Dáil debates

Wednesday, 6 October 2010

The following motion was moved by Deputy James Reilly on Tuesday, 5 October 2010:

That Dáil Éireann, noting with concern:

— that there are more than 46,000 adults and children on hospital waiting lists across the country, which is 5,400 patients more than last year;

— that over 272,000 bed days were lost in 2009 due to the delayed discharge of patients;

— that 50,000 operations have been cancelled since 2007, leaving many patients waiting in pain;

— the anguish that continues in hospital accident and emergency departments, with an average of 300 patients on trolleys each day; and

— that no further loss of capacity can be sustained;

calls on the Government to:

— ensure that there are no further reductions to front line staff or services;

— suspend the loss of front line health services and capacity at hospitals, for example, at Clonmel, Merlin Park, Nenagh, Roscommon, Navan, Sligo, Letterkenny, Portiuncula, Wexford, Monaghan, Ennis and Louth county; and

— immediately open the €16 million community hospital facility in Dingle, County Kerry.

Debate resumed on amendment No. 1:

To delete all words after "That Dáil Éireann," and substitute the following:

"in the context of the current economic challenges facing the country and the need for all regions in the Health Service Executive to operate efficiently within their 2010 budget provision:

— notes the huge improvements in recent years in the health of the Irish population, including the increase in life expectancy to 76.8 years for males and 81.6 years for females, increased survival rates for conditions such as breast and prostate cancer and reduced mortality from cardiovascular diseases, including strokes;

— notes the decrease in hospital infection rates of over 40% between 2006 and 2009;

— recognises that Ireland has one of the lowest infant mortality rates in the world;

— welcomes the endorsement from the European Union on being ranked second in Europe in quality palliative care;

— notes the very real progress in cancer screening and the fact that 122,000 women were given free breast cancer screening and 285,000 women had free cervical cancer screening last year;

— welcomes the fact that the HSE will deliver fully on the key areas of activity promised in its service plan for 2010, including 540,000 inpatient treatments, 689,000 day cases and 3.4 million outpatient attendances, 1.1 million emergency department attendances, over 9,500 home care packages and home help to 54,500 people;

— notes that the number of patients treated is a better indicator of the level of service provided than the number of beds available;

— welcomes the very positive impact of the fair deal scheme on the affordability of nursing home care for the 15,500 people who have applied for it and its positive impact on the problem of delayed discharges which has decreased by 30% since last year;

— welcomes the fact that data indicate that a significant majority of patients attending emergency departments are treated and discharged or admitted within the maximum waiting target of six hours;

— recognises that in these challenging times, the opportunity through the Croke Park agreement of introducing modern work practices, flexibility and deployment maximises the care available to patients;

— rejects misleading claims about the cancellation of operations which take no account of normal postponements for clinical reasons and the fact that hospitals arrange to reschedule patients' admissions for the earliest possible date;

— welcomes the appointment of national clinical leaders in many medical specialties such as neurology, diabetes and stroke, who will determine how best to provide services which will give patients the best chance of a good outcome;

— rejects inaccurate claims about inpatient waiting lists and welcomes the fact that the average waiting time for elective treatment is now just 2.6 months, down from between two and five years in 2002; and

— pledges its continuing support to the Government in its work to provide a safe, fair and cost-effective service for all."

- (Minister for Health and Children).

1:00 pm

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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I wish to share my time with Deputies Seán Sherlock and Liz McManus. I am very glad a Minister of State from the south east is present.

I have a good understanding of the Minister's position and she made a reasonable speech in the House last night. However, I wish to spend the time I have talking about reconfiguration, a process that has been under way in the south east for almost two years. The people of, and the elected Members from, Wexford engaged in the process of reconfiguration in a rational, open and non-locally focused way. We agreed to the centralisation of cancer care in Waterford Regional Hospital. Many years ago we agreed to the centralisation of acute orthopaedics in Waterford Regional Hospital. The people of Wexford do not have a parochial attitude. The criteria we applied to the entire process has been that there would be a rational health outcome, a best health outcome for the people we represent.

After almost two years of discussions, it was shocking to come into possession of a leaked document, which was about to be brought to the south east reconfiguration group last week, and to discover that decisions, which had at least been committed to paper, had no basis in a rational health decision and no basis in any conceivable good health outcome for the people of the south east as a whole.

Looking at the geography of the south east, Wexford is the largest county and has the largest population base. It must have access to 24 hours per day, seven days per week accident and emergency services. The distance is compelling on that point and we understood that was agreed.

There was a commitment, subsequent to the furore caused by that leaked document, that planning permission would be submitted this week for a new accident and emergency department in Wexford. We will judge the bona fides of the HSE on that and on the new obstetrics facility. We will engage on a reasonable basis but the HSE is putting at risk the possibility of any consensus on these matters. There is genuine concern among the people of Wexford about what might emerge from any decisions made behind closed doors by clinicians acting in their own interests rather than in the best health care interests of the people.

To give an indication of the concerns of the people of Wexford, I wish to bring two cases from my clinic list this week to the attention of the House. A child aged four has had throat problems for the past 24 weeks, has been on antibiotics for 13 weeks, has had numerous GP visits and has been hospital once during this period. Her GP referred her to the specialist in the regional centre, Waterford. On 4 October, this child was notified that she has been given an appointment to see the ENT specialist in 2013, three years from now. This four year old child is constantly sick and in pain.

The second case is of another child waiting to have a hearing test in Waterford. The reply I received to my query about when this child would be seen for a hearing test in Waterford Regional Hospital and which was signed by the network manager, hospital group south east, stated that the Waterford Regional Hospital routine waiting list for a hearing test in audiology services was two years and eight months. If that is centres of excellence and regionalisation of services, we will not have it.

Photo of Seán SherlockSeán Sherlock (Cork East, Labour)
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The motion speaks to the very notion of capacity and that there will be no further loss of capacity. We support that very notion. In regard to the reconfiguration process, in particular as it pertains to hospitals such as Mallow General Hospital, there is often the accusation that we are being overtly parochial. It must be remembered that a hospital like Mallow General Hospital will serve more than 100,000 people and will have approximately 100 GPs referring to it.

Mallow General Hospital is under the umbrella of Cork University Hospital but there is a deficiency in that Cork University Hospital has never viewed Mallow General Hospital as being under its umbrella or its ambit. The Health Information and Quality Authority is in the hospital currently. A case is being made in regard to Mallow General Hospital by all of the stakeholders, including the hospital representative groups, the GPs and the consultants, that we will accept changes. We accept change management and that there are budgetary constraints but we want a more lateral view to be taken by the HSE in regard to the future capacity of Mallow General Hospital.

We will accept changes in regard to Mallow General Hospital but one can do that and save money without reducing capacity. What is needed is for the sister hospital, Cork University Hospital, and the HSE to think more laterally about how they deploy resources from the centre to the margins to serve this community such that one does not have a bottleneck effect, that is, a reduction of capacity in Mallow General Hospital filtering through to Cork University Hospital and thereby undermining the capacity which will not be there because the budgetary provision will not be made to allow for increased capacity at Cork University Hospital.

We speak common sense. Large swathes of the population are served by the hospitals mentioned in the motion. We noted that Mallow General Hospital was not mentioned in the Fine Gael motion but I am sure that was an oversight on its part. We speak for those hospitals and support the motion in that regard.

Photo of Liz McManusLiz McManus (Wicklow, Labour)
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I thank my colleagues for the opportunity to raise an issue in my constituency which is causing grave concern, namely, the future of Wicklow hospital which provides long-stay care for the elderly. It is the only facility in Wicklow Town available for this purpose.

In recent days much concern has been expressed by local people because of indications that this hospital may close. We cannot get answers from the HSE. I ask the Minister of State, Deputy John Moloney, or the Minister, Deputy Mary Harney, to intervene to get the answer we need to hear from the HSE. The HSE has not met public representatives. The town council and the county council have all sought meetings. We know an engineer's report has been prepared but we do not know what it means.

There will be a public meeting this Saturday and there will be a large turnout. That kind of anxiety has been generated because the secrecy and uncertainty surrounding this issue is unacceptable. We need to hear loudly and clearly that the future of Wicklow hospital is secure and that improvements will be carried out as necessary.

We have already lost beds in the Orchard nursing home in Bray. At the time, the fire report made it clear that it could not continue to provide for elderly people because of the condition of the nursing home but those beds have not been replaced. In Wicklow town the problem is even more serious. I ask the Minister of State to make it his business to investigate and intervene in this matter.

Photo of Séamus KirkSéamus Kirk (Ceann Comhairle; Louth, Ceann Comhairle)
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There are many speakers in the next slot. I call the Minister of State, Deputy Mansergh, who will be followed by Deputies Seán Ó Fearghaíl, Margaret Conlon, Johnny Brady, Eamon Scanlon, Michael Kitt, Michael Lowry, Máire Hoctor, and the Minister of State, Deputy John Moloney, in that order.

