Dáil debates
Wednesday, 29 March 2006
Leaders' Questions.
10:30 am
Enda Kenny (Mayo, Fine Gael)
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We meet on a day of national emergency. The matter of accident and emergency units has been raised on at least two dozen occasions in the past two years by the leaders of the Opposition parties and by other Members on this side of the House. I wish to ask the Taoiseach and the Tánaiste the question that is on everybody's lips about this matter. When did the penny drop with the Government? Was it the doctors, nurses, patients, their relatives, the constant radio phone-ins or Brendan Gleeson? It was none of these people. The realisation of the accident and emergency problem has come about because for 17 opinion polls in a row, the Taoiseach's party has been languishing in the mid-30s. This national emergency is driven by a sense of political desperation. The Minister for the Environment, Heritage and Local Government, Deputy Roche, can smirk all he likes——
Dick Roche (Wicklow, Fianna Fail)
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I was thinking of Deputy Kenny's 30 years in the Dáil.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Deputy Kenny, without interruption, please.
Enda Kenny (Mayo, Fine Gael)
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——with his unbridled arrogance, but it is no joke for the——
Dick Roche (Wicklow, Fianna Fail)
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I am laughing at Deputy Kenny's smugness.
Enda Kenny (Mayo, Fine Gael)
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——384 people lying on trolleys today.
Dick Roche (Wicklow, Fianna Fail)
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Deputy Kenny is the only joke here. Thirty years with nothing to show for it.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Minister should allow Deputy Kenny to speak without interruption.
Enda Kenny (Mayo, Fine Gael)
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The Minister for the Environment, Heritage and Local Government and his lot have sat around the Cabinet table for nine years and it was only yesterday that this became a national emergency in the eyes of the Tánaiste. On 12 October 2004, I asked the Tánaiste, Deputy Harney, what would be her political priorities upon taking office as Minister for Health and Children and she said:
One of the priority areas is accident and emergency units. It is unacceptable that people have to spend upwards of 12 hours on a trolley.
In 2006 this becomes a national emergency, the penny has dropped. The realisation is clear around the Cabinet table——
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Deputy's time has concluded.
Enda Kenny (Mayo, Fine Gael)
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——that the people have had enough and do not want any more of this Government, which has proven itself to be completely incompetent in dealing with this matter. Is the Taoiseach prepared to apply to his Government, the targets that the Tánaiste——
Dick Roche (Wicklow, Fianna Fail)
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A return to the days of Deputy Noonan.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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I ask the Minister to allow Deputy Kenny to conclude.
Enda Kenny (Mayo, Fine Gael)
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The Minister for chewing gum is at it again. His conceit and arrogance are unbridled in the history of Fianna Fáil Governments. Without interruption from the Wicklow hills, when can we expect to see real improvements in the accident and emergency units? Will it take one month or six months, or is this another false dawn like all the other false dawns we have had from the Government in the past three years? In the poorest countries in the world, for instance in Peru, people bring their own drugs to hospital. In a country that is knee-deep in financial wealth it appears that people here need to bring a bed or chair to a hospital. While the Minister for the Environment, Heritage and Local Government, Deputy Roche, might not like that, it is almost a fact of life.
Bertie Ahern (Dublin Central, Fianna Fail)
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Last Wednesday, Deputy Kenny asked if we could give a greater sense of urgency to the implementation of the ten-point plan and to dealing with the excessive number of people who, unfortunately, are wrongly waiting in some of our accident and emergency units. More than 1 million people a year use accident and emergency units, which is approximately 3,500 people a day. In spite of the enormous resources and huge improvements in many of the hospitals — the new accident and emergency units in St. Vincent's hospital, in Cork and Blanchardstown, and stand-down beds in many other locations — there are still problems in some areas.
Last week I told Deputy Kenny that the Tánaiste was about to set up a task force of some of the key specialists involved to try to complete the implementation of the ten-point plan in the areas that are not yet done and to try to get better co-ordination and co-operation across the medical and nursing sectors to resolve the difficulties. We have put in the resources, as I indicated last week. In the areas where there are still difficulties, the Government has made clear we are prepared to put in extra resources. I pointed out that many of the key hospitals have put forward short-term, medium-term and long-term plans. Many of the short-term plans are complete, like the one I mentioned last week in the Mater, and other units have opened up. Some medium-term plans have been implemented and others are being implemented — the issues are resolved in the areas where they have been implemented. There are some long-term ones that are still required. I pointed out that in many of the hospitals, this year will see additional beds.
I made the fair and valid point as to why we are still having difficulties despite having put in so many resources. As I said last week, the admissions in the early months of this year have been up by more than 20%. We have an older population, who, in the obvious sense, require better services. In the early weeks of this year, we also had the flu difficulties and the winter vomiting bug which affected and closed down units in some areas.
