Tuesday, 22 November 2005
This week, four years ago, the Government launched one of the greatest election scams of the decade, namely, the national health strategy. We were promised a world class health strategy, launched by the Taoiseach, the Tánaiste and the then Minister for Health and Children, Deputy Martin.
Deputy Power should remain quiet. The national health strategy was to deliver 3,000 beds, a wish list of services for the elderly, 600 primary care centres and a national cancer strategy by the end of 2002. Four years later, after tens of billions of euro, we do not have the world class health system promised by the Government.
This week, many are left wondering where all the money has gone when we read the truly damning letter in the Irish Examiner to the Tánaiste and Minister for Health and Children from the southern region's only consultant medical oncologist, Dr. O'Reilly, who is now serving 500,000 people. In his letter he states he could not get hospital care for dying cancer patients because of a lack of beds. As a result of the failure to roll out breast cancer screening services, women in the southern region need more extensive surgery, radiotherapy, chemotherapy and hormonal therapy.
Dr. O'Reilly describes how a cancer patient was left at home in pain as the only alternative was to admit her on a trolley in the accident and emergency unit. Previous cancer patients were put in wards surrounded by intoxicated people. The southern region has fewer consultants, fewer junior doctors and fewer liaison nurse supporters than any other region. In the ninth year of the Government, why in the name of heavens is a skilled and senior medical professional reduced to a desperate plea for action on behalf of his patients? Is this not a damning indictment of the Government? Does it not expose the inability to plan properly, spend wisely and invest well? Does it not expose the hypocrisy of the words of the Government for the past nine years in respect of national cancer strategy and world class health services? Does it not demonstrate how the Government has wasted the people's money, and as a consequence why, in some circumstances, people have died?
I do not accept that people working in the health service, the new units in the health service or the facilities are a waste of money. Money and a large amount of resources are used. The issues raised by Dr. O'Reilly, the consultant medical oncologist to whom Deputy Kenny referred, namely, the management of delivery of health, personal and social services, are the responsibility of the HSE and it has issued a statement outlining the investment made in the service in which Dr. O'Reilly works. Dr. O'Reilly had a colleague who left for another job so he is presently working on his own.
The former colleague of Dr. O'Reilly has taken up another post and I understand there is a locum working with Dr. O'Reilly. The matters to which he referred are being addressed by the management of Cork University Hospital. Since the implementation of the national cancer strategy some €80 million cumulative additional funding has been made available to the southern region.
An additional 11 consultants and support staff are being appointed across the region. The HSE has advised that approval has been secured in recent weeks to proceed to the next phase of the development of a €47 million oncology, cardiac and renal centre, which will include a dedicated 30-bed oncology ward. It is planned to commence construction of that centre next year.
Arrangements are also being made to give effect to the establishment of a ten-bed medical oncology ward within the Cork University Hospital. Nobody would say that those facilities and new units are not enormously welcome and will prove to be very good value for money and a good allocation of resources.
The Deputy can argue that it would be great if it was there 20 years ago but it was not. The fact is that it is there.
The expansion of radiation oncology services under the national plan announced by the Tánaiste last July has increased the number of linear accelerators from four to seven, which will greatly improve the access for cancer patients throughout Cork and the southern region to radiotherapy treatment. Planning is also under way for the development of the necessary infrastructure for the roll-out of the BreastCheck programme——
These are major investments in the area that Dr. O'Reilly, who is the consultant medical oncologist, wants to see. The fact is that these issues have been approved. I presume he hopes that these facilities can be put in place as quickly as possible. There is approval for the oncology, cardiac and renal centre, which will include a dedicated 30-bed oncology ward. I am sure that will greatly assist Dr. O'Reilly, his patients and those in the Cork region who use the services. That is a fair and valid point.
As usual, the Taoiseach answers every question about health matters with a pained expression, a flurry of figures, a litany of what has been spent and a firm resolve to do better. Will the Taoiseach acknowledge — we have heard all this before — that in his letter, Dr. O'Reilly states that he has been trying to resolve these issues for four years? Of course, Cork University Hospital is a wonderful building, a flagship hospital, and many of the people there do a wonderful job. However, this is about the level of service delivered inside the walls of the hospital. The specialists and frontline people are not there and dedicated staff in the wards are not available to patients when they need them.
The Taoiseach's Government has shown an unlimited capacity to spend the people's money. We remember the fanfare and the failure attached to the health strategy. We remember the €160 million spent on PPARS, the €3 million spent on the web portal of the former Minister for Health and Children, Deputy Martin. It is not about what one spends but how one delivers that spend.
