Dáil debates

Wednesday, 5 March 2008

1:00 pm

Photo of Jack WallJack Wall (Kildare South, Labour)
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Question 86: To ask the Minister for Health and Children if she has approved the Health Service Executive budget for 2008 and the addendum thereto; if she is satisfied that the proposals are adequate to address service needs; and if she will make a statement on the matter. [9323/08]

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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Under the Health Act 2004, the Health Service Executive, HSE, must prepare and submit a national service plan, NSP, each year in accordance with any directions from the Minister. The NSP must, among other things, indicate the type and volume of health and personal social services to be provided. The NSP for 2008 was submitted to me on 19 November 2007 by the chairman of the HSE board. In accordance with the Health Act 2004, I approved the plan on 10 December 2007 and it has been published.

In my letter of approval, I requested the board to pay particular attention in 2008 to the absolute necessity for the HSE to operate within the limits of its voted allocation in delivering, at minimum, the levels of service activity specified in the 2008 service plan. This means that the voted allocation, approved employment levels and service activities, within the HSE itself and in HSE funded agencies such as the major voluntary hospitals, must all be actively planned and prudently managed from the very start of the year.

Considerable additional funds, over and above those provided in the Estimates, are being made available to the HSE in 2008 as a result of the December budget day announcements. These additional funds are being provided for the further development of specific services in 2008, most notably services for older people, cancer services and services for persons with disabilities. At my request, the HSE has provided me with an addendum to the national service plan, detailing these additional services and enhancements. I approved this addendum on 20 February and it too is being published.

The HSE has been allocated almost €15 billion gross for 2008 in total current and capital expenditure, an increase of over €1.1 billion, or almost 9% when provision for the long-stay repayments scheme is excluded. I have emphasised to the HSE the need to secure greater value for money and cost effectiveness from its core funding. This is essential if the HSE is to meet its obligation to provide the best possible services within the funding made available to it.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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Has the Minister any mechanism for ensuring that what happened, for example, with the money for A Vision for Change is not replicated with other moneys this year that have been specifically allocated for particular developments — in other words, money meant for a particular area actually being used to plug the holes in the HSE's budget? A Vision for Change, as raised by Deputy Neville, is of particular concern.

Is the Minister aware that unfilled positions are, in effect, saving the HSE money? Has she any way of ensuring positions will not be left unfilled in order to balance the budget? I raise this in the context of figures in the media at the weekend which showed that people were waiting up to a year and a half for colonoscopies, despite what was said after the sad death of Ms Susie Long, who had been waiting on a public list for this procedure but did not get it.

How will the Minister bring down those waiting lists if the HSE budget is so limited that it cannot even do what it did last year? I ask this because of the various pressures on money such as a rising birth rate, growing activity levels, medical inflation, national wage increases, etc.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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A 9% increase is considerable. Ireland has been increasing current spending on health over the past decade faster than any country in the OECD, yet we have one of the youngest populations in the world. Only 11% of the population is over 65, as against 17% in the UK and 27% in Germany. The HSE has to manage its budget in accordance with the money voted for it by the Oireachtas. We cannot have over-runs. Money given for new developments, in particular, must be spent on them.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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How will the Minister ensure that happens?

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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We have made it clear. The HSE has put procedures in place — I am sure we will discuss this in the morning at the Joint Committee on Health and Children — to ensure that moneys identified for mental health, A Vision for Change and disabilities are spent in those areas.

The employment ceiling is obviously important. Some 80% of HSE spending is on staff and, using full-time and wholetime equivalents, it employs 112,000 people directly or indirectly through the voluntary hospitals, which is a considerable resource. Last year, it employed an extra 4,000 people approximately and this year it will employ more people, but this will be justifiable in the delivery of new services.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Will the Minister confirm she wrote to the chairman of the HSE, Mr. Liam Downey, as regards the executive's national service plan? In the course of that correspondence, did she express concern over shortfalls in services to be provided in 2008 under the plan, especially in the whole area of mental health, as Deputy O'Sullivan has indicated, as well as primary care? How is the service plan target to reduce inpatient numbers in 2008 reconciled with the failure to improve primary care? Does she not agree that without the promised roll-out of primary care centres, there will continue to be an inordinate demand on acute hospitals? Does she not accept that, as Minister, she must approve the service plan for the HSE each year? If she is as discomfited by what is being proposed, should she not have taken steps to reject the plan and put the responsibility back on the HSE to present an initiative in keeping with the Minister's alleged intent?

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy has raised a number of issues. Clearly, the preferred health system is one in which more procedures are carried out at community and primary care levels, and 90% of health needs can be met in these areas. This year, primary care teams are being rolled out and additional staff recruited, particularly as regards therapies, to ensure we have the range of expertise at community and primary care levels to provide a service. We are moving from inpatient to day cases, and in particular outpatients. Professor Keane has commented on this move.

