Jimmy Deenihan (Kerry North, Fine Gael)
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Question 27: To ask the Minister for Defence his plans in view of the medical service review report conclusions (details supplied) for the implementation of the report; the resources he proposes to devote to the implementation of the report; the timeline he is working to in order to implement the recommendations of the report; his views on the report's conclusions; and if he will make a statement on the matter. [25226/09]

Willie O'Dea (Limerick East, Fianna Fail)
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The development of the medical corps in the Defence Forces forms part of the agreed programme for Government. I am committed to providing a sustainable medical service to meet the needs of the Defence Forces both at home and abroad. As the Deputy is no doubt aware, the challenges in the medical arena have been recognised for some time and a review of the provision of medical services has been ongoing as part of the modernisation agenda for the Defence Forces. In view of the complexity of the challenge facing the Defence Forces in this area, I decided to engage PA Consulting to make recommendations on the best means of meeting the medical requirements of the Defence Forces. To meet this objective PA Consulting reviewed the medical services required for the Defence Forces in light of its roles and operations as required by Government, assessed the current arrangements for the provision of medical services and proposed a model for future delivery of medical services.

The consultants recommended a programme of major change. Their report makes a number of recommendations, including a centralised command structure and the creation of a medical services management and administrative function. This structure will provide strategic planning, resource allocation and overall responsibility for the management and delivery of the medical service. They also propose the development of medical officer lead care teams together with a refocusing of medical staff on appropriate clinical tasks. The report also recommends steps leading to a reduction in the number of doctor interventions and medical assessments and better management of health services outsourcing. The structure and systems recommended have been designed to meet the needs and demands of modern Defence Forces at home and overseas and provide medical officers with a fulfilling and rewarding career.

The report reaffirms the need for a dedicated medical corps and addresses the challenges facing the Defence Forces in the recruitment and retention of medical officers. Implementation of the recommendations will result in major change at both strategic and operational levels in the Defence Forces. Thankfully in these difficult times, the report shows that major additional investment is not needed to meet the medical needs of the Defence Forces. Change will be achieved in the main through better use of the available resources. The PA report is an important milestone in addressing the challenges to the provision of medical services in the Defence Forces. Implementation will take time and commitment. This will be achieved in consultation with the representative associations. I have asked that implementation of the recommendations of the report proceed immediately.

The report makes a number of recommendations regarding a governance structure for change delivery in this area. The structure recommended, including a high level steering group composed of both military and civilian personnel, will be used. At a lower level a dedicated programme group with civilian and military representatives will manage the delivery of a suite of projects identified by the consultants. I welcome the recommendations and fully support their implementation. Implementation by the military authorities will commence immediately. Certain recommendations will require further elaboration. Consultation with the representative associations will also take place.

Jimmy Deenihan (Kerry North, Fine Gael)
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I welcome the report. I remind the Minister this was the first question I put when I became an Opposition spokesperson on defence. I am pleased the Minister has responded and set up and appointed a group of consultants to draw up a very comprehensive report. I believe the Minister would agree this is a damning report on the present level of health services to which our Defence Forces are exposed.

We have a very professional Defence Force which has responded very positively to the White Paper. It is now very well equipped, the command structure is streamlined and, overall, it is an extremely fit, lean force. However, in the medical area the Department has fallen down and it has taken several years for the Minister to realise as much.

Let us consider the findings of the report. For example, there is a 60% shortfall in medical assessment in the Defence Forces, which is damning and puts the lives of personnel at risk. There are chronic difficulties in recruiting medical personnel, especially for overseas missions. A very basic service such as physiotherapy is outsourced. Given the large number of physiotherapists available at present, it should be easy to recruit several to work within the Defence Forces in some fashion. Some 30% of dental care is outsourced. Referrals to HSE, Health Service Executive, secondary and acute care are not tracked or monitored hence there are potentially dangerous gaps in medical reports.

Overall this is a very critical report. I realise the Minister has given some assurances today that the findings of the report will be implemented immediately. Specific health care teams comprising doctors, nurses and physiotherapists could be set up immediately by the Minister. Will he give a commitment to the House that he will begin to implement the recommendations in this report immediately? Is the funding ring-fenced? He said there would be very little financial commitment. Is funding available to implement these proposals immediately?

Willie O'Dea (Limerick East, Fianna Fail)
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I do not accept the report is a damning indictment of the Defence Forces medical services. It is clear from the report that medical treatment is available to members of the Defence Forces when they need it, whether that be from within the Defence Forces or outside.

I agree with Deputy Deenihan that there is considerable outsourcing, particularly in the physiotherapy area, and 30% of dental care work is outsourced. It must be borne in mind that there will always be outsourcing of medical facilities available to the Defence Forces because the Defence Forces medical services are not equipped to carry out certain procedures. A better management of outsourcing is required and it would be preferable to have as little outsourcing as possible. Good work has been done by the Army medical staff, but the model does not meet the needs of a modern army. The Department appointed consultants to advise on how to resolve that issue and we will take their recommendations on board.

In answer to Deputy Deenihan's question as to the timeframe for the implementation of the report's recommendations, we must first talk to the representative associations and a number of stakeholders must be consulted. I have asked the Department to begin implementing what can be done immediately.