Joan Burton (Dublin West, Labour)
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There is overcrowding in the hospitals.
Jim O'Keeffe (Cork South West, Fine Gael)
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We have had nine years of Fianna Fáil and Progressive Democrats Governments.
Bertie Ahern (Dublin Central, Fianna Fail)
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There are a number of old people in beds who need to be taken out of the hospitals. They are not able to go home.
Bertie Ahern (Dublin Central, Fianna Fail)
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They are medically cleared to go home by their physicians, but they are not, for one reason or another, able to go back. We need to provide alternative accommodation for these.
Joan Burton (Dublin West, Labour)
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Why does the Government not provide that accommodation?
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Allow the Taoiseach to speak without interruption, please.
Bertie Ahern (Dublin Central, Fianna Fail)
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We provided 250 beds in the autumn and we provided another 250 beds.
Bertie Ahern (Dublin Central, Fianna Fail)
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As the Tánaiste made quite clear yesterday, in our various home care packages and health packages, we will continue to do that.
Enda Kenny (Mayo, Fine Gael)
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We have heard most of this before. The Government has decided and agreed——
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Allow Deputy Kenny to speak without interruption, please.
Dermot Ahern (Louth, Fianna Fail)
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Deputy Burton should stop interrupting Deputy Kenny.
Enda Kenny (Mayo, Fine Gael)
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The Government has decided and agreed, and accepted the repeated observations by parties on this side of the House, that there is a national emergency in so far as accident and emergency units are concerned. We have heard nothing from the Taoiseach on behalf of the Government as to the Government's plan to deal with capacity. What is the target for capacity? There seems to be confusion about the number of beds which are required. Why has the Government not dealt with the acute medical units which were supposed to be put in place under the Tánaiste's ten-point plan or the after-hours GP service, both of which would relieve stress on accident and emergency units? There is no reference to such matters in the plans to deal with this national emergency, which requires a national response.
It is interesting to note that the Tánaiste said in an interview yesterday that there were 500 people on trolleys in hospitals three weeks ago. She rightly said that it was completely unacceptable. Given that the figure she cited had been issued by the Irish Nurses Organisation, can we take it that yesterday's figure of 384 is also correct? Is the phoney war between the HSE and the Department of Health and Children, on the one hand, and the INO, on the other hand, now at an end? Does the Tánaiste accept that the figures issued by the INO are correct?
The Tánaiste's statement that the problems in accident and emergency units constitute a national emergency represent a complete reversal of the Taoiseach's claim that there is no crisis in the health service. We found out yesterday that the HSE is happy to accept that there should be a waiting period of 24 hours, rather than 12 hours, in accident and emergency units. This is completely unacceptable. The Tánaiste, who has been Minister for Health and Children for 18 months, said when she took office that accident and emergency departments were her first priority. The ten-point plan she set out at that time has since been abandoned, clearly as a result of a difference of opinion about hospital capacity figures. Responsibility for matters of this nature is being deliberately hived off to the Health Service Executive.
Enda Kenny (Mayo, Fine Gael)
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No questions are being answered in this House and nobody is accepting political responsibility for the problems about which we are speaking. It has suddenly dawned on the Government after nine years that this is a national emergency. The Tánaiste's statement yesterday was not driven by political sympathy for patients who are lying on trolleys today and every day, but by political desperation. The Government knows that the people are waiting for the members of its parties when they next seek their support. It has failed to use this country's unprecedented wealth and resources to provide proper services for the people. As they say in the medical profession, the Government is "TATT"— tired all the time.
Bertie Ahern (Dublin Central, Fianna Fail)
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Deputy Kenny knows I will not rise to any of his political charges, but I will give some of the facts.
Tom Hayes (Tipperary South, Fine Gael)
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The Minister, Deputy Roche, would rise to them.
Damien English (Meath, Fine Gael)
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The Taoiseach will rise to them when he meets the people on the streets.
Bertie Ahern (Dublin Central, Fianna Fail)
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We have moved health——
Bertie Ahern (Dublin Central, Fianna Fail)
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——in recent years. We have increased the health service budget from €3 billion to €12 billion. The fact that we did not realise that it required——
Olivia Mitchell (Dublin South, Fine Gael)
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We never doubted the Government's ability to spend money.
Bertie Ahern (Dublin Central, Fianna Fail)
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If I am allowed to answer Deputy Kenny's questions, I will be happy to do so.
Damien English (Meath, Fine Gael)
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The Taoiseach should answer the real questions. We know the Government is able to spend.