The Taoiseach might not believe my words and might say that they are purely political. Let me quote from a letter from a constituent of Deputy Jim O'Keeffe's about her mother:
On the 23rd of October, my mother lay in bed at home crying with pain and Dr. O'Reilly could offer us no help as the hospital are short of beds and staff. We were forced to watch a lady, with pride and dignity, dying in front of us, due to a failing health service and for this I am angry, hurt and lacking confidence in Mary Harney's effort at reform... The following day I brought her to Cork University Hospital and again she was in a waiting room from 9 a.m. until she was given a bed in what I would call appalling conditions, 11 hours later. This ward was a rapid transit ward and although these staff were outstanding, patients were subjected to a distinct smell of urine and, I believe, unhealthy conditions in general. It was three days before she was transferred to a proper ward. Rapid transit? I don't think so.
These are the words of a constituent about her mother, in respect of whom the Taoiseach is spending money, her money, and the services are not being delivered. A world class health service? I do not think so.
I do not think increasing the number of consultants by 700 is a waste of money. The implication, every time Deputy Kenny says that, is a negative one, though I know that is not the way he means it. Most of the money in the health Vote goes into buildings, equipment or staff. The buildings certainly are not a waste of money, I do not think the equipment is a waste of money because it is world class equipment and I do not think the staff is a waste of money. In the case of consultants, we have doubled the number of consultants. If Deputy Kenny or anyone else wants to say that we have doubled the number of consultants but they are all playing cards, I would accept that as a criticism if he believed it to be true, but I do not believe it to be true.
I will not leave it go unanswered that the money is wasted. The money is not wasted. The people are doing their jobs and working hard. We know that cancer will affect one in three of the population. There are now 107 more consultant posts and 245 more clinical nurse specialists in cancer services——
They have helped to achieve a cut in cancer mortality of at least 15% for those under 65. They have made an enormously successful indent into the problem that existed a few years ago. I am not saying everything is perfect, nobody is saying that, but we are building a radiotherapy network that will bring the service as close as possible to people in every region. That service has opened up in Galway, it has been expanded in Cork, two major centres will be built in Dublin — in Beaumont and St. James's hospitals — and in the area where Dr. O'Reilly is based. He is making points that he obviously believes are highly valid and I accept that.
Approval has been secured in the past few weeks to move to the development of a €47 million oncology, cardiac and renal centre, which will include a dedicated 30-bed oncology ward. Dr. O'Reilly is making the point that his facilities are not good enough. In response, I am saying that these facilities have been improved. If the doctor is saying that he would like the development to happen more quickly, we will accept that and will do all we can to make things happen faster. Arrangements are also being made to give effect to the establishment of a ten-bed medical oncology ward within Cork University Hospital. It is not that nothing has happened or that money is being wasted.
We should ask that question of the 104,000 staff who are responsible and the management of those staff. I do not know if there is a smell of urine in the wards, but there are 104,000 people in the health service who are paid as much as I am to make sure that it is not there.
We all have a responsibility and everyone is drawing their week's salary. If those problems exist, people are employed, under good conditions, to deal with them.
Dr. O'Reilly makes valid points on which I was asked to respond today and I am explaining what is happening in that hospital to deal with those issues. I accept that the improvements will not be made tomorrow, but they have been announced and approved and hopefully the work can be completed as soon as possible.
I think the Taoiseach misses the point. The issue raised with him by Deputy Kenny is the extraordinary letter published in the Irish Examiner yesterday from the lone consultant serving 500,000 people in what was formerly the southern health board area. The Taoiseach said that a considerable indent has been made and then goes on to confuse the matter with national figures and so on. According to his letter, Dr. O'Reilly is the only oncologist in the region and is solely responsible for providing cancer care for 500,000 people. Is that true? Where does that leave the 107 consultants the Taoiseach says he has appointed during eight and half years in Government? The Taoiseach makes remarks about people who are paid as much as he is but the IMO is reported in the Irish Examiner this morning as stating that oncology nurses are leaving because of the lack of oncology support services in the former southern health board region. I hope the Taoiseach is not saying nurses are paid the same as he is. Those services are not being provided despite the fact that the Government has been in power for eight and a half years. The consultant in question said this week that a woman at home in pain and dying from cancer cannot be admitted to any of the four hospitals and the only way she can get access to care in a hospital is on a trolley in an accident and emergency department. How is that acceptable in 2005?
A consultant from Northern Ireland appeared on the television news last night to point out that lives have been saved in Northern Ireland because of their superior screening programme. There is no cervical screening in this jurisdiction and BreastCheck has not been rolled out in Counties Cork and Kerry. Hundreds of women in the southern region have attended meetings organised by my colleagues Deputy McManus, Deputy O'Sullivan, Deputy Lynch and Deputy Moynihan-Cronin demanding a service that, as Dr. O'Reilly confirms, is not available. What is the point in talking about billions of euro and appointing consultants when that is the position in the former southern health area?