Photo of Martin ManserghMartin Mansergh (Minister of State with special responsibility for the Arts, Department of Arts, Sport and Tourism; Minister of State with special responsibility for the Office of Public Works, Department of Finance; Tipperary South, Fianna Fail)
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Few issues are more sensitive, emotive or important than hospital reconfiguration. However, in an extremely difficult financial position where, as one commentator put it, Ireland is in the spotlight "24 seven", we must be measured and responsible even when expressing strong feelings. Comments beamed at the constituency may end up in the Financial Times or other international media as evidence of political instability or an inability to take measures required. "Loose lips sink ships" was said in Second World War Britain. Today, they can heighten nervousness on bond markets and, more importantly, the cost of borrowing.

South Tipperary General Hospital, in the words of the Health Service Executive, is a good, functioning hospital and is in itself a result of reconfiguration. It has received a great deal of investment and is only recently firing on all cylinders, so to speak. There is a determination in the community that it preserve its general hospital status and core services such as obstetrics, paediatrics and acute medicine. There are no resources for a major new regional hospital and, as we have heard already this evening from Deputy Howlin, the existing one in Waterford is fully stretched, to put it mildly.

The Tipperary Oireachtas Members met the HSE last week and the Government ones met the Minister, Deputy Mary Harney, today. A number of options are being considered, not just the one leaked last week, and they will not be finalised before clinical examinations at national level of different sectors are concluded in up to two years' time.

There will be regular meetings between the Oireachtas Members and the HSE, and we were told by the HSE last week that obstetrics would continue in South Tipperary General Hospital and in all the four south eastern hospitals-----

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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For the foreseeable future.

Photo of Martin ManserghMartin Mansergh (Minister of State with special responsibility for the Arts, Department of Arts, Sport and Tourism; Minister of State with special responsibility for the Office of Public Works, Department of Finance; Tipperary South, Fianna Fail)
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-----for the foreseeable future, something to which I attach particular importance. I understand the Minister of State, Deputy Andrews, may not necessarily go that far but I am satisfied that no decisions are likely in the lifetime of this Dáil.

The Minister, Deputy Harney, stressed the importance of patient safety at each hospital and made it clear that the health service would have to bear cuts which should not be interpreted as part of a plot to downgrade the hospital.

South Tipperary General Hospital is a vital part of the infrastructure of south Tipperary and Clonmel, one of the most important inland industrial towns. The determination to safeguard the future of the hospital must be combined with some flexibility, although it is important that nothing be done that would pre-empt or prejudice its equivalent role in the future to that it is playing now.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Kildare South, Fianna Fail)
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I am grateful to have the opportunity to contribute briefly in support of the Government's amendment to the Fine Gael motion before the House this evening.

It was appropriate that in her contribution last evening the Minister placed this debate in its proper context, that is, how can we as a country continue to provide the best possible health services to all our people at a time of enormous economic constraints? The statistics are worth repeating. The €15.2 billion that will be spent on health services in 2010 will exceed our total income tax take by a massive 33% and will represent 49% of the State's total tax receipts. It is impossible, therefore, to address the nation's budgetary problems without achieving savings in this area of massive expenditure.

The challenge for us all is to ensure that front-line services are protected to the fullest extent possible. That can be achieved only through urgent reform of systems and work practices across the entire health service.

The Croke Park agreement promises reform but in the health sector that reform must be delivered immediately. During the halcyon days of the Celtic tiger we could perhaps have afforded the luxury of indulging in procrastination and rhetoric but time lost now in achieving essential reform will result in inexorably growing waiting lists for both outpatient clinics and inpatient procedures, which ultimately increases human suffering and misery.I would urge that we capture this crisis and turn it into an opportunity to deliver a new partnership within the health sector, a partnership that permeates through all levels of the sector and one that is flexible, co-operative, innovative and effective in achieving even greater productivity at less cost.

On the matter of waiting lists, the progress achieved in recent years and that has been outlined here on numerous occasions by the Minister, Deputy Harney, must be acknowledged. The reduction of the average waiting time from between two to five years in 2002 to 2.6 months currently for surgical and medical procedures is highly significant. The work of the National Treatment Purchase Fund, NTPF, has been hugely effective in this area.

Another significant factor in achieving these efficiencies has been the recruitment of additional consultants and the implementation of the new consultant contract. In mentioning the consultant contract I would highlight again the protracted process that surrounded the negotiation of this contract as an example of what we cannot allow to occur in the package of reforms we must now achieve.

While acknowledging the major progress achieved, it would be remiss of me on the matter of waiting times not to highlight the difficulties public patients in my constituency are experiencing in accessing orthopaedic services, in particular at Tallaght hospital. Waiting times in that hospital are well in excess of 12 months, and the NTPF will provide service only to patients who have waited in excess of nine months. As a consequence, patients are enduring unnecessary physical pain, psychological distress and must resort to expensive medications, some of which have significant side effects. The economic costs of delays in treatment are evident, including loss of productivity within the workforce and extended primary care costs.

I am firmly convinced that we must apply the principles of the smart economy to achieving efficiencies within the health sector. The capacity exists across the country to effect waiting time reductions by utilizing technologies within the private sector and applying the principles to the NTPF. I propose that we give direct access to general practitioners, through competitively negotiated contracts, to MRI scans for investigations of conditions such as back pain. In so doing, many unnecessary referrals from GPs to orthopaedic clinics would be eliminated. The same approach could be applied to other areas of the medical field.

Photo of Margaret ConlonMargaret Conlon (Cavan-Monaghan, Fianna Fail)
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I welcome the opportunity to contribute to the debate. In setting the context for this debate it is important to state again that the budget for the HSE for this year is €14.6 billion. That is a huge amount of money in terms of what was spent on health care 20 years ago. The HSE must ensure that the services it delivers are delivered in the most cost effective and efficient manner.

At the end of August the HSE had a deficit in the hospital sector of €108 million. That is a huge amount of money. The HSE, no more than any other statutory body in the country or people in their own homes, must live within its budget because in a time when we are spending €5 for every €3 we take in in revenue, it is unsustainable. It cannot continue into the future.

I agree that people who are sick deserve the very best treatment in a dignified setting where patient safety is central. The patient must be the number one priority. He or she must have confidence in the care they receive and get the best possible outcome.

There are many good people working in the HSE delivering front-line services and good outcomes for patients on a daily basis but they are truly demoralised due to the large amount of negative publicity they receive. Those people must be recognised and affirmed. For example, the HSE published its hospital league tables for July and Cavan hospital was only one of two hospitals in the country to achieve green light status, having scored highly in many areas. That would not be possible without the hard work, dedication and commitment of the staff and the board. It is often the case that negative news hits the headlines but we must highlight the positive news. For most people the experience in hospital is positive and I would argue that only our sickest people need to be in hospital. Hospital should be the last place one ends up.

I am aware from a friend who works in an accident and emergency department that the weekends are very busy. In some cases people are bypassing the out-of-call service and going straight to the hospital. This is unnecessary and unfair and increases pressure on the services.

Medicine is not an exact science. There will always be challenges and there will never be enough money. Therefore, we must use what we have to achieve the maximum benefit for patients. I have witnessed first hand in my constituency the difficulties faced when reconfiguration takes place. I do not have medical expertise but I am guided by the experience of those who do. I understand that if we had a blank canvas in the north east, we would not have five hospitals but change is difficult. I spoke to a doctor a few months ago who told me that in his country change was something to be embraced, but that in this country it was something that was feared.

Since the changes came into effect in July last year there have been many positives. The minor injuries unit is working well and there is room for expansion. The medical assessment unit, MAU, in Cavan is excellent and the CT scanner is ready to run in Monaghan. We are waiting for the application specialist to provide the training. The ear, nose and throat, ENT, service is also working very well and there is scope for cross-Border development. We must all show leadership and courage in dealing with these sensitive issues to ensure better outcomes for patients.

Photo of Johnny BradyJohnny Brady (Meath West, Fianna Fail)
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In recent months my constituents have been greatly inconvenienced by the HSE decision to immediately end all acute and emergency surgery at Our Lady's Hospital, Navan. This is a major cause of concern to me, my constituents and staff at the hospital. I am also dismayed and dissatisfied with the way announcements were made, by the lack of consultation and by the absence of any clarification as to why these decisions were taken. I do not understand why the decision was made with such urgency. Since 2006, major surgical interventions have not occurred in Our Lady's Hospital, Navan. In February 2010, the previous practice whereby patients requiring major surgical intervention were taken by ambulance to Navan to be stabilised and then transferred to other hospitals ceased. Complex trauma patients who require major surgical interventions are now taken directly by ambulance to Our Lady of Lourdes Hospital, Drogheda or another appropriate hospital.

