Dáil debates

Thursday, 11 November 2010

3:00 pm

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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Approximately 77 million laboratory tests are undertaken across 44 public hospitals each year. The HSE announced plans last year to modernise laboratory services and achieve significant efficiencies in the configuration and operation of such services. As part of this initiative, the HSE is in discussions with the National Development Finance Agency about the capital financing of a small number of dedicated cold laboratories which would process the large volumes of routine patient tests currently processed in hospital laboratories. An outline business case, including a cost-benefit analysis, has been developed. It identifies and analyses a number of options for financing the various cold laboratory site configurations. The options include direct public provision, direct private provision and public private partnership. These options are being considered by the HSE. The Croke Park agreement acknowledges the advanced level of engagement of the relevant stakeholders in the delivery of major changes to medical laboratory services. We would like to see early progress in this area. Discussions between the HSE and the relevant trade unions on the introduction of revised work practices in existing laboratories, in the context of the Croke Park agreement, are under way. I understand good progress is being made in this regard. This process will quickly help to inform decisions on the modernisation of medical laboratory services within the cost, efficiency and quality parameters that need to be met.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I asked the Minister a couple of questions on 22 April last. The answer I received to one question, which was particularly detailed, was incomplete. I have to say, with respect, that the answer the Minister has given me this afternoon is also incomplete. I will persist, however. The Minister claimed in response to Questions Nos. 84 and 85 of 22 April last that the Association of Clinical Biochemists in Ireland was consulted when the Teamwork report was being drawn up. I have the parliamentary replies in question if the Minister wishes to refer to them. The association has assured me that it was not consulted, contrary to what the Minister said. I am aware that the association has also contacted other Deputies. Have the Minister and the HSE examined the danger that this service will become fragmented, for example when the testing that is done in primary and secondary cases is separated? Do they agree it is possible that clinical liaison and input will be weakened under the proposed privatised and centralised model? The Minister did not reply to that important part of the question I asked on that occasion. Will a cost-benefit analysis be carried out on the aspect of this approach that would see many tests being done externally, and possibly overseas? Is any effort being made to establish the real cost of this approach?

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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I said in my reply that there is good engagement on this issue, through the Croke Park agreement, between the staff representatives and the HSE. There has been some rationalisation and reconfiguration in this area since the Teamwork report was published. Work practices have changed and more laboratories have been accredited. That is the good news. We need to achieve efficiencies in this area. The more efficiencies we achieve, the more money we have for patient services. It is intended to roll out the changed work practices in a number of key hospitals, including St. James's Hospital and Beaumont Hospital, quite soon. That will inform that decisions that will be made. It is clear that a cost-benefit analysis will be carried out. The Teamwork report gave us a great deal of food for thought on how we can offer a safer and higher quality service that is more cost-effective. That is what we have to do.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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We know what happened when changes were made to the system of reading smear tests. The outsourcing of that service created difficulties.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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I need a question from the Deputy.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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How much is the Minister hoping to save from the restructuring of this laboratory service? How will this saving be made predominantly? Will it be made through cuts in staff or overtime? When will this begin?

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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Those discussions are taking place with the staff representatives but my understanding is they will start in December on a number of key sites. The sites chosen are St. James's, Beaumont, Waterford, Galway and Cork. They are having discussions with staff representatives regarding those sites and I understand they are at an advanced stage.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Is the Minister concerned that she gave false information in a parliamentary reply to this Deputy on this issue, as I have indicated to her?

With regard to the certification and proper standards of the laboratories to be employed, what assurances do we have the laboratories that will be outsourced domestically or to foreign locations will reach the standards we hope for? Is she aware that her policy of essentially ending the role of hospital laboratories is resulting in the flight of highly trained, highly qualified people who would ordinarily have taken up employment in laboratories on a number of hospital sites across the State? We are losing them and we are witnessing a brain drain. How does she square that with the Government's so-called commitment to a knowledge economy?

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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There will be a huge need for highly qualified medical scientists in Ireland. This is about how we organise the service and whether we continue to provide it all in house or whether we outsource it or combine the public and private sectors. Above all, we have to ensure quality in as efficient a way as possible. That is what will guide the response of the HSE and the Government in this area. I understand the discussions with staff representatives are leading to a fair agreement between both sides and I hope that can be the case.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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How is it hoped to make the savings? Will it be predominantly through cuts in overtime or staff cuts?

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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I do not have all the detail but it is generally about providing the service in a more cost-effective fashion.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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Does the Minister agree what while she seeks efficiencies - which is important and we all support her in that - it is equally important to retain our indigenous ability to do these tests and not to outsource them outside the country?

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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We would never outsource everything outside the country. One cannot run a hospital system without a laboratory system and, therefore, there is no question of that. Clearly, we have to provide these quality services in the most cost-effective way we can for all our patients and that is what will happen.