I referred to the health services in their entirety. Dr. O'Reilly is not the only consultant dealing with cancer. He is a medical oncologist but there are surgical oncologists, radiographers and clinical oncologists, a number of people working in cancer services. He has a locum since his colleague left to come back to Dublin, which was his wish.
Dr. O'Reilly said the facilities there are inadequate. Nevertheless it is relevant that 107 more people now work in the service in numerous areas, particularly Cork University Hospital where the doctor has complained he does not have all he wishes. We have in recent weeks progressed the development of a €47 million oncology, cardiac and renal centre, which will include a dedicated, bedded oncology ward planned to commence construction next year.
The money has been allocated. This will be of major assistance to medical oncologists and their colleagues. In addition to 107 new consultants there are 245 more clinical nurse specialists. It is not correct that we are losing nurses, because the rate of turnover of nurses has dropped dramatically in recent times. This service, which people portray as terrible, and I do not portray it as perfect, has seen a reduction in cancer mortality among under-65s by at least 15%, which is a huge figure. Deputy Rabbitte makes a good point about Northern Ireland. Medics there say the reason they have achieved success is they have centralised all their facilities into one unit.
People have made the argument at many of the meetings to which Deputy Rabbitte referred that they have brought about a huge improvement in the North by centralising services into one location. Deputies do not want to hear this but precisely that point has been made here for some time, whereas lobby groups argue against it because they want services spread thinly, the opposite to what Deputy Rabbitte correctly said has happened in Northern Ireland.
I heard the consultant from Northern Ireland with my own ears last night. He said their superior performance was due to the existence of screening programmes, which do not exist in the health board areas we are talking about.
In his letter published yesterday Dr. O'Reilly said interviews for the post had been held but they failed to fill it because of the conditions. The Taoiseach trots out the line that whoever was there left for a better job. When Dr. Halligan failed to take up the HSE job, the Taoiseach spun the line that he wanted a job in England, which the media faithfully reported. There is only one consultant oncologist in this area. There is no point confusing it with nurses because the number of vacancies in nursing is 1,100 and rising.
Dr. O'Reilly writes, and I have no reason to believe he is lying, that the oncology and renal ward to which the Taoiseach refers has been approved but that funding has not been approved. What is the point in saying in the national Parliament that they have approved a dedicated ward for this purpose when no funding has been provided? The post is still vacant and, no matter what the Tánaiste says, there is no funding for the ward.
What will the Tánaiste give back from the capital spend budget this year? The Book of Estimates states it will be €56.4 million. That happens to be 10% and is the figure that can be rolled over. How much will she actually give back? How can she give back that amount of capital moneys when there is such a need in the Cork and Kerry region and for the promised roll-out of BreastCheck? Three years later women in that area do not have access to that essential service, which the same oncologist said has cost 65 deaths in one year in this jurisdiction. I am not suggesting the Taoiseach is any less sensitive to the human tragedies involved than anybody on this side of the House, but he is entirely remote. The Government has learned the mantra about the successful economy — it is a single transferable speech. Every Minister is rolled out on television to relate how successful the economy is and how many billions have been spent. No one has questioned his ability to spend money but it is his ability to waste it and not provide essential services that concerns Members on this side of the House.
On BreastCheck, this is not the point consultants in the north have been making. They have a good centralised unit. As Deputy Rabbitte and the House knows, BreastCheck is now available in many regions throughout the country and it will be rolled out in full by January 2007. Significant resources have been put into the service, but it will not solve all the problems. One in three people have cancer and BreastCheck will not resolve that. Dedicated units are required, including radiologists and medical and surgical oncologists to provide the service. That is what the Government has been trying to provide. There are 107 more consultants working in the cancer area, who are making a considerable impact.
There are other facilities, including the building of a radiotherapy network to bring the service as close as possible to the people in the regions. People would like the service to be provided throughout the country, but no one else has done that. Since the Tánaiste made her announcement in July, we have increased the number of linear accelerators from four to seven, which will improve greatly access for cancer patients throughout the country. The work which is going on in various parts of the country will help in that regard. Unfortunately, it will not mean that people will not die from cancer. Even with the best cancer services and facilities in the world, people still die from cancer, but we must try to provide as good a service as possible.
We are a long way from where we were. While expenditure of €12 billion on health services in a country with a population of 4 million is significant, I do not believe the money is wasted. The facilities are improving all the time. New units are being opened and new staff are being employed, which is good. There will always be new inventions to improve the service. Planning is under way for the development of the infrastructure that will roll out BreastCheck.
