Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

I welcome the opportunity of addressing the financial challenges that confront the Health Service Executive for 2009. Within the next three weeks or, as the Taoiseach stated, in early April, the Government will introduce a new set of financial and spending measures for 2009. Therefore, to some extent, this debate is somewhat premature, because it would be my intention to either revert to the House or to a committee of the House to deal with the issues arising for the HSE in the context of the financial measures agreed and introduced in the House on that date. Health expenditure for 2009 is €16.4 billion, of which 93% will be spent by the Health Service Executive and 7% by the Department of Health and Children. The Department's budget of €531 million includes more than €100 million for the National Treatment Purchase Fund, the allocation to the Health Information and Quality Authority and funding for a number of other agencies which come within the remit of the Department and are independent of the HSE. The budget of the Minister of State with responsibility for children is €548 million, the bulk of which is spent on the early childhood payment.

In total, the public health service accounts for 25% of the money spent on running the country. This year, based on forecasts for GNP, it will account for 11% of national income. I note the Governor of the Central Bank today forecast a contraction in GNP of approximately 6% this year. When the €4 billion spent in the private health sector is included in the figures, health expenditure as a proportion of national income increases to 13.5%. This figure is on a par with the highest spending countries in the European Union.

The fiscal and expenditure challenges facing the country are unprecedented. Earlier, Deputy Bruton asked a question on forecasts for tax revenue. While I am not an accurate forecaster, I understand we are working on the basis that in 2009 tax revenue will be between €34 billion and €35 billion, current expenditure will be approximately €50 billion and net capital expenditure will be approximately €8 billion. One does not need to be a genius to understand that a deficit well in excess of €20 billion is not sustainable from the perspective of the public finances or as a member of the eurozone.

In light of the financial challenges facing the country, the health service will be challenged to deliver greater efficiency for the resources allocated to it and greater flexibility in terms of how and where people work. This year, we will spend more on health than we are forecast to collect from VAT — €13 billion — income tax — €13 billion — and food — €12 billion.

The HSE submitted a service plan to me early this year based on its initial allocation and the figures on which we were working in December last. The plan indicated that, notwithstanding the financial challenges it faced, the executive would operate the same level of services as it did in the previous year. Its allocation for 2009 was between 3% and 4% higher than in 2008. The HSE gave a commitment that it would maintain existing levels of services to patients. This was to be done by increasing day case activity which is 12% lower than the OECD average and only 50% of the best performing countries such as Canada. Even within Ireland, there are variations in day case activity, with some hospitals performing well and others performing not so well.

The average length of hospital stay also need to be addressed. The HSE has been doing amazing work in reducing the average length of stay. Despite recent improvements, however, the average length of stays here are between 0.6 and 1.9 days longer than for similar procedures in the United Kingdom. We also need to address the population of patients in our acute hospital system. A survey done on bed utilisation showed that approximately 12% of patients were in hospital for IV therapy, which in many other countries is delivered in patients' homes or community based centres.

Additional funding of €8.1 billion has been allocated to public health since 2002. To put this figure in context, it is twice the level of expenditure on health in 1996-97. Of this increased expenditure, 36% has been expended on pay, 14% on drugs and 29% or almost €3 billion on new service developments in the areas of older people, services for people with disabilities, the acute hospital sector, cancer control, screening and so forth.

The sustainability of our public finances is a challenge for all of us, not least the Government. Countries and health ministries around the world face the same challenge. We estimate, at this point, that the financial challenge facing the Health Service Executive for the remainder of this year amounts to €480 million. I reiterate the point I made before Deputy Reilly entered the Chamber that the position may change when fiscal measures are introduced in the House in three weeks. In that case, I will revert to the House or a committee thereof to address the new position.

The €480 million figure includes an estimated €100 million shortfall in receipts from the health levy. The substantial shortfall in January eased somewhat in February and will, we estimate, amount to €100 million over the year. We also estimate a shortfall of between €57 million and €60 million in long-stay repayments. This figure arises primarily from the success of some appeals. The HSE's contingency figure may not be sufficient to meet requirements. The estimated shortfall in the allocation for medical cards is approximately €170 million.

The remainder of the €480 million figure is made up of an additional €30 million for the consultants' contract which arose because more people signed up for the contract than we anticipated when the allocation was made to the HSE. The cost of the Hickey judgment, under which retrospective payments must be made, is estimated at €35 million. The failure to implement the judgment this year will give rise to costs of perhaps €50 million. Under the emergency provisions introduced by the Minister for Finance, I commenced consultation with the Irish Pharmacy Union and other professional organisations in health care, including the Irish Medical Organisation, on fees and the need to ensure the distribution margin is substantially reduced. I anticipate that this consultation will be completed by 3 April. At that point, it will be a matter of making a determination which is in line with the outcome of the High Court proceedings. If that occurs, we expect to achieve savings in this area for 2009.

The €480 million shortfall at this point presents a major challenge for the HSE. I have asked the board of the HSE, which meets on Thursday, not to reduce levels of services to patients if this can be avoided before the Government makes its determination on expenditure and fiscal matters in the next three weeks. As the Taoiseach stated, the Cabinet will tomorrow morning decide on the date on which the budget will be introduced in the House. The question is whether it will be introduced on 2 April or the following week. Once this has been done, we will be clearer on the financial implications for the health service in 2009.

Many people would argue that as more people become unemployed, pressure increases on demand led schemes, particularly medical cards. There will be a shortfall in the levy, for example, moneys from which are allocated to appropriation-in-aid to the Health Service Executive. Unlike the social welfare system, where additional money is provided when unemployment increases, as is appropriate, other State services do not receive additional resources to address increased demand that had not been anticipated when services were being planned for at the end of the previous year.

To be fair to the HSE, last year it achieved value for money savings of approximately €280 million. At this time last year, it was predicted that the HSE would exceed its budget. I compliment the Accounting Officer, management team, board and staff of the executive on operating within their budget, challenging as that was. Not only must it operate within the allocated budget for 2009, it must meet the unexpected new issues which arise as a result of the economic pressures confronting the country.

There has been speculation in the public domain about the new consultant contract. I will address this issue briefly bearing in mind that I will also take questions later. The new consultant contract was welcomed by all sides in the House when it was successfully negotiated after a prolonged and protracted period of negotiations lasting more than four years, which included the term of office of some of my predecessors. It is not a pay increase for consultants but a new way of working. It is fundamental to the recruitment of new consultants that they are recruited on the basis of a contract that meets the needs of the public health care system rather than one that was negotiated in the early 1980s, when relatively few people in this country had private health insurance, and did not meet the needs of the public health service.

The essential elements of the new contract are that each consultant will work as part of a team with a clinical director. It will be the responsibility of that clinical director to make sure the team provides cover for the acute hospital at appropriate times. A longer working day and working week are envisaged for consultants and there will be structured cover over the weekends. In addition, there is one-for-all access to diagnostics, which is significant. We all know of many cases in which access to diagnostics was a factor, not least that of the late Susie Long, who was told when she sought a colonoscopy in a public hospital that if she had private health insurance she could have one within a week or ten days but as she did not she must join a queue. That is not acceptable in our public health system and, under the new consultant contract, this system will come to an end. These are fundamental changes to the way in which consultants work.

Consultants must also subject themselves to clinical audits, not just of outcomes but also of performance. The HSE has recently done some interesting work on key performance indicators. I mentioned in the House the work done in the area of neurology services, which showed a major discrepancy between the number of new patients seen by neurologists in different parts of the country and in different hospitals. The power of performance indicators, auditing and data in changing performance and delivering better outcomes for patients cannot be underestimated.

Under the budget, as I mentioned, 93% of the allocation for health in 2009 will go to the HSE. That represents a quarter of all the money we will spend running the country in 2009. As I mentioned earlier, if we accept, as the governor of the Central Bank said today, that the economy will contract by 6%, an increase of 3% or 4% for the HSE represents an actual increase of 9% or 10%. If we add to that the amount of public money spent on health — 78% of spending on health in Ireland comes from the public purse and 22% from private sources — we can see that spending on health represents about 13.5% of our national income, which is by any standards a major investment in our health services.

Among the areas in which the HSE must see change in order to deliver patient care in a way that does not adversely affect patients is that of work practices. Between allowances and overtime alone we spend more than €1 billion. The HSE is currently in discussions with non-consultant hospital doctors, in particular, but also with other staff. There is a high dependence on agency nurses and a very high dependence on allowances. We all accept that the health system does not operate on a nine-to-five basis, and people must be remunerated for the anti-social hours they work. Notwithstanding that, the pay pressures are immense, and unless we can achieve greater flexibility for the major increase in pay we have had each year for the past number of years, the health service will not be able to provide the services we all expect, whether in the community or in the acute hospital system.

