Gerry Adams (Louth, Sinn Fein)
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Question 1: To ask the Taoiseach if the Cabinet Sub Committee on Health has met since its establishment. [28544/11]

Gerry Adams (Louth, Sinn Fein)
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Question 2: To ask the Taoiseach the Ministers, advisors or other persons who attend the Cabinet Sub Committee on Health. [28546/11]

Joe Higgins (Dublin West, Socialist Party)
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Question 3: To ask the Taoiseach if he will report on the schedule of the Cabinet sub-committee on Health. [29816/11]

Micheál Martin (Cork South Central, Fianna Fail)
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Question 4: To ask the Taoiseach if he has instituted any changes to the membership of the Cabinet Committee on Health. [31044/11]

Enda Kenny (Mayo, Fine Gael)
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I propose to take Questions Nos. 1 to 4, inclusive, together.

The Cabinet sub-committee on health had its first meeting on Wednesday, 5 October. It comprises me as chairman and the Minister for Health as convenor. The other members are the Tánaiste and Minister for Foreign Affairs and Trade, the Minister for Public Expenditure and Reform, the Minister for Children and Youth Affairs, the Minister of State with responsibility for primary care and the Minister of State with responsibility for disability, equality, mental health and older people. The chairman and CEO of the HSE also attend, as do senior officials from relevant Departments and the HSE. Ministerial advisers may attend as required. As with all Cabinet sub-committees, other Ministers, Ministers of State and the Attorney General may also attend if and when required.

The sub-committee is meeting on a monthly basis, with the next meeting set for this Friday, 11 November. I have not made any changes to the sub-committee since its establishment. The membership is reflective of the key ministerial responsibilities and along similar lines to previous such committees. The work of the sub-committee is to provide a basis for political oversight of the development and delivery of the key health service reforms in line with the commitments in the programme for Government and to drive improvements in selected priority service delivery areas.

Gerry Adams (Louth, Sinn Fein)
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If I understand properly, the Cabinet sub-committee on health has met only once since its establishment. That is ridiculous. There are 366 patients on hospital trolleys today and, once again, the highest number is in Drogheda, where 38 are on trolleys, despite the efforts of nurses and other staff in the institution in question. Last week a former nurse and patient, Louise O'Connor, wrote-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I cannot allow this because this is Question Time.

Gerry Adams (Louth, Sinn Fein)
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It is still important. I will send a copy of her letter to the Cabinet sub-committee. She wrote about patients having to strip inappropriately, a lack of screens, there being no dignity, rancid wounds, filthy feet, faecal matter, poor hygiene and smells. She also wrote that there was no time to clean trolleys, floors or surfaces and related how an older gentleman with a suppressed immune system had to lie in the corridor depressed and close to tears. Does the Taoiseach accept that this is inhuman? Does he accept, whether he meant it, that by paying €700 million to unguaranteed bondholders, resources are stripped from front-line health services in order to prioritise the payment of the private debts of bankers? I will send a copy of the letter to the Cabinet sub-committee, but will it deal with it and will the Taoiseach respond to Louise O'Connor?

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I remind Deputies that this is Question Time and that the questions relate to the Cabinet sub-committee on health, how often it has met and whether advisers or other persons attend. We are not debating health policy.

Enda Kenny (Mayo, Fine Gael)
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I did not form a Cabinet sub-committee on health in the beginning because we thought these matters might be assimilated into a smaller number of committees. That did not prove possible, however, and as a result of observations in the House, I formed a special committee on health. The sub-committee on health used to meet every quarter, but since the first meeting of the sub-committee, it will meet every month for six months and the position will then be reviewed.

The Deputy has referred to the position at Our Lady of Lourdes Hospital, Drogheda on a number of occasions. The special delivery unit set up by the Minister for Health has focused and is focusing on accident and emergency departments and dealing with the situation described by the Deputy. When I was in opposition I found it unacceptable and still do.

