Tuesday, 20 March 2007
This Government has spoken many times in the past ten years about the delivery of a world-class health service. It was the Government's number one commitment before the last election and has turned out to be the number one hoax from Fianna Fáil and the Progressive Democrats. This has been the case for ten years, billions of euro have been spent by three Ministers for Health and Children, and the service is absolutely appalling in some circumstances.
At Our Lady of Lourdes Hospital in Drogheda the midwife staffing levels are far below what they should be. Mr. Patrick Kinder, the head of the maternity task force there, said this showed the extent of serious risk to women in the north east who are forced to rely on the services of this hospital. Women attending the maternity unit there must wait until the fifth month or 20th week of pregnancy before seeing an obstetrician. No expectant mother, particularly a young mother with a first pregnancy, should be forced to wait 20 weeks to see an obstetrician when she should have that appointment within 12 to 14 weeks.
That level of "world-class service" is not unique to Drogheda. I received an e-mail from a woman in my county about her experience in Mayo General Hospital in February. She spent three days on a trolley in the accident and emergency unit. To judge from what she told me, her experience was not an isolated incident. Despite the efforts of the fantastic staff to whom she refers, she said the overcrowding was reminiscent of a Third World service and not what should be expected in modern Ireland.
She wrote an eyewitness account on her trolley according to which on Sunday, 25 February she had no pillow and her blanket had a blood-type stain. There was no ladies toilet available, only the gents was working. There was no visible security. On Monday, 26 February a lady with pleurisy was placed opposite an entrance-exit door which opened onto the casualty waiting area. At times one could hear the wind whistling through. There was no place to have a shower. Trolleys blocked areas which bore a sign stating "keep clear at all times".
On Tuesday, 27 February the toilets were absolutely filthy. She said she could not begin to describe the nauseating stench. The patients' trolleys were taken and they were given chairs. When they asked why they were told the trolleys were needed for the day care patients.
That is the lady's summary of the world class health service the Government promised to deliver: more than 30 on trolleys, with no privacy, washing facilities, hot food or visible security. As an elderly woman was escorted down the public corridor her nappy fell off. What does the Taoiseach say to the people who must put up with this standard of care? What does the Taoiseach say to expectant mothers who must wait 20 weeks to see an obstetrician? Is that what the Taoiseach meant when he said his Government, comprising members from Fianna Fáil and the Progressive Democrats, including the absent Minister for Health and Children, would deliver a world-class health service to the people?
On the general question about a world-class health service, we have made real progress in the health service. We have over 100,000 dedicated professionals treating over 1 million patients in our public hospitals alone. There are 38,000 new staff, including 2,700 medical dental personnel and 9,000 nurses. Some 8,700 specialists were recruited in the past ten years and almost 1,000 consultant posts were created. Since I became Taoiseach, the numbers on hospital waiting lists have more than halved. In the past year, accident and emergency waiting lists have almost halved and, because of good practice and resources, 60% of hospitals have nobody at all waiting in accident and emergency units for more than six hours. The Irish taxpayer is funding the increase in spending from €4 billion to €15 billion, as Deputy Kenny correctly stated.
It is hard for Deputy Kenny to analyse the system on the basis of one letter and I could quote letters written by very satisfied people. I take the Deputy at his word regarding the letter he quoted, notwithstanding all the great staff. The letter stated nobody was cleaning or looking after the toilets, food or anything. The Deputy will be aware that there are several hundred staff in the hospital in question, employed at a cost of tens of millions of euro. Perhaps the day referred to was a bad day and the staff were elsewhere.
However, the Deputy cannot assert that all those things are true while acknowledging all the staff are great.
On the antenatal outpatient clinic at Our Lady of Lourdes Hospital, the HSE has confirmed that, because of the increased number of births therein, it has been very hard pressed to get the waiting list in line. There is no doubt that this is a real problem and I will not defend the fact that people are waiting for 20 weeks, if they are doing so. The HSE said it has a problem related to people having to wait a number of weeks for a routine appointment and this is certainly not good enough.