Dermot Ahern (Louth, Fianna Fail)
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Deputy English is here today.
Dick Roche (Wicklow, Fianna Fail)
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It is nice to see him earning the few shillings today.
Damien English (Meath, Fine Gael)
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I will still be here next year.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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I ask the Ministers to allow the Taoiseach to answer without interruption. Deputy English, please——
Damien English (Meath, Fine Gael)
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I have to answer the Ministers.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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You do not have to answer them. You have to keep quiet and allow the Taoiseach to answer. Your own leader went four minutes over his time.
Bernard Durkan (Kildare North, Fine Gael)
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The Minister, Deputy Roche, went two minutes over time as well.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Taoiseach is entitled to be heard without interruption and the Chair will insist on it.
Jim O'Keeffe (Cork South West, Fine Gael)
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The Government can spend the taxpayers' money, but what else can it do?
Bertie Ahern (Dublin Central, Fianna Fail)
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I remind Deputy Kenny that the Government has recognised since it took office that additional resources are required. That is why the health service budget has been increased from €3 billion to €12 billion. This year's health service capital programme is worth €500 million, as it has been every year in recent years. We have finished many units. St. Vincent's hospital is almost a new hospital. Similar investment has been made in hospitals in Cork, Galway and other places throughout the country. An additional 35,000 staff have been employed in the health service. Some 3,000 people who would not have been helped previously will benefit from the home care packages this year.
Jim O'Keeffe (Cork South West, Fine Gael)
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What about home help hours?
Bertie Ahern (Dublin Central, Fianna Fail)
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Deputy Kenny has spoken about the number of people on trolleys, but I am sure he knows the reality is that 411 people have been medically discharged from the main hospitals in this city — they have finished their entire treatment in this city's acute medical hospitals — but they cannot go home for a variety of reasons.
Liz McManus (Wicklow, Labour)
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That is the responsibility of the Government, which did nothing——
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Taoiseach, without interruption, please. The Deputy will have an opportunity.
Jim O'Keeffe (Cork South West, Fine Gael)
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The Government cut home help hours.
Emmet Stagg (Kildare North, Labour)
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The problems are the direct result of the Government's actions.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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This is the Fine Gael question and the Deputy is not a member of that party.
Bernard Durkan (Kildare North, Fine Gael)
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He is getting closer.
Michael Ahern (Cork East, Fianna Fail)
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Why do we not talk about Deputy Stagg's actions?
Bertie Ahern (Dublin Central, Fianna Fail)
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We have provided private beds for the patients in question. We provided 250 beds before Christmas and we are providing a further 250 beds now. We have had to buy private accommodation in which these people can be located. That is the only way to free beds in accident and emergency departments so that people can move through the system. I will outline what the Tánaiste has been doing for the past 18 months——
Jim O'Keeffe (Cork South West, Fine Gael)
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She has been making up for the ineffectiveness of her predecessor, Deputy Martin.
Bertie Ahern (Dublin Central, Fianna Fail)
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——and what the Government has been doing in recent years. We have been trying to improve bed capacity, employ more consultants in accident and emergency units and increase the extent to which nursing and other services are provided in such units. As the Tánaiste said yesterday, we need the co-operation of the medical services in other areas, such as diagnostic services, so that people do not have to wait several hours for a fairly simple x-ray or other procedures. We should ensure that enough staff members are available at weekends to provide diagnostic services and improve patient flow.
Seán Ryan (Dublin North, Labour)
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The Government should do something about it.
Bertie Ahern (Dublin Central, Fianna Fail)
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We cannot do such practical things without the co-operation of the paramedical, nursing and medical staff.
Jim O'Keeffe (Cork South West, Fine Gael)
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The Government has been in office for nine years.
Bertie Ahern (Dublin Central, Fianna Fail)
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There is no difficulty with paying such people, but it can be difficult to get their co-operation in helping us.
Brendan Howlin (Wexford, Labour)
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It is everybody else's fault.
Seán Ryan (Dublin North, Labour)
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The Taoiseach is blaming the staff.
Bertie Ahern (Dublin Central, Fianna Fail)
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As I said last week——
Olivia Mitchell (Dublin South, Fine Gael)
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He is blaming the nurses.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Allow the Taoiseach to conclude, please.
Michael Ahern (Cork East, Fianna Fail)
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He could blame the Labour Party Members.
Bertie Ahern (Dublin Central, Fianna Fail)
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Nobody is blaming anybody. The Opposition Members want to make political points, but we are trying to solve problems.
Bernard Durkan (Kildare North, Fine Gael)
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Why not blame the patients?
Jim O'Keeffe (Cork South West, Fine Gael)
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Who will the Government blame when it is facing the electorate?
