Dáil debates
Wednesday, 24 June 2009
Leaders' Questions
10:30 am
Enda Kenny (Mayo, Fine Gael)
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The House is debating a Private Members' motion in the names of Deputy James Reilly and all Fine Gael Deputies on cutbacks at Crumlin hospital. This is a matter of serious concern, particularly to the parents of the children involved. The Taoiseach is aware that Crumlin hospital provides 80% of the country's specialist treatment for children.
During the course of the debate last night, the Minister for Health and Children stated: "I find it strange that when we ask hospitals to make efficiency savings, some hospitals decide that the most sensitive area is the one that must be cut first." This statement amounts to an outrageous attack on the doctors and nurses who keep this element of our health service ticking over.
Bernard DurkanEnda Kenny (Mayo, Fine Gael)
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As the Taoiseach is well aware from his visits to Crumlin hospital, parents who go through its doors are not looking for a manager or Professor Drumm, but a doctor or nurse to treat their sick children. This is probably the most emotive and sensitive aspect of health. I have visited the hospital many times. The children there have cancer, holes in their hearts, curved spines and so on. Their problems are the most sensitive.
Does the Taoiseach believe and accept the Minister's statement last night that doctors and nurses are effectively victimising children with serious illnesses in the interests of saving money? If he does not, will he ask her to withdraw her outrageous attack or remove her from her position?
Brian Cowen (Laois-Offaly, Fianna Fail)
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Of course the Minister for Health and Children was not saying that at all. The Minister for Health and Children was making the point that, before last Monday-----
Brian Cowen (Laois-Offaly, Fianna Fail)
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-----evening, it was being suggested that it would be necessary to close theatres and wards. That would be the job of the board of management and the management of the hospital. The board met on Monday evening and thankfully was in a position, with no changes to the budgetary arrangements, to make a decision that ensures that this in fact will not be the case.
I think that what the Minister for Health and Children is simply trying to outline is that an excellent service is being provided by that hospital. A reputation has been hard won and built up over many years. In the context of finite budgets, even in the context of this year's budget of a 3% reduction compared to last year, there is an increased level of activity in Crumlin hospital, which itself is confirmation that, through more efficiencies and more effective management of the resources, it is possible to increase throughput and output without generating the need for extra resources per se.
There will always be, in the context of any hospital or any health facility in the event of more resources being available, the possibility of more throughput and output in activity being able to be generated, but we have all agreed in the House for many years that it is only through service planning on a year-to-year basis that we can provide a sustainable health service. Working within those budgets, Crumlin management and its board of management were able to make a decision where, in fact, the closures that were regarded as necessary or unavoidable before last Monday's meeting thankfully did not come to pass because of the fact that they were able to make other decisions.
Enda Kenny (Mayo, Fine Gael)
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The Taoiseach did not answer the question. I asked him whether he believed the Minister for Health and Children's statement to the effect that she found it strange that the first cut to be made would be in the most sensitive area, thereby directly attacking doctors and nurses-----
Enda Kenny (Mayo, Fine Gael)
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-----who are not responsible for this position. The layers of bureaucracy above them, created in the bureaucratic monster funded by the Taoiseach and the Minister, are responsible.
The Taoiseach did not tell me that St. Joseph's ward is closed or that 4,000 bed days will consequently be lost. He did not tell me that 800 operations for young and sick children will be delayed this year. These facts were determined and witnessed by the Members of the Oireachtas, including some from Fianna Fáil, who visited Crumlin hospital yesterday.
Savings of just over €9 million are being sought in a system built up and funded by the Taoiseach and the Minister, Deputy Harney, and through which she is making an outrageous attack on doctors, nurses and other front line staff. Between 2007 and 2008, €60 million was spent on taxis and transport. A 10% efficiency would have created 66% of what Crumlin hospital needs this year. Bonuses for HSE bosses amounted to almost €1.5 million in 2007.
Enda Kenny (Mayo, Fine Gael)
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Outside consultants and PR cost €17 million last year. In her contribution last night, the Minister admitted that we are spending too much on advisers and outside consultants. On the growth of bureaucracy in the Health Service Executive, HSE, there were six grade eight senior management positions in 2000. Now there are more than 700. Despite all of that administration, there is at least €160 million in unpaid bills to hospitals. Advisers to Government last year cost €6.2 million. Some of that expenditure was transferred into the Taoiseach's Department from the Minister for Health and Children's budget. There is no evidence of any efficiency being created by Government in the HSE.