I am happy to engage in this debate in the House, although I accept that it is premature given that there is to be a budget in three weeks' time. In the context of that budget, nothing is off the table. I am not ruling anything in or out. We are in a new financial situation, and we must all play our parts in making sure we address the major deficiencies in the public finances in a way that has minimum impact on those at the very bottom in our society, particularly in terms of the provision of public health services to our population.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

I thank the Minister for this debate. As she points out, although I welcome the opportunity to discuss the health service, it is premature in view of the upcoming budget. It is important that we have a follow-up debate after the Minister has deliberated and made her determinations on what is and is not to be cut. I will set out the areas in which cuts should not be made, in which they have been already made, and in which they could be made. Cuts of themselves do very little; we need real reform. The Minister mentioned a total of €1 billion in overtime in a year, which is an extraordinary sum and a poor reflection on the management of the health service and the Minister's supervision of it. That we are spending so much money on health, as the Minister has mentioned, is worthy of query. We know that €1.5 billion or so is spent by the VHI; from where does the rest of the €4 billion not associated with the HSE and the Department come?

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

People who pay themselves — those who go to the Deputy's practice as private patients.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

Has that been analysed? It seems a lot of money. I would have thought it was more like €500 million, but if the Minister has facts to show otherwise I would be delighted to hear them, because it makes our task in the future much easier.

We cannot have a debate on the health service today without acknowledging that we did not just arrive here out of the blue. The same Minister has been in place for the past number of years and we have had the same Government for the past 12 years. Under their auspices the HSE was set up. The service plan approved by the Minister in 2009 cannot deliver 2008 levels of services, as we now know. On top of €500 million worth of savings initially planned for 2009, an additional €600 million will need to be saved. In addition to the 500 hospital beds currently not in use, a further 600 are expected to be taken out of the system, which gives a total of 10% of the bed complement. Eleven accident and emergency departments will be rationalised, front-line staff will be cut, and critical overtime will stop. However, the reason overtime has become critical is that we do not have the manpower to allow the work to be done in ordinary time. I encourage the Minister to correct the overtime requirement. I do not believe it is safe for patients or doctors to work inordinate hours. However, patients must be served and doctors must be there to serve them.

Rather than tackling wasteful spending within the HSE and approving a redundancy programme, as mentioned by the Minister last year, to reduce management and administrative bureaucracy within the HSE, the Minster is more interested in withdrawing lifesaving HPV vaccines from young girls for a minimal saving of €9.7 million. Although a voluntary early retirement scheme for the HSE was announced last July, the Government has yet to decide on the detail. In fact, the Minister said in the House only a couple of weeks ago that it was now a matter for the Minister for Finance. Reading between the lines, I can conclude that no progress has been made.

Let us consider the existing cutbacks and mismanagement that have hurt patients and the taxpayer. We have seen the withdrawal of the automatic entitlement to a medical card for the over 70s — the generation that paid 60% tax and educated themselves. This caused unprecedented public outrage, and is still very much in people's minds. The Minister was on "Questions and Answers" with me last night, and a gentleman in the audience raised the issue yet again. When out canvassing I have been told by elderly people that when Fianna Fáil Deputies called around they would show them the medical cards they tried to take from them. The Minister tried to take the soft option in that case. Yet there has been no move in terms of achieving savings by using generic drugs. The withdrawal of the automatic entitlement to a medical card, which was supposed to save €100 million, has saved only €20 million.

Another issue on which there is still no clear direction is that of oral nutritional supplements. A group led by Dr. Michael Barry was to report to the Minister in this regard. We still do not know what supplements will be included in the proposed cuts, and rumours are rife.

In August 2008 the Minister approved the introduction of a vaccination programme against HPV, which can lead to cervical cancer. This was due to commence in September 2009. The programme was welcomed; HIQA recommended the vaccine and the National Immunisation Advisory Board welcomed it. We were told the vaccine would reduce the incidence of pre-cancer by 66% and that of cervical cancer by 50%, while deaths from cervical cancer would be reduced by 45%, the equivalent of 52 lives per year. The annual cost was estimated at €10 million, although I believe it could be lower. However, in November 2008, the Minister did a U-turn on the cervical vaccine notwithstanding a confirmation by the winner of the Nobel Prize, Dr. Harald zur Hausen, of the vaccine's efficacy. It is a mystery why we cannot find €10 million in an overall budget of €16 billion to protect our children.

In November 2008, the Minister announced a new private health insurance levy of €160 for each adult and €53 for each child under 18 on foot of a Supreme Court decision which found her risk equalisation to be ultra vires. She claimed that insurance premiums for older people would increase substantially by up to 60% with no evidence to back this up other than the assertions of the VHI, which is the dominant player in the market. If passed on fully, the health insurance levy will cost a family of two adults and three children almost €500 per year before whatever substantial increase in premiums is now in prospect. This is being introduced even though the VHI posted a profit of €112 million in 2007. Community rating continues to ensure that a person's age does not determine the level of premium he or she pays because the law clearly prohibits an insurance company from selectively deciding that certain age groups should pay more for insurance. This is, therefore, a revenue gathering exercise. As health insurance becomes less affordable, families will be forced out of the market.

My late arrival to the House, for which I apologise, is because I attended a meeting between the Committee on Health and Children and Age Action Ireland. I wanted to hear that organisation's view of the new annual nursing home fee of €190 per bed. Nursing homes with 40 to 50 beds will have to pay between €7,600 and €9,500 to HIQA. As it appears that individuals will be paid €85,000 or more to inspect nursing homes, the money will be spent on personnel. In fairness to HIQA, it had no part in devising this stealth tax. I do not doubt that it will be passed to the relevant consumers, namely, elderly patients. Costs will arise to the HSE for public nursing home beds and public patients in contracted private nursing home beds. If the Minister is determined to impose a charge, it should be double rather than triple digits. The maximum charge should be less than €50.

We do not know what the impact will be on HSE nursing homes in terms of how many homes will meet the standards and the amount of capital available to make the requisite improvements. I acknowledge that they will be permitted a six-year period to make these improvements but they are unlikely to get the funding they need. The ensuing closure of many of our public nursing home facilities will further the agenda of driving people into private health care. Bethany Home and St. Brigid's ward in St. Patrick's hospital, Waterford, closed because they did not meet the standards but there was no consultation or discussion locally in advance of their closure. Having visited both facilities, I am aware that a great deal of money has been raised for St. Brigid's ward. It meets all the health and safety regulations and the number of beds in the ward has been reduced. All that remains to be done is to spend a few bob on fire screens in the attic. We lack a national plan on future bed requirements. We are closing beds in rural communities whereas people are lying on beds in Dublin long after they have been medically discharged.

General cutbacks include a reduction of €18 million in the money promised for palliative care and a reduction of €50 million for mental health. Moneys intended for disabilities, diabetes and older people have been diverted to meet spending deficits in other areas. This afternoon, the Committee on Health and Children met representatives of Pavee Point, which is experiencing similar problems because the money set aside for Traveller health has been spirited away to meet day-to-day budget needs. This is especially frightening given the life expectancy for Travellers and the health issues they face. Budget 2009 saw a 50% increase in accident and emergency charges, a 14% increase in inpatient charges, a 20% increase in private and semi-private bed charges and a further increase in the threshold for the drugs payment scheme, which has increased by 80% since 2002.

Increasing charges and hurting patients is one way to stay within budget but what about addressing the waste over which the Minister has presided for the past four years? The HSE has spent €292 million on staff transport costs since 2005. Approximately €1 million was spent on consultants to advise on the deconstruction of the HSE. The Minister spends €1 million on special advisers, press officers and constituency staff. A total of 216,000 bed days were lost, which is the equivalent of Tallaght hospital remaining closed for one year. This represents an increase of 30% in the number of people who were not discharged from hospital because no investment was made in nursing home beds in Dublin and other urban areas. Nursing Homes Ireland has informed us that up to 300 beds in the greater Dublin area are available to be contracted in the next six months. Why are we continuing to spend €1,400 per day on the care of a person for whom medical treatment is complete instead of €1,400 per week? It is a nonsensical waste.

Over the past couple of years, 31,000 operations were cancelled. Money was spent on HSE bonuses and PPARs but the 320 people who are lying on trolleys today represent an increase of 25% on this time last year. I make no apology for pointing out problems and castigating the Minister on her failure to act, but I will also offer positive alternatives. Why are we not doing a better job of managing the hospital system to avoid lost bed days and cancelled operations? We should make better use of existing capacity. Community rehabilitation and diagnostics services could be improved. We should abolish the National Treatment Purchase Fund, thereby saving €110 million per year. A special delivery unit was established in the North of Ireland at a cost of €30 million and the waiting list there was cleared in 18 months. Unlike the NTPF, this investment did not recur annually.

Where is the promised HSE redundancy programme? Why is the Department of Health and Children not being streamlined? That Department has seen little reduction in its staff since the establishment of the HSE. Why does the Department need four junior Ministers? Their number should be halved at least. Savings could be made through generic and better prescribing and by teaching people how to use medicine properly.

Services have been withdrawn in the mid-west and the north east and cutbacks have been imposed in Portlaoise, Navan, Mercy Hospital in Cork, the orthopaedic service at Naas General Hospital and in dermatology departments. The hospitals in Galway and Blanchardstown have had to withdraw services in order to meet break-even pressures. A 12-bed orthopaedic unit in Letterkenny hospital closed and Mayo General Hospital's break even plans have led to the closure of a number of beds at weekends. Half of one wing remains empty in Mullingar hospital and Tullamore hospital is also half empty.

Following the North's example of getting rid of waiting lists will require direct action from the Minister. She will need to take responsibility for oversight on a daily basis. In the coming two weeks, Fine Gael will launch a new direction for health that will result in 10% efficiencies, rid us of our waiting lists and ensure fair and equitable access to health care, thus ending the long era of two-tier health care in this State. I hope that we will have a full debate on the health service once the Minister has completed her deliberations and the intended cuts are made public.

