James Reilly (Dublin North, Fine Gael)
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Question 1: To ask the Minister for Health and Children the reason dedicated palliative care funding announced by her in 2006 and 2007 was not expended on palliative care services; if she has taken steps to ensure the Health Service Executive will repay funding that was redirected away from palliative care services in order that it will be dedicated to the development of palliative care services; and if she will make a statement on the matter. [22486/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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In 2007, overall spending by the HSE on palliative care services amounted to €75 million. That includes some, but not all, of the additional €18 million funding that was provided by the Government in budgets 2006 and 2007. The HSE has advised me that some of the remaining funding was used in other parts of its services, particularly in acute hospitals. Clearly, the HSE has to operate within the resources made available to it in any given year. However, that should not mean that new funding provided by the Government for specific service enhancements is redirected to other purposes. Accordingly, we need to focus on improving the management of existing services and associated funding. In particular, making better use of existing capacity within acute hospitals and managing hospital activity on a planned basis would deliver better hospital services and, at the same time, allow primary and community services to be improved in line with the Government's plans.

My primary concern in regard to palliative care services at this stage is to remove existing regional disparities and enhance palliative care services throughout the country. The HSE is currently finalising a plan for the development of palliative care services on a national basis. That is being done in consultation with the Irish Association for Palliative Care, the Irish Hospice Foundation and the Irish Cancer Society. I have asked the HSE to ensure that the implementation of this plan is prioritised within its overall resources and its service planning process.

James Reilly (Dublin North, Fine Gael)
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Is it not the case that it is the Minister's role to advise the HSE on the strategic development of the health service through the identification of areas of need, the setting of targets and the allocation of specific resources to achieve targets? Did the Minister not make specific commitments on palliative care and promise that during 2006 and 2007 some €18 million of Government funding would be dedicated to the purpose? However, when it came to applying the resources the HSE decided to divert the funding away from palliative care to meet core deficits in other areas. When was the Minister made aware that the funding was diverted away from the development of palliative care services? Did she give approval to Professor Drumm to divert resources away from its intended purpose and, if not, what action does she intend to take to ensure that funding allocated to palliative care services will be replaced?

Is it not the case that any budget that is unused is taken back — or as someone put it, robbed back — by the HSE? It appears that the HSE can implement its own policy regardless of the Department of Health and Children or the Government and that by failing to spend money in an allocated area the funding is taken back to be used at its discretion. Does that not undermine democracy and the value of any promise the Minister, the Government or any Government can make if the HSE can undermine policy in such a fashion and through either deliberate obstruction or incompetence not allow people to use up the budgets for recruitment? Is it not the case that HSE south has filled only 17.5 posts out of 33, Dublin north east region has only filled six posts out of 26 whole time equivalents and Dublin mid-Leinster has filled only 15 posts out of 38?

Will the Minister correct the situation that pertains? When was she made aware that the funding was diverted? Did Professor Drumm ask for permission to do that? What is the point of having policy directives and allocations if the HSE can through various mechanisms redirect that money to wherever it deems fit?

Mary Harney (Dublin Mid West, Progressive Democrats)
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Obviously, the HSE like every other organisation has to live within the resources allocated to it. If they do not do that, they cannot have priorities or make plans and it would be highly disruptive. For the past couple of years we are aware that the new development moneys, including in palliative care, have been redirected to deal with day-to-day issues. For example, last year I understand an extra €40 million was spent on drugs for cancer patients that had not been envisaged at the start of the year. Clearly, the executive's priority has to be to live within the resources allocated to it. The Deputy's colleague spoke this morning, as he has done on many occasions, about the fact that we are spending too much. In the past three years we have put in three additional beds in Blackrock, four in Galway, ten in Milford, two in Waterford and six in the Curragh. This year an additional €3 million was allocated to palliative care and I have asked the HSE to ensure that money is spent on service delivery, in particular, in those areas where there are huge regional disparities in the provision of palliative care inpatient beds. One such area is the midlands.