Let me return to the point I made at the outset, children from all over the country have to visit Crumlin hospital when they have a major problem. I spoke to a mother in the hospital recently who was sleeping in a room for three months with her head under the sink while her child with cancer was receiving treatment. The Taoiseach is aware that doctors and nurses work under the most pressurised conditions in that hospital to deliver what they know they can do best, namely, the sensitive treatment of major operations for young children. What happened in the House last night amounts to an outrageous attack on the nurses and doctors in Crumlin by the Minister for Health and Children.
Enda Kenny (Mayo, Fine Gael)
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The Taoiseach should have her withdraw that statement or remove her from her position.
Enda Kenny (Mayo, Fine Gael)
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This is not the kind of health system we want. This party will assist the Government to bring about efficiencies so that children can get treatment when they need it. When parents burst through the doors of a hospital, it is not Professor Drumm they are looking for, it is not a manager nor a senior executive at grade eight level, it is a doctor and a nurse who will be able to treat their child. As Deputy Reilly has pointed out, the longer one leaves curvature of the spine problems, the more costly it will be and the more interventions that will be required to bring children to a point where they can live a normal life.
Where does the Taoiseach expect to make efficiencies this year so that Crumlin hospital will not have to cut back on operations? Does he agree with the Minister for Health and Children's statement that doctors and nurses are deliberately victimising children with serious illness in the interests of saving money? If he does not agree with that statement, will he ask her to withdraw it or remove her from her position?
Noel Dempsey (Meath West, Fianna Fail)
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If she did not say it, she cannot withdraw it.
Brian Cowen (Laois-Offaly, Fianna Fail)
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The Minister, Deputy Harney, did not say that.
Brian Cowen (Laois-Offaly, Fianna Fail)
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That is the problem with Deputy Kenny. I heard the quote.
Enda Kenny (Mayo, Fine Gael)
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She said, "I find it strange that when we ask hospitals to make efficiency savings, some hospitals decide-----
Noel Dempsey (Meath West, Fianna Fail)
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Deputy Kenny has had his say.
John O'Donoghue (Kerry South, Ceann Comhairle)
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The Taoiseach should be allowed to speak without interruption.
Brian Cowen (Laois-Offaly, Fianna Fail)
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Here are her words. Deputy Kenny had approximately ten minutes when he should have had only three.
John O'Donoghue (Kerry South, Ceann Comhairle)
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It is the Taoiseach's turn now.
Enda Kenny (Mayo, Fine Gael)
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-----that the most sensitive area is the one that must be cut first." That is what she said. What does that mean?
John O'Donoghue (Kerry South, Ceann Comhairle)
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The Taoiseach should be allowed to speak now without interruption.
Mary Harney (Dublin Mid West, Progressive Democrats)
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It is not happening now, Deputy.
Brian Cowen (Laois-Offaly, Fianna Fail)
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What it means is that there is a need to manage the resource and direct it to the priority areas where it is required. It was directed not just in this specific case but generally to all boards of management in voluntary hospitals and to the HSE in respect of those hospitals that are run by the HSE. The reforms are ongoing and they are providing savings and putting clinicians at the front line. The whole purpose of the reforms the Minister has been leading is to bring hospital teams together to work for a better output for the resource that is available. That is being achieved by bringing forward clinical directors and involving clinicians in decision making and the management of hospitals, rather than have people acting individually as consultants within the hospitals. That is the case with many important services, including cancer services. It was suggested last week, for example, that cancer services would come to an end in Galway but that proved not to be the case either. If one looks at it simply on the basis of a status quo, against a background of a finite and challenging budgetary situation, then one has to make changes to ensure we get the outputs we need. The fact of the matter is that on page 19 of the Fine Gael Party's pre-budget statement it is suggested that efficiencies of 3% should be imposed on all health budgets.
James Reilly (Dublin North, Fine Gael)
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The efficiencies must be targeted.
Brian Cowen (Laois-Offaly, Fianna Fail)
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The reduction in the budget-----
Enda Kenny (Mayo, Fine Gael)
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Outside consultants cost €17 million.
Brian Cowen (Laois-Offaly, Fianna Fail)
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If I might complete the point-----
Enda Kenny (Mayo, Fine Gael)
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I agree there should be efficiencies, but not at the expense of children.
John O'Donoghue (Kerry South, Ceann Comhairle)
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Deputy Kenny should allow the Taoiseach to speak without interruption.
Brian Cowen (Laois-Offaly, Fianna Fail)
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-----because I listened in silence to what Deputy Kenny had to say.