Jan O'Sullivan (Limerick East, Labour)
Link to this: Individually | In context

With the permission of the House, I wish to share time with Deputy Sherlock.

John O'Donoghue (Kerry South, Ceann Comhairle)
Link to this: Individually | In context

Is that agreed? Agreed.

Jan O'Sullivan (Limerick East, Labour)
Link to this: Individually | In context

It is important that we have this debate today, although we will need to return to it in the context of a budget in early April. The background to the significant health cuts is the failure of the Government to handle the economy, going rapidly from boom to bust, and giving rise to a situation where there will be severe health cuts that will cause pain and take a long time to recover from. If the proposals in the media come to pass, we will see huge levels of distress in many communities.

The Minister has rightly pointed out that we increased funding in health over a number of years but the problem is that we did not reform the sector over those years. There will now be drastic cuts to a health service that, despite the rhetoric of the Minister, has not been reformed. When the HSE was established, its layers of management were not removed and the HSE is now cutting across the board, which will have an undoubted impact on front line services.

It is not a reformed service because the improvements that would have made it more lean and efficient have not happened. The Minister has talked about it many times but she has done nothing about it. Money is still being allocated throughout the system without being related to outcomes in any way and that is the problem. We have models of good practice but they have not been implemented so we do not have the practices that would ensure that money is well spent.

We have a relatively high percentage of total spending going on health — 25% according to the Minister, 11% of national income and up to 13.5% if we include private money. That is what the US is spending but the outcomes are just as bad there, despite the high level of income spent on health.

The amount of money being spent on health is not the issue, however. The issue is spending the money well. Deputy Reilly has suggested ways in which money could be better spent. I also have suggestions that are preferable to slashing across the board, closing beds, cutting public services, reducing the progress planned for community services or even closing hospitals. My colleague, Deputy Sherlock, will refer to closures but there have been suggestions that the board of the HSE has considered closing hospitals, not just reconfiguring them in the manner that has seen services in the north east drastically damaged and services in the mid-west about to be drastically damaged. The promised cuts in the various reports will be made but none of the benefits, where increased money was supposed to be spent for services such as day care treatment and building up of central hospitals, will be provided.

The report for the south has not yet been published because all these things are taking place behind closed doors. People do not know what is happening. That is a symptom of what is going on — these drastic cuts are being made and although the Minister puts up a good front, people are terrified.

I was talking to representatives of Age Action earlier and they are receiving telephone calls from people saying there is a limit on the budget for the fair deal scheme; it is resource capped. People are scared that care of the elderly will get much worse because even if they qualify for a place in a nursing home, the money might be gone. All of this is taking place behind closed doors. I strongly support the sentiments of Rebecca O'Malley, the patient advocate, who stated that any proposed cut should be transparent, we should be told what it is and the savings involved, and it should be debated.

There have been cuts of €6 million in Crumlin Hospital, €12 million in Tallaght Hospital and St. James's Hospital and €11 million in Beaumont Hospital, with similar proposals throughout the country. Beds will be closed and there will be longer waiting lists. Undoubtedly, patients will be on trolleys in corridors waiting for services. The minor progress made in the past few years will be reversed.

I will not stand over cutbacks in services that will hurt patients. There must be a bottom line below which services will not go. We must ring-fence funding for development, for projects for Travellers, such those mentioned in the presentation by Pavee Point, the mental health budget, palliative care, disability budgets and, particularly, child and adolescent mental health, which was to see service developments that have now been put on the long finger. We must also have money spent on colon cancer screening proposals to ensure that programme is introduced in the coming years. There is a specific commitment to establish it this year and I want the Minister to give an undertaking that it will be forthcoming. The HPV vaccine should undoubtedly be reinstated for September 2009 because of its capacity to save lives in future.

We must get our priorities right because there is still wastage in the system. There is no reason that spare administrative staff could not be transferred to HIQA to do inspections instead of charging for them, something which is of great concern to the elderly. There is no reason, as Deputy Quinn just said, that if there is a shortage of staff in the Department of Education and Science and too many staff in the Department of Health and Children, because numbers have only been slightly reduced since the HSE was set up with all of its bureaucracy, those staff should not be transferred to do that work.

I propose that the NTPF be scrapped instead of closing beds in public hospitals. The Minister has introduced measures because she believes in privatisation and the private sector providing health care. The Labour Party does not believe in that and the majority of the public does not believe that is how the health services should be provided. The National Treatment Purchase Fund is a middle-man for private health care to make money out of the public system. If we still had a lot of money, we might say that it shortens waiting times for some people but if we are cutting the budget for public hospitals, we should get rid of the NTPF and save the money, around €100 million per year.

The consultants should be told that the increase agreed with them is to be deferred. The Minister is cutting funds to other health care providers through the legislation we passed last week so I do not see why consultants should not be asked to implement the new working arrangements, which I agree with, but to defer the payment. What they get is a multiple of salaries for consultants in other European countries. Starting salaries are three times those of British consultants and the OECD pointed out in its review of public services last year that, even before the higher wages were agreed, their incomes were 50% higher than in France and 80% higher than in Germany.

The Labour Party strongly advocates the scrapping of the co-located hospital proposal, which would save €1.3 billion over seven years. It was supposed to produce 1,000 beds but four years later it has not produced a single bed.

There is room for general efficiencies. Following the publication of the 2009 service plan, €530 million must be cut before the €480 million shortfall mentioned by the Minister is even taken into account. That is a huge challenge. The use of information technology, however, offers the opportunity for efficiency. I spoke recently to a man who wanted to pay by credit card in the accident and emergency department but he was told he could not because a bill had to be sent to him. This caused a raft of paper work when he was quite willing to pay on the spot.

The Department of Social and Family Affairs automatically gets money in times of high unemployment. I do not know why the Department of Health and Children does not also get money concerning its loss of income because of the loss of jobs from the levy and medical cards.

I look forward to returning to this topic again because it is such a vital service for people. There is much fear among the public over what is happening to health services, so we must find better ways of saving money than the ones that have already been proposed.

Seán Sherlock (Cork East, Labour)
Link to this: Individually | In context

I thank Deputy Jan O'Sullivan for sharing time with me.

I will start with a simple question — will the Minister close Mallow General Hospital? I want a clear "Yes" or "No" answer from her. If it is the Minister's intention to keep the hospital open, people want to know the extent of its services in future. We have been met with nothing but confusion and obfuscation concerning the provision of services in the HSE south region in recent months. We have had the national service plan 2009, the reconfiguration of hospitals report for the HSE south region, which was also published this year, and we have also had the teamwork report and the Howarth report. Now we are being told that Professor John Higgins will examine proposals on savings that will be garnered as a result of the cuts to be implemented.

The people of the HSE south region want to know what will happen by way of facts, figures and timelines. We are sick of this culture that exists whereby the only person who will answer publicly for HSE decisions is Professor Drumm. We want to know why people in the hospital networks office of the HSE south region, and other such high-ranking figures, are not speaking publicly and answering in proper, public fora for the decisions they are taking.

There is a positive alternative to the scenario that is currently provided by the HSE south region. The Minister must listen to GPs who are referring to hospitals like Mallow and Cork University Hospital. She must listen to people working at the coalface. If we listened more to doctors and other health professionals and less to the coterie of managerial mandarins, we would be able to effect a proper system that could guarantee health services to the public.

With respect to the Minister, I want to know today if she intends to close Mallow General Hospital. On behalf of that region's taxpayers, I also want to know what future scenario she envisages for the hospital. We can rotate far more disciplines from Cork University Hospital through to Mallow General Hospital. In addition, we can enhance the services at Mallow and add value to them. That case is also being made by health professionals who are operating in that catchment area. We need proper answers without obfuscation.

Martin Ferris (Kerry North, Sinn Fein)
Link to this: Individually | In context

The Health Service Executive faces a shortfall of over €1 billion in 2009. Our already inequitable health system is now faced with even more savage cuts that will drastically affect the care of patients if the Government is allowed to continue to hide behind the HSE which will wield the knife on behalf of Fianna Fáil, the Green Party and the Progressive Democrats.

Real savings need to be made and can be made by ending all State subsidies for the private for-profit health sector, reining in those consultants who profit from both the private and public systems, cutting bills through the use of generic drugs and the establishment of a State pharmaceutical procurement and distribution company.

The Government could also cut massive salaries and allowances at the top of the HSE, including €16,000 per month for an adviser to HSE chief, Professor Brendan Drumm. This massive salary and allowance is disgraceful and indefensible in any circumstances. In the current economic situation, it is criminal. People are struggling to survive and make ends meet, yet the Government allows such salaries and allowances to continue.

Meanwhile, the Government and the HSE are preparing to cut services for patients and the pay of front line health care workers. If they proceed in that way, the damage to our public health services will be catastrophic and will exceed the damage caused by cuts in the 1980s. It is now time for strategic decision-making to be taken out of the hands of the HSE and placed where it belongs — with the elected representatives of the people in this House. There must be such political accountability. Any revised service plan and budget for the HSE must be placed before the Dáil so that the Taoiseach, the Minister for Health and Children and their colleagues can be fully accountable.