Deputy Rabbitte referred to Dr. O'Reilly. I do not know the man and I am not saying he is a liar. I am sure he is working very hard. My information is that the resources in that area have been sanctioned and approved. I will check it out but my information is that the resources have been made available for the €47 million unit.
He is working with the management of the hospital, therefore, someone should tell him. The main point is that Dr. O'Reilly said he needs better facilities. I am saying the new unit, including the ten-bed oncology ward, is approved. It is going ahead and will be put in to Cork University Hospital.
The Taoiseach was asked a number of questions by Deputy Kenny and Deputy Rabbitte on the injustice and shortcomings in the health service, mainly in Munster, as a result of the letter from Dr. Séamus O'Reilly. As the Taoiseach said, he does not know Dr. O'Reilly, but is it his intention to meet Dr. O'Reilly, given that it is something he asked for explicitly in his letter? He was anxious to explain the reality on the ground, which it is important for the Taoiseach to understand. I would like to know if the Taoiseach will meet Dr. O'Reilly.
Will he answer the question asked in regard to the shortcomings in Munster and not simply say there is a general situation throughout the country? Is it right that there is just one oncologist in the Cork region? Is this acceptable and adequate from the Taoiseach's point of view? Is it right that the one oncologist operates in four hospitals, catering for 500,000 people? Is it right that none of the hospitals has a seven-day inpatient ward? Will the Taoiseach acknowledge the many people who are of the view — I cannot understand why Professor Drumm is not of this view — that there are not sufficient beds? Dr. O'Reilly made it clear that people are dying at home, that they are not able to get a bed even when they are dying. Is it clear that there is a problem with bed numbers, to which there must be a response, and when will that response come?
In regard to BreastCheck, we all know one cannot announce the service today and provide it tomorrow. The Taoiseach knows this is not what the Government proposed.
The Government was elected on the basis of a promise that BreastCheck would be available countrywide by 2007. Will that promise be fulfilled or will the Taoiseach stand up and say it is one more promise that will be broken?
When there is a full-time post, the locum will become a full-time oncologist, but there are still two people employed. The Deputy asked me not to generalise when responding but to stick to Cork, which means I must repeat myself. I said that approval has been secured to proceed to the next phase of the €47 million oncology-cardiac-renal centre which will have a dedicated 30-bed oncology ward. It is planned to commence next year with a ten-bed medical oncology ward.
The BreastCheck programme covers east to west and is being extended to Galway. The Tánaiste and I met some consultants earlier in the year. The service covers approximately half the population. It will be rolled out in the rest of the country between now and the beginning of 2007, which is in 14 or 15 months' time. This progress has been made from a time when there was no BreastCheck service. There are many additional consultants providing a far better cancer service throughout the country now than was ever the case. There are 107 dedicated consultants working in this area at senior level, plus 245 clinical nurses. The units are improving dramatically the cancer services.
Under the cancer strategy, €80 million in cumulative additional funding has been made available to the southern region alone, with an additional 11 consultants and support staff being appointed throughout the region. It is a considerable investment and while it will not solve every case, it will go a long way towards improving the service.
It is important for the Taoiseach to realise that the second oncologist resigned on the basis that the conditions were intolerable. If the remaining oncologist is not to resign, will the Taoiseach meet the man? He is in a desperate situation and wants the Taoiseach to understand what he is going through. Such a meeting would be timely and important. Asking on behalf of the 500,000 people in the region, the Taoiseach mentioned BreastCheck and said it would happen sometime but is it not a serious indictment that planning permission has not even been sought for BreastCheck premises and facilities in Cork? Does that not indicate that heels are being dragged on the matter and that it should be fast-tracked and priority given to it? Will the Taoiseach meet Dr. O'Reilly? Will he ensure planning permission is sought in Cork? Will we get a completion date for the BreastCheck services that are due if the Government promise is to be believed?
Whatever the reason, Dr. O'Reilly is working with a locum in Cork and that post will be filled in due time.
Planning is underway for the development of the remaining half of the country on the infrastructure for the national roll out of BreastCheck. BreastCheck has advertised for the key lead consultant radiologists and radiotherapists for the programme and to recruit other key clinical posts that will commence early in 2006. That will complete the programme. BreastCheck, on its own admission, has stated it can finish this work in 2007. We have provided the resources.
I am sure he is too busy, I accept that. There is a locum working in Cork so two consultants are there. They are not the only people, there are 11 consultants in place. We have already improved the new unit and BreastCheck is being rolled out.
I am asking the Deputy to leave not for the issue but because he is being disorderly. The Deputy will leave the House, he was warned at least six or seven times. Deputy Allen has continued to interrupt on all three questions and the Chair has warned him often enough.