Eight of the hospitals visited by the special delivery unit require high support, including Our Lady of Lourdes Hospital, Drogheda. As part of the engagement with the unit, the hospitals have prepared plans setting out measures that could be taken quickly in the hospital or community concerned to significantly reduce pressure on the accident and emergency department. Following consideration of the matter and as part of the overall process followed by the special delivery unit, a package of short-term measures has been agreed for Our Lady of Lourdes Hospital, Drogheda. The supports being provided for it and other hospitals are dependent on a range of conditions being met. These include a commitment on the part of the hospital to progress implementation of the HSE acute medicine programme and ensure the hospital has seven day ward discharge rounds and, in particular, the cost of additional capacity funded by the initiative must not be offset by making reductions elsewhere. A sum of €725,710 is being made available for proposals relating to Our Lady of Lourdes Hospital, Drogheda between now and the end of the year. The measures being taken are aimed at easing the pressure in Drogheda and also involve Louth County Hospital, Dundalk and Our Lady's Hospital, Navan, as well as community measures. These measures comprise additional assisted discharge packages, including home help, home care and funding for aids and appliances; the extension of the hours of the acute medical assessment unit at Drogheda to 18 hours a day, seven days a week; the opening of eight medical beds in Drogheda; the opening of an additional 28 low-acuity beds in Louth and Navan, and the opening of an additional 27 low-acuity beds in the community. The funding support is dependent on the hospital meeting the performance conditions set down. The special delivery unit will be monitoring the position closely. I hope the plans being implemented at Our Lady of Lourdes Hospital, Drogheda, will quickly address what is, without question, an unacceptable level of overcrowding in the accident and emergency department.

Joe Higgins (Dublin West, Socialist Party)
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Will the Taoiseach restate the purpose of the Cabinet sub-committee on health? Will he indicate the effect the work of the sub-committee will have in the delivery of comprehensive health services during the coming 12 months? Does the sub-committee consider, for example, what will be the impact on the health service in general, and hospital services in particular, of the €2.2 billion in cuts announced in recent days by the Minister for Finance? Has the sub-committee received a report on that matter and, if so, what was its reaction? How detailed are the reports the sub-committee receives from the health service? Nurses at Limerick Regional Hospital were obliged to strike in order to highlight the intolerable conditions being endured by patients and 28 surgical beds were closed at Connolly Hospital in Blanchardstown two weeks ago.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The Deputy is straying into the area of policy.

Joe Higgins (Dublin West, Socialist Party)
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Are matters of this nature, including the disastrous cuts to which I refer, brought to the attention of the sub-committee? Does it take a view on such matters? Does it inform the HSE that what is happening is disgraceful or does it state cuts must be made because the Government must continue paying billions to gambling bondholders?

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I ask the Taoiseach to confine himself to answering the questions asked. We are straying far too deeply into areas of policy.

Enda Kenny (Mayo, Fine Gael)
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The purpose of the sub-committee is to provide, in line with the commitments contained in the programme for Government, a basis for political oversight of the development and delivery of key health service reforms. Everyone would like a situation to develop where those who require hospital treatment would be able to obtain it as close to home and as quickly as possible. Such treatment should be of the highest standard. In order to arrive at the position to which I refer, we must change the structures relating to something that is extremely large. Yesterday I launched an awareness week relating to drug and alcohol abuse and misuse. Is the Deputy aware that each night 2,000 hospital beds are filled by people suffering from the effects of alcohol abuse? He and I both have a responsibility in this matter, by which I mean that there is an onus on us to speak to those of our constituents who are afflicted by the problem of alcohol abuse. The fact that these 2,000 beds are unavailable for other purposes is having a direct impact on the quality of services that can be provided in accident and emergency and other hospital departments.

Joe Higgins (Dublin West, Socialist Party)
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The Taoiseach should start the ball rolling in this matter by banning the advertisement of alcohol.

Enda Kenny (Mayo, Fine Gael)
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I am glad that the matter relating to the Mid-Western Regional Hospital in Limerick was resolved, not through confrontation but by the parties discussing the matter of the need to change rotas. I am extremely happy that the matter was resolved after it had been brought to the attention of the public and those involved in the political process.