Management at the hospital already said it is trying to address these issues and that it has recently approved 22 new midwife posts, two specialist nurse posts and three new consultant anaesthetist posts with a view to improving its services. It has also confirmed that a new 25-bay emergency department is being developed at the hospital and it is to be opened early next year. Two new floors are also being built above the emergency department to provide more space. Obviously these are needed and the resources have been provided therein.
We are spending almost €500 million on the capital programme this year, as we have done in the past few years. Ireland and Norway are on top of the list of countries investing money in the capital programmes pertaining to their health systems. Obviously our system needs this investment and there is no doubt about this.
I have answered the Deputy's question on accident and emergency figures. The accident and emergency figures continue to be well over 50% down, as they have been the whole winter. We are now in what we consider the 24th week of the winter and there was one difficult week in which reductions of over 50% were not achieved. Even Deputy Kenny, from his position, will have to acknowledge this represents a big improvement in a year. It is still not good enough and that is why we are investing the resources I have outlined. I hope a big improvement will be made over the next year when all the facilities come on line. The Government continues to put in place the resources and staff and continues to make the necessary improvements and seek reform. This is the correct approach.
The Taoiseach is probably correct in that he is on the run-in to being run out of office. When he visits hospitals, does he take the time to go down the corridors? We do not live in fantasy-land any more. Mr. Patrick Kinder, chairman of the taskforce dealing with Our Lady of Lourdes Hospital, does not live in fantasy-land and said the women of the north east are exposed to serious risk because they cannot see an obstetrician for 20 weeks once pregnant. That is a scandal. The lady who wrote to me from her trolley in Mayo General Hospital is not fantasising either.
In the past fortnight, I have been in St. Vincent's, Cavan, Mayo General, Galway Regional, Nenagh and Limerick hospitals, and in a number of others. In every one, people who built this nation are lying on hospital beds and trolleys with their medical problems exposed for all to see. A general practitioner in Kildare stated recently that 35 weeks elapsed between a screening test and a hysterectomy and that, in his opinion as a physician, the woman in question was essentially killed as a result. In Tralee Hospital last week, the consultants told me quite clearly that people are dying because of the endless waiting list for scope analysis and endoscopies. This is simply not acceptable.
I agree that when people get through the system and are treated in hospital, their care can be fabulous, but it is a scandal that the Government has, for ten years, failed to manage competently the accident and emergency system, thus causing all these problems.
The general practitioner in Kildare is not fantasising, nor is the consultant in Tralee. It is not just a case of spending money on the system, but of reform, change and competent management, together with performance audits. These have not occurred under the Taoiseach's Government and that is why every Deputy in the House is getting endless streams of letters about the appalling circumstances that obtain daily in our hospitals. Is this the kind of world-class health system the Taoiseach and his absent Minister for Health and Children said they would deliver to the people?
By referring to a "world-class health service", was the Taoiseach referring to nappies falling off in public, elderly patients marching up and down in their underwear, filthy toilets and an endless series of waiting lists, including a waiting period of 20 weeks for expectant mothers?
I understand the agenda of the Deputy, who has visited all the hospitals in question. We are tracking each other in that I have been to most of them also. I have heard the negative comments but have also heard an endless number of positive ones. People who have been in for major cardiac surgery, heart and lung transplants, maternity care or other kinds of treatments, including people who believed they were on death's door, have said they were treated well. It is true that I have encountered problems and seen old buildings that in my non-professional view are past their sell-by dates and can never be addressed and that is why we are investing the resources.
There are 140,000 positions, including 100,000 full-time equivalents. There has been a great increase in the number of doctors, and the number of consultants has doubled. There are thousands of extra nurses and an additional €11 billion or €12 billion has been spent in a short period. Spending compares well pro rata against that of other countries and problems are being addressed.