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Allow the Taoiseach to continue without interruption.
Bertie Ahern (Dublin Central, Fianna Fail)
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The only fear the Opposition has is that we might resolve this issue. What we want to do is solve the issue and we will continue to do that.
Bernard Durkan (Kildare North, Fine Gael)
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There is no fear of that. The Government will not solve it in this century.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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I call Deputy Rabbitte.
Dermot Ahern (Louth, Fianna Fail)
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Ask Mr. Fitzpatrick. He wants to close all the hospitals.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Deputy Ryan should allow his leader to speak without interruption.
Seymour Crawford (Cavan-Monaghan, Fine Gael)
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Half of the beds in Monaghan General Hospital have been closed.
Dermot Ahern (Louth, Fianna Fail)
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Mr. Fitzpatrick wants to close them.
Pat Rabbitte (Dublin South West, Labour)
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Whatever the Taoiseach says——
Bernard Durkan (Kildare North, Fine Gael)
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The Minister, Deputy Roche, should concentrate on polishing his rusting ballot boxes.
Dick Roche (Wicklow, Fianna Fail)
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What about the Deputy's valuable contribution on the health board?
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Deputy Rabbitte, without interruption.
Bertie Ahern (Dublin Central, Fianna Fail)
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The Deputy's party will not allow anybody else to talk.
Bertie Ahern (Dublin Central, Fianna Fail)
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On a point of order, I ask my colleagues to allow Deputy Rabbitte to speak, but I ask Deputy Rabbitte to ask his colleagues to allow me to speak.
Pat Rabbitte (Dublin South West, Labour)
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They find me less provocative.
Bertie Ahern (Dublin Central, Fianna Fail)
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Nobody is being provocative. You have campaigned that every time I speak, your colleagues——
John O'Donoghue (Kerry South, Fianna Fail)
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Deputy Rabbitte should not underestimate himself.
Bertie Ahern (Dublin Central, Fianna Fail)
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I will ask my colleagues to stay quiet for Deputy Rabbitte, as they should, but he should ask his colleagues to stay quiet for me.
Liz McManus (Wicklow, Labour)
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Why can the Minister not stay quiet?
Brendan Howlin (Wexford, Labour)
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He is acting like a bullyboy.
Bertie Ahern (Dublin Central, Fianna Fail)
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It is a simple matter.
John O'Donoghue (Kerry South, Fianna Fail)
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Deputy Rabbitte should not underestimate himself.
Pat Rabbitte (Dublin South West, Labour)
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The Taoiseach has rhymed off a number of statistics and practical things which he claims the Government is doing. Is it not the bottom line that whatever the Taoiseach thinks the Government is doing is not working? Is that not why the Tánaiste and Minister for Health and Children has declared a national emergency, nine years after the Government took responsibility for the health services? The last national emergency related to an outbreak of foot and mouth disease. It is not plain why the national emergency in the accident and emergency services has been declared at this time, after nine years in which there were two Ministers for Health and Children from Fianna Fáil and one from the Progressive Democrats Party.
Can it be the case that they have realised that the people are dissatisfied with the health services, just as Mr. Haughey discovered when he went on the election trail in 1989? We have been telling the Government for a number of years that the people are not happy with the health services. The ten-point plan that was announced by the Tánaiste in November 2004 has not worked — the situation has got worse. According to the Irish Nurses Organisation, there were 384 patients on trolleys yesterday. That is the position. Why has the Government now recognised that there is a national emergency in this area? Does it relate to the imminence of the next general election?
Pat Rabbitte (Dublin South West, Labour)
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The situation in accident and emergency departments is worse than it was when the Government took office. Will the Taoiseach tell the House whether there is agreement or consensus among the stakeholders about the diagnosis of this problem? Specifically, has the Government, particularly the Minister for Health and Children, reached agreement with Professor Drumm about the solutions to the problem? The rest of us who are able to keep up with the debate hear conflicting analyses and recommendations.
Pat Rabbitte (Dublin South West, Labour)
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Professor Drumm says one thing, Deputy Harney says another. The Tánaiste is beginning to take on the bewildered bystander persona, so affected by the Taoiseach. She was on television last night to say this was something which we cannot put up with, as if she had not responsibility for it or as if somebody on this side of the House was responsible. Who has been in Government all those years? We have now moved from a Minister for Health and Children who does not read his brief to one who cannot handle her brief. We have reached the stage where the Taoiseach's backbenchers are sniggering at the fact that the two PD Ministers are up to their arms in trouble everywhere they look. The backbenchers are beginning to enjoy it. Meanwhile, unfortunate patients, including the aged, are kept in the most inhumane undignified circumstances in hospital corridors, in accident and emergency units all around the country. There were 384 of them yesterday, and the Taoiseach rhymes off statistics about what it is he thinks he is doing. Whatever he is doing is not working. If this national emergency plan makes an assault on this serious problem, it has our full support. However, why should this plan be successful when all of the others failed? We had the ten-point plan in November 2004 and it did not work. Why should this one work?
