Dáil debates
Wednesday, 17 May 2017
Ceisteanna - Questions
Cabinet Committee Meetings
1:45 pm
Micheál Martin (Cork South Central, Fianna Fail)
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1. To ask the Taoiseach when the Cabinet committee on health last met; and when it is next due to meet. [23026/17]
Mick Barry (Cork North Central, Solidarity)
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2. To ask the Taoiseach when the next meeting of the Cabinet committee on health will be held. [23041/17]
Brendan Howlin (Wexford, Labour)
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3. To ask the Taoiseach when the Cabinet committee on health last met; and when it next plans to meet. [23047/17]
Enda Kenny (Mayo, Fine Gael)
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I propose to take Questions Nos. 1 to 3, inclusive, together. The Cabinet committee on health last met on 27 April and is scheduled to meet again on 30 May.
Micheál Martin (Cork South Central, Fianna Fail)
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It is about four years since the Taoiseach announced that he was taking personal charge of health service delivery-----
Brendan Howlin (Wexford, Labour)
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Somebody had to.
Micheál Martin (Cork South Central, Fianna Fail)
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-----because, apparently, somebody had to. I note that a future leader has suggested the same, that when he gets in, he will take charge of it also. There are about 666,000 patients on inpatient and outpatient waiting lists. There are record high waiting lists. Children are waiting for more than a year for access to elective surgery. The Cabinet committee on health which the Taoiseach has chaired for many years failed on the compulsory health insurance plan. The Taoiseach spoke about removing the HSE, but he was not in a position to do so. It was a broken promise. He got rid of the board and made a mess of governance. The crisis in the health service is quite shocking. When the Taoiseach looks back on it, does he accept that the Cabinet committee on health has failed abysmally to tackle the issues arising in the health service, particularly in providing access to treatments for many patients? He has been unlucky with the Ministers he appointed. The former Minister, former Deputy James Reilly, ended up in trouble because of the absence of blueprints behind ideas that had been floated. The former Minister, Deputy Leo Varadkar, now Minister for Social Protection, ran out of the Department as quickly as he could get into it and was determined to be a commentator, rather than a doer. Apparently, if one looks at the Minister for Foreign Affairs and Trade, Deputy Charles Flanagan's WhatsApp group, it seems the Minister, Deputy Simon Harris, wants to do the same. He is also in a hurry to get out. I would appreciate it if the Taoiseach indicated to me what can be pulled from the wreckage in developing a coherent reality-based health policy and how the Cabinet committee can become far more effective than it has been for the past few years.
Enda Kenny (Mayo, Fine Gael)
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The role of the Cabinet committee is not to run services for the Department of Health or the HSE but to provide a basis for political oversight in the development and delivery of key health service reforms in line with the commitments in A Programme for a Partnership Government and to drive improvements in selected areas. It maintains oversight of the most significant areas of the health service. In the case of the winter initiative, it provided €40 million in additional funding for preparation for issues that would arise. A significant focus was placed on reducing the numbers of delayed discharges in acute hospitals through the funding and provision of additional home care packages, additional home help hours and additional transitional care beds. The number of delayed discharges was reduced from 638 in September 2016 to a low of 434 at the end of December 2016. It was maintained below 500 from mid-December through to the end of February. Obviously, there were staffing challenges. A significant issue last winter was the day-to-day maintenance of staffing levels and the ability to flex staffing levels to meet open surge capacity, in other words, at times when there was a spike in the numbers of patients coming through emergency departments. The figures released by the National Treatment Purchase Fund on Friday, 7 April confirmed that there were 84,838 patients on inpatient or day case procedure waiting lists; 18,000 waiting for a routine GI endoscopy procedure; and 466,000 waiting for a first outpatient appointment. In 2017 there are a range of initiatives designed to deal with the issue in a way that will ensure an improvement. These are the reports that come before the Cabinet committee to maintain political oversight of the key areas of responsibility.
Mick Barry (Cork North Central, Solidarity)
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When I was out and about in my constituency at the weekend, I saw a neighbour of mine limping a little more badly than usual. I asked him what the story was about his hip. He is a man who had a knee operation a few years ago privately, but his private insurance has lapsed. He was placed on the public list last June for a hip operation and told recently to expect to undergo an operation about 18 months from now. He is in fierce pain and thinking of giving up his job because he really cannot hack it at the moment. He is one of 658,677 health service patients who are in a queue of one kind or another. They will soon be talking about the Taoiseach's legacy. I do not think there is much of one. We have the longest health service waiting lists in all of Europe by some distance. In the city of Cork, between Cork Univeristy Hospital and the Mercy Hospital, there are four times as many waiting for 12 months or more for an outpatient appointment than three years ago. What will the Taoiseach do to address the scandal of the two tier health service and the longest waiting lists in Europe? Where does the Cabinet committee fit into that process?
Enda Kenny (Mayo, Fine Gael)
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The Cabinet committee does not deal with the detail of the running of day-to-day services, but it does have political oversight of what is happening. The net expenditure of the HSE to the end of February was €2.226 billion, which was under profile. The expenditure of acute hospitals was about €28 million above profile. We are providing more money than ever before for the health service, at €14.5 billion. I have outlined that the winter initiative was to deal with the increased numbers of cases coming through and the challenges in staffing and so on. I assume that in the case of Deputy Mick Barry's friend, because the condition of his hip is deteriorating, his doctor should be in contact with management in the hospital to say it has now deteriorated to a point where it needs urgent attention. As the Deputy knows, these things take a while to develop. If his friend's condition has worsened, the clinician might make a decision that it needs attention more urgently than thought.