Over recent weeks, my colleagues and I have met the relevant authorities associated with the hospital to try and establish the truth of the situation and to seek clarification. My first and foremost priority is the safety of all prospective patients in County Meath. Consultants are adamant that there is no justification for the removal of keyhole surgery. All surgical activity is discussed at weekly audits and no concerns have been raised in the four years these audits have been held. The decision to prohibit this type of keyhole work in the hospital means arrangements must be made for patients to undergo their surgery in other already overcrowded and busy hospitals. Figures and data since 2003 for keyhole surgery at the hospital compare favourably with those of other hospitals.

Last month the HSE said that following ongoing clinical review at Our Lady's Hospital, there were a number of concerns regarding surgery. Developments and assessments since then show that concerns have not been justified and the hospital remains within peer unit norms for this type of surgery. Removing this elective work is therefore not justified. All the evidence indicates that elective surgery is safe at the hospital. Removal of this surgery would impact negatively on other services at the hospital, such as accident and emergency services, medical and orthopaedic services. This is unacceptable.

The management of our multi-billion investment in health in this country is of great concern. In comparison with value for money and services provided in other jurisdictions, we need to get better value for our investment. In the current economic climate, if we asked any businessman or woman what would be necessary to be done to survive in business, their first action would not be to make cuts in their front lines. I call on management of the HSE in the north east to reassess their priorities and spending processes. Frontline services are vital to our community. Over burdening other hospitals is not the answer. Our Lady's Hospital has an orthopaedic unit that has served people in the north east with great effect and excellent results for many decades. It is vital this service remains in place. We do not have the capacity within local hospital structures to accommodate the amount of work that has been dealt with in the Navan hospital.

The recent news that wards are to close shortly and that staff can expect to be redeployed is unacceptable. With the approach of winter and the extra pressure this inevitably brings on hospitals, I urge the HSE to rethink its position and consult with hospital staff. It is vital that all less complex care and significant diagnostics are provided locally.

Photo of Michael KittMichael Kitt (Galway East, Fianna Fail)
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I am pleased to have this opportunity to contribute. I know the Government must tackle a difficult budgetary situation but its priority must remain to protect frontline health services and meet the health and safety standards for patients. Portiuncula Hospital, Ballinasloe has been mentioned in the motion and I would like to cite what Dr. David O'Keeffe, the recently appointed clinical director of acute services for Galway and Roscommon has said about the hospital. He said that Portiuncula Hospital provides the majority of hospital services required by people living in east Galway and surrounding areas and would continue to do so. He went on to say that he wanted to reassure people that no hospital closures were taking place and that every hospital in the acute hospital network would continue to deliver the majority of health services required by the local community it served. He stated clearly, with the hospital manager in Ballinasloe, Ms Bridget McHugh, that the 2010 service plan covered in-patient targets, day cases, emergency presentations, emergency emissions and outpatients. I welcome that.

I also welcome the fact that there has been a big effort to tackle the overspend in the hospitals in counties Galway and Roscommon. For example, in July the overspend in Ballinasloe was heading for €7 million but by September the deficit was reduced to €4.5 million, a reduction of €2.5 million. Similarly, in Roscommon the deficit of €4.7 million was reduced to €2.2 million in September. There have been concerns with regard to configuration, particularly that involving Galway and Roscommon where there are four hospitals, the two in Galway city, Portiuncula and Roscommon. Of course there were concerns. Now we have Mr. O'Keeffe as clinical director to manage the four hospitals, with each hospital also having its own individual manager. That is welcome. I do not have to praise Portiuncula Hospital to the Minister, Deputy Harney, as she has often been reminded she was born there. She also opened a special babycare unit there early this year. Two new surgeon appointments have now been approved for the region and I hope that as a result we will see more procedures carried out in the hospitals outside of Galway city, namely, Roscommon and Portiuncula hospitals.

I commend the HSE and the trade unions on the talks they have had on cost savings. They have looked at non-pay related savings, career breaks, unpaid leave, use of overtime only as a last resort and flexibility in the reallocation of staff. They also examined spending on agency staff at weekends and weekend premia. Savings have been made and that is welcome. We must make savings and the hospitals have done that. At the same time, they have observed health and safety standards.

On the question of beds, there has been much mention of there being too many hospitals and too many beds. I cannot agree with that. We must deal with the situation as it is. There is no point in making sweeping statements about too many hospitals or beds. However, we must be clear about what each hospital does and about the certainty this gives to families and communities. I would welcome that clarity.

Photo of Eamon ScanlonEamon Scanlon (Sligo-North Leitrim, Independent)
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I thank Deputies Brady, Kitt and Conlon for sharing their time and am glad to have the opportunity to speak about Sligo General Hospital. The Sligo General Hospital management team is currently developing a cost containment plan to ensure that the hospital can deliver on service targets while remaining within the allocated budget. This plan will examine all areas to see where efficiencies and cost savings can be made. Staff have been briefed on the overall budgetary situation and on what is being proposed to address this.

Despite the financial challenge faced this year, Sligo General Hospital will deliver the level of care and service targets for which it is funded, as set out in the 2010 service plan. This includes 14,770 inpatient cases, 23,343 day cases and 92,256 outpatient visits to be delivered in 2010. On behalf of myself and the general population of Sligo and north Leitrim, I thank the 1,400 members of staff of the hospital, from the back door staff to the front door staff, who provide this service. They do an enormous amount of work and deserve our thanks and I want that to be on the House record.

While a reduction of some services within the hospital is inevitable, we are endeavouring to keep the reduction to a minimum to ensure the impact on service users will be kept to the minimum. There are more beds open in Sligo General Hospital today, 6 October, than on 6 October last year, despite what we have read in the press or heard from the media. We must do the right thing for the future and must eliminate inefficiencies and maximise the use of our resources to protect the future of our services. These are challenges in all health services across the country. Given the current economic climate, we in the west must be in position now and for the future to meet these challenges and ensure we have the best possible service for the people living in our area.

With regard to capital investment, I would like to mention that the extension to Sligo General Hospital has been approved for development as a public private partnership. Work has advanced on the preparation of the business case and other scoping information needed to support the cost-benefit analysis required for a project of this scale. Enabling works must be dealt with before the main project can commence on site. Detailed design is in progress on the main advance enabling works - the ring road - to ensure this is tendered and completed in time for construction of the main project. A planning application for the ring road will be submitted next week and the HSE will go to tender at the end of November. Construction of the ring road is scheduled to commence in early 2011 and market soundings are also being carried out to explore procurement options for the construction of a multi-storey car park to meet the increasing car parking requirements of the hospital, including those associated with all planned developments. The lead-in construction time for the PPP is approximately two years.

Many good things have happened. The acute assessment unit opened in the past 12 months, which is positive. Sligo General Hospital was also approved for a picture archiving communications system, a second oncology post has been approved and funded and we are awaiting two more posts. The hospital was deemed the fourth best performing hospital in Ireland last year.

Photo of Michael LowryMichael Lowry (Tipperary North, Independent)
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The motion is ill-timed, unwise and unhelpful to the cause of Clonmel General Hospital. It is unfortunate that it could be interpreted by the HSE as Oireachtas support for any negative proposal that may emerge regarding the status of that hospital. No decision has been taken on any proposal to remove further services from the hospital. The reality is nine reconfiguration options have been prepared and suggested for consideration by the HSE. I am satisfied following discussions with senior HSE executives that the reconfiguration and consultative process will take a minimum of two years to complete. The preferred options of the national steering group will be published and open to extensive consultation in advance of any decisions being made.

The Minister for Health and Children confirmed to me at a meeting this evening that there is no current risk to the core existing combination of services provided at Clonmel general hospital. I have made it clear to her and the Government that if any substantial proposal to downgrade the hospital emerges after the reconfiguration process is complete, I will vigorously oppose it. I have informed the Government that I will vote against any plan which would alter or diminish the range and quality of services provided at the hospital.

With regard to Nenagh General Hospital, I acknowledge and thank the Minister for delivering on the commitments and the promises I received from the Government in respect of my agreement for support. The phased implementation of the investment and development plan will continue in 2011. As part of a designated €5 million fund, a new endoscopy suite was recently completed, two new lifts were installed and commissioned this week and a new hospital sterile services department will be completed next month or early December. In addition, there has been an increase in day surgical beds from six to 14 bays while an eight-bed acute medical unit was opened in 2009 and a pre-operative assessment clinic commenced last November. Extended day surgical and outpatient services, including those relating to vascular, orthopaedics, dental and urology, are functioning successfully. New planned services include a further increase in day surgical beds from 14 to 20 and increases in endoscopy services and day surgery and outpatient services.

I acknowledge the commitment of the Department of Health and Children to the continuation of services in Nenagh General Hospital. My full support will be there for Clonmel hospital if and when it is needed.

Photo of Máire HoctorMáire Hoctor (Tipperary North, Fianna Fail)
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I am grateful for the opportunity to contribute to the debate and I thank the Minister of State, Deputy John Moloney, for sharing time. As a native of Nenagh who was born in Nenagh hospital and whose first job was as a domestic staff member there, I would like to acknowledge the extensive capital works carried out there over the past number of years. Front line services have been improved with the introduction of emergency technicians and paramedics who are fully operational. One of the campaigns I strongly supported was increasing patient safety in an attempt to bring those services as near to us in our local community as possible.