Equally importantly, the Government must listen to and take on board the constructive proposals of all parties. They need to listen to those of us who have been elected to serve the needs of the people. We all have a responsibility to those who elect us.

In the absence of real accountability and a Government that listens to the people, especially those who use the health services we have the disgraceful decision to scrap the national carers' strategy. The revenue saved as a result of services provided by our carers is huge. Across the country, dedicated people are looking after family members in the home with inadequate support from the State. In my own county of Kerry, there are almost 6,000 carers. However, continued lack of adequate support will lead to worsening health for both carers and cared-for, resulting in much greater health care costs to the State.

I would also like to draw the attention of the House to the discovery by my colleague, Deputy Caoimhghín Ó Caoláin, that a range of health and community projects in disadvantaged areas, including 120 announced by the Government last December, is now in jeopardy as the Department of Finance is set to block the funding. We need answers regarding those commitments. These are projects in disadvantaged urban and rural areas across the State, which were to be funded by the RAPID and CLÁR programmes and administered by the Health Service Executive. The announcement of the projects was made just before Christmas by the Minister for Community, Rural and Gaeltacht Affairs, Deputy Ó Cuív, and the Minister of State at the Department of Health and Children, Deputy Hoctor, who said that €4.6 million would be made available for the 2008-09 scheme. This was to allow elderly people to be able to live independent lives.

All Members of the House welcomed the intended programme. The 120 projects range from a drop-in centre in Cavan town to a meals-on-wheels service in Dublin 12, from a bus project in Cork city to the refurbishment of an Alzheimer's Society facility in Drogheda. All of these are worthy projects and would have contributed greatly to the needs of the individual older people concerned. In many cases also, their family members would be given some respite from constant care, particularly where people are suffering from conditions such as Alzheimer's disease, which places such a demand on carers.

My own county is among those badly hit by the proposed withdrawal of funding. Projects with a projected investment cost of €1.2 million — funded by a combination of CLÁR and HSE inputs — are under threat. They include programmes to improve services and community support for older people based in community centres at Lixnaw, Knocknagoshel and Listry, as well as the Coomnassig centre in Sneem, Caherciveen social services centre, Portmagee social services, Duagh resource centre, Glencar care of the aged and the Glen social centre in Ballinskelligs. All those centres in isolated rural areas require Government support. Also at risk are plans to improve child care and family support at the Scartaglin child care association and the tele-medicine centre in Faranfore.

The overall cost of the proposed joint CLÁR and Health Service Executive programmes was to come to €8.9 million. It was also included in the provision of day-care services development in Castleblayney, County Monaghan, and the upgrading and equipping of ten day-care centres for older people in County Donegal.

The Health Service Executive has apparently been required to re-submit all these capital projects to the Department of Finance. There is a general expectation in the sector that the funding will be withheld. I reiterate Deputy Ó Caoláin's appeal to the Minister for Finance, Deputy Brian Lenihan, not to axe any of these projects which are based in disadvantaged areas and are especially important in enhancing the health and quality of life of older people. The Minster should also reflect on the fact that while withdrawing the funding may represent a small short-term saving, in the long run it will increase the demand of those concerned on the health services, their GPs, hospitals and, ultimately, represent an even greater draw on the Exchequer. It is far better and makes more economic sense to provide those services which will improve the quality of life for the people affected, therefore improving their health and lessening their dependency on direct provision from the health services.

This is only the latest in a series of blows to the health sector across the country. It is one which will inflict more hardship on those least able to cope with it, especially older people. The overall impact of the health cuts in Kerry has already been dramatic. The Health Service Executive has announced planned cutbacks of €4.5 million which will devastate an already overburdened and under-funded service. It will have a serious impact on patient care, particularly at mental health facilities in the county. The Government's imposed cuts in staffing and beds stand in stark contrast to the private health industry continuing to enjoy massive tax breaks.

Among the proposed cuts is €1.2 million to be removed from mental health services in Kerry. This will include bed closures and staffing reductions at the acute psychiatric unit at Kerry General Hospital. The Health Service Executive has implemented these cutbacks without properly consulting the staff's union representatives as required by the Labour Court. Last week, I tabled a series of parliamentary questions on this but have not yet received a reply as they have been referred to the parliamentary affairs division of the Health Service Executive.

There are two psychiatric wards at Kerry General Hospital which, at night, are staffed by three nurses. It is proposed to reduce this to two, a ridiculous and ill-thought decision considering most psychiatric admissions take place late at night. Psychiatric nurses at Kerry General Hospital have one of the most demanding jobs in the health service. To attack them in such an underhanded way and against the spirit of the earlier Labour Court rulings requiring consultation is repulsive.

I have also asked that a full health and safety audit be carried out in the acute unit to assess the likely impact of the cuts on both staff and patients' safety. People are appalled that such miserable cuts are being made to front line services while the Minister for Health and Children continues to defend the tax breaks available in the private-for-profit health sector.

The threatened withdrawal of the promised CLÁR and Health Service Executive funding for services for the elderly comes shortly after the Government decision not to publish its long-promised national carers' strategy. This will affect up to 160,000 family carers whose work in the home saves the State hundreds of millions of euro every year. The decision is in direct breach of the Towards 2016 agreement. It also reneges on the commitment in the programme for Government to "ensure a national carers strategy focusing on supporting informal family carers in the community will be developed by the end of 2007".

It is extremely short-sighted. Even with the current desire to save money, any scaling down of the carers' schemes will exacerbate existing problems, have economic consequences for carers and lead in the long term to greater dependency on direct provision by the State. Instead of making real savings, the miserly cutbacks will only create a vicious circle which, in the long run if people's health disimproves and they require more direct care from the State, will add to the costs of the health service. This is assuming that even such basic provisions survive the current onslaught on the existing services.

This illustrates the extent to which health spending and the health services are inextricably linked to the overall state of society. It is no mystery that those on lower incomes tend to have poorer health and, therefore, to be more dependent on the health services. It is also true that people's lifestyles in what they eat, drink, whether they smoke, whether they use illegal or legal drugs and the extent to which they engage in physical exercise also affects their health.

People have a responsibility for their own health and lifestyles but society must create an environment which encourages people to live in a healthier manner. Unemployment, low incomes and poor accommodation contribute greatly to poor health. The lack of sporting and other recreational amenities prevents people from engaging in healthy pursuits. The current economic situation has impacted and increased these negative factors.

It is all the more important that in the current economic situation the State does not make matters worse by implementing cuts that will, on the one hand, contribute to a worsening of people's health and, on the other, impost actual cuts in the health service itself. The first contributes to an increased demand on the health service while the second further increases the difficulties of adequately addressing those problems when they do arise.

Barry Andrews (Dún Laoghaire, Fianna Fail)
Link to this: Individually | In context

I welcome the opportunity to contribute to this timely debate which anticipates what will happen in the next several weeks.

Child protection services, provided by the Health Service Executive, are sometimes forgotten and considered a poor relation in these debates. They only seem to arise in debates on a crisis, not allowing for calm and rational debate.

According to the 2008 Euro Health Consumer Index, Ireland has moved from a position in 2006 of 25th to 15th out of 26 countries. This is a dramatic improvement with Ireland being the highest mover in the two years. The reason given by the index for this dramatic change was that the creation of the Health Service Executive had been a much-needed reform. It also acknowledged this new position may be an underestimation of Ireland's position. For example, one indicator used by the index is the number of cataract operations per 100,000 of a country's population. It is a rather crude indicator, putting countries with young populations at a disadvantage. Ireland has one of the youngest populations in the EU which would have a much lesser need for cataract operations.

It is not just the formation of the Health Service Executive which has made these improvements. The Euro Health Consumer Index commented that recognition of patients' organisations and legislation supporting patient welfare have also contributed to Ireland's improved placement. Several years ago the type of issues dominating the health debate in this Chamber, and elsewhere, mainly concerned primary care, cancer care, hospital waiting lists and consultants' contracts. From an honest analysis, it would be fair to say substantial progress has been made under each of these headings.

There has never been a time when health has not been a contentious issue, nor has there been a time when it has not given rise to, in some instances, properly emotive debate. There will probably never be a time when health does not give rise to serious and interesting debate in the House. It will always be a matter of great public concern. We must, therefore, reflect on the substantial improvements that have been made. In that context, we must consider the number of primary care teams already in place, and the further such teams will be put in place this year, and the benefits to which these teams give rise.

We must also examine the position regarding day or ambulatory care, the cornerstone of HSE reform and what Professor Drumm is trying to achieve. There has been a 40% increase in the level of ambulatory care. The knock-on effect of this increase is obvious, namely, that fewer people are lying in our hospitals, that there is a much greater volume of operations and procedures and that there are better outcomes for patients. Everyone says that once one enters the health system, the care provided is first class. We are all aware of the problems that exist with regard to getting into the system.

Reference has been made to the spirit of the age and the fact that we must begin to talk up what we do in this country. There is no doubt that real progress has been made. For example, the level of MRSA in hospitals has decreased by 25%. A major debate took place a number of years ago regarding hospital-acquired infections and substantial progress has been made in respect of combating these infections. However, not enough is said with regard to such progress.