I agree with Deputy Kenny that there are problem areas; there is no doubt about this. If the consultant in Tralee could use his influence to complete the consultants' contract, it would help to deal with some of the endoscopies. If he could put a word in with his union, in addition to talking to the Deputy and me, it would also help. The Deputy is correct that certain reforms are required. We are trying to make these reforms in the ongoing negotiations.
If, in any area of life, one goes around the country looking for problem cases, one may find them, but one must acknowledge that, according to independent surveys, the vast majority of the 1 million patients in our public hospitals last year were happy with the service. There are problems in accident and emergency wards, that is why we are building so many new units, why we are putting so many extra services into accident and emergency wards, why we are setting up primary care teams and injury clinics, why we have emergency consultants working in accident and emergency and why we have increased the staff in accident and emergency.
Many of the buildings are just not suitable for the necessary developments but there are construction programmes in every area. In Drogheda, there is an ambitious plan for the whole north east. The Teamwork Management Services report spelled out what is needed in that area. I admit the report points out that the present system, whereby five local hospitals in the north east deliver acute care and services for people with severe illnesses to a relatively small population, has exposed patients to increased risks and this must change.
I know there are Members of the House who believe we should hold on to all of those hospitals, something we cannot do. This plan, which is costly and which the Government supports, will ensure the north east will get a modern, integrated and safe hospital and patient services.
Deputy Kenny knows that whoever is in Government for the next number of years, that plan will be unveiled. It is right to do this. We want to protect small hospitals that are unable to provide the services while on the other we want to argue for better medical services. We will continue to implement a better health service. We are not world class in every area, we know that, but we continue to resource the health service and make our services top class in many areas. We should acknowledge that.
Does the Taoiseach know that 25% of medical patients in Drogheda Hospital spend their entire stay in the accident and emergency unit? This is what he holds up as a world-class service. This is no world-class service.
The Government has decided to give private developers a write off for the construction costs of private hospitals on the grounds of public hospitals. On 28 February, I asked the Taoiseach if it was the Government's intention to proceed with the signing of contracts to implement that scheme between now and the general election. The Taoiseach told me, "I am not aware of any contract. The Deputy can table a parliamentary question to the Minister for Health and Children. I am aware of no contract at any stage of negotiation."
The following day, as it happened, the Secretary General of the Department of Health and Children and the chief executive of the HSE were before the Committee of Public Accounts. My colleague, Deputy Burton, asked a similar question, to which the Secretary General replied: "I understand the procurement process will proceed along a timeline which means contracts could be or would be expected to be, whatever phrase the Deputy wants to use, awarded some time in April, that is the latest information I have."
The Taoiseach would have us believe he knows nothing about this, the Secretary General says it will go ahead in April and the Minister for Health and Children goes on the radio this morning to say it is nothing to do with her, the HSE will sign any contracts. The Labour Party's desire to maintain an improved public health service is ideological, she says, a concept entirely alien to her and her party leader. She then said that it is not a sale anyway, it is a lease.
As luck would have it, at that meeting of the PAC, Professor Drumm was asked, "Is it a lease or is it a sale?" This is the man who is supposed to be handling the process. Professor Drumm said, "While I understand it is a sale, I must check." I do not believe for a second that Professor Drumm does not know the answer. I believe that like 85% of consultants in Ireland, he does not agree with what the Government is forcing on him. The Chairman, Deputy Noonan, reminded the Secretary General what he had been asked. He said: "Specifically, the Deputy asked whether contracts will be signed for the disposal of HSE land to the private sector between now and the general election." Mr. Scanlan replied, "My understanding is that the answer is "Yes" as that is the timeline being worked to."
How is it, with all the running around the Taoiseach is doing, as Head of the Government he has never heard of any of these contracts? Is this a lease or a sale? Will they be signed in advance of the general election and what is the estimate of the cost to the taxpayer of so doing?
I refer to the last day when we debated this issue when I said to Deputy Rabbitte that I did not know of any contract negotiations and that he should table a question. He obviously did the right thing the following day and asked the people directly involved. The Minister for Health and Children has answered since and answered again today in an interview. The Deputy knows the answer to the question because she answered it a few hours ago and he was obviously listening or read the text of the answer.