I would be the first to acknowledge that accident and emergency services are not satisfactory at the Mid-West Regional Hospital. We had sought the implementation of services there before the service after 8 p.m. in Nenagh was removed. However, we will continue to work with the Minister and the HSE to provide greater patient safety and services in a much swifter fashion in the near future. Final preparations are in place and we look forward to the launch of the full service in a new state-of-the-art endoscopy suite at a cost of more than €2 million. I was pleased to first welcome that in July 2007 under our programme for Government. In-house training of nurses is under way among the existing staff of the hospital and the training plan is in place to up-skill to work in the new suite. Nenagh enjoys the presence of one of the most highly regarded gastroenterologists in the State. The two lifts were installed and they were fully operational this week. They needed to be replaced as did the CT scanner in our hospital. We look forward to a national cancer control assessment unit.

Former Deputy Barry Desmond and Deputies Brendan Howlin and Michael Noonan served as Minister for Health but not one of them spent a cent on capital funding for Nenagh hospital during their tenures. The division later will be lightweight on the part of those who tabled the motion in view of what the Government has achieved, given the economic constraints. Their vote will have no credibility.

With regard to Clonmel general hospital, of the nine options that have been discussed with the steering group and those involved in the specialised areas, none will be operational. They are being explored and one option was leaked to the media recently, conveniently for some political people. We can anticipate further leaks of misinformation, possibly from HSE staff members. However, no decision will be made, at least within the next year, regarding services at the hospital. I look forward to increased patient safety and enhanced services in all our hospitals. I have no hesitation supporting the Government amendment.

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 am grateful for the opportunity to contribute. In response to Deputy McManus regarding Wicklow hospital, I met local public representatives from her party and the other political parties yesterday morning at separate functions in Wicklow and I gave a commitment that I will arrange a meeting within the next two weeks to discussion the future of the hospital.

During Private Members' business, the Opposition must try to expose the defects and faults in the health service and we try to highlight the achievements and successes in the health sector over the past number of years, particularly given the Minister's commitment some years ago to deal with a number of significant issues, such as the need for a national cancer control programme. We all agree when the programme was established, it highlighted the defects in the system and it placed an emphasis on lifestyle change and support structures for cancer sufferers. Audits have been published and that is one of the greatest achievements of the current health service. The breast cancer survival rate is estimated to be 80.6% up from 74.2% while the prostate cancer survival rate is 87% up from 77.6%. These are serious life and death issues.

Nursing home charges and how people would pay for the escalating cost of care was another major issue. I acknowledge the commitment of the Minister and the Government to introduce the fair deal scheme. HIQA, which is statutorily supported, is now in place and it is addressing the need for inspections, which was a huge issue for public representatives. The authority has the teeth and imprimatur to conduct inspections independently.

Last night, the Minister referred to how the health of a country is measured. It is important for us all to recognise that the fact people are living longer supports the thesis that health services are improving. I thought it peculiar that the Private Members' motion made no mention of mental health. It is only when something goes wrong in the area of mental health that we then hear all about it. There has been criticism about under-spending in the health sector. This year's capital programme has provided for the turning of the sod in Letterkenny for a new acute psychiatric unit. This is currently under construction and there will be no more referrals to the old hospital. For the first time since 1815 there will be no further referrals to Grangegorman. Patients are now transferred for support to the new unit at Blanchardstown. Contracts were signed recently for developments in Clonmel and south Tipperary. This is not a bragging exercise on my part but rather about putting things into context. Ten houses will open next month for people with intellectual disabilities. I acknowledge there are difficulties in the health services but there is also progress and I hope we can work together to achieve further progress.

Photo of Séamus KirkSéamus Kirk (Ceann Comhairle; Louth, Ceann Comhairle)
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There are nine speakers in the next speaking slot, beginning with Deputy Noel Coonan who has five minutes.

Photo of Noel CoonanNoel Coonan (Tipperary North, Fine Gael)
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I am sharing my time with other Deputies and the Ceann Comhairle will call them. I come from the mid-west region. We bought into the reconfiguration project on the basis that services would be put into the regional hospital and improvements would be carried out in tandem to Nenagh General Hospital as a result. While I welcome what services have been implemented in Nenagh hospital, the promised improvements are not yet complete. I ask the Minister of State to inform the House with regard to the surgical unit promised for Nenagh hospital. I ask him to confirm that our accident and emergency department in Nenagh is safe, bearing in mind that the intensive care unit, the cardiac unit and the anaesthetists are being withdrawn soon. Does this mean our accident and emergency department will continue to exist or will be able to function without those services or will it become solely a minor injuries unit?

I was amazed to hear my colleagues from north Tipperary, in particular the Independent Deputy, who stood up and has now become more classically Fianna Fáil than Fianna Fáil itself, blaming the Opposition for the closure of Clonmel hospital. He said our motion proposed closing Clonmel hospital. That is an appalling suggestion, coming from him and one which I reject out of hand.

There is a lack of trust among the people. We were promised that the current staff complement of three accident and emergency consultants in Limerick would be increased to eight, that 135 additional acute care beds would be provided in Limerick but this has not happened. We were promised a high dependency unit in Limerick hospital but that has not happened. It was promised that the necessary upgrade of the accident and emergency department in Limerick would take place in tandem with services being withdrawn from Nenagh hospital. We accepted that all services could not be provided in Nenagh and we welcome those services that are being enhanced. However, Deputy Lowry in his comments stated there would be significant improvements in the level of comfort for the people of north Tipperary. Today the people of north Tipperary must go down to Limerick. Today there were 33 people on the corridors and they did not even have trolleys for some of them in the regional hospital. Last week up to 40 people were in the corridors in Limerick last week. Is this comfort for a person in hospital? Is this what we were promised? That is why we are in trouble here with the people. God help the people of the south east when they buy into this process. I tell them to look at what is happening in the mid west.

My colleagues promised a 20-bed long stay community care unit would be provided in Borrisokane in County Tipperary. That has not happened. No sooner had the announcement been made then the money was withdrawn a few months later. There was no excuse offered nor any apology given to the people of Borrisokane.

On the issue of waste of resources, the cat scanner in Nenagh General Hospital is only available to inpatients and the number of inpatient beds is being cut from 106 beds down to 50 or fewer. The people of north Tipperary who are waiting 12 months and two years for scans must travel to Limerick or Dublin or go wherever they like but they will not get a scan in north Tipperary. Does the Minister of State consider this to be value for money? Is it any wonder the people are annoyed?

A person came to me who was two years waiting for neurological treatment in Beaumont Hospital. She was assured she would have her operation this June. Nothing happened in June. She contacted the hospital. September has now passed and we are in October and she still has no appointment, almost two years later. Is this the service and level of comfort, the improvement of which Deputy Lowry speaks? It is fine for himself and Deputy Hoctor to say that nothing will happen about Clonmel hospital for two years. They know damn well it will get them over the coming general election and then, God help the people of Clonmel.

Photo of Martin ManserghMartin Mansergh (Minister of State with special responsibility for the Arts, Department of Arts, Sport and Tourism; Minister of State with special responsibility for the Office of Public Works, Department of Finance; Tipperary South, Fianna Fail)
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Will it happen when the people on the other side are in power?

Photo of Noel CoonanNoel Coonan (Tipperary North, Fine Gael)
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The Minister of State referred to the mental health services. An acute psychiatric unit was promised for Nenagh and the mental health services in north Tipperary. We do not have acute services in north Tipperary. We can go down to south Tipperary or we can go to Limerick but Limerick will not take patients because the service is over-subscribed with too many patients. We can go wherever we like but we do not have a unit. The Minister of State travelled to Letterkenny and I ask him to come to Nenagh and provide that service there.

Photo of Terence FlanaganTerence Flanagan (Dublin North East, Fine Gael)
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This motion tabled by Deputy James Reilly seeks to protect the front line staff and services which are Fine Gael's priority. The Government's counter-motion shows that the Government is in denial. The amendment contains no criticism of the current system nor any suggestion of any problems in the health service. It gives the impression that the health service is functioning properly with no problems. The Department of Health and Children has been selective with regard to the measurement used of the average waiting time for appointments. It does not refer to the number on the waiting lists which is the better measurement of the demand for services.

A total of €11 billion will be expended on the health service this year and this is a considerable sum of money. We have a Third World health service for people who have to wait and unfortunately, it has deteriorated down through the years. The front line staff work in difficult and extreme conditions. Theatre equipment in some hospitals is outdated and needs to be upgraded. This should have happened while the country was awash with money but this was not one of the Government's priorities during the Celtic tiger years.