Bertie Ahern (Dublin Central, Fianna Fail)
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I reiterate what I have said a number of times. We are talking about the problems in the accident and emergency service. It is internationally recognised that this country's health service is very good. Because of it people are living longer and getting hospital treatment faster.
Jim O'Keeffe (Cork South West, Fine Gael)
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The Taoiseach is full of excuses.
Bertie Ahern (Dublin Central, Fianna Fail)
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They are getting to see far more specialists. They are working in much healthier workplaces and we are dealing with disabilities and a range of other services far more effectively. Across the cancer, cardiac and paediatric services there are enormous improvements of which the staff involved and the country should be hugely proud. There are well over 1 million inpatients, over 500,000 day patients with more than 1 million going through accident and emergency units. The point is that one important facet, namely accident and emergency, which has traditionally been a difficult area for the health service, is not up to standard we want in all the regions and hospitals. It has been Government policy to deal with that issue. Over a number of years, in different ways, we have dealt with a whole range of issues, for example increasing the number of consultants. This was not formerly the situation. There was only a handful of them in the country in 1997, while now there are dozens in our hospitals. We have not yet got them to work after 6.30 p.m., but these are issues we are trying to deal with. There are additional nurses and in all we have given 35,000 additional staff to the health service, a large proportion of whom have been allocated to accident and emergency departments. We have provided 1,500 beds for respite care to deal with these issues.
However, the population of the country is getting older. Many general practitioners do not want to work after 5.30 p.m. If no GP services are available after 5.30 p.m.and there are no consultants in accident and emergency departments after that time, one can see why there are problems. We are trying to deal with those problems. I have never said there is not a problem in accident and emergency. I have defended the health service and we are trying to put in the resources, staffing and free-flow arrangements in an attempt to improve those areas which still face difficulties. In St. Vincent's Hospital and in hospitals in Blanchardstown, and in Cork and Galway where the excellent facilities have been built, we might not have solved all the problems, but we have seen improvements.
Deputy Rabbitte knows as well as I do that life, time and circumstances are changing. There was a time when families and everyone concerned wanted to get people home from hospital. There are other pressures nowadays, and that is how it is. This means we now have to deal with matters differently. We are doing our utmost and asking people to co-operate with us. We did not realise this today or yesterday. I realised it when I worked in the Mater Hospital 30 years ago, and I am trying to do something about it now.
Pat Rabbitte (Dublin South West, Labour)
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The difficulty is that the Taoiseach is out of touch. He probably genuinely believes what he is asserting. However, he is completely out of touch with what is happening on the ground and in the wards. He should know better than most that 3,000 beds were taken out of the system in 1987-89 by his predecessor, Charles Haughey. How can he make an argument to me about the population increasing since then, people living longer etc., while not acknowledging that the nub of the problem is that those 3,000 beds were taken out of the system in 1989? He seemed to acknowledge it in the Ballymascanlon strategy when the previous Minister for Health and Children pledged the restoration of those beds and a €7.7 billion programme. That was scrapped as soon as the Taoiseach appointed his new Minister for Health and Children. I cannot figure out whether the view is that we do not need any beds. That is what I appear to be hearing from Professor Drumm, who seems to be making policy as well as being responsible operationally. The Tánaiste seems to concur with that except that she will provide tax incentives for investors to build beds on the campuses of public hospitals.
What is the net Government position on the critical question of bed capacity? How can one deal with a population that has increased by more than 500,000, where people are living longer, medicine has become more advanced, and where we have fewer beds? Is that not the net issue? What is the response to that? Will the Taoiseach say what exactly is in this national emergency plan that is different? When the Tánaiste says that she is going to target resources at the HSE for improvements to be made, does that mean there will be a Supplementary Estimate for health? How much money exactly will be targeted for the elimination of the accident and emergency crisis? What in particular is the Tánaiste offering that is different from what she offered in November 2004?
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Deputy's time has concluded.
Pat Rabbitte (Dublin South West, Labour)
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After three Ministers and nine years, the best this Government can do to alleviate the accident and emergency crisis is to declare a national emergency. I am merely asking the Taoiseach the elements that are different in this plan as compared to its predecessors.