John O'Donoghue (Kerry South, Ceann Comhairle)
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Deputy Kenny should allow the Taoiseach to conclude.
Brian Cowen (Laois-Offaly, Fianna Fail)
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Based on that assessment by Fine Gael, in order to get some consistency into the argumentation-----
Enda Kenny (Mayo, Fine Gael)
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A total of €17 million was spent on outside consultants.
Brian Cowen (Laois-Offaly, Fianna Fail)
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If I might be allowed to make my point.
John O'Donoghue (Kerry South, Ceann Comhairle)
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Deputy Kenny, the Taoiseach listened to you in silence and he must be extended the same courtesy.
Enda Kenny (Mayo, Fine Gael)
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I am sorry for being unruly, Taoiseach, but this is a sensitive matter. It is about children.
John O'Donoghue (Kerry South, Ceann Comhairle)
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He must be extended the same courtesy.
Pádraic McCormack (Galway West, Fine Gael)
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Even if he is talking rubbish.
John O'Donoghue (Kerry South, Ceann Comhairle)
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As I pointed out previously, this is a democratic forum. The Taoiseach has been asked a question and he must be allowed to answer it.
Pádraic McCormack (Galway West, Fine Gael)
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He is not answering it.
Brian Cowen (Laois-Offaly, Fianna Fail)
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That is a novel idea for the Deputy. The point is that the 3% reduction aligns exactly with the comparison between the 2008 budget and the 2009 budget for this hospital. It involves a 3% reduction in its budget. If, as stated on page 19, before the budget the Fine Gael Party says-----
Enda Kenny (Mayo, Fine Gael)
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A total of 800 operations have been postponed.
Brian Cowen (Laois-Offaly, Fianna Fail)
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-----there should be an efficiency, how can it suggest a 3% reduction in the budget cannot generate any efficiencies?
Enda Kenny (Mayo, Fine Gael)
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The Government has postponed 800 operations.
Brian Cowen (Laois-Offaly, Fianna Fail)
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Worse still, there is an inconsistency in Deputy Kenny's approach.
Enda Kenny (Mayo, Fine Gael)
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A total of €17 million has been paid to outside consultants.
Brian Cowen (Laois-Offaly, Fianna Fail)
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As the Minister, Deputy Harney-----
John O'Donoghue (Kerry South, Ceann Comhairle)
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The Taoiseach should be allowed to finish, please.
Enda Kenny (Mayo, Fine Gael)
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Some children will not be able to have operations.
Brian Cowen (Laois-Offaly, Fianna Fail)
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As the Minister, Deputy Harney, outlined in her speech yesterday evening, there has been an increase in staffing, including nurses and clinicians. We welcome that.
James Reilly (Dublin North, Fine Gael)
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Now the Government wants to leave them idle.
Brian Cowen (Laois-Offaly, Fianna Fail)
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Based on reportage I saw in newspapers, including this morning, there is approximately €30 million in a fundraising account that is available also in that hospital. It is a matter for the management to decide how it wishes to utilise those funds.
Brian Cowen (Laois-Offaly, Fianna Fail)
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It is important that we can ensure children with scoliosis have the required procedures carried out as quickly as is clinically appropriate and based on the advice and expertise available. The HSE has asked the hospital to come forward with a position on that to see how many more procedures can be carried out this year.
Paul Connaughton Snr (Galway East, Fine Gael)
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Why did the HSE not do that two months ago?
Brian Cowen (Laois-Offaly, Fianna Fail)
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We have seen through the National Treatment Purchase Fund and other mechanisms, means by which this can be done.
Enda Kenny (Mayo, Fine Gael)
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Only two cases will be treated in the next month.
Brian Cowen (Laois-Offaly, Fianna Fail)
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It is only fair, therefore, that if we are to have a debate on health reform and the need to improve the provision of our health service, it must be based on the fact that we have finite budgets that are challenging. We cannot come to the House and suggest we continue with the status quo and expect the same outputs.
Enda Kenny (Mayo, Fine Gael)
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Yes, but the Government spent €17 million on outside consultants.
Dermot Ahern (Louth, Fianna Fail)
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That is a political football.
Brian Cowen (Laois-Offaly, Fianna Fail)
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We should have a continuing debate on it. All of us must be prepared to challenge everyone in the health service to make the necessary reforms that will get the outputs that need not result in the closures that were predicted in this case or in Galway-----
Seymour Crawford (Cavan-Monaghan, Fine Gael)
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That has happened.
Brian Cowen (Laois-Offaly, Fianna Fail)
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-----that can allow for a mature debate in this House that will serve the people better by the provision of the taxpayers' money to best effect.