We need a radical change in health policy and this is what the Fine Gael Party is offering with Dr. James Reilly's FairCare policy. Low morale seems to be a common thread in the health service and in all Departments. The staff are embarrassed about their working conditions and are under-staffed. Even though we have a small population we do not seem to be able to do anything right. We have no excuse not to have a properly functioning health service.

When political change comes, the people of Ireland will see a great difference in the health service and a world class health service will be provided.

Inefficiency is the order of the day in sections of the health service. I refer to the HSE medical card section where telephone calls are only answered in the afternoon and none accepted in the morning. This is a very wrong policy. Medical card holders have to telephone constantly and leave messages. This policy must change. The harsh reality of the cutbacks is evident in my own constituency. A total of 1,200 operations were cancelled in Beaumont Hospital in 2009. The hospital has run out of money and this is having a knock-on effect on patients. Better value for money needs to be achieved.

Photo of Tom HayesTom Hayes (Tipperary South, Fine Gael)
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I congratulate Deputy James Reilly for tabling this Private Members' motion. Its importance cannot be underestimated from the point of view of south Tipperary. This motion will help the situation in Clonmel hospital rather than jeopardise it.

It took until tonight to get the exact position of everyone in respect of future services in South Tipperary General Hospital. After rumour, innuendo and many statements in local newspapers, on local radio and in other media about the future of the hospital, last week we met with the HSE and for the first time we received reasonable assurances that in the short to medium-term the services are guaranteed. It is only tonight that we are happy that the commitment of the HSE officials last week will hold into the future.

This is of great importance because the concern of the people of south Tipperary was evidenced by 13,000 people marching on the streets of Clonmel earlier this year. The reason they marched is that south Tipperary has already been affected by reconfiguration. There was amalgamation of services in Cashel and Clonmel a number of years ago. Despite what Deputy Hoctor said, when Deputy Michael Noonan was Minister for Health, a plan was put in place for a top-class health service for the people of south Tipperary. He gave a commitment and a High Court order was made binding the Government to provide the services. Under no circumstances will the people of south Tipperary accept anything less. They have a fully functioning hospital, which is efficiently run with committed staff. The Minister of State was there and he saw it. There is no hospital to which people are more committed.

The community is committed to keeping the Clonmel hospital. This matter is above politics and jibing because the people believe in the hospital and in the services provided. They have suffered already. While I am in this House and while any Member is the Minister, I will not allow any situation to develop where those services are downgraded. The people deserve it and they have fought long and hard for this. Their commitment to the service goes beyond belief. I know of no situation where people are so committed to fighting. Let us forget the politics, the photographs, "The Frontline" programme, the newspapers and how people will vote. We want the services kept in south Tipperary.

Photo of Joe McHughJoe McHugh (Donegal North East, Fine Gael)
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I congratulate Deputy Reilly for tabling this motion. It provides us as Opposition Deputies with an opportunity to put forward observations and viewpoints. We must consider a new way of doing business. We are pumping all this money into the HSE and the health structure. While people who go through the system give positive feedback and are treated well, we must consider those waiting outside the system. We must consider the National Treatment Purchase Fund, which was not touched when there were cutbacks in the last budget. We must examine value for money, whether it is working out and whether it is being taken up in all parts of the country. In County Donegal there are variations and conflicting feedback about it.

Although I do not say this in a parochial sense, Letterkenny General Hospital is part of the Galway outreach service. Letterkenny has a good oncology unit and telecommunications services on which consultants, doctors and nurses can examine slides on a daily basis and work through the communication and technological channels. However, Letterkenny has become a victim of its success. Year-on-year, it gets less money but delivers more services to the community in counties Donegal, Sligo and Leitrim. It should be rewarded for the work it is doing but it is not.

Regarding the cross-Border aspect of this, we have talked a great deal since the Good Friday Agreement about the integrated strategies on transport, health and marine but it is not happening on the ground in terms of essential services. Co-operation and Working Together, CAWT, is co-operating for cancer care in Northern Ireland and southern Ireland, is working well and is putting together plans and proposals. However, we must challenge the cultural barriers that operate at management level between hospitals on either side of the Border.

We are here to discuss frontline services. Without frontline services, we cannot provide facilities. If we get rid of our nursing staff, continue to downgrade and get rid of the 28 student nurses dragged out of Letterkenny General Hospital at the end of August, we will not be able to provide adequate, efficient and proper health care. We must examine new ways of doing business in a more efficient way. This side of the House is considering universal health care and efficient and proper health care for everyone. If we take people from the coalface, we will have a second-class health system.

Photo of Michael D'ArcyMichael D'Arcy (Wexford, Fine Gael)
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I speak about the reconfiguration in the south east as someone who participated in the debate on cancer care services soon after becoming a Member of the Dáil. I refer to the BreastCheck cancer care services in the south east. I supported the removal of services from Wexford to Watford on the basis that it provided the best clinical outcome. At the same time, Ministers refused to support any change in services or reconfiguration in their area because they were playing politics. I bought into reconfiguration on the basis of the HSE acting in good faith. It should have acted in good faith but it is with a sad heart that I say it did not. Oireachtas Members were to be kept updated on the direction the HSE was going in, in consultation with the clinical leads from the south east region.

However, the HSE operated as it does on the basis that it does whatever it wants and everyone else can go to hell. The HSE thought it would do so in this instance and attempted to present a fait accompli to the clinical leads of the south east region. The clinical leads said "No" and this culminated in the resignation of the clinical lead, Dr. Colm Quigley. Without that man standing up and doing what was right, in contrast to the HSE choosing the best option and presenting it to the clinical leads, Wexford and Clonmel would have been significantly downgraded.

The south east region is an enormous geographic area and I am the furthest point from Waterford. We are two hours from Waterford and one hour from Dublin yet the HSE saw fit to ignore the area. In the past month, two babies have been born on the road to Wexford, which is nearer than Waterford. One was born in the car park of St. Senan's Hospital, the other was born on the side of the road. Adding another hour to that journey means that patients, children, mothers and babies will be lost. I will not participate in this under any circumstances.

St. Senan's Hospital falls under the brief of the Minister of State, Deputy Moloney, who was to brief Oireachtas Members at the end of September. We are now into the first week of October and I want to see progress on this matter. I also want to see progress on the retention of acute admissions services in County Wexford. As the Minister of State said when we met previously, Wexford is the size of Laois and Offaly yet there is a service in both counties.

8:00 pm

Photo of Dinny McGinleyDinny McGinley (Donegal South West, Fine Gael)
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While I welcome the debate on health in the Dáil this week, we are only dealing with the symptom of a hopelessly out-of-date health service in this country. We are not getting to the root cause of our difficulties, which is that we do not have a proper service. There is a solution, which we have on this side of the House. Other parties also have the solution, namely, the introduction of a new type of service in this country, universal health insurance. This has been tested and tried in other jurisdictions not 500 or 1,000 miles from where we sit. Until we adopt the system, we will have a crisis in the health services in this country.

I wish to address a number of issues. I am pleased that more than one Minister is present. I refer to the transport of cancer patients from Donegal to Dublin. For the past 15 years we have used a system which is probably a Donegal solution to a Donegal problem. If cancer patients from west Donegal and the islands come by road to Dublin for radiotherapy or chemotherapy treatment, it will take them up to six hours to get there. Fifteen years ago we came up with a new idea which was based on a tripartite agreement between Aer Arann, the Health Service Executive and the North West Cancer Group. The arrangement provided that anyone travelling to Dublin for cancer treatment would get a return fare from Aer Arann for €90. A total of €60 would be paid by the Health Service Executive and €30 by the patient. It was all organised by the North West Cancer Group. Now there are serious indications from the Health Service Executive that the subsidy of €60 will no longer be available due to the cutbacks.

Every year approximately 250 seriously ill patients from west Donegal and other parts of the county have availed of the service. They arrive in Dublin in 40 minutes and approximately a half hour later they are in the hospital where they are to receive treatment. Everyone knows that if one is getting chemotherapy or radium treatment for prostate or other cancer, one cannot get a train from Donegal. It is completely unacceptable for a cancer patient to have to undertake a bus journey for several hours and have to stop here and there. It would be a major setback for cancer patients in Donegal if the service is withdrawn. I appeal to the Minister to get in touch with the Health Service Executive and to ensure that this good solution to our problem is allowed to continue.

Photo of Seymour CrawfordSeymour Crawford (Cavan-Monaghan, Fine Gael)
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I thank Deputy Reilly for the opportunity he has given us to speak about the continuing serious failures in the health service. It is extremely difficult to listen to the Minister for Health and Children, Deputy Mary Harney, making totally unjustified claims regarding her improvements to the health service. This is at a time when there is still an average of 300 patients a day on trolleys, not including those who cannot get into hospital or were sent home early and, unfortunately, we in County Monaghan have plenty of experience of both.

