Dáil debates

Wednesday, 12 May 2010

Adjournment Debate

Accident and Emergency Services

8:00 pm

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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I thank the Ceann Comhairle for permission to raise this important matter. I hope the Minister of State has good news because the Government has spent more than €11.5 million on a state-of-the-art accident and emergency unit in Our Lady of Lourdes Hospital, Drogheda, which has lain idle since the end of last year. It is, therefore, in its fifth month without use. In the meantime, every week dozens of patients lie on trolleys in the hospital. Patients, staff and the good name of the hospital are suffering as a result. The hospital has received bad publicity in the past but the medical staff want this facility to work. The people need the unit, which should have been built five years ago. It is well behind schedule and we want to look forward to its opening.

A total of 34 additional staff are needed for the new unit but I understand this is an issue. The taxpayer has made a commitment to a state-of-the-art facility in the north east and it is imperative that the Government recruits the necessary staff. The HSE has not made a decision to prevent the unit opening. It is prepared to hire the staff but the issue is whether the Minister will give consent in order that specialist nursing and care staff can be appointed.

This week the Drogheda Independent described the appalling conditions in which people must work and in which patients must stay. A 91-year old lady suffering from Alzheimer's disease spent more than 28 hours on a trolley while a 70-year old woman spent more than 32 hours on a trolley in recent months. It is not good enough. When will the unit open? Why has consent not been given to recruit staff? The people of the north east need this facility. The Government has closed services in Dundalk and Monaghan, which people have not accepted, and there is significant pressure on the Our Lady of Lourdes Hospital, which is chock-a-block day and night. Sick people need the new unit and medical staff, who have waited patiently for many years for this facility are becoming increasingly angry that they have to look at a ghost department. State-of-the-art beds and equipment are covered in plastic and cannot be used. Doctors and nurses with tremendous skills need this equipment and they need to provide a service to save lives. Patient care is suffering as a result. I hope the Minister of State has good news.

9:00 pm

Photo of John MoloneyJohn Moloney (Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Justice, Equality and Law Reform; Laois-Offaly, Fianna Fail)
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I apologise on behalf of my colleague, the Minister for Health and Children, who could not be present. I thank the Deputy for raising this matter.

The transformation programme for the north east involves widespread and fundamental change. It is designed to build a health system that is in line with the model of care emerging internationally. This can be achieved by centralising acute and complex care in order that clinical skill levels are safeguarded by ensuring access to a sufficient throughput of cases. The need to reconfigure health services in the north east was highlighted, along with identified patient safety and quality of care issues, in the 2006 teamwork report to the HSE: Improving Safety and Achieving Better Standards - An Action Plan for Health Services in the North East. This report demonstrated that the service configuration in the region was unsustainable.

This report demonstrated that the service configuration in the region was unsustainable.

The first step in transforming services in the north east is to develop a fully integrated regional health service to ensure that people in the north east have local access to both routine planned care and immediate life saving emergency care. The HSE began this process with the transfer of acute inpatient services from Monaghan Hospital to Cavan General Hospital on 22 July 2009, which was supported by the opening of the medical assessment unit, MAU, in Cavan General Hospital in March 2009, the development and implementation of an enhanced ambulance and pre-hospital thrombolysis service, together with enhanced primary care services.

The immediate focus is now on service reconfiguration in the Louth and Meath area, which involves transferring acute services to Drogheda, strengthening existing medical services, enhancing emergency department capacity, developing appropriate ambulance protocols, completing surgical reconfiguration and providing additional community packages of care. The new emergency department at Our Lady of Lourdes Hospital Drogheda will provide an improved service to both patients and staff within the Dublin north east region. This new department, which encompasses best design principles, is approximately 1,300 m2 in size, and represents a 300% increase in size from the existing department in use today. The increased size of the department and the specific entrance points will allow patients access the department in a more timely manner by segregating patients at first point of contact with a separate entrance for ambulance and stretcher-borne trauma and another separate entrance for the walking wounded, as it were.

