Haras are not alone in the treatment they have received from persons acting in the name of the HSE. Does the Taoiseach agree that an investigation by a competent person into the HSE's handling of the case is necessary? Will the Taoiseach provide an assurance that no further threat will hang over the family in the absence of any allegation of wrongdoing on their part? I stress that the O'Haras have been commended on their diligence and care of their children as the clinical psychology report testifies.
Bertie Ahern (Dublin Central, Fianna Fail)
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As Deputy Rabbitte will appreciate, I have not followed the case in the last few weeks. I accept the Deputy's statement that no one has called on them and will request that the matter is examined. I recall the matter and have the note I used to inform the House earlier last month of what the family's needs were. I recall also why the issue arose and the children were taken from the family. I do not wish to get into saying anything unhelpful about the family or the staff involved. The staff had consulted at some length and had to take into account the threats that were made on the lives of the children, which were something they could not ignore. Qualified staff made their decision on the basis that it was a matter which could not be overlooked. I am not in a position to overlook the matter either. They acted and after the subsequent case the children were released. I am sure the staff acted on the basis of their professional knowledge. They were not inexperienced.
Deputy Rabbitte has asked me to discover why, if these issues were so important then, nothing has happened since. From the State's point of view, there was a recognition of the unique needs of the family, which was under pressure. I recall the matter well and have every reason to understand the pressure the family faced in the circumstances. My Cabinet colleague, Deputy Noel Dempsey, who is very familiar with the case and had been dealing with it, outlined the circumstances to me at the time. I do not wish to go through them all but the State provided many different services to the family in various ways and also gave a statutory payment to the family. As I understand it, the Deputy's question is whether I will ask that this matter be examined by a competent person and I will certainly take that up.
4:00 pm
Pat Rabbitte (Dublin South West, Labour)
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I do not expect the Taoiseach to recall the detail of this case. I wrote to the Tánaiste about it on 24 March asking her to investigate the policies, procedures and practices of the Health Service Executive in this area. I appreciate that the Tánaiste has other pressures on her. I know that, like me, she met the O'Hara family recently. However, the Taoiseach has missed the point if he believes that the actions of the HSE personnel were caused by threats made to them or that the children were at risk. There is no evidence to bear that out and the judge made that clear. Furthermore, this is not the only family that has been treated in this fashion. The Taoiseach has missed the basis of the point I raised, which was that it was a gross abuse of authority and an act of vindictiveness by personnel employed by the Health Services Executive in that particular area. When they were negotiating for a care package, it was not forthcoming. How is it that if the family concerned was deemed to be at sufficient risk to be taken into care, in the seven weeks that have transpired since the court caused them to be returned to their parents, nobody in the HSE has even made a telephone call to know how they are? The Taoiseach is seriously misinformed if he believes that there is justification, despite the judgment of the court in this matter.
Bertie Ahern (Dublin Central, Fianna Fail)
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As Deputy Rabbitte knows, the point I made concerned why the team acted as it did in the first place, not after the court case. According to my note, the provision of the multidisciplinary team service together with all the other service elements is dependent on the service of a case manager to co-ordinate and complete service delivery. An experienced case manager was employed in early 2005 to undertake this work.
Bertie Ahern (Dublin Central, Fianna Fail)
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However, as a result of verbal abuse received by telephone from Ms O'Hara, the case manager resigned. Following his resignation, Ms O'Hara visited his house and was asked to leave by the case manager's spouse. However, Ms O'Hara returned and this violation of privacy has had a further distressing impact on the staff member whose family and home have now been inappropriately involved in the service issue.
The Meath disability service awaits proposals from Enable Ireland in respect of the case management function together with the multidisciplinary team interventions, but recent communications from the family indicate they do not consider Enable Ireland to be appropriate providers of the case management function.
Damien English (Meath, Fine Gael)
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That is not actually the truth.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Please allow the Taoiseach to continue.
Bertie Ahern (Dublin Central, Fianna Fail)
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My note also goes into all the family's needs. The case has been in court but the point I made was that when the people acted in the first instance, before the court case——
Pat Rabbitte (Dublin South West, Labour)
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That is what the court adjudicated on.
Bertie Ahern (Dublin Central, Fianna Fail)
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Yes but why does the Deputy say that the staff were vindictive when they were acting? I do not know if they were or not, but they were professional staff.
Pat Rabbitte (Dublin South West, Labour)
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The court has decided.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Deputy Rabbitte should allow the Taoiseach to conclude.
Bertie Ahern (Dublin Central, Fianna Fail)
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The court decided professional staff were doing what they thought they should do in the first case. Does that mean that these people should never take action in any case?
Pat Rabbitte (Dublin South West, Labour)
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They have not taken any action since.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Deputy Rabbitte should allow the Taoiseach to conclude.
Bertie Ahern (Dublin Central, Fianna Fail)
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They formed a judgment and it went to court, although fortunately not every case ends up in court. They had put in place a range of services for family needs. The case was in court. As Deputy Rabbitte said, the Tánaiste has met the family and I know that the Minister for Communications, Marine and Natural Resources, Deputy Noel Dempsey, has also met them. Deputy Rabbitte asked me whether a competent person would examine the case and he also asked why nobody had called to the family since. I cannot answer the latter question but I have the list of all the needs that have been put in place, although I do not think it is necessary to put the personal details of a case on the record. I will inquire as to why nobody has called but these needs were put in place and they went through a fairly detailed report.
Pat Rabbitte (Dublin South West, Labour)
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Will the Taoiseach investigate this matter?
Bertie Ahern (Dublin Central, Fianna Fail)
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I will ask a competent person to do so.