The Irish norm is unusual in his experience where, after a person receives cancer treatment, he or she continues to attend the treating consultant. Best practice in Canada and internationally, he has said, provides that patients come back only in a rare number of cases. Follow-up treatment should be provided through the general practitioner. As a result of this practice, many people never get to see a consultant in the first place. Much of what we are trying to do is to change the way that outpatient and other services are provided.

As regards the plan——

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Do we have enough general practitioners?

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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We have 2,500 general practitioners, who provide a very good service. People in the UK can wait for up to four or five days to see a GP, while in Ireland it is a same-day service, and a good one. As the Deputy knows, we are training more and more doctors. As I said in a different forum, health care professionals, like others, always do well in a well developed society. The reason we took such a strong view on the pharmacy issue was to save €100 million, so that it could be put into areas such as primary care and targeted at many of the other concerns raised by the Deputy.

Photo of Pádraic McCormackPádraic McCormack (Galway West, Fine Gael)
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The Minister said she approved the budget on 10 December and that the HSE had to work within its allocation and manage programmes prudently. That is the key to the whole problem. Who is responsible for prudently managing the budgets? Deputy Jan O'Sullivan said unfilled positions sometimes saved money. Unfilled positions sometimes cost hospitals a good deal of money. For example, at University College Hospital, Galway, a nurse cannot be appointed to the dermatology unit. Last year, some 30 dermatological patients were admitted to the hospital, at least 20 of whom could have been dealt with if a nurse had been appointed. They spent an average of five nights in hospital, equivalent to 100 bed nights, the expense of which could have been saved if a nurse had been appointed. When the manager of the hospital is asked about this, she refers the issue to the Health Service Executive.

Who is responsible for such problems in the Health Service Executive because it never gets back to the person concerned? A good deal of money is being wasted in hospital units. Talk of prudent management is a joke.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I must refer to the Minister's comments on general practice. It is a great shame, given that she mentioned the good work done by GPs, that the funding for GP training this year was pulled and the 75 extra places so badly needed to train doctors of the future will not now be available.

In light of the PPARS debacle and the Comptroller and Auditor General's report for last year, which identified another €4.5 million alone in IT overspend, Mr. John Purcell questioned the value of the HSE's report because so many errors and information gaps were contained in it. Given today's FitzGerald report, which specifically mentions the lack of clarity of roles for senior management in the HSE and poor communications, does the Minister have confidence in the executive to deliver the service for which she has paid it almost €15 billion in an efficient, effective and timely fashion?

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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Bearing in mind that an inadequate €44.3 million is allocated to the Road Safety Authority and 338 people died in road accidents last year, how can the Minister justify the allocation of just €3.5 million to the National Office for Suicide Prevention when 500 people die by suicide? How can she justify not increasing the level of funding this year?

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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A very competitive proportion is allocated to each area, be it cancer care, mental illness care, including suicide prevention, or primary care. They are all very worthy causes. The reality is that we have increased funding for health care substantially. The increase the HSE received since it was established, that is, over €4 billion, is more than we spent running the entire service approximately 11 years ago. This puts the expenditure into perspective. If money alone could solve our problems, none of us would be here today talking about the health service. A programme of massive reform must accompany investment and that is why I, along with many Deputies, believed strongly for 20 years that a unified system with consistently enforced standards in respect of cancer care and quality——

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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There is no consistency. There are different rates.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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——was not possible under the former health board regime.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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It is not happening under the current one.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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On the question on confidence, the HSE is a new organisation and it is not perfect. It is the largest in the country and employs one third of all staff in the public sector. Many of the staff who work in the hospital sector work in voluntary hospitals that are not owned or controlled by the State. I accept they would not be able to function without the resources of the State.

A report on one particular hospital in Dublin, in which the HSE conducted a study, identified that 65 acute beds could be freed up, at no extra cost, if the hospital changed the way in which it went about its business. That is the kind of approach I support.

Deputy McCormack should note that there are 2,600 staff in Galway hospital and they comprise a considerable resource.

Photo of Pádraic McCormackPádraic McCormack (Galway West, Fine Gael)
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It needs a dermatology nurse.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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The number has doubled in a relatively short period. I read a story about a patient who fell out of a bed, supposedly because there was nobody on hand to assist. I do not accept a lot of that but that is not to say hospitals could not do with more staff. There has been a considerable investment in resources in the acute hospitals in recent years.

Photo of Pádraic McCormackPádraic McCormack (Galway West, Fine Gael)
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Why can we not get a dermatology nurse?

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Please, Deputy.

Photo of Pádraic McCormackPádraic McCormack (Galway West, Fine Gael)
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The Minister wants to make progress.