Once the department opens, all paediatric patients presenting to it will be assessed and treated in a designated paediatric area. Adult patients will be allocated to one of three distinct assessment and treatment areas; the minor injuries department, the major treatment department and the resuscitation area. Patients will have more immediate access to diagnostics with an on-site emergency department, dedicated X-ray facility and staff. Patients will benefit from more immediate treatment, enhanced outcomes and a more patient-focused environment. Staff will benefit as the new infrastructure and design of the department will facilitate easier access to patients and ultimately earlier admission or discharge.

The increase in size of the emergency department means that staffing levels must be examined. That is the nub of the issue. Under the 2010 employment control framework the filling of posts is in the first instance to be by redeployment from within current services. Once redeployment options have been explored, external recruitment may then proceed in line with this framework. The HSE is committed to opening the new emergency department at Our Lady of Lourdes Hospital in Drogheda at the earliest possible date. Negotiations are in progress between the HSE and unions in order to agree a mechanism to redeploy staff at all grades and in some instances to consider outsourcing or contracting. Unfortunately, it has not been possible to reach agreement on these matters to date but the HSE will continue to try to achieve an agreement as quickly as possible in order to open the facility.

Photo of Jimmy DevinsJimmy Devins (Sligo-North Leitrim, Independent)
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I thank the Acting Chairman and the Ceann Comhairle for allowing this motion on the Adjournment tonight. I welcome the Minister for Social Protection, Deputy Ó Cuív, and thank him for attending. We live in times of great financial difficulty. At the moment every citizen of our country is suffering from reduced income, in some cases, much reduced income. The Government is to be commended on taking the corrective action needed to stabilise the national finances, painful and all as it is. Among the people who have suffered are the recipients of social welfare who have seen a dramatic reduction in their payments. In the light of the reduced money available to Government, it is essential that those who are genuinely in need of social protection receive it. We must do all in our power to ensure they are protected from further cuts.

In that context, any abuse of social welfare payments must be eradicated. In recent months I have become aware of anecdotal evidence of false

claims made by some people on social welfare. That evidence has become stronger recently. I pay tribute to the citizens who have brought that to my attention, some of whom are themselves social welfare recipients.

A recent letter in the Irish Independent on 24 April summed up in a succinct way the point I am making. It asked how a non-national living and working in Norway for the past three years can still receive €600 per month jobseeker's allowance from the State. I suggest that the following measures, if implemented, would save a considerable amount of money, which then could be used to protect the genuine recipients of social welfare payments. We must examine the possibility of ceasing the payment of unemployment benefit-jobseeker's allowance into bank accounts. The money should be collected by the recipient presenting himself or herself in person at the post office. If that is not feasible and the money continues to be paid into a bank account, it should be collected personally in the bank. Those measures would prevent a serious abuse of the payment system.

We could also introduce a change in the practice of giving one month's notice of signing on. That could be reduced to one week's notice. Thus, if someone is out of the country, he or she would not be able to obtain a cheap flight to return to the country to collect the money, thereby making it uneconomic for him or her to claim the allowance while abroad.

The Minister is innovative. I urge him to devise schemes whereby worthwhile community work could be done by those who are able to work but who through no fault of their own are unemployed. Such people want to work. In his previous Ministry the Minister initiated many very good schemes, such as the rural social scheme, which were and still are highly regarded by those who partook in them. Asimilar scheme in this area would be very welcome. There exists a serious abuse of our social welfare system by a small minority and it is imperative that the majority of social welfare recipients who are genuinely in need of social welfare support are supported.

Photo of Éamon Ó CuívÉamon Ó Cuív (Minister, Department of Social and Family Affairs; Galway West, Fianna Fail)
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I thank the Deputy for raising this issue. As he rightly pointed out, every euro that is fraudulently claimed is a euro taken out of the pockets of those who urgently need those payments. We must view fraud in that context.