Pat Rabbitte (Dublin South West, Labour)
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I thank the Taoiseach.
Trevor Sargent (Dublin North, Green Party)
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When the Minister for Agriculture and Food answered questions earlier, she told us that one fifth of all farm land is now leased. As we know, one of the reasons is that the cost of purchasing farm land is so exorbitant. Does the Taoiseach and his Government accept some of the responsibility in this regard? One area in rural County Dublin has a price tag of €200,000 per acre based on the plans for the relocation of Mountjoy Prison. Does the Taoiseach accept that the price of €30 million for 150 acres is considerably more than the going rate of €17,000 per acre? Even with a compulsory purchase order, the National Roads Authority would pay a maximum of €24,000 per acre after capital gains tax. Does the Taoiseach accept that a serious problem is being created by taking the eye off the ball when it comes to agricultural land acquisition for which the Government is responsible?
Is that fiasco not being compounded by the second annual report of the inspector of prisons, which was published recently? That indicated that relocation was not the only option, even through the inspector, Mr. Kinlan, wrote that he had witnessed very low standards in the running of prisons. Whom does the Taoiseach hold responsible for this? Does he regard the Minister for Justice, Equality and Law Reform as being responsible for driving this relocation project, for placing no limit on the money that could be spent on it and for not seeking an environmental impact assessment on such a large site, which would be normal practice? Does the Taoiseach also regard the Minister as being responsible for not investigating the breach of normal procurement procedures when a member of the extended family, who was the special adviser, was found to be related to the vendor of the site? Would he regard the Minister as being responsible for stigmatising people with mental illness who, in the Central Mental Hospital, will find themselves living beside Mountjoy Prison if it is relocated? The Taoiseach should investigate this matter and put it on hold. Will he do so?
Bertie Ahern (Dublin Central, Fianna Fail)
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The Deputy asked me about two issues. His first question concerned the statement by the Minister for Agriculture and Food that 1% of agricultural land is being made available for the market. That is a matter for the market. I cannot force people who own agricultural land to sell it. If they wish to use it for agricultural purposes, that is a matter for them. If I were to bring proposals to the House for the compulsory acquisition of agricultural land, we would see what the difficulty would be, apart from the fact that it would be unconstitutional.
Bernard Durkan (Kildare North, Fine Gael)
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That is the Taoiseach's philosophy.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Please allow the Taoiseach to continue.
Pat Rabbitte (Dublin South West, Labour)
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I thought the Taoiseach was a socialist.
Bernard Durkan (Kildare North, Fine Gael)
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A committed socialist.
Bertie Ahern (Dublin Central, Fianna Fail)
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Deputy Rabbitte would not support me on that measure if I, or anybody else, brought it to the House.
On the Deputy's second question, it has long been pointed out that we need prison accommodation to replace Mountjoy. It has been highlighted by many reports over many decades, not to mention Judge Kinlan's recent report. A long process was entered into, which included the examination of suitable sites, to try to find one large enough to replace Mountjoy with a modern facility appropriate for the inmates and close enough to Dublin from where a large proportion of prisoners come. It had to be capable of being built in such a way as to seclude it from other lands by properly protecting it. That is what the Government decided and it is what the Minister is following through on.
Trevor Sargent (Dublin North, Green Party)
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It amazes me to hear the Taoiseach decrying compulsory purchase orders when the National Roads Authority uses such orders with impunity. I do not regard them as a significant problem, except perhaps in the sense that people may complain they are not getting enough for their land. Why would they complain, however, when sums of €200,000 per acre are offered? Why is the Taoiseach standing over such a gross overspend of public money?
The Mountjoy site has a new women's prison, €10 million has been spent on a training centre in St. Patrick's Institution and capital expenditure of €6 million has been spent on Spike Island which is to be closed down. Questions have arisen regarding a conflict of interest in the deal for the prison site which I understand could have been settled for much less. Will the Taoiseach ensure the Comptroller and Auditor General is made aware of this? It is a matter of public interest that he be informed and investigate what appears to be a strange purchase.
Will the Taoiseach insist that an environmental impact assessment is carried out given that the relevant directive appears to indicate that one is required for an area of this size? They are definitely necessary if a planning application is required. Does the Taoiseach realise he will be in trouble again with the European Court of Justice unless he insists such an assessment is carried out?
Bertie Ahern (Dublin Central, Fianna Fail)
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Perhaps some land costs €200,000 per acre and other land is worth far more. We have seen sites in this and other cities——
Dan Boyle (Cork South Central, Green Party)
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Is the Taoiseach referring to Abbotstown?
Bertie Ahern (Dublin Central, Fianna Fail)
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In general, land prices have gone up from under €5,000 per acre ten years ago to about €14,000 per acre now. That is the going rate rather than the prices which have been mentioned. Sometimes trying to relocate a prison is difficult while at other times relocation is welcomed. I was Minister for Finance some years ago when a prison was opened in Roscommon. People were very glad to see the prison there, with employment and other knock-on effects of the move.
Deputy Sargent will agree that Mountjoy Prison, with the exception of the women's prison which is a new building, has long outlived its use. It has been condemned in report after report as not being suitable to deal with the population it has and not having the kind of facilities which are required.
Ciarán Cuffe (Dún Laoghaire, Green Party)
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The Government recently spent €10 million on St. Patrick's Institution.
Bertie Ahern (Dublin Central, Fianna Fail)
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Obviously, relevant matters relating to planning and environmental impact assessments will be looked at in due course by the officials involved in trying to make this a proper location.
Trevor Sargent (Dublin North, Green Party)
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An environmental impact assessment will be carried out.