If the Minister, Deputy Harney, had to sit beside a grieving widow and her family in Monaghan, as I did on Sunday last, and listen to a full history of their difficulties in dealing with their loved one's last few days on this earth, she might change her tune. Only last weekend a friend of mine whose son was critically injured in an accident in January 2008 and has been hospitalised until the last few weeks when he was moved to a nursing home under HSE care was told that she would have to pay for the cost of a carer to look after her son as he waited in the accident and emergency unit in Beaumont Hospital. The lady in question is on social welfare. Where is the love and compassion in a tragic situation like that?

The Minister did not have to deal with an 80 year old man who was in urgent need of eye treatment and had his eye appointment postponed for three months just a couple of days before his long-awaited appointment was due. How does she justify her great claims for cancer reform when people from counties such as Monaghan cannot get a bed in a Dublin hospital to get their necessary and possibly urgent operations carried out?

I ask the Minister to forgive me for saying this, but I believe if people die before they get into the system it does not seem to be a problem for the Health Service Executive or her as long as they can prove the statistics are right. It is extraordinary to read in the newspapers today of the retirement bash paid for by the Health Service Executive similar to the wanton waste of money which happened in FÁS when the Minister, Deputy Harney, was in charge in the Department responsible for that body. Does she not accept responsibility for anything or does she not have a conscience?

I draw attention to the situation with psychiatric care in County Monaghan where the Health Service Executive and the Minister are winding down the in-care services in St. Davnet's Hospital and moving them to the basement of Cavan hospital. This again is being done in the name of progress but it has serious implications for both patients and staff. On a daily basis I get telephone calls from individuals or their families where there are serious problems with depression. In the current difficult financial and economic situation there has been a major increase in suicides and the Minister and the Health Service Executive can no longer ignore the bloated, unnecessary administrative structure. She must ensure that front line services are retained on a 24-7 basis.

It is strange that Professor Drumm admitted that there was a total over-supply of administrative staff in the Health Service Executive but nothing was done about it in the years he was in charge.

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Fine Gael)
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The Health Service Executive is devising plans at present to transfer vital services such as accident and emergency services from Roscommon and Portiuncula hospitals, and maternity services from Ballinasloe to University College Hospital, Galway. That makes no sense, especially when services are being transferred to a hospital which is already bursting at the seams. In fact, one cannot even park a car let alone get a hospital bed. Last night, the Minister, Deputy Mary Harney, was trying to spin the story that cutting services and downgrading hospitals is the only way to make savings. Why does the Minister not abolish the failed entity that is the HSE? The experiment is costing taxpayers millions and is eating up valuable front line resources. We need people on the front line to treat patients who are in need of care, not more managers to spin to the media. The failure to deliver on this basic principle is even threatening the delivery of life saving cancer services. Instead of getting a better service, we now have to fight for any service at all.

Just over a month ago a shameful and disgusting threat hung over oncology services at Portiuncula Hospital in Ballinasloe. Last night we heard about a young mother in County Galway whose chemotherapy was postponed for nine months at University College Hospital, Galway. This evening, I was informed that one of the new outreach services established at Portiuncula Hospital in Ballinasloe, namely a plastic surgery day service, which is taking 24 patients per month off the University College Hospital, Galway, backlog, is to be pulled because no one is available to type up 24 letters a month. The lack of a clerical backup service is now leading to a situation where people with lumps and bumps, some of which may be cancerous, are to be put on a never-ending waiting list. How can this be allowed to happen when the Health Service Executive west employs the highest proportion of corporate staff compared to any other Health Service Executive region? So much for the commitment to the centres of excellence.

The decision to close down hospitals in Roscommon and Portiuncula make the situation at University College Hospital, Galway, even worse than it is at present. It will put people on longer waiting lists for cancer treatment, not shorter waiting lists. The Health Service Executive's own HealthStat data recently indicated that waiting times at University College Hospital, Galway, are "unsatisfactory and require urgent attention". The plans for the transfer of services from Roscommon and Portiuncula to University College Hospital, Galway, will ensure the situation will get even worse. It will result in a 50% increase in the waiting times for trolleys. The reality is that what the Government is doing is putting the lives of those who are battling cancer at risk just to raise the money needed to bail out a septic banking system.

Photo of Joe CareyJoe Carey (Clare, Fine Gael)
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I commend Deputy Reilly on tabling this motion on behalf of Fine Gael. Our motion this evening is about putting the patient first. That can only be achieved by protecting front line staff and services. I object in the strongest possible terms to the notion put forward last night by the Minister, Deputy Mary Harney, that the reconfiguration of services in the mid-west area is an example for the rest of the country to follow. The view that it is all plain sailing, that reconfiguration is the promised land of an ideal health care service is totally wide of the mark. The reality is quite different; in fact, it is fundamentally different. Limerick Regional Hospital simply cannot cope with the demands placed upon it. Less than a month ago, on Tuesday, 14 September, 46 patients were on trolleys in our so-called centre of excellence, 23 were in the emergency department, 14 were in a transit lounge and nine were on the hospital corridor. On Tuesday of this week, 33 patients were on trolleys while on Monday the number was 30. These are real people with real lives and loved ones, whose interests and care have been cast aside by the Government. The lack of strategic planning and the agenda of "cut the service and replace it with nothing", otherwise known as centralisation, have created this crisis. I ask the Minister, Deputy Harney, to take a quick step into the real world, forget about the spin and press statements and sort out the crisis at Limerick Regional Hospital.

I also want to put on record my anger at the announcement that the €40 million redevelopment of Ennis General Hospital will no longer proceed. This is outrageous considering there were pledges to the people of County Clare from the then Taoiseach, Deputy Bertie Ahern, down that this development would proceed. It never materialised. The county has now lost its acute services as a result of the failed policy and broken promises of Fianna Fáil. The policy of "cut, cut, cut" must stop. I urge all Deputies in the House to support the motion.

Photo of Barry AndrewsBarry Andrews (Minister of State with special responsibility for Children and Young People, Department of Health and Children; Minister of State, Department of Justice, Equality and Law Reform; Minister of State, Department of Education and Science; Dún Laoghaire, Fianna Fail)
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During the debate, the improvements that have taken place in the health services in recent years, for example, under the national cancer control programme and in addressing waiting lists, have been outlined by the Minister for Health and Children and other speakers. The Government has a serious job to reduce the general government deficit to 3% of GDP by 2014 but its priority remains to protect frontline health services and ensure they meet appropriate quality and safety standards.

Over the past decade, Ireland has achieved a rapid and unprecedented improvement in life expectancy. Irish men can now expect on average to live until they are 76 years while Irish women can expect to live until they are over 81 years. Much of this increase is due to significant reductions in major causes of death such as cancer and circulatory system diseases. The health services have played a significant role in these remarkable improvements.

The national service plan for 2010 commits the HSE to a range of measures to ensure that services are delivered more efficiently, including carrying out an increased proportion of surgery on a day basis, increasing rates of day-of-surgery admissions and working to reduce average length of stay consistent with patients' clinical needs. I should also point out the service plan refers to commitment under the children and family services area, which was not referred to during the course of this debate. Some 200 additional social workers have been appointed or will be appointed by the end of this year in order to tackle the issues that have arisen in regard to child care in this country, in particular to ensure every child has an allocated social worker and a care plan, and that all of our foster carers are properly assessed.

The actions being taken by the HSE to control expenditure and ensure that budgets are not exceeded are focused on protecting front line services and, in particular, emergency services, maintaining the quality and safety of services, delivering on service plan targets and protecting jobs. Notwithstanding the difficult financial environment, the Government is determined to do everything possible to protect patient services, to respond to priority demographic and other needs and to support ongoing reform of the public health services within the resources available for health. To achieve this, staff at all levels will have to work together to deliver services in a more flexible way. Without that co-operation and flexibility, services to patients cannot be protected. It is not just for HSE management to protect services; there is also a responsibility on everyone involved to deliver services within budget in new ways that will better serve patient needs.

Patient safety is at the forefront of the Government's health policy. As well as having potentially devastating consequences for individuals and families, poor patient safety represents both a severe public health problem and a high economic burden on limited health resources. A large proportion of adverse events, both in the hospital sector and in primary care, are preventable. Major components in this process are the establishment the Health Information and Quality Authority in 2007; the report of the Commission on Patient Safety and Quality Assurance in 2008; the modernisation of legislation regulating key health professions, particularly the Medical Practitioners Act 2007; and the Health Information Bill, which will be published shortly and will provide for the mandatory reporting of serious adverse events and, to support this initiative, will give legal protections to those reports. Legal protections will also be given to the voluntary reporting of other adverse events. The Bill will also provide legal protections for open disclosure of patient safety incidents to patients.

The overwhelming consensus among clinical experts, as seen in cancer care, is that patients have demonstrably better outcomes where complex care is delivered with the necessary staff and equipment and with sufficient volumes of activity. The evidence also emphasises the need to provide timely emergency care to patients in an appropriate setting. Achieving better outcomes for patients will require hospitals to change the services they deliver to their communities and how those are delivered. The clinical benefits for patients will be significant and the treatment offered will be of the highest standard.

