Dáil debates
Wednesday, 15 November 2017
Ceisteanna - Questions
Cabinet Committee Meetings
2:00 pm
Brendan Howlin (Wexford, Labour)
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1. To ask the Taoiseach when the Cabinet committee E (health) will next meet. [47835/17]
Leo Varadkar (Dublin West, Fine Gael)
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Cabinet committee E met on 12 September and is scheduled to meet again on 23 November. Committee E covers issues related to the health service. As well as considering current issues and challenges faced by the health service, such as measures to improve access to scheduled and unscheduled care over the months ahead, the