Dáil debates

Wednesday, 13 November 2013

Ceisteanna - Questions - Priority Questions

Hospital Services

9:40 am

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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2. To ask the Minister for Health his views on the letter from the CEOs of the Mater, St. James's, Tallaght and Crumlin children's hospitals, Dublin, stating that the health cuts are unsustainable and a threat to the safety and quality of patient services; and if he will make a statement on the matter. [48146/13]

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Does the Minister agree it is a seriously worrying development when the chief executive officers of four of the largest hospitals in the country write to the HSE to warn that the quality and safety of patient services in their hospitals is seriously threatened by the cuts imposed by his Government? These four large hospitals - the Mater hospital, St. James's Hospital, Tallaght hospital and Crumlin children's hospital - provide national services. As the responsible Minister, he has chosen not to respond, although the correspondence went to the HSE. I have not noted any response from the Minister in this regard. Why is that?

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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The issues raised by the hospitals in the letter referred to by the Deputy will be considered in the context of the HSE plan for 2014. I wrote to the HSE last Thursday, 31 October, to confirm that the executive has until 15 November to submit its service plan. In that letter, I also conveyed to the executive that my overriding priority is patient safety, with the next priority being to treat patients in as timely a fashion as possible.

Clearly, 2014 will be a very challenging year for the health services. In meeting this challenge, the goal, wherever possible, is to cut the cost of services rather than the level or quality of the services delivered, and to accelerate the pace of reform. The reform programme for hospitals, as set out in Future Health, aims to deliver more responsive and equitable access to services for all patients, to organise public hospitals into more efficient and accountable hospital groups, which can deliver better patient care for less cost, and to ensure that smaller hospitals continue to play a key role.

It can be difficult to achieve the necessary reform while hospitals exist in isolation from one another. The formation of hospital groups, which I announced last May, will allow each group to manage its own affairs and operate with maximum autonomy. It will also ensure that the treatment required by patients is received at the most appropriate level in the most appropriate and safest setting.

I have now appointed chairs to all seven hospital groups, the process of recruitment of CEOs has commenced and the process of establishing a strategic advisory group to guide the reorganisation of services by hospital groups is under way. The overall aim is to provide efficient and effective care, as close to the patient's home as possible, with a view to improved health outcomes and satisfaction for patients.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister stated that his overriding priority is patient safety and yet from my reading of the correspondence from the four CEOs, that is also their overriding priority but there seems to be such a gulf between the Minister's and their position. The Minister falls back on the unpublished national service plan 2014 and yet the CEOs are clearly indicating that the situation, which they seek to be addressed, is current and is a consequence of the collective impact of a succession of five budgets that have seen €206 million removed from their spending capacity. They stated that this short-sighted and random application of budgetary reductions is clearly likely to seriously damage the foundation of the system. That has to be of concern to each and every one of us.

The CEOs are saying the cuts imposed by the Minister and the Government, coupled with demands for fewer staff while at the same time insisting on shorter waiting lists, is totally unsustainable. The Minister must have a better answer than what he just gave. It is not a pig in a poke situation. We cannot wait for the next national service plan and whatever further cuts it might outline for these hospitals.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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With respect, there is nothing remotely random about the manner in which the budget was allocated for 2013. Hospitals were actually given an increase. The hospital budget got an increase. Two of the hospitals mentioned in that letter received increases of 5.5% and 2.8%, respectively, and two of the hospitals received a small reduction. That is what the rebalancing of the budget is about. I have no issue with CEOs writing to the head of the HSE seeking to protect their budgets. All groups do that. Patient safety is my main priority and patients being seen as quickly as possible, allowing for the constraints under which we operate, is my second priority.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The four CEOs make it very clear that the situation is as a result of the composite impact of a succession of five budgets, and there is no getting away from that fact. Their language shows they are at breaking point and if there are further cuts in the national service plan for 2014, the consequences will be dire. Patient safety will suffer. That is why they have taken the very bold, brave and welcome step of outlining the factual situation for all to note and not just the HSE, the Department of Health and the Minister and his colleagues.

Will the Minister recognise that any further cuts across the hospital network will have serious consequences for citizens? I appeal to him to take heed of the CEOs appeal, which is what it is. They are saying to him that they cannot sustain any further cuts. It is reasonable that the Minister should respond because although he has lauded the advances made in cancer care provision on many occasions, make no mistake about it, even cancer patients are now experiencing unacceptable delays in access to treatment. The situation has become that grave.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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On that very point, I am not aware of any untoward delays in the treatment of cancer patients in any of our adult hospitals. I am concerned to hear about a situation in Our Lady's hospital in Crumlin and l have asked for an investigation into it. The budget should allow for priority to be given to those who are most acutely ill, in particular children with cancer. The management of those budgets is a responsibility for the CEOs. I have also made it very clear that patient safety is a core responsibility of a CEO because there seems to be a mind abroad that thinks this is only an issue for doctors and nurses but it is not. It is a core issue for management. I expect the CEOs to do their jobs, as all CEOs do, in meeting their budgets and meeting their patients' requirement for which they are responsible.

The budget this year is more than €13 billion. We have an increasing population, about which there is no question. We have a demographic challenge in that every year we have 20,000 more people over the age of 65, which is a growth rate of 3.5% whereas the average rate of growth in the population is only 0.5%. It is great news we are all living longer but it presents challenges to us and it is why we must continue the reforms in our health service. As to whether money could have solved this, as the Deputies opposite know, there were halcyon years here when money was abegging and the money spent on health was more than quadrupled over a ten year period and yet the health service did not seem to improve.