The National Treatment Purchase Fund has delivered procedures for 140,000 people who would otherwise have been obliged to wait for such procedures. As the Minister stated earlier, there has been a huge take-up in respect of the consultant contract. I accept that the contract is not perfect. However, that fact should not — as was often the case in the past — be used as an excuse to do nothing. People should not wait for everything to be perfect before serious and radical reforms become the norm, not the exception, and before vested interests are faced down.

The improvements to which I refer have been made and should be recognised. It is clear that the HSE faces challenges with regard to the delivery of services. To its credit, the HSE balanced its budget in 2008. I am confident that in the difficult months ahead it will do the same within the new parameters set down for it.

As Members are aware, the problems and difficulties to which I refer are not exclusive to Ireland. We must acknowledge that issues arise, in an international context, with regard to the cost of health care services. Dr. Michael Barry has provided information in respect of drug use and we must face the challenge in this regard as strongly and honestly as possible.

I have responsibility for child protection services. Such services are delivered by the HSE through various local health offices. As with so many health services, a legacy issue arises as a result of the changeover from the former health boards to the HSE. Again, however, I am of the view that substantial progress is being made in this area.

As stated at the outset, the services provided by the HSE are often considered to be exclusively geared towards medical needs. We must reflect, however, on the vital nature of the child protection services it provides. A child who is damaged by way of abuse or neglect will carry a psychological scar throughout his or her life. Medical problems can often be resolved without there being any undue legacy for the child or patient. Child protection should, therefore, always be one of the most important services and should always be at the forefront of the debates in which we engage with regard to the HSE. Let us be honest. The debate on this issue has been ongoing for an hour and no one previously referred to child protection. I am of the view that it should always be central to debates of this nature.

We want to move forward in the context of standardising the business processes that obtain within the HSE. In certain instances to date, performance has been patchy with regard to the way in which waiting lists are calculated and referrals to social work services are assessed. We cannot, therefore, truly compare the delivery of child protection services throughout the country in a contemporaneous way. As a result, the process must be standardised. We have made substantial progress in this regard and I met representatives of the HSE earlier today in order to discuss the nature of that progress. Cases such as that which arose in Roscommon underline the absolute importance of delivering a first-class, standardised HSE service.

The HSE is also responsible for the delivery of social services. The services provided by social workers are too often denigrated. In my view, social workers must deal with incredible challenges. For example, they must decide whether to leave children with their families or remove them. Such decisions can affect children for the remainder of their lives. We must support social workers and talk up the work they do. Morale is crucial to the delivery of good social services and we have an extremely important role to play in that regard.

I hope that in the coming months — if it can be agreed among those responsible for delivering the relevant services — we will be in a position to place in the public domain the information relating to some of the progress we have made. By European standards rather than any subjective analysis, the HSE has made substantial progress. We must remember the crucial and central role to be played by those charged with delivering child protection services and social workers in the overall area of health service delivery.

Dan Neville (Limerick West, Fine Gael)
Link to this: Individually | In context

I wish to refer to a matter of concern that arose last week, namely, a cut of 12.5% in the funding provided to the National Office for Suicide Prevention. The voluntary organisations which work in this area and which receive funding from that office will be affected by this cut. In addition, it will give rise to a diminution in the work carried out by the office.

I wish to comment on the approach adopted by the Minister for Social and Family Affairs, Deputy Hanafin, in respect of the stresses caused by the downturn in the economy. Levels of suicide and psychiatric illness, particularly depression, increase during recessionary periods. In addition, during such times the level of suicide among those who are unemployed is higher than that among those who are in employment.

It is my intention to contrast the decision of the HSE to reduce funding to the National Office for Suicide Prevention with the approach of the Minister for Social and Family Affairs, Deputy Hanafin, who allocated an additional €11 million in order to deal with the new stresses that are having an impact on family life. The Minister for Social and Family Affairs recently stated that there is now, more than ever, a need to ensure that quality services are available in order to help families which may be experiencing new pressures and stresses in their lives. In that context, we must recall that people are coming under psychological and emotional pressure and that there has been an increase in the incidence of suicide.

Rather than emulating the approach taken by the Minister for Social and Family Affairs, the Minister for Health and Children and the HSE have decided to reduce the funding available to the National Office for Suicide Prevention. The former Minister also stated:

The difficult economic situation being experienced throughout the country is filtering into the lives and homes of families throughout Ireland. Where a person loses their job or has their working hours cut back, this financial strain can lead to pressures in relationships.

The Minister for Health and Children must recognise that pressure also comes to bear on the mental health and well-being of people affected by the downturn. Why is this area of pressure being ignored? In fact, there is a reduction in funding in this regard. Another Minister, Deputy Hanafin, recognises the pressures that arise within a family. She spoke about having a network of support services available throughout the country to provide marriage and relationship counselling services, which is the core part of helping families to cope with the problems with which they are confronted. In her press release she identified up to 20 organisations for which she had significantly increased the Department's contribution. However, the Minister for Health and Children has cut funding for suicide prevention by 12.5%.

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

I gave extra money.

Dan Neville (Limerick West, Fine Gael)
Link to this: Individually | In context

The Minister has cut it to all organisations. An instruction was given to the National Office for Suicide Prevention, and it appeared in the press last week. I have researched the matter and I am informed that this is the case.

Research into suicide since the 1890s shows there is an increase in suicide rates and mental illness during times of economic recession. Instead of cutting the level of funding to the National Office for Suicide Prevention, the Minister should emulate the action of the Minister, Deputy Mary Hanafin, and increase the funding by €10 million to allow the office to respond to the need that inevitably exists due to the recession and the increase in unemployment. Economic strain and personal financial crisis have been well documented as precipitating events in individual deaths by suicide. Research has been conducted in the United States, Canada, Australia and Europe on this. Stressful life events, financial and otherwise, have a significant impact on those who are vulnerable to suicide where typical coping mechanisms are compromised by the effects of mental disorder, substance abuse, acute psychiatric symptoms and the other risk factors associated with suicide. There have already been several suicides that can be attributed to the difficulties and pressures arising from the current economic changes.

Increasing unemployment leads to an increase in suicide rates. Unemployment has a profound effect on the person, especially on the young and middle aged. Irish society still awards status and prestige according to a person's position and contribution to work. Correspondingly, unemployment is associated with loss of face and of prestige. This is compounded by the fact that we are emerging from a period when people had an expectation of high levels of income and high standards of living. Many professional people, along with people from other socio-economic groups, are losing employment and their expectations for their futures are destroyed. The level of pressure on them is accentuated due to the level of income and economic activity they experienced during the years of the Celtic tiger economy.

The unemployed are six times more likely to suffer from a psychiatric disorder than people in employment. Studies show that those who die of suicide are significantly more likely to have experienced unemployment, job instability or occupational problems. The Kelleher-Daly study conducted in Cork during the economic recession in the 1980s showed that of the male deaths by suicide analysed, two thirds involved men who were out of work at the time of their deaths.

The high rate of home foreclosures is of particular concern. There have been studies conducted in the United States with regard to suicide levels and their relationship to home foreclosures. For most Irish people, their homes are their primary investment and the locus of their identities and social support systems. When combined with loss of employment, home loss or the threat of home loss has been found to be one of the most common economic strains associated with suicide. While there is a moratorium on foreclosures on the part of some of the banks, newspapers reported today that the courts yesterday approved nine home foreclosures. The Minister has decided banks should not move to foreclose for a period of time, but the threat of what will happen their homes after 12 months will have a serious effect on the psychological well-being of people in those circumstances.

The Minister must immediately respond to the psychological, emotional and psychiatric difficulties affecting people as a result of the changed economic times. In doing so, she must recognise the need to enable the National Office for Suicide Prevention to respond adequately to the inevitable growing demand for its services. Dr. John Connolly, secretary of the Irish Association of Suicidology, stated recently in a newspaper interview that despite the shrinking public finances, it is vital that the Government invests more in suicide prevention and mental health services to reduce the number of deaths. He said: "We must be aware of the fact that research reaching back to that of Emile Durkheim in the 1890s shows that in times of recession, suicide rates inevitably increase." He told a meeting of the Oireachtas sub-committee on the high level of suicide in Ireland: "Unfortunately, this will happen in the coming months and years unless we ensure that funding for the implementation of the national suicide prevention strategy and other services is guaranteed."

I ask the Minister to respond to that point.

Martin Mansergh (Tipperary South, Fianna Fail)
Link to this: Individually | In context

I wish to share time with Deputy Timmy Dooley.

I will start by doing something that is probably unheard of in this House, which is to praise the HSE. I had the pleasure of opening a new facility owned by the Irish Wheelchair Association in Tipperary and both the association and those running the facility could not have been stronger in their praise of the co-operation they received from the HSE. It underlined the fact that much good work is done each day by the people who work in and administer the health services, yet there is almost a blanket media and political negativity about the HSE. It must make it more difficult and demoralising for people to do their job, and it is mostly a very good job.

I take this opportunity to express my admiration for and confidence in the Minister for Health and Children, Deputy Mary Harney. She took on a very difficult job some years ago and, despite the difficult financial situation, she is continuing to develop the health services and has managed to keep real cutbacks to a minimum in all circumstances.

I wish to put on record a few observations on the reconfiguration of hospital services in the south east. There has been a great deal of investment in the South Tipperary General Hospital in Clonmel which, after decades, was chosen to be the principal site of services. The choice was between it and Cashel.