I also explained that day the general policy of the Government and the decisions we had made two years ago in the summer of 2005 regarding the issue. As I understand it, eight hospitals remain in the process: Limerick Regional Hospital, Waterford Regional Hospital, Cork University Hospital, St. James's Hospital, Beaumont Hospital, James Connolly Memorial Hospital, Blanchardstown, Tallaght Hospital and Sligo General Hospital. The examinations are under way to see if there are contracts done in these areas. As the Minister said today, she does not know at this stage whether they will take a period of weeks or months because negotiations are ongoing and the HSE will issue the invitation to tender to the selected bidders at the end of this week or early next week.
The HSE aims to evaluate the tenders and select the successful bidders over the period it requires to examine this. The Minister said today that some of those could be in April and that the final contract would be subject to planning approval. The system is to try to free an additional 1,000 beds for public patients that are currently being used for private cases. That has been our stated policy for the last number of years and those negotiations are continuing.
Once again the Taoiseach has not answered any of the questions I asked. He said he does not know. Quite honestly, I do not believe that for a second. None of the Taoiseach's predecessors could come into this House and get away with the way the Taoiseach twists and obfuscates. Is the Taoiseach seriously telling me that the Government is maintaining this shift towards a for-profit system of medicine and he, the socialist Taoiseach, knows nothing about it? I do not believe that for a second. I ask again — is it a lease or a sale? Will the contracts be signed? The Minister for Health and Children said nothing about not knowing if it would be weeks or months today. The Taoiseach is right, I listened to the interview and she did not say that.
I am asking the Taoiseach if this is a lease or a sale and what the cost is to the taxpayer. Is the story at the weekend by the eminent political correspondent of The Sunday Business Post true, that the tender process will conclude by 30 March and sites will be "awarded", to use his term, by 16 April? Is that the position? Will sites be awarded? How can the Taoiseach claim not to know the answers to something as major as this, on the biggest priority confronting our people, namely the state of the health services? I give him another opportunity to indicate whether contracts will be signed or are we engaging in some kind of Aer Lingus ruse about letters of intent that will prove to be irrevocable some months from now? This House is entitled to know the answers to those questions and the Taoiseach has been evading, obfuscating, twisting and distorting, ducking and diving. What is the answer to the question?
Deputy Rabbitte should listen because if he listened he might know the position. I said clearly that the Health Service Executive will issue the invitation to tender to the selected bidders at the end of this week or early next week. Is that clear to the Deputy?
It will not be a sale. The Minister, Deputy Harney, said today that she wanted to attract investment into the health service and contrary to some view, which is mainly Deputy Rabbitte's view, we will not give away any land. The land would be leased. The private providers will profit share with a public hospital.
That has been the position for a long time. To answer the second question, it will be leased.
In reply to Deputy Rabbitte's third question, the Government wishes to build eight private hospitals on these lands as soon as possible——
——which will be far quicker than the public sector doing it, and take 1,000 additional beds for public patients to try to stop the current position. Deputy Rabbitte is right. I do take the socialist view on this matter. It is wrong that private beds in public hospitals are being only part paid — 40%——
——by the private operators. It would be far better if we could build private hospitals that would take the private beds out of the public hospitals and put 1,000 public patients in to reduce waiting lists. In that way we would be able to have a faster and better health system.
It would be far better to have public patients dealt with in public hospitals than the current system where the State and the taxpayer strongly subsidise the private beds rather than have people on long waiting lists.