11:00 am
Bertie Ahern (Dublin Central, Fianna Fail)
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Deputy Rabbitte asked me a number of questions. There are 1,000 more beds in the public system in the last three years alone. I do not have the figures back to 1997. Some 500,000 patients are being dealt with effectively and efficiently by the medical services on a daycare basis. It was a fraction of that ten years ago. Thankfully, the same acute highly sophisticated hospital beds are no longer needed, as in the past, since the system has been modernised. That is the point Professor Drumm is making. We have the ability to take people in as day cases. Hernia operations are now performed on a one-night basis. They took ten days when I worked in the health service. Cardiac surgery could have taken six weeks and now people are being moved out after five or six days. These are major improvements in the service. The Deputy referred to the problems of 1989. There were problems with the entire health service because it was under-resourced. That it why we raised the health service budget from €3 billion to €12 billion. It was under-staffed and that is why we put over 35,000 more people into it.
On the beds issue, I again ask Members to please listen to the point I am making. The figures were higher when the winter vomiting bug was at its height and with the 'flu epidemic in January and February, because I watch the statistics every day. Today, 411 patients in this city are being medically discharged. Traditionally, such patients would have gone home, but they cannot do that. That is why we have been using——
Bertie Ahern (Dublin Central, Fianna Fail)
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——for a range of issues——
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Taoiseach should be allowed to speak without interruption.
Bertie Ahern (Dublin Central, Fianna Fail)
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A total of 3,000 home care packages will be provided this year alone. That is why we are using a good number of the 2,500 private beds that are available. In total there are 16,000 beds in the health service — 13,500 public beds and 2,500 private beds. I do not like using the medical term that is applied to people who are in beds in that situation.
Bertie Ahern (Dublin Central, Fianna Fail)
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I am answering. The Deputy knows what is the difficulty.
Ruairi Quinn (Dublin South East, Labour)
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The Taoiseach is not answering.
Bertie Ahern (Dublin Central, Fianna Fail)
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Some 411 people have to be put in——
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Taoiseach should be allowed to speak without interruption.
Bertie Ahern (Dublin Central, Fianna Fail)
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I announced last week that we have provided an additional 250 beds on top of the 250 provided at Christmas time for those particular patients.
Bertie Ahern (Dublin Central, Fianna Fail)
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Deputy Rabbitte asked me what is different about what we are doing now. We have put in place a range of activities and measures, including the provision of high-dependency beds — which the Tánaiste has announced — intermediate care beds in private nursing homes, additional beds in public nursing homes, 3,000 home care packages and enhanced subventions. This has already facilitated 1,500 patients to leave acute hospitals.
Seán Ryan (Dublin North, Labour)
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How many public beds have been provided in the nine years?
Dermot Ahern (Louth, Fianna Fail)
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Does Deputy Ryan want to know?
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Taoiseach should be allowed to speak without interruption.
Jim O'Keeffe (Cork South West, Fine Gael)
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The only change is that people are now queuing for the trolleys.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Taoiseach should be allowed to speak without interruption.
Bertie Ahern (Dublin Central, Fianna Fail)
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I am trying to answer the questions Deputy Rabbitte put to me. The last question he asked was about what additional issues we are addressing. In response to what he said and just in case there is any confusion, we have not abandoned any of the remaining points of the ten-point plan. The purpose of the new task force which the Tánaiste has announced is to bring together those people who have expertise in co-operation and who have proved in their own hospitals how one can get a better flow of patients to wards, better discharging practices and better time in discharge which are all relevant to this problem and how we can deal with it.
I should not be answering for Professor Drumm and the HSE but the point he has made is that pro rata, the ratio of the number of acute beds in this country per thousand of population and the number of staff compared with the age profile of the population is far higher here than it is in the UK or in most other countries.
Jim O'Keeffe (Cork South West, Fine Gael)
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It is a total failure. We will be sending them to Angola next.
Dermot Ahern (Louth, Fianna Fail)
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The Deputy is waffling again.
Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Yesterday, the Tánaiste and Minister for Health and Children announced she had made a discovery and the nation quite frankly is aghast, not at what she has discovered but that it has taken her so long to recognise the basis of this discovery, that we have a serious crisis in our accident and emergency units throughout the hospital network. It is absolutely incredible that despite the repeated pointing out of this fact in this Chamber by Opposition voice after Opposition voice, it has taken this time for this Minister to recognise the crisis and the emergency that exists. This is not something that has only happened in the past week. This has been building not only since 2002 but going back to when the Government first took office in 1997. The situation today is much worse.