James Reilly (Dublin North, Fine Gael)
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Nothing the Taoiseach has said will relieve the pain and suffering of children and the distress of their parents.
James Reilly (Dublin North, Fine Gael)
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No, it is being real. The Minister should go back and look up a tree somewhere in north Dublin.
Eamon Gilmore (Dún Laoghaire, Labour)
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Since this time last year approximately 200,000 people have lost their jobs. When people lose their jobs they apply for social welfare payments. It usually takes a number of weeks for a social welfare payment to be processed and paid. If there is any complication with a claim, for example, if the paperwork is wrong, in particular if somebody has been self-employed, it can take much longer. In some cases it takes three months but it may be more before a social welfare payment is made. While somebody who has lost his or her job is waiting for a social welfare payment, he or she is expected to go to the health centre to make an application to the community welfare officer for supplementary welfare assistance. The problem now is that the community welfare system is creaking under the strain due to the large numbers of people who are turning up, and due to the impact of the Government recruitment and replacement embargo.
Let me give the Taoiseach a couple of examples. The community welfare officer in the Loughlinstown health centre in my constituency has been out sick for the past four weeks approximately. He was replaced, and his replacement is now out sick.
Pádraic McCormack (Galway West, Fine Gael)
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They are sick of it.
Eamon Gilmore (Dún Laoghaire, Labour)
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There has been no community welfare officer in the centre for the past several weeks. The community welfare officer in the Dún Laoghaire health centre has been out sick for the past three or four weeks, and there is no community welfare officer there either. I have heard of a number of other cases where community welfare officers are on holidays, which is perfectly understandable. The difficulty is that people are turning up at the centres but there is nobody to deal with their claims.
I met a man who has been out of work since 11 May. He has not received a payment of any kind from social welfare or the community welfare officer. He told me that but for the Society of St. Vincent de Paul he would have starved. I met another person who is out of work since January of last year who has a mortgage and is under pressure from the financial institution to pay the mortgage arrears. The person is entitled to mortgage interest relief but cannot get a community welfare officer to make a decision on it. Another woman, who was self-employed, has been trying to reach a community welfare officer for three weeks to address her requirements. I received a report stating people queued for two and a half hours at the Loughlinstown health centre this day last week to meet a community welfare officer, only to be told eventually that none would appear to deal with their problems. I do not blame the community welfare officers because I know them and realise they have done and are doing a fine job in very difficult circumstances.
There are two problems that must be urgently addressed. First, many of the people who are now attending at social welfare and community welfare offices have never had any contact with the social welfare system and never wanted to have any. It is a grim experience for them to find themselves out of work with no social welfare payment coming through and to discover the emergency service that is supposed to assist them is not available and nobody is present to deal with their problem. Second, there is a problem with the degree of pressure and stress now experienced by the community welfare service as a result of the large numbers attending and of the complicated circumstances of those who are presenting to make claims. I refer to those coming out of self-employment with varying types of social welfare records.
What will the Government do to ensure somebody who is already in bad circumstances as a result of having lost his job will receive the service to which he his entitled when he turns up at a social welfare or community welfare office? Will there be sufficient staff drafted in to ensure an adequate service is provided to meet the increasing demand? The service was dealing with approximately 150,000 unemployed people but there are now 400,000. The service needs to be adjusted to meet the new demand.
Brian Cowen (Laois-Offaly, Fianna Fail)
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I take the point that the Department of Social and Family Affairs has an increased workload as a result of the unfortunate rise in unemployment, particularly over the past 12 months. That point is known to all of us as constituency Members in so far as we have dealt with social welfare claims.
Some 365 staff have been transferred from other Departments to the Department of Social and Family Affairs and further transfers will be required. Deputy Gilmore has outlined to me some of the problems in his constituency regarding the sick leave of community welfare officers. I do not know the specific details. As the Deputy knows, there has been a long-standing industrial relations issue regarding the transfer of community welfare officer staff from the HSE to the Department of Social and Family Affairs, despite many attempts to address this on everyone's behalf. Bringing this process to a successful conclusion will greatly assist with the management of the situation, quite apart from addressing the extra pressures people are experiencing due to changed circumstances.
Special dedicated units have been established by the Minister, on her direction, to deal solely with claims, improve the throughput and reduce assessment and waiting times. An appointment system is in place in some offices and it is being rolled out nationally over time to assist people in avoiding queues. The Minister is aware of the need for a dignified effort by everybody to assist those who have to make social welfare claims.