I, too, noted the Taoiseach's responses of 28 February on this issue. He indicated, and I ask him to revisit it this afternoon, that he had no knowledge of proposed contracts in regard to the co-location on public hospital sites of private for profit hospitals. I also noted on that occasion that he indicated he would give no guarantee to this House that he would not sign contracts for same prior to the dissolution of the current Dáil. Can the Taoiseach explain to the House his notion of socialism when he states that he cannot accept the presence of private beds in public hospitals but he has no problem in accepting private hospitals co-locating on public hospital sites? That is ridiculous. Will the Taoiseach not accept that is the case? Will he not accept also that while his response to Deputy Rabbitte's point is very weak, a full four weeks prior to the set of responses we are both now quizzing him on further, in response to a parliamentary question from myself, the Minister for Health and Children, Deputy Harney, indicated on 31 January exactly what was taking place regarding the eight sites mentioned? Is it at all possible that the Taoiseach could not have been aware a full four weeks later, on 28 February, that it was the intention to move towards the invitation to tender to each of the selected interests by early March?
All of that information is contained in the response to Question No. 867 from the Minister for Health and Children, Deputy Harney, the former Tánaiste. It does not hold much weight that the Taoiseach could not have known of such an important intent on the part of a key Minister and Ministry within his Cabinet and Government. How can the Taoiseach reconcile such a proposal? Why, even at this point, can he not give an assurance not to commit the State and future Government to a set of contracts, one or more depending on whatever number of the eight designated sites will move towards that within the coming weeks? Does the Taoiseach not believe it is wrong of him and his Government to commit this State and future Government to contracts that he, this Government, the Department of Health and Children and the Health Service Executive cannot currently deliver, and with a general election pending? That is not acting in the public interest, apart from the fundamental flaw in the very notion of co-location and the reality of closing the potential to develop public hospitals on public sites into the future.
I think the Deputy is confused on the issue. The policy of co-location was enunciated in July 2005. There is no confusion about the policy. The question I was asked on 28 February was about the contracts. I am not involved in the detail of the contracts. I do not involve myself with any of the agencies about the stage of contract and negotiation they are in. I have no knowledge today, nor had I then, of the stage the contracts are at. The contracts are being dealt with by the negotiators in the HSE and I do not know whether they will be finished this week, next week or in six months' time. They have told me they will issue an invitation to tender to selected bidders at the end of this week or early next week. That will be in March. Where they go from there will be a matter for their negotiations but the Minister for Health and Children said today she expected some of those would be finished at the end of April. The overall issue on co-location is to achieve one central purpose, namely, to improve the services for all patients, particularly public patients at public hospital campuses.
For many years, which I do not think people quite understand, we have had 2,500 private beds in public hospitals ring-fenced for privately insured patients. In addition many public beds have been used for private patients. We have excessive use of the public hospital beds for private fee earning by consultants. That has been the system for decades. This system has reached its limits and it simply must change. Since we enunciated the policy in summer 2005 we have said we want all the beds in public hospitals to treat all patients and we have moved on the first 1,000 of those. We will free up many of these beds by inviting the private sector to invest in new hospital facilities in a planned way and a way that integrates services in public hospital sites and protects the public interest. We believe this is an innovative way. We are not saying it is the first place in the world to do it because many others have done it.
We believe it is a good solution under a number of headings. In value for money, it will achieve new public beds at less than half the cost of direct construction of equivalent beds. That seems like a good idea to us. As we know from our own experience it takes years on end to try to get a public hospital from the time it starts to the time it is constructed, commissioned and staffed. By doing this we could get 1,000 public beds in operation far more quickly. The best commercial terms will be paid to the State for leasing the land. Nothing will be given away.
The second position is the speed of building. The private sector has a track record of building quickly. I have been criticised several times on Leaders' Questions as to why we can build in the private sector but cannot do it in the public sector. It is true. We have all the procurement and other arrangements, but we cannot do it as fast. That is a second good reason.
The third reason is that it is a new source of investment in health. The new private-sector investment will complement our public health capital programme, which is already the highest in the world as a proportion of national income. With billions of euro being invested in international property every year there is nothing wrong with channelling private investment into health. The next reason is that it gives equity for all patients. All admissions to a public hospital will be on the basis of medical need and all beds will be routinely available for public patients. As well as availability of new services the public sector will be able to purchase services from private providers at discounted prices. We believe all of those are good ideas, which will dramatically assist the public patient. That is the reason we are pressing ahead with this.