Patients get the best health outcomes when complex care is delivered in hospitals with high volumes of patients. We have seen this in cancer care and it is an accepted international medical principle. Less complex care and much diagnostics can and will be provided locally throughout the country. In 2012, we will have a new licensing system underpinned by standards. All hospitals will have to meet these standards which will ensure that people are getting the right care in the right place at the right time from the right person.

The clinical director of the HSE has appointed a number of medical specialists to examine different areas of medicine. They will consult widely and recommend how we can provide a better and safer service nationally. Areas being examined include obstetrics, stroke services, neurology, rheumatology, diabetes, epilepsy, heart failure and cystic fibrosis. All decisions in regard to how we provide our health services will be guided by this work. One of the specialists is Professor Michael Turner, who is examining how we currently provide our obstetric services nationally. He will be consulting with colleagues throughout the country before he makes his recommendations and no decisions have yet been made. There will be no change to obstetric services anywhere in the country, including in the south east, as some speakers suggested, until Professor Turner concludes his work on the national clinical programme on obstetrics, which is expected to be late next year.

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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I welcome the opportunity to contribute to the debate and congratulate Deputy Reilly for bringing it forward. I want to refer to an issue raised on "Morning Ireland" today, namely, the placing of four teenagers in adult psychiatric units in Waterford, which has drawn attention to a much wider problem. It must be remembered that 200 children were admitted nationally to adult units last year. This represented 55% of all the admissions of children and illustrates that the absence of age-approved centres for children and adolescents means this unacceptable practice is widespread.

Changes by the Mental Health Commission to the code of practice on the admission of children, after the numbers admitted to adult units rose between 2007 and 2008, were necessary and welcome. However, it must be remembered that the latest report of the commission shows that only five of the 64 approved centres were fully compliant with the code of practice, so there is much work to be done. More important, as the commission itself acknowledges, the lack of child and adolescent inpatient and day-hospital facilities is the crux of the issue.

There is an historic under-investment in child and adolescent psychiatric services, which has resulted in services which are either sporadic or non-existent. This situation has been allowed to develop despite the fact that in excess of 200,000 children have a mental or behavioural problem at any one time. The infrastructure is not in place to meet these needs and the lack of specialised services for young people has led to unacceptably long waiting lists and the admission of children into adult services.

For children to endure inappropriate accommodation in adult units is a gruelling experience and surreal in the context of 21st century Ireland. The reality is that unless the Government renews its commitment to the full implementation of A Vision for Change, the mental health policy, it is difficult to see how a community-based, person-centred mental health service, grounded in the principle of recovery, can be realised.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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I compliment my colleague on bringing the motion before the Dáil. I call on my colleagues from throughout the country to support the motion because, by doing so, they will be supporting their home hospitals and the health service, and sending a message to the Minister that enough is enough.

My region of HSE west is reducing the number of home help hours. At the same time, €10 million is not being collected from private insurers. People in the HSE are travelling all over the world on holidays. They are getting sunstroke when they get there. When they come back, they attack the sick, the old and the weak. People are frightened by what is occurring. Every day when they get up, they listen to the HSE on radio saying it is cutting here, there and everywhere. People are sick and want help and to be looked after. They are sick of the Minister, Deputy Harney, and the Government.

I have a message for the Government. The Minister has been there for too long. She is tired, weary and dreary. To replace her, we have a man with new ideas and new thinking. A new Government with a new way to do things. We will get rid of the waste and the wasters because there is plenty of both in the health boards. Old people want to be looked after when they go into hospital. They are sick and tired of home help and other services being cut. People who are sick want to be looked after, not to always be hearing bad news from the HSE, which has too many people who are not doing their jobs.

Photo of Andrew DoyleAndrew Doyle (Wicklow, Fine Gael)
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I seem to have followed Deputy Ring a few times. I cannot talk that loudly.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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Have a go.

Photo of Andrew DoyleAndrew Doyle (Wicklow, Fine Gael)
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I welcome the opportunity to speak on this motion. It highlights what is wrong as a result of what the HSE has become. When the HSE was introduced in 2004, we were told that the problems we have listed would disappear under the new structures. While it must be acknowledged that some improvements have been made in other areas of health delivery, this does not change the fact that the HSE is making decisions about which none of us knows until we see the consequences. We do not know how or why the HSE reaches a decision or how decisions are costed.

In giving a simple example I will be parochial, as that seems to be the fashion. There is a small district hospital in Wicklow town. Its bed capacity of 32 has been reduced to 22 or 23, including one hospice and four respite beds. We are told that HIQA visited it and believes it is not fit for purpose, but it is the HSE that is not fit for purpose and has not been for some time.


Hear, hear.

Photo of Andrew DoyleAndrew Doyle (Wicklow, Fine Gael)
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This is the real problem. Unfortunately, what we read in today's newspapers was a symptom of it. I was the chairman of the former East Coast Area Health Board when it told the then Minister, Deputy Martin, that doing away with public scrutiny and public accountability through the public representative membership of the board structure was a recipe for disaster. We cited the disastrous example of the old Blood Transfusion Service Board as a typical case, in that there was no one to keep an eye on the ship. That is what has occurred in this instance.

Nine years ago, the friends of the patients benefit fund wanted a new physio unit at Wicklow hospital and was able to invest £90,000 raised by the local community as well as £120,000 from the health board. This was value for money. Today if, for example, the damp will cost such an amount to fix, no one is working with the benefit fund to raise more money in the community. Instead, the HSE wants to close it. The HSE's real reasons for its decision are that 23 beds have been made available in the other hospital in Rathdrum, it wants to get rid of agency staff instead of employing more nurses and it wants to consolidate. Bray hospital is gone and Wicklow hospital is going. Next is Rathdrum.

We have also been told that there is no demand for public beds because, under the fair deal, people are choosing private nursing homes. That is nonsense. That 270,000 bed days have been lost because of delayed discharges does not square with that argument. I respectfully ask the Government to not allow the HSE to mislead or fool us. It should put more nurses on the front line and save the money spent on people going abroad. These are unaccountable and faceless people on a board that holds its meetings in camera. The former East Coast Area Health Board and every other board held all of their meetings in public, yet we are facing this situation. We are the country's legislators, yet we do not know what is happening with the largest public spending budget. The Department of Health and Children comprises 400 people. They are wholly policy makers.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I thank everyone who contributed to the debate. I will point out a few inaccuracies from the other side of the House. Less than 10% of improved longevity in the past 20 years can be attributed to health care once vaccination is excluded from the figures. Notwithstanding the contention of the Minister of State, Deputy Barry Andrews, that the Government puts patient safety first, there is no patient safety authority. Last might, the Minister for Health and Children did not want to distinguish between elective general surgery and elective orthopaedic surgery. She fully admitted that, despite the protestations of the clinical director in the north east that it was a question of patient safety and standards, it was about money. The people know where the Government is focused.

Those who suggested that hospitals or other services were excluded from this motion did not want to read it. It reads "for example" and is not an exhaustive list. The Minister failed to understand the motion. No one on this side of the House has ever accused her of being stupid, so I can only assume she deliberately misunderstood for her own political ends.

This side of the House has acknowledged the need for savings in the health budget, but not at the cost of frontline services. Rather, it should be by cutting out the waste and gross inefficiencies in the HSE. This is what needs to be done and is where the focus should have been for the past six years. Instead, the Minister allows the HSE to take the lazy, easy way out, namely, to hit the front line and hurt patients. The motion is clear - find the necessary savings within the waste and inefficiencies of the HSE and not at the patients' expense. This means negotiating, consulting, compromising and engaging in conciliation with all stakeholders, but always with the understanding that the key stakeholder is the patient.

The Minister read out a list of costs for retaining frontline services at several hospitals. We acknowledge that savings must be made, but not by cuts in front line services. There is enough waste and inefficiency in the system to allow for these savings without affecting the front line. Herewith, a menu to choose from. The annual overtime bill is €1 billion. Why has this not been addressed? Some €121 million is spent on taxis, but tendering and proper logistics could surely reduce this. Some €60 million is spent on medico-legal fees, of which €20 million goes to lawyers. Surely savings could be made in this respect. The 6,000 redundancies in administration and management identified by Professor Drumm could yield hundreds of millions of euro in savings, yet all we get is talk and rehashed plans.

Where generic drugs are concerned, the drug reference pricing bill has been put on the long finger. It could save €200 million, but all we get is more talk. As to HSE west, Deputy Ring referred to the €10 million outstanding from insurers and the €5 million lost through absenteeism. Why is it a surgeon can say to me that he or she can only do nine procedures per week in a public hospital but ten on a Saturday in a private facility? Clearly, there are considerable inefficiencies. In tomorrow's Irish Independent, we will read of tens of millions of euro spent on outside consultants in the past three years. We were promised this issue would be tackled, but it goes on.