I take the point that some people never believed it probable they would be dependent on social welfare payments during their careers. This issue, including the need to have more staff in the Department, is being dealt with as a matter of priority by the Minister. I will have to check the specific community welfare officer issues raised by the Deputy and revert to him on why there may be a problem with the officers' replacement.
Eamon Gilmore (Dún Laoghaire, Labour)
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My purpose in raising this problem is to get it solved. I am concerned about those who have lost their jobs. It is stressful for them in any event and involves a considerable change to their living circumstances. Suddenly having to turn to the social welfare service for assistance is bad enough but it is even worse if that assistance is not available and if one turns up at one's local office on any given week and finds a notice on the window stating there will be no staff present. This is not acceptable. If the process is working like this in the constituency of the Minister for Social and Family Affairs, which I have the honour of sharing with her, I suspect it is happening elsewhere also. I know it is from colleagues. I want to see the problem resolved such that one's social welfare claim will be dealt with promptly and that there will be a member of staff available to meet one at the social welfare office.
Apart from the consequences of the delays for the individual, which are my primary concern, there are knock-on consequences. My colleague, Deputy Higgins, drew attention recently to the consequences of the delays for people being offered short-term work. If an unemployed person takes up an offer of short-term work for a week or two, he will be placed at the end of the queue when he re-applies for social welfare. Somebody who has had to wait three months for his claim to be processed and who has had the experience I have described in respect of community welfare officers will wonder what will happen next time at the social welfare office when his or her short-term job is finished. Apart from the need to resolve the problem in the interest of the unemployed, it must be resolved in the interest of the existing cohort of community welfare officers who are under strain. It is a very stressful to be dealing with the number of claims being made at present and the system, as it operates, acts as a disincentive to unemployed people to take up short-term work. I ask that the matter be dealt with promptly. I will return to it if it is not.
Brian Cowen (Laois-Offaly, Fianna Fail)
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As I stated, I understand there is an accelerated process for people moving in and out of work and those requiring FÁS training, etc. The Deputy highlighted two points that are valid and need to be addressed. They are being addressed to the best of our ability under present arrangements. Reviewing present arrangements in terms of flexibilities across the public service and getting people to the point of contact at the pressure points more quickly are in the interest of all of us who wish to defend public services and see them provided in a timely and appropriate away.
In the context of the social partnership talks we are having at present on a sector by sector basis, there are discussions taking place on how we can improve the system, through the transforming public services agenda, to provide sufficient personnel when services pressures are particularly severe in specific areas of activity. Everyone must be prepared to review existing agreements and arrangements for this to happen, as Deputy Gilmore will know from the expertise he gained during his career in industrial relations. There is a requirement in general policy terms that all of us step up to the mark to ensure we can deal with these matters in a timely and appropriate way. The processes and systems we have in place in the industrial relations area mean, as the Deputy said, those who are dependent on services, whether for a temporary or more prolonged period, find their availability is not quite what they would desire.
It is in the interest of all of us who believe in public services to have flexibility on the ground to achieve the required outputs and service levels so they will be made available to those who have lost their jobs in a timely and appropriate way. This point is well made and the Government is making it in the social partnership talks. It needs to be addressed successfully by all of us collaboratively so we will achieve the outcomes people desire.
The industrial relations problem concerning community welfare officers generally has been with us for far too long. As the Deputy knows, there has been a series of recommendations-----
Brian Cowen (Laois-Offaly, Fianna Fail)
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It is in that we do not have the flexibility needed across the services to put the personnel in position when they are required.
Eamon Gilmore (Dún Laoghaire, Labour)
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It is a management issue.
11:00 am
Brian Cowen (Laois-Offaly, Fianna Fail)
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While I agree it is a management issue, it is not just that. It is also an issue that all of us involved in social partnership must address successfully.
Eamon Gilmore (Dún Laoghaire, Labour)
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A partnership agreement is not necessary to put in a replacement officer.
Brian Cowen (Laois-Offaly, Fianna Fail)
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With respect, the process of transferring more personnel into the Department of Social and Family Affairs to meet the need, has been successful with 360 employees thus far. We need more and we need them more quickly to ensure that service is available. We need to update the processes so that this happens in a more timely and expeditious way. That should be done, while respecting everyone's position, so that the people who depend on the service, not the service providers who have a job on their hands, get the it as they need it. That is the challenge for the transforming public services agenda and we are addressing it sector by sector. My colleague will furnish the full information on how to rectify the specific problem the Deputy raises as soon as possible.