The Minister for Health has set out a whole range of issues with which he is dealing to improve the health situation and he will keep at that for the future.
1:55 pm
Brendan Howlin (Wexford, Labour)
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I also sat on the Cabinet sub-committee on health for five years. The drive to abolish the HSE has left us in a completely invidious position. The health Vote rests with the Department of Health which is accountable for the money but the HSE is responsible for the spending of the money with no accountability. The Taoiseach has given various figures and made reference to them being on-profile or over-profile but in truth the tracking of expenditure has been extremely difficult in the last few years. In the last number of years, the HSE has been on target, more or less, until around November but some miraculous thing happens in the last few weeks of the year and the executive requires an additional €500 million, €600 million or €700 million to balance the books. That cannot be right and we need to look again at accountability and oversight in a real way.
There is enormous concern in the south east about the issue of cardiac care in University Hospital Waterford. An interim solution was announced by the Taoiseach and the Minister for Health, namely, that a second mobile catheterisation laboratory would be provided. That was a solemn commitment made in January of this year but to date it has not happened. The south east is the only region in the country that does not 24 hour cardiac catheterisation laboratory facilities. When will this happen? When will the interim solution of a mobile unit happen and when will the decision be made regarding a second permanent catheterisation laboratory should that be determined by the Government to be required?
Enda Kenny (Mayo, Fine Gael)
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I am aware of the commitment made to provide a mobile catheterisation laboratory but that is not something that we can just drive into position. There are elements that need to be put in place before it can happen but there is no resiling from the commitment. I am aware of the situation regarding the numbers in Waterford. I cannot give the Deputy a date for when it will happen but the commitment will be honoured.
Brendan Howlin (Wexford, Labour)
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Will it be this year?
Enda Kenny (Mayo, Fine Gael)
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I will advise Deputy Howlin as to the progress made since January for the provision of the catheterisation laboratory which I hope will help to relieve the backlog of cardiac cases in Waterford.
Donnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
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Recently the Irish Nurses and Midwives Organisation, INMO, released figures showing that overcrowding levels for the first four months of this year were are their highest levels since records began, with 36,048 waiting on trolleys from the start of the year until the end of April. Last night in my own constituency, there were 26 patients on trolleys in Cork University Hospital and 16 in the Mercy University Hospital. Even well out from winter, the numbers on trolleys remain very high despite the best efforts of health care staff and overworked nurses and doctors. This is evidence of a system that is completely and utterly dysfunctional. Whatever action the Government has taken has failed to make a significant dent in the problem. The trolley crisis is a symptom of a health system in crisis, as is the shocking rise in public waiting lists for treatment. There is now a record of well in excess of 660,000 patients on waiting lists for some kind of hospital care. The €50 million sticking plaster that the Government is spending on initiatives to cut waiting lists is having no appreciable effect. In the days, weeks or months left to him in office, will the Taoiseach establish an emergency department task force on a permanent basis to deal with the crisis at hand? Will he also agree to increase the number of hospital beds, nursing home beds, home help hours and invest in community services? The under-resourcing of the latter services ultimately leads to more people ending up in hospital when they could and should be cared for in the community.
Enda Kenny (Mayo, Fine Gael)
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The Deputy makes a valid point about trolley numbers and the Minister for Health has made this a particular priority. Emergency department overcrowding and long patient waiting lists are of critical concern here. Last September the HSE's winter initiative was announced which provided €40 million of additional funding to deal with these matters. A range of practical measures to address emergency department overcrowding were implemented, including 90 newly-opened additional hospital beds and a reduction in delayed discharges nationally from 668 in September to 434 in December. Delayed discharges were maintained below 500 to the end of February. Aids and appliances were given to over 4,450 patients, 1,000 additional home care packages were provided and 615 additional transitional care bed approvals were also made. All these measures enabled patients to be discharged from hospital sooner. A key element of the winter initiative was for the HSE to work with hospitals to develop improvement actions and winter plans at each location. Learning from the most recent winter initiative will be important for the future.
As part of the ongoing measures to relieve pressure in emergency departments, several major capital projects are under way or in the process of completion which will increase overall capacity in the hospital system. These include a new ward block and an adult mental health unit at University Hospital Galway, a new emergency department in Limerick and an extension at Our Lady of Lourdes Hospital in Drogheda. The Department has also commenced a bed capacity review in line with the commitment in the programme for Government. That review will feed into the mid-term review of the capital programme which is under way at present. The Minister and the Department will continue to work intensively with the HSE to address the challenges and monitor the performance in the emergency departments. In Deputy Howlin's constituency in Wexford, for example, the design and construction of the new emergency department has eliminated a great deal of the pressure and stress in what was previously a very constrained and confined emergency department. A number of modular units will be put in place as extensions to existing emergency departments in some hospitals to relieve pressure. Members are aware that the population of this country is ageing. We must think in terms of 2020, 2030 and even 2040. By 2040 Ireland may have 1 million additional people and will need 0.5 million extra houses. We will also have to deal with our ageing population in the context of hospital locations, primary care centres, community homes and so forth. That is all part of a ten year capital programme in which everyone will have to be involved because Ireland's current health facilities will have to be radically different in ten years' time.