The prevention of fraud and abuse of the social welfare system is an integral part of the day-to-day work of the Department. I listened with great interest to what the Deputy said and I will examine all of the suggestions he has made. The expenditure of the Department exceeded €21 billion in 2009 in respect of approximately 50 schemes. During 2009 the Department processed 2.5 million claims and issued in excess of 83 million payments. It must be emphasised that the majority of people are receiving the entitlement due to them.

The objective of the Department's control strategy is to ensure that the right person is paid the right amount of money at the right time. The prevention of fraud and abuse of the social welfare system is an integral part of the day-to-day work of the Department. Approximately 620 staff work in areas related to control of fraud and abuse of the welfare system. At the end of 2009 more than 750,000 individual claims were reviewed and the Department recorded control savings of approximately €484 million. The control savings target for 2010 is €533.31 million.

The level and types of fraud and error vary across schemes but customers typically incur fraud in situations such as failure to disclose their full means or increase in means; failure to disclose the true employment or residential status of their spouse, partner or dependants; claiming jobseeker's payments when they are in fact working; absenting themselves or their dependants being absent from the State; and working while claiming to be incapable of work.

In recent years the Department has undertaken a range of initiatives to tackle the problem, including increased control activity focused on the prevention of fraud and error at claim application stage.

This is the most cost effective mechanism of reducing losses through fraud and error in social welfare schemes. Significant advances have been made to reduce the risk of overpayment through systems "talking" to each other. With the introduction of the new service delivery modernisation, SDM, a greater number of the Department claims and payments are sharing a single technical platform. This basically stops double timing and the various systems being abused in that manner.

The Department is moving to a risk-based system of claim review, which focuses resources on the most appropriate cases. This involves assigning and recording a risk rating at the award and review stage. In order to identify fraud and error levels in schemes the Department carries out detailed fraud and error surveys on individual schemes which provide evidence-based indicators for levels of fraud and error on those schemes at a particular time.

The Department has also introduced a series of certificate processes in its schemes. Certificates issue to the customer for completion, for example to targeted customer groups by age, payment method, location or country. Certificates that fail to be returned or are completed incorrectly may result in suspension or termination of claims.

As a fraud preventative measure the option to receive payments by electronic fund transfer, into a bank account, was removed for new claimants of jobseeker payments and that addresses one of the Deputy's issues. Border regions put an increased emphasis on control of claims from applicants with a previous address in Northern Ireland. One-parent family payment recipients with earnings are the subject of an ongoing review. Data matching requests to other Departments and agencies is considered a vital tool for targeting effective reviews and successfully achieving savings. New anti-fraud measures have been included in the Social Welfare and Pensions Act 2009 which provide for the transfer of bulk information relating to recipients of social welfare payments to the competent authority of another member state, international organisation or other country with which reciprocal agreements have been made.

One of the anticipated advantages of the introduction of the public service card, which will include a photograph and signature, is that it will help to reduce fraud and error which result from the incorrect identification of benefit claimants. The special Investigation unit of the Department works with other agencies such as Revenue, NERA, Customs and the Garda to ensure that control activity is being targeted at high risk categories of claimants or employers.

Since January 2010, members of the public can report suspected social welfare fraud anonymously to the Department by completing a new online form on the Department's website at www.welfare.ie. The number of anonymous reports from members of the public has increased dramatically, with over 6,400 made at the end of 2009 compared to approximately 1,000 in 2008. Each report is followed up. The Department is committed to ensuring that social welfare payments are available to those who are entitled to them. In this regard the control programme of the Department is carefully monitored and the various measures are continuously refined to ensure that they remain effective.

I assure the Deputy that I will ask my officials to review the suggestions he has made. We all have a duty to ensure that fraud is minimised so that we can pay those who badly need the support of the State and so that we may retain the money for the targeted groups. Savings can be used over time to make improvements. The Deputy has mentioned the various schemes and I am anxious to see when we get the new transfer of powers as regards CE, RSS, CSP schemes whether we can pay fewer people not to work and pay more to be active in community services.