James Reilly (Dublin North, Fine Gael)
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With respect——

Charlie O'Connor (Dublin South West, Fianna Fail)
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We have just 50 seconds.

James Reilly (Dublin North, Fine Gael)
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Will the Minister answer the question? When did she find out and did Professor Brendan Drumm seek permission?

Mary Harney (Dublin Mid West, Progressive Democrats)
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No, he does not require permission.

James Reilly (Dublin North, Fine Gael)
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When did the Minister find out?

Mary Harney (Dublin Mid West, Progressive Democrats)
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Find out what?

James Reilly (Dublin North, Fine Gael)
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That the money had been reallocated.

Mary Harney (Dublin Mid West, Progressive Democrats)
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It has been well known for the past couple of years that new development moneys, including in the mental health and disability sector, were not all used in those sectors. That has been known at the end of each year in 2006 and 2007.

James Reilly (Dublin North, Fine Gael)
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So the Minister has known for a couple of years.

Mary Harney (Dublin Mid West, Progressive Democrats)
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At the end of each year we know whether the new developments took place.

James Reilly (Dublin North, Fine Gael)
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Basically, the Minister knew it in 2006——

Mary Harney (Dublin Mid West, Progressive Democrats)
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The HSE produces——

James Reilly (Dublin North, Fine Gael)
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——and she allowed it to happen again in 2007, and we can expect more of the same in 2008.

Mary Harney (Dublin Mid West, Progressive Democrats)
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No. The organisation has to live within the resources allocated to it.

James Reilly (Dublin North, Fine Gael)
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Why does the HSE——

Charlie O'Connor (Dublin South West, Fianna Fail)
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The Minister should be allowed to conclude.

James Reilly (Dublin North, Fine Gael)
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——not reallocate funding from administration or the burgeoning bureaucracy? It does not do that, it takes it off front line services.

Charlie O'Connor (Dublin South West, Fianna Fail)
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Will the Deputy allow the Minister to conclude?

Mary Harney (Dublin Mid West, Progressive Democrats)
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No, it does not take it off front line services. We had no palliative care specialty or facilities a couple of years ago. Ireland was the second worst country in Europe. In addition to the inpatient services we are developing, we also have huge investment in home care services in palliative care.

James Reilly (Dublin North, Fine Gael)
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Can I come back on that point?

Mary Harney (Dublin Mid West, Progressive Democrats)
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Clearly——

James Reilly (Dublin North, Fine Gael)
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It is interesting that in the midlands and the north east where the HSE is responsible, as opposed to the voluntary sector, only 20% of posts have been put in place. In the other areas where voluntary organisations are in charge, who are interested in patient care, the uptake is much higher. That speaks volumes.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The voluntary organisations are supported by the State.

Charlie O'Connor (Dublin South West, Fianna Fail)
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I remind colleagues of Standing Orders. They require that I now proceed to Ceist Uimhir a dó. I apologise.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Much of the support for the voluntary organisations comes from the HSE. For example, the Blackrock Hospice is a voluntary organisation but the activity is funded by the HSE. Equally, while the HSE is not directly providing the beds itself, it is funding various hospices around the country to provide the service. In Milford, for example, which I visited on a number of occasions——

James Reilly (Dublin North, Fine Gael)
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That is the point. Where there is a strong voluntary voice to demand the service——

Jan O'Sullivan (Limerick East, Labour)
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My time is being eaten into. I asked the second question and I want the time for it to start when the reply to this question finishes.

Charlie O'Connor (Dublin South West, Fianna Fail)
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The Deputy should trust the Chair. I will do my job in so far as I am able. The full time allocation will be given to Ceist Uimhir a dó.

Jan O'Sullivan (Limerick East, Labour)
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The Chair called the Minister on Question No. 2.

Charlie O'Connor (Dublin South West, Fianna Fail)
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Yes, I did. I lost a little bit of control through no fault of my own.

Jan O'Sullivan (Limerick East, Labour)
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I do not blame the Chair.

Charlie O'Connor (Dublin South West, Fianna Fail)
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That is okay. The Deputy can trust me.