There has been much discussion and some speculation that may have been motivated with an eye to forthcoming elections. There is no reason that a hospital such as South Tipperary General Hospital should not keep its maternity services. There are no health reasons for concentrating maternity services in regional centres and centres of excellence. I notice that in the reconfiguration of the Dublin hospital scene it has been suggested that stand-alone maternity hospitals should gradually cease to function and join with more general hospitals. That situation exists in south Tipperary where there is no evidence of maternal or infant health problems, nor is there any suggestion that the hospital's performance is any less than in hospitals with an even larger throughput. I make a strong plea that maternity services are maintained at South Tipperary General Hospital.

I gather that when it comes to accident and emergency services there is a rule of thumb to the effect that people should not be more than one hour from a hospital. However, by the time an ambulance gets to somebody, very often much of that hour will have already gone. Even if an ambulance were to arrive instantaneously, there are many parts of south Tipperary that are more than an hour away from Kilkenny, Cork, Waterford or Limerick. There has been much investment in South Tipperary General Hospital and I hope its character as a general hospital will be maintained. I believe there is every reason that it should but I wish to put it on the record of the House.

Timmy Dooley (Clare, Fianna Fail)
Link to this: Individually | In context

I welcome the opportunity to contribute to the debate. We have had an opportunity to discuss the issue on a number of occasions recently and it is always important that we continue to discuss the various changes that are taking place. Health is an extremely emotive issue. As a result, the notion of change within the system as it is delivered generates a considerable amount of fear. Some of that fear is clearly well founded but more of it is unnecessary. The difficulty is who decides what is well founded and what is not. Therefore, it is important that people set out their views and proposals clearly on the delivery of health services.

I am reminded of an issue that developed in the area with which I am most familiar, namely, the mid-west, and the changes that were brought about to Shannondoc some time ago, which allowed GPs to facilitate their normal existence by putting in place a centralised out-of-hours service. At that time people in rural and isolated areas had real concerns and fears that a doctor would no longer be available on-call. Their fears were proven to be largely unfounded when the centralised service took up office and the necessary facilities were put in place. The GP who is on-call is provided with a base, a driver and nursing backup. That assisted to a considerable degree in allaying people's concerns out of hours.

I am somewhat concerned that, in their desire to have that service rolled out, GPs are now seeking to involve themselves in a debate that is largely to do with hospital consultants. That is not to take from the work GPs will have to do to provide an ongoing out-of-hours service that will be affected by the reconfiguration proposals. However, I appeal to GPs, the HSE and hospital consultants to come together to begin a dialogue for the sake of patients and the people who are perhaps unnecessarily concerned. Given that there is a level of discord among all those involved, it is not clear to patients that there has been joined-up thinking. I would welcome those three parties coming together to put in place the necessary solution to the problem. There are always solutions to the kinds of problems that arise. I hope the Minister might be able to facilitate that. Clearly, there are industrial relations issues and financial implications for any agreement that might be reached. However, I believe a resolution can be found. Some GPs to whom I have spoken believe a solution exists to the concerns that have been expressed.

Particular concern has been expressed about accident and emergency services in Ennis General Hospital. Much of it is unfair and unnecessary as a result of a number of cases that were highlighted. Those cases have occurred in all smaller hospitals and it is unfair that the focus has been unnecessarily visited upon Ennis hospital. We have to move beyond that because there is a fantastic team of very well qualified people there who have worked very hard in difficult circumstances to deliver a very good level of patient care over the years. I hope that can continue.

Notwithstanding that, we must be open to change. The system has let down many people. I do not refer to the mid-west. People have been let down from a patient safety point of view and from the perspective of outcomes throughout the country. It is incumbent on all of us to listen to the advice of senior clinicians who have put forward a different model and methodology to deliver a service that will save lives. It is easy to get tied up to some extent in the political debate and point scoring and to rely on what I believe is an outdated principle, the notion of the "golden hour", because the advent of advanced paramedics has enabled that to be overcome in terms of stabilisation on the roadside or other site. For that reason we must listen to the people who are putting forward a better level of service.

I appeal to the Minister to continue with the transformation she has started and to back it up, as she has indicated she will, with a level of investment. Regarding the reconfiguration of the mid-west, there is a requirement for a considerable amount of funding to upgrade the ambulance service and the facilities at Ennis General Hospital. Based on the various discussions I have had with the Minister, I know she is committed to that.

This is a political Chamber and we have political debate in it. People on the other side have put forward various different points of view. They have asked pertinent questions. I wish to pose some questions to the other side through the Acting Chairman, Deputy Kathleen Lynch.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context

Deputy Dooley has 12 seconds.

Timmy Dooley (Clare, Fianna Fail)
Link to this: Individually | In context

If the Fine Gael Party is in Government, will it reverse the reconfiguration decisions that have been put forward by the HSE? If it does not, will the Deputies concerned resign from their party? That will clearly set out whether people are playing politics with the issue. They are two simple questions and they should be asked.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context

We have very little time.

Pat Breen (Clare, Fine Gael)
Link to this: Individually | In context

Things are changing rapidly with the HSE. The Minister of State, Deputy Mansergh, and Deputy Dooley appear to disagree on the "golden hour" even though they are in the same party. The Minister of State is very concerned about the time it takes to get to Clonmel hospital from parts of Tipperary while Deputy Dooley said the "golden hour" makes no difference whatsoever. That shows there are differences within the Fianna Fáil Party as to how the health service should proceed.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

Listen to the doctor.

Pat Breen (Clare, Fine Gael)
Link to this: Individually | In context

Obviously, €480 million is a significant shortfall to have to make up. We met the Minister for Health and Children recently and it is evident that things have changed rapidly in the meantime. She indicated in regard to funding that she is ruling nothing in or out tomorrow morning and for the budget. Does that mean the promises made at the meeting attended by the mayor of Clare and councillors have gone out the window and that there are changes to what the Minister outlined? She indicated to me that there are no plans to close the hospital or acute hospitals but at the same time she said the situation regarding funding will be kept under review. There is much uncertainty currently. People are fearful about what will happen.

The Minister indicated she would implement the Teamwork report. Given the serious funding problem, what will happen to the required upgrading of the ambulance service and to the funding required to upgrade Limerick Regional Hospital? Will the Minister put the Teamwork report on hold? That issue is also very important.

Deputy Dooley inquired whether Fine Gael Members would resign if we were in the same circumstances. I remind him that not one cent has been spent on Ennis General Hospital in recent years. We have received promises from Minister after Minister and we still do not know what will happen to the hospital. Perhaps we can get some answers from the Minister for Health and Children in that regard.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context

We will now move on to a question and answer session for 30 minutes. I suggest the three spokespersons put their questions first and we will then take the response to those questions. We will keep both questions and responses brief.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

I am happy to limit myself to brief questions if that will allow Deputy Carey an opportunity.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context

We will try to have a second round.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

I understood the VHI spend was €1.5 billion and when I asked the Minister where the rest of the money came from, she informed me that it came from the private sector. I hope she will be able to share her sources with the House to back that up. How many new consultant posts, rather than new consultants, will there be? I am not interested in hearing about how many consultants will retire or how many new ones will take their place, but in how many new consultant posts there will be outside of the cancer strategy. She could also inform us how many new consultant posts there will be including the cancer strategy.

I am in no doubt about where cuts should take place and where they should not. We must protect patients and patient services, stop the huge amount of waste and reform the service. This has not happened and the Minister has not outlined a clear plan or strategy for reform, which must be an integral part of what she is attempting to do through budgetary restraint.

Jan O'Sullivan (Limerick East, Labour)
Link to this: Individually | In context

Will the Minister comment on the difference between the comments of Deputy Dooley and the Minister of State, Deputy Mansergh, on the "golden hour"? Does the Minister think the "golden hour" is important? I would like to follow up on a question asked by my colleague, Deputy Sherlock. Is the report correct and is the Minister considering closing Ennis, Bantry, Mallow and Monaghan hospitals? Is that one of the issues being considered by the HSE and has it informed the Minister of that? If it is, what is the Minister's view on it?

Must the Minister approve the HSE cutbacks? The HSE has already made a cutback of €530 million, identified after the agreement of the 2009 service plan. Now there is an extra €480 million shortfall, which brings the total shortfall to over €1 billion. Will the Minister approve the cutbacks or will the HSE be free to make cuts without approval? In other words, is there political control over them?

Both Deputy Neville and I pointed out that the number of extra people needing medical cards because they lost their jobs would lead to a predicted shortfall of €170 million and that we would also have a €100 million shortfall in the health levy because people had lost their jobs. The Minister stated it was appropriate that the Department of Social and Family Affairs should get extra money in order to provide unemployment benefit and assistance to people who lose their jobs. Is it not appropriate that the Department of Health and Children should also get extra money? The Minister should fight for her Department to get the estimated shortfall of €270 million following the loss of the levy and the increased number of medical cards. Professor Drumm has estimated a slightly higher shortfall. Should this loss not be spread out over all Departments and spending rather than have to be covered by the health budget?