Does the Taoiseach recall that in his health strategy in 2001 he stated that an additional 3,000 beds would be needed in the public health system, yet we see the continuation of public money being spent in the provision of private health care? We see the absolutely incredible situation where the Taoiseach's manifesto in the last general election in 2002 declared he would work towards the end of the two-tier system, yet he is reinforcing it. Does he not think it is obscene to see the numbers of consultant doctors competing for the €1 million suites in the new private hospital development that the Tánaiste heralded and introduced in Dublin? Those investments and that opportunity have been funded by this Government out of public moneys. The reality is that we want to see our public moneys invested in public health provision and not in tax breaks for private health care providers who are there to make profit. Instead of that money being wasted as it is, and the further waste in terms of the failed effort on the part of the HSE to bring in various computer systems, it could have provided 1,000 of those 3,000 acute hospital beds.
Last week I raised what I described as the farce of the recent reference by the Tánaiste and Minister for Health and Children that accident and emergency units were to be renamed and reconfigured to include admission lounges yet we heard on national radio this morning where an accident and emergency consultant in St. James's Hospital described the reality more as departure lounges because in that hospital alone they are losing at least one patient per month because of the inadequate provision for people presenting at that accident and emergency unit. Will the Taoiseach recognise that the only way to address this national emergency is for the Government to ensure all public moneys are invested in the public health system and that we move with alacrity to ensure the provision of the 3,000 additional acute hospital beds to which the Government committed in its health strategy in 2001?
Bertie Ahern (Dublin Central, Fianna Fail)
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There is no need for me to go back over all of the issues but I will just mention a few of them. The Deputy knows the Government's view on the common hospital contract. The Tánaiste has set out the position. He is also aware that the existing 2,000 consultants have contracts and they provide for a private and medical mix.
Ruairi Quinn (Dublin South East, Labour)
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That Mr. Haughey provided.
Brian Cowen (Laois-Offaly, Fianna Fail)
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Deputy Noonan negotiated them in the Opposition's time in power.
Bertie Ahern (Dublin Central, Fianna Fail)
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Historically, the argument has been that we have provided very good medical consultants. A number of negotiations have been held as far back as 1974 to try to change that. The late Brendan Corish tried that and totally failed. Charles Haughey made contracts in 1979 and Deputy Noonan gave further concessions. Consultants have extremely strongly based contracts. The Tánaiste set out her position in negotiations to try to make changes and amendments to that. Without losing the professionalism we have we could make a number of changes for new posts. We would like to try to get on with those negotiations and we would like the consultants' associations to work with us to make these changes, as we would also like other sectors in the health service to work to make these changes.
In the past the argument was about resources but this is not about resources. Neither is it about staff numbers. It is about how we manage the health care system on the accident and emergency side. It is not a case of the Government issuing a diktat and then it all just happens. The Government is not saying it is the responsibility of the HSE and we have nothing to do with it. We spend an enormous amount of time, collectively, working on this issue which is important for the public. That is why we have spent a huge amount of resources improving the standards of hospitals in terms of facilities, beds and equipment.
Yesterday, the Tánaiste stated that resources will be targeted for improvements that will be made and she has outlined those. We have changed practices so that better patient care will be rewarded so we can try and deal with these matters. Diagnostic tests will be provided at weekends and evenings which will help the waiting time. New beds will be assigned immediately to accident and emergency units to ensure older people do not have the difficulties of being on trolleys. People will be discharged each day of the week to keep beds available, which does not happen at present in all hospitals. Discharges will be planned so that home care will be ready when patients are medically fit. We will put 3,000 new home care packages in place. People will be helped to move out of hospital beds by the provision of more home care packages and nursing home places. If patients go home they will get a home nursing home package to assist them which works very well in other countries.
The HSE will step up the pace of availability of home care places. It will fund as many places in the community and private sector as it takes. For the past umpteen budgets, the Government has put in additional resources to try to make this possible. We have bought and provided additional beds and built additional accident and emergency services. It is not a question of making excuses but we require the co-operation of those in the medical service. We are aware of the statistics; we do not need everyone telling us the figures every day because we are provided with them. We need people working collectively to try to resolve the problems.
In answer to Deputy Ó Caoláin, I wish the problems of dealing with industrial relations issues with the Irish medical service were as easy as he suggests because they are not and I have a feeling they never will be.
Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I appreciate it is not easy but neither was it easy for Aneurin Bevan when he took on the whole consultant and GP situation in Britain. I remind the Taoiseach that the consultant contract was in his party's manifesto in 2002 when he indicated a commitment to end the two-tier system. Does he really believe this is the appropriate Minister to be in charge of working that out, of delivering on that commitment? Does he really believe her record measures up to the commitment that he and his party put before the people in 2002? If he believes this, it is time he took a wake-up call because the two do not replicate——
Seán Power (Kildare South, Fianna Fail)
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The Deputy should look to his own record.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Allow Deputy Ó Caoláin without interruption.
Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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——-or even come close. In my opinion and in the opinion of many people, they are working to extreme opposites and this is clearly the case.
Has the Taoiseach seen the report by the Nenagh Hospital Action Group? Has he taken on board the clear information that it indicates the importance of smaller hospitals in the provision of accident and emergency care? Has he taken on board the findings of that report? Does he recognise that the smaller hospitals, including Nenagh and Monaghan General Hospital and others around the State, have a critical role to play in the delivery of safe accident and emergency services? The Nenagh hospital was targeted by the Hanly report and the Hanly implementation group but this failed because his colleagues exercised themselves and it did not happen. Were it to have happened and if they had exercised themselves as well in the case of Monaghan General Hospital, then I warrant it would not have a closed accident and emergency unit today. As well as the 3,000 acute hospital beds that need to be provided and in the situation of a national emergency having been declared, will the Taoiseach now look seriously at ensuring the future not only of all the existing accident and emergency units but also those that have been reduced or closed and put them back up and running on an active footing, giving the service they have given so well in the past and taking the pressure off other hospital sites within the overall configuration of the 37 hospitals across this jurisdiction? That is the commitment we in County Monaghan need to hear from him and it is the commitment people in other parts of the country need to hear from him because it is only by taking measures such as those, rather than tinkering at the edges, that he will ensure we will make a real difference and that people will not have to languish on trolleys for excessive periods of time, not only hours, but days, in many cases. This is the Taoiseach's responsibility and I encourage him to take responsibility and to be accountable for it. There should be no more passing of responsibility to another political party or indeed to the HSE and Professor Brendan Drumm. Accountability ends with the Taoiseach as the overall steward of this Government.
Bertie Ahern (Dublin Central, Fianna Fail)
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If the Deputy is purporting that the hospital waiting lists have not changed I can state they have changed dramatically. The waiting time for 14 of the top 16 specialties is down to under four months whereas ten years ago it was several years. There have been significant improvements in waiting times. With the advent of the National Treatment Purchase Fund——
Jerry Cowley (Mayo, Independent)
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The waiting time is still seven years and it is five years at least for urology.
Bertie Ahern (Dublin Central, Fianna Fail)
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——we are giving top class quality services to people and as a result the waiting lists have decreased dramatically.
Bertie Ahern (Dublin Central, Fianna Fail)
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The Deputy knows what the issues in Monaghan are. He knows some of the issues have been mentioned in other parts of his region on several other occasions. Whether Deputy Ó Caoláin likes it or whether I do not like it, the reality is that expert medical advice has been that what is required is a critical mass of proper services both in paramedical——
Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It is time to listen to alternative experts.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Allow the Taoiseach without interruption.
Bertie Ahern (Dublin Central, Fianna Fail)
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I have found to my expense that it is the case that when one pays for advice, there will always be another expert to give another view.
Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Taoiseach should consider where their advice led him.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Please allow the Taoiseach without interruption. The Deputy went three minutes over his time.
Bertie Ahern (Dublin Central, Fianna Fail)
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I must listen to the physicians and to the Royal College of Surgeons in Ireland who make the statements on behalf of their practitioners in this country. In the interests of patient safety and health, we must listen to their views on Monaghan hospital and elsewhere. I remind the Deputy there has been significant political involvement in many of these decisions relating to his region. I also remind the Deputy that when his colleague, Bairbre de Brún, was Minister for Health for a short period in Northern Ireland, she ran into difficulties with what were historically the longest waiting lists ever experienced in Northern Ireland. If these issues could be easily resolved then we would all have easy solutions but that is not the case.
The Government is committed to dealing with this remaining area of the health service in an up-front manner. With regard to the Deputy's remarks about the Tánaiste, she has been the first Minister for Health and Children since attempts at reform were made in the 1960s, to try to tackle this difficult issue.
Ruairi Quinn (Dublin South East, Labour)
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What about Micheál Martin?
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Allow the Taoiseach without interruption.
Bertie Ahern (Dublin Central, Fianna Fail)
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Deputies Cowen and Martin did not take on the review of the common contract because it was not there to be reviewed. The last one was given by Deputy Noonan when he was Minister and when he gave significant breaks in the common contract.
The Government is committed to tackling these issues. The Tánaiste has entered into negotiations on a fair basis with the consultants. We have put in hundreds of consultants. The Deputy referred to comments made today by an eminent consultant. I have no doubt he is a very eminent consultant. Most of these eminent consultants would not be employed back in this country only for this Government.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Allow the Taoiseach without interruption.
Bertie Ahern (Dublin Central, Fianna Fail)
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I have no difficulty with them giving interviews because this is a free society but I wish that as well as giving interviews they would help us to resolve the problem.