What evidence does the Taoiseach have to support the proposition he now defends — the notion and idea mooted by the Minister for Health and Children, Deputy Harney, and the Progressive Democrats? With his declared position the Taoiseach has now become a champion for it. Regardless of the position on leasing or selling, does the Taoiseach not recognise that this is a DBO — design, build and operate? Ultimately these people will have control. Is the Taoiseach not aware that the entire motivation behind this is profit-driven and has nothing to do with the delivery of care? Is he aware that all the Opposition parties in this House are opposed to the proposition that is presented with one voice by the Government? Is he aware that he has no mandate for this proposal? The proposition did not appear in either of the manifestos of the Fianna Fáil or Progressive Democrats parties prior to the last general election.
Is the Taoiseach aware that nowhere within the health strategy or the programme for Government was there any reference to it and yet today he is again prepared to indicate a willingness to sign contracts that will bind future Governments and the State into arrangements with people whose intent is to create a whole new stratum of private, profit-driven health care in this jurisdiction? For the Taoiseach to suggest for one moment that this is about creating greater equity——
There is nothing he can do to assuage the fears of eminent consultants and those at the coalface of the delivery of health care who continually state in the case of this proposal that the Government has no clothes——
I do not really understand the Deputy's argument, but I will give him my answer having listened carefully to him. He asked me on what basis do we judge it. We base it first on international experience where Sweden, Germany, France, Spain, UK, Australia and others operate this system. In the past few years we have successfully brought into our health service, for both public and private, 7,500 nursing home beds, which we otherwise would not have, by having private investment in the service. We would be in a very difficult position if we did not have that today. I base it on the view of already having so many private hospitals in the State that operate very effectively. Many of them have being doing it for many years. I base it on the operation of the National Treatment Purchase Fund, which we only introduced a few years ago and which is catering for 50,000 public patients who are getting the benefit of a private service. All of those provide good enough evidence for me.
This is where I do not understand the Deputy's argument. He claims that consultants tell him this will not work because they do not see it as providing equity. I suppose a consultant receiving the income from beds in a public hospital that are designated and ring-fenced as private would hold that view. I understand the argument from the Deputy's point of view — to protect the consultants in that position. I have nothing against the consultants.
I am trying to create the facilities in public hospitals to give more beds for public patients so public patients can get equity, good service and good medical staff. As I said when this came up the last day, I do not object to the same consultants also working in the collocated site in their private capacity. I object to public patients not being able to get into a public hospital because a large amount of the beds, fully subsidised by the taxpayer, are not open to public patients.
The Deputy is not a member of Sinn Féin. This is Deputy Ó Caoláin's and Sinn Féin's question. The Members are not even in the Sinn Féin Party and should allow Deputy Ó Caoláin to hear the answer to his question. Allow the Taoiseach to speak without interruption.
I believe we can do that this way very quickly. If we wait and take the long option of trying to provide 2,500 public beds on standalone sites, our experience is that it would take an age. We will continue as we are. Ireland and Norway have the highest expenditure on capital projects in the health service. To do it quicker would be to take 1,000 of the 2,500 private ring-fenced beds——
The Labour Party asked a question but it does not want to hear the answer. It continues to interrupt. It is a sore issue for the Labour Party to find itself in a position — I can understand its argument but it will not say it——
I ask Deputy Ó Caoláin, as a reasonable person, to look at the argument. If we take 1,000 public beds and improve on that number in a short period, the consultant staff, about whom the Deputy said he is concerned, will still have the private beds but we will have more beds in co-located sites. There is no difficulty with that. The system will work perfectly well. It works well at present in a range of public and private hospitals and co-located hospitals. I have watched it work well for years and there is no difficulty.
Deputy Stagg, the Chair is speaking. Seven minutes are allotted for each question. The leaders of each of the parties take up the seven minutes, then they allow their members to interrupt and do not allow the member of Government, in this case the Taoiseach, to respond. The Chair will have to take action——