Martin Ferris (Kerry North, Sinn Fein)
Link to this: Individually | In context

Are the health and community projects in disadvantaged areas, including 120 projects announced by Government last December, in jeopardy given that the Department of Finance is set to block their funding? Can the Minister give a commitment that these will be maintained, particularly given they are in the RAPID and CLÁR areas?

On the issue of Mallow and Monaghan hospitals, will Thursday's HSE meeting consider the closure or partial closure of these hospitals?

With regard to the acute unit in Kerry General Hospital, will the Minister ensure that a health and safety audit will be carried out on the acute psychiatric unit to assess the impact of the cuts on both staff and patients and the likely implications these may have on the health and safety of those concerned? I submitted a question previously to the Department on the issue of a related Labour Court decision and it has been referred to the HSE. The decision was that a consultation process would take place between the staff, a union representative and the HSE before the cuts were made.

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

The figure for new consultants is 283 and 156 of these are new posts.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

Will they be filled this year?

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

The recruitment process will take place this year. As the Deputy is aware, it sometimes takes a while to carry that out. Recruitment for some posts has been taking place, but it is intended to recruit the consultants. The cost of new consultant posts must come from a reduction in the amount of money we spend on non-consultant hospital doctors, of whom we have 4,900. Deputy Reilly made the point earlier that doctors should not work such long hours. I mention in passing that the overtime bill was €347 million and the allowances negotiated in various negotiations amounted to €700 million. The total for both is €1 billion. Clearly, people cannot be paid more for working fewer hours than they were paid for working longer hours and that is the issue currently being negotiated through the industrial relations machinery of the State.

I will get the information the Deputy requires on the €4 billion. Some 78% of the money spent on health in Ireland is from the public purse, at €16.2 billion, while 22% is private. That includes, in addition to the VHI, the other insurers — the Garda, the ESB, Hibernian and Quinn. It also includes people who pay fees to their general practitioner, money paid for drugs and a host of other things, such as outpatient charges, etc. However, I will get the data for the Deputy on the matter. I do not have it to hand.

With regard to Deputy O'Sullivan's question and the reconfiguration of hospitals, even if there was no extra money available, this must happen. It is a patient safety issue and a priority. The manner in which we organise the delivery of acute hospital services does not deliver safe care to patients. Approximately two weeks ago, I said in the House that we are moving to a scenario, on foot of the recommendations from the patient safety commission, where all health providers, beginning with the acute hospital sector, will require licensing not just for the hospital, but also for the activities within it. We know that no licensing system would licence many of the activities in our hospitals because we are not in a position to deliver quality care given the configuration of our acute hospital services. Therefore, we are moving to a scenario where hospitals will be networked together with a specialist hospital at the centre and the less acute activity happening in the smaller hospitals.

This is the model of care that will be replicated around the country. It is the only model of care that can deliver safe care. It is happening very successfully with breast cancer, where 60% of the transition has now occurred. The rest will occur this year. This has been highly successful and great credit is due to Professor Keane. As he said to the Cabinet sub-committee, which I mentioned publicly last night, when that happens, it will put Ireland in the top three countries worldwide as far as the organisation of breast screening and breast cancer services are concerned. We must emulate that with lung and prostate services and move on to colon and colorectal screening and so on.

With regard to Mallow, the HSE must submit a revised service plan to me for that hospital. I wrote to the chairman of the HSE in the past week in response to his letter and asked for a response. However, in advance of the Government's determination, in the context of the forthcoming measures to be brought to the House in early April, clearly they are not in a position to finalise the changes that might take place until we see the actual scenario. As I said at the outset of my comments earlier, we are premature to the extent that there will be budgetary changes on spending and taxation brought before the House in three weeks time. Clearly, health, given it accounts for 25% of budgetary spending, will be affected.

The effects of the growing level of unemployment on both the levy on the appropriation side and the medical cards on the cost side will be considered by the Government, but in advance of any Government determination, which has not happened, I am not in a position to deal with that issue here.

We are not discussing the closure of hospitals but the reconfiguration of hospital services around the patient safety agenda.

Jan O'Sullivan (Limerick East, Labour)
Link to this: Individually | In context

Can the Minister say she definitely does not propose to close those four hospitals this year?

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

I am not proposing to close any hospital. The configuration is all about reorganising what happens within the hospital system.

Pat Breen (Clare, Fine Gael)
Link to this: Individually | In context

Were any planned closures discussed in the HSE?

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

They may have been discussed in the HSE and some people may feel the configuration of hospitals is inappropriate. There is no doubt about that. I quoted the Minister for Health in 1975, the late former Deputy, Brendan Corish, in this House referring to the FitzGerald report and saying it was urgent we got on with the implementation of the change, and we know how long ago that was.

Pat Breen (Clare, Fine Gael)
Link to this: Individually | In context

Will the Minister rule against the HSE?

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

No, every facility on the acute hospital side must operate to the highest possible standard of patient care. If we moved to a licensing system or to an insurance model where the insurers determined where things happen, many of our small hospitals would be closed overnight. There is no doubt about that.

Jan O'Sullivan (Limerick East, Labour)
Link to this: Individually | In context

Can the Minister clarify that so far the HSE has not proposed the closure of hospitals to the Minister and that if it does, she will be asked first?

Pat Breen (Clare, Fine Gael)
Link to this: Individually | In context

That is what we want to hear. Will the Minister reassure us?

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

The service plan and any adjustment of it must be approved by the Minister and laid before the Houses of the Oireachtas. That is in the 2004 Act and will be complied with. We are making radical changes in what happens in the hospitals with terrific clinical leadership, which has emerged for the first time.

Deputy Ferris asked about an audit. I do not know who is supposed to carry out the audit. We have had health and safety reports and fire reports on some of the long-term facilities and people do not seem to be very happy to accept them. Experts on safety from either a health and safety or fire point of view are often challenged in this House when recommendations are being implemented.

Deputy Ferris asked a similar question on hospitals to Deputy Jan O'Sullivan. There is no plan to close any hospital in the country. Major reform is taking place in the north east, particularly regarding what happens between Monaghan and Cavan where there is a single hospital on two sites. There is reconfiguration on what happens in each site. The more acute services happen in Cavan and many of the day procedures happen in Monaghan. That is well documented. Deputy Ferris's colleague recently attended a meeting with me and all the Oireachtas Members for Cavan-Monaghan with the chief executive officer of the HSE.

I do not have details on the disadvantaged area projects the Deputy mentioned. If he submits them to my office, I will seek to get a response for him.

Joe Carey (Clare, Fine Gael)
Link to this: Individually | In context

On the day the Teamwork report was published, there were patients on trolleys for up to three days in the north east and the hospital had to close for a time. Is the Minister familiar with the highlands and islands of Scotland model of health care delivery? Is she familiar with the models used in Cornwall and in the Downe hospital in Downpatrick, which provides health care to a peninsula, which is similar to County Clare? It is essential that we maintain and work within the "golden hour", the standard international maximum time limit to treat anybody who has suffered a stroke or heart attack or who has been involved in an accident. I want to know if the Minister is familiar with those models of health care.

I appeal to the Minister to walk away from the Teamwork report. Great concern and anger has been expressed by the people of County Clare. Along with other Deputies, I have attended public demonstrations and meetings where GPs, nurses and ambulance personnel have expressed deep fears and concerns about patient safety if accident and emergency services are removed from Ennis General Hospital. I ask the Minister to step back from this, examine it and listen to the people on the ground, the GPs, nurses and ambulance personnel who have major concerns about this. I ask the Minister to take those concerns on board and walk away from the Teamwork report.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context

I must confine Deputies to questions. Does the Deputy have a question for the Minister?

Joe Carey (Clare, Fine Gael)
Link to this: Individually | In context

Yes, I asked whether the Minister is familiar with the highland and island, Cornwall and Downpatrick models. Does the Minister hold the "golden hour" in regard? It seems Deputy Dooley does not. I ask the Minister to walk away from the Teamwork report.

Jan O'Sullivan (Limerick East, Labour)
Link to this: Individually | In context

Will the critical care unit promised for the Mid-western Regional Hospital in Limerick be in place before there is a reduction in accident and emergency services in Ennis and Nenagh, as proposed? Will the ambulance services be available, as promised? Patients will not be any safer sitting on trolleys for hours on end waiting for attention in the accident and emergency in Limerick than they will be in the smaller hospitals. While the Minister says it is a matter of safety, surely putting in the resources and capacity in the central regional hospital is vital to safety.

Could the Minister answer a question on colorectal screening I raised during my contribution? Will she assure us that the funding promised for this year to provide the screening into the future will be made available so the programme can go ahead in the timeframe planned?

Dan Neville (Limerick West, Fine Gael)
Link to this: Individually | In context

Does the Minister accept the research I quoted earlier on the increase in suicide levels during periods of recession? Research going back to the 1890s by Emile Durkheim shows there is an increase in suicide during recessionary periods. Does the Minister accept that is the case and that provision must be made to deal with it? What, if any, will be the cuts in funding to the National Office for Suicide Prevention in the 2009 budget? If there are cuts, will they be in the operation of its direct services and what level of cuts will there be to the voluntary organisations funded by the National Office for Suicide Prevention?

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

I have the service plan for 2009 and under mental health there is an extra €2.8 million for suicide in 2009. One of the sums of money I mentioned in this House before is an additional €1.75 million. Any revision of the service plan will have to come before me, and suicide prevention is a priority. The Deputy has raised this matter on the Adjournment debate and it will be taken this evening.