The Minister is like an observer looking on while taking no action. Six years in the job and all she does is outline the problems. She never solves them. Last night, I mentioned Taiwan because it introduced universal health insurance in 1995. One could get a hip done in one or two weeks after being diagnosed, yet it only spends 6.4% of GDP on health. Last night, the Minister told the House that we spend 11.8% of our national income on health.

We know that savings must be made and where this can be done. What we are trying to get across is that there is another way to make them. Consider the menu of cuts I have supplied instead of looking to those with chronic illness, like the six year old child with diabetes, the middle aged man with chronic lung disease or the woman with rheumatoid arthritis, those with a disability or those with mental health issues, especially children. As Deputy Neville pointed out, children were placed in totally inappropriate adult facilities. There are young people with cystic fibrosis fighting to catch their breath as they wait on one broken promise after another for their new life-saving unit at St. Vincent's hospital. How many more must die prematurely before they see that false dawn? The terminally ill fight for their lives without medical cards being available to them. I ask the Minister, Deputy Harney, to give patients and our people a break and crack the whip over the wasteful and inefficient HSE.

It is the duty of Opposition to expose, oppose and propose. Tonight in this Chamber we exposed the deficiencies and flaws of the HSE and passionately opposed them. We proposed sensible and responsible alternatives. I fear the Minister and her Government will not listen but I hope the people have heard.

I commend the motion to the House.

Photo of Séamus KirkSéamus Kirk (Ceann Comhairle; Louth, Ceann Comhairle)
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As it is 8.30 p.m. I am obliged to put the amendment in the name of the Minister for Health and Children, Deputy Harney.

Amendment put. The Dáil divided by electronic means.

Photo of Paul KehoePaul Kehoe (Wexford, Fine Gael)
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A Cheann Comhairle, given the importance of the issue that we have been debating, as a teller and under Standing Orders of the House, I am demanding a vote by other than electronic means.

Photo of Séamus KirkSéamus Kirk (Ceann Comhairle; Louth, Ceann Comhairle)
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As Deputy Kehoe, who is demanding the division, is a teller, the vote will proceed in accordance with Standing Order 69.

Amendment again put.

The Dail Divided:

For the motion: 77 (Bertie Ahern, Dermot Ahern, Michael Ahern, Noel Ahern, Barry Andrews, Chris Andrews, Bobby Aylward, Niall Blaney, Áine Brady, Cyprian Brady, Johnny Brady, John Browne, Thomas Byrne, Dara Calleary, Pat Carey, Niall Collins, Margaret Conlon, Seán Connick, Mary Coughlan, John Cregan, Ciarán Cuffe, John Curran, Noel Dempsey, Jimmy Devins, Timmy Dooley, Michael Finneran, Michael Fitzpatrick, Seán Fleming, Beverley Flynn, Paul Gogarty, Mary Hanafin, Mary Harney, Seán Haughey, Jackie Healy-Rae, Máire Hoctor, Billy Kelleher, Peter Kelly, Brendan Kenneally, Michael Kennedy, Tony Killeen, Michael Kitt, Tom Kitt, Brian Lenihan Jnr, Conor Lenihan, Michael Lowry, Jim McDaid, Tom McEllistrim, Mattie McGrath, Michael McGrath, John McGuinness, Martin Mansergh, John Moloney, Michael Moynihan, Michael Mulcahy, M J Nolan, Éamon Ó Cuív, Seán Ó Fearghaíl, Darragh O'Brien, Charlie O'Connor, Willie O'Dea, John O'Donoghue, Noel O'Flynn, Rory O'Hanlon, Batt O'Keeffe, Ned O'Keeffe, Mary O'Rourke, Christy O'Sullivan, Peter Power, Dick Roche, Eamon Ryan, Trevor Sargent, Eamon Scanlon, Brendan Smith, Noel Treacy, Mary Wallace, Mary White, Michael Woods)

Against the motion: 73 (Bernard Allen, James Bannon, Seán Barrett, Joe Behan, Tommy Broughan, Richard Bruton, Ulick Burke, Joan Burton, Catherine Byrne, Deirdre Clune, Noel Coonan, Joe Costello, Simon Coveney, Seymour Crawford, Michael Creed, Lucinda Creighton, Michael D'Arcy, John Deasy, Jimmy Deenihan, Andrew Doyle, Bernard Durkan, Damien English, Olwyn Enright, Frank Feighan, Martin Ferris, Charles Flanagan, Terence Flanagan, Eamon Gilmore, Noel Grealish, Brian Hayes, Tom Hayes, Michael D Higgins, Phil Hogan, Brendan Howlin, Paul Kehoe, Enda Kenny, Ciarán Lynch, Kathleen Lynch, Pádraic McCormack, Shane McEntee, Dinny McGinley, Finian McGrath, Joe McHugh, Liz McManus, Olivia Mitchell, Arthur Morgan, Denis Naughten, Michael Noonan, Caoimhghín Ó Caoláin, Aengus Ó Snodaigh, Kieran O'Donnell, Fergus O'Dowd, Jim O'Keeffe, John O'Mahony, Brian O'Shea, Jan O'Sullivan, Maureen O'Sullivan, Willie Penrose, John Perry, Ruairi Quinn, Pat Rabbitte, James Reilly, Michael Ring, Alan Shatter, Tom Sheahan, P J Sheehan, Seán Sherlock, Róisín Shortall, Emmet Stagg, Billy Timmins, Joanna Tuffy, Mary Upton, Leo Varadkar)

Tellers: Tá, Deputy John Cregan and Deputy John Curran; Níl, Deputy Paul Kehoe and Deputy Emmet Stagg.

declared carried

Question put: "That the motion, as amended, be agreed to."

The Dail Divided:

For the motion: 74 (Bertie Ahern, Dermot Ahern, Michael Ahern, Noel Ahern, Barry Andrews, Chris Andrews, Bobby Aylward, Niall Blaney, Áine Brady, Cyprian Brady, Johnny Brady, John Browne, Thomas Byrne, Dara Calleary, Pat Carey, Niall Collins, Margaret Conlon, Seán Connick, Mary Coughlan, John Cregan, Ciarán Cuffe, John Curran, Noel Dempsey, Jimmy Devins, Timmy Dooley, Michael Finneran, Michael Fitzpatrick, Seán Fleming, Beverley Flynn, Paul Gogarty, Mary Hanafin, Mary Harney, Seán Haughey, Máire Hoctor, Billy Kelleher, Peter Kelly, Brendan Kenneally, Tony Killeen, Michael Kitt, Tom Kitt, Brian Lenihan Jnr, Conor Lenihan, Michael Lowry, Jim McDaid, Tom McEllistrim, Mattie McGrath, Michael McGrath, John McGuinness, Martin Mansergh, John Moloney, Michael Moynihan, Michael Mulcahy, M J Nolan, Éamon Ó Cuív, Seán Ó Fearghaíl, Darragh O'Brien, Charlie O'Connor, Willie O'Dea, John O'Donoghue, Noel O'Flynn, Rory O'Hanlon, Batt O'Keeffe, Ned O'Keeffe, Mary O'Rourke, Christy O'Sullivan, Peter Power, Dick Roche, Trevor Sargent, Eamon Scanlon, Brendan Smith, Noel Treacy, Mary Wallace, Mary White, Michael Woods)

Against the motion: 70 (Bernard Allen, James Bannon, Seán Barrett, Joe Behan, Tommy Broughan, Richard Bruton, Ulick Burke, Joan Burton, Catherine Byrne, Joe Carey, Deirdre Clune, Noel Coonan, Joe Costello, Simon Coveney, Seymour Crawford, Michael Creed, Lucinda Creighton, Michael D'Arcy, John Deasy, Jimmy Deenihan, Andrew Doyle, Bernard Durkan, Damien English, Olwyn Enright, Frank Feighan, Martin Ferris, Charles Flanagan, Terence Flanagan, Brian Hayes, Tom Hayes, Michael D Higgins, Phil Hogan, Brendan Howlin, Paul Kehoe, Enda Kenny, Ciarán Lynch, Kathleen Lynch, Pádraic McCormack, Shane McEntee, Dinny McGinley, Joe McHugh, Liz McManus, Olivia Mitchell, Arthur Morgan, Denis Naughten, Dan Neville, Michael Noonan, Caoimhghín Ó Caoláin, Aengus Ó Snodaigh, Kieran O'Donnell, Fergus O'Dowd, Jim O'Keeffe, John O'Mahony, Brian O'Shea, Jan O'Sullivan, Willie Penrose, John Perry, Ruairi Quinn, Pat Rabbitte, James Reilly, Michael Ring, Alan Shatter, Tom Sheahan, Seán Sherlock, Róisín Shortall, Emmet Stagg, Billy Timmins, Joanna Tuffy, Mary Upton, Leo Varadkar)

Tellers: Tá, Deputies John Cregan and John Curran; Níl, Deputies Emmet Stagg and Paul Kehoe

Question declared carried