The third issue to which the Deputy referred relates to the level of detail made available to the Cabinet sub-committee. It receives whatever level of detail is necessary. It all depends on the questions being asked. Personnel from the Department and the HSE can be required to attend meetings of the sub-committee in order that the detail requested in the context of a particular question can be provided.

Micheál Martin (Cork South Central, Fianna Fail)
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My initial question relates to whether there have been changes to the membership of the Cabinet sub-committee on health which, to date, has only met on one occasion. I tabled it as a result of the fact that there was a degree of uncertainty in respect of health policy per se. There is also an incredible lack of clarity with regard to the future direction of health policy. Is the HSE going to be abolished? It would regrettable if that proved to the case. I accept that there is a need for reform and consolidation in respect of the transformative changes which have taken place during the past decade in the health of the population. The two major changes have come about as a result of how we deal with heart disease and cancer, historically the two biggest killers in society.

The second matter to which I wish to refer relates to the commitment in the programme for Government regarding the development of a pathway to universal health insurance. This will be an enormous undertaking. I do not agree with the policy in this regard, but it is the prerogative of the Government which has a mandate to pursue it. In view of the way matters are progressing, particularly in the context of the work of the Cabinet sub-committee on health, there is no sense of conviction in this matter. Has consideration been given to the sub-committee receiving external presentations on, for example, how the universal health insurance model in the Netherlands operates?

There are a number of key issues with regard to the privatisation of management in local hospitals as a preparatory step towards moving to the local trust model. Has this matter been placed on to the agenda of the Cabinet sub-committee? I refer to the concept of bringing in private contractors to manage local hospitals. I am also concerned about the privatisation of district hospitals. There appears to be a policy of creeping privatisation-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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This matter relates to policy.

Micheál Martin (Cork South Central, Fianna Fail)
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It relates to the work of the Cabinet sub-committee on health.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I was present for Priority Questions when this matter was addressed to the Minister for Health. These are policy issues.

Micheál Martin (Cork South Central, Fianna Fail)
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I am trying to obtain from the Taoiseach a sense of what is happening. These are issues which the Cabinet sub-committee on health should be considering.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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This is not a matter for the House.

Micheál Martin (Cork South Central, Fianna Fail)
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I want the Taoiseach to indicate whether there has been a change in the membership of the sub-committee which reflects the changes to which I refer.

Enda Kenny (Mayo, Fine Gael)
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There has not been a change in the membership of the Cabinet sub-committee which I chair. The Minister for Health is its convenor, while the Tánaiste and Minister for Foreign Affairs and Trade, the Ministers for Public Expenditure and Reform and Children and Youth Affairs and the Ministers of State with responsibility for primary care and disability, equality, mental health and older people are also members. Individuals such as the Attorney General and the Chairman and CEO of the HSE may attend our meetings. Any other personnel required to attend can do so.

There is absolutely no intention to privatise any hospital in the public health sector. The Minister for Health brought in external expertise in the establishment of the SDU. The individual involved has a proven record and has already identified a number of serious possibilities regarding the introduction of changes to reduce waiting times, get patients off trolleys, etc.

In the case of the hospitals in Galway and Limerick, the Minister is clearly aware of the need to develop further competency in the management of these two very large hospitals. For that reason, he has introduced, with the approval of the Minister for Public Expenditure and Reform, a package in respect of the attraction of outside assistance in order to help with the development of the management competency to which I refer. The existing staff at these two extremely large institutions will benefit from working with world-class individuals who have experience of managing facilities of this kind. The lessons they learn will enable them to carry on with their work. Following a tendering process, a framework agreement involving five companies was established in September. A mini-competition to source and propose candidates for an interim management support structure for HSE West is under way and expected to be completed in the coming weeks. The HSE briefed IMPACT on its intentions in this regard and I understand further discussions are to take place.

I wish to make it clear that there is not a process of creeping privatisation. We have no intention of privatising any of these hospitals. External assistance is being brought in in order that staff at the hospitals in question might develop competence in the management of these hospitals, thereby bringing about greater efficiencies by ensuring costs are kept down and patients receive better treatment.