Dan Neville (Limerick West, Fine Gael)
Link to this: Individually | In context

It will not be answered on the Adjournment debate. There will be a pre-written reply.

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

The service plan provides additional funding of €2.8 million. Deputy Neville can obtain a copy of the service plan.

Dan Neville (Limerick West, Fine Gael)
Link to this: Individually | In context

What about the voluntary organisations?

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

I told the Deputy an extra €2.8 million has been allocated for 2009.

Dan Neville (Limerick West, Fine Gael)
Link to this: Individually | In context

Will there be cuts in funding to voluntary organisations?

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

There may well be cuts around administration. Time and again people in this House scream about bureaucracy, administration, travel and subsistence, but when we implement cuts there is more criticism.

Dan Neville (Limerick West, Fine Gael)
Link to this: Individually | In context

I am not being specific.

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

The Minister of State, Deputy Moloney, will be here later to deal with the specific issue the Deputy has raised.

Dan Neville (Limerick West, Fine Gael)
Link to this: Individually | In context

Will there be a cut to voluntary organisations?

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

There may well be cuts to voluntary organisations, but, if so, they will be around administration, as there is in the voluntary sector generally. We have 600 voluntary organisations in the disability sector in Ireland. Last year, they had to take a 1% cut in their administrative budgets and this year there will be a second 1% cut in that administrative budget. Unless we do that, we will not have the money to provide services to patients, whether more professional staff in mental health or more therapists in disability, etc.

With regard to Deputy Joe Carey's question, I am well aware of the highlands and lowlands and everywhere else. I am also well aware of everybody who does not want any change in Ireland. They will search the world to find something that might give them some credibility.

Joe Carey (Clare, Fine Gael)
Link to this: Individually | In context

This actually works.

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

I am aware that going into an accident and emergency department where the doctors treating one have no specialist training is unsafe and is not recognised by anybody. Earlier this afternoon, I had a meeting with Professor Tanner of the Royal College of Surgeons of Ireland, an accident and emergency unit consultant from Beaumont Hospital and others on trauma and the importance of auditing. In the course of this meeting, we discussed the importance of getting victims of trauma experiences such as road traffic accidents to a specialist centre as quickly as possible after paramedics get to the scene of the accident. Mortality outcomes are improved by 25% when this happens.

The "golden hour" is not about taking one to a place called "hospital" and once one is there, suddenly one will be saved. It is about getting one as quickly as possible to specialist care. This brings me to Deputy Jan O'Sullivan's question. Mr. Burke has been given clinical leadership responsibility in the mid-west. He will press the green button on when accident and emergency services transfer. My understanding is, and the intention is, that it will happen in April, which is next month.

The two vehicles for the advanced paramedics have been purchased and are ready. They are in place. Some capacity issues have been dealt with in the hospital in Limerick. The critical care unit is a longer-term project and it will not happen prior to the summer. It is not a necessity for the transfer of seven patients on average per night from Nenagh, six of whom should have been with their GP, and the nine patients from Ennis, many of whom should have been seen by their GP also. This transfer does not need the critical care unit to be in place in advance.

Joe Carey (Clare, Fine Gael)
Link to this: Individually | In context

Does the Minister have the eight consultants?

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

Many of the consultants have been recruited and are part of the group I mentioned earlier.

Joe Carey (Clare, Fine Gael)
Link to this: Individually | In context

How many?

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context

We have very limited time left.

Joe Carey (Clare, Fine Gael)
Link to this: Individually | In context

There are only three.

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

There are 400 doctors and 1,400 nurses in the mid-west. We do not get the outcomes we should with this huge number of clinicians in the region because of the fragmented nature of the service they provide.

Joe Carey (Clare, Fine Gael)
Link to this: Individually | In context

They have no facilities.

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

We have 12 surgeons spread across four hospitals. This does not deliver the best outcome for patients. The intention is that these surgeons will work as part of a surgical team doing the more acute work in Limerick and the less acute work in Ennis, Nenagh and St. John's. We know more patients from Clare and Tipperary will be treated in their local hospital as a result of the reconfiguration than is the case today.

Jan O'Sullivan (Limerick East, Labour)
Link to this: Individually | In context

I asked a question about colorectal screening.

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

I am in discussion with the National Cancer Screening Service with regard to colorectal screening. It is the next screening programme we want to put in place and I want to see that happen as quickly as possible. I have not provided additional money for it this year but I am in discussions with the National Cancer Screening Service on these issues. All the cancer experts available to me within the Department, clinicians in the field and Professor Keane state that it is the next very important area where we must provide resources. It is my intention that this will happen as quickly as possible.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

I ask the Minister to forgive me for smiling earlier but Deputy Dooley appeared to be having a minor "Paul Gogarty moment" behind her.

I do not intend to reopen the mid-west issue. It is quite clear from the Teamwork report that certain continuances were to be put in place prior to the services being moved. This has not been done. With regard to recruiting consultants, the Minister pointed out that this takes many months, if not years. They will not be in place this year. However, the Minister is quite happy to fire everybody up to the accident and emergency department in Limerick which has not been upgraded in the way the Minister said it would be. The critical care unit there, which will be needed, is not in place and the extra beds are not in place.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context

I am very conscious of time and I am trying to get everyone in.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

I am also conscious of time. This debate is about the health cutbacks and the HSE generally. More than 100,000 people work in it and it is not delivering. Regardless of what the Minister's colleagues state, all 320 people who are lying on trolleys today know that it is not working. People waiting for colonoscopies for as long as Susie Long did know it.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context

Does the Deputy have a question?

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

There should be less of the soft peddling of ideas that do not match fact. Will the Minister tell the House whether she will ensure that as a result of these cutbacks, which as far as I am concerned are due to mismanagement, patients will not suffer and there will not be an increase in delayed discharges, cancelled operations or the number of people lying on trolleys?

Pat Breen (Clare, Fine Gael)
Link to this: Individually | In context

Has the Minister seen the HIQA report on patient safety at Ennis General Hospital? When will the report be published? Will the Minister assure us that the €39 million earmarked for Ennis General Hospital will be ring-fenced and spent in the hospital? Let us be clear on this as it is an opportunity for a one to one exchange and my good colleague, Deputy Dooley, is also in the House.

Timmy Dooley (Clare, Fianna Fail)
Link to this: Individually | In context

Will Deputy Breen answer the question I asked before he sits down?

Seán Sherlock (Cork East, Labour)
Link to this: Individually | In context

Earlier, I asked whether it is the Minister's intention to close Mallow General Hospital. I would like a clear "Yes" or "No" answer. I understand the Minister replied by stating it would be subject to revised service plans. In the event that the subject plan does not adhere to standards laid down by the Department, what does she envisage for the future of the hospital? We need clarity on this once and for all.

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

I already answered "No" to this question. I want to state to all Deputies, in particular Deputy Reilly who comes in here week in week out and opposes every reform——

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

I supported the cervical cancer vaccine.

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

He has not taken on a single person in the health service. Every vested interest is represented by him in this House and it is about time we heard from him where he would make the changes.

Timmy Dooley (Clare, Fianna Fail)
Link to this: Individually | In context

Hear, hear. That is a good question.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

I just did if the Minister was listening.

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

Every reform is opposed by Deputy Reilly. With regard to the HIQA report, it will be published. I have not seen it but I understand it has not been completed. As soon as it is completed, I will——

Joe Carey (Clare, Fine Gael)
Link to this: Individually | In context

Will it be published prior to the local and European elections?

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

I hope it is published as quickly as it is completed. This is the intention. We do not sit on reports like that.

Joe Carey (Clare, Fine Gael)
Link to this: Individually | In context

It was supposed to be published in January.

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

It is not complete and it is a complex task to carry out an inquiry of this kind, as Deputy Carey well knows.

Joe Carey (Clare, Fine Gael)
Link to this: Individually | In context

The team of reporters was stalled as well.

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

Anybody that may be adversely affected by the findings must be given an opportunity to make a contribution. HIQA is no different from any other organisation carrying out an inquiry. It must follow due process.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

The people affected were crying out for HIQA months before the Minister let it do the inquiry.

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

Deputy Reilly is a doctor and it is about time——

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

The Minister has been in this Government for more than 12 years.

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

It is about time Deputy Reilly stopped going around the country playing politics with patient safety because that is what he is doing. Politics before patient safety.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

The HSE is a Frankenstein for which the Minister will not take responsibility.

Pat Breen (Clare, Fine Gael)
Link to this: Individually | In context

I asked the Minister a question about the €39 million for the hospital and she refused to answer it like she refused to answer all questions asked this evening. There is a problem——

Timmy Dooley (Clare, Fianna Fail)
Link to this: Individually | In context

There is and it is over there.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context

In fairness, there were more questions asked in a half an hour than is normal.

Pat Breen (Clare, Fine Gael)
Link to this: Individually | In context

There were no answers. Deputies Dooley and Mansergh were arguing about the "golden hour". There is no unity there.

Mary Harney (Dublin Mid West, Progressive Democrats)
Link to this: Individually | In context

It is about convenience and not quality.

Pat Breen (Clare, Fine Gael)
Link to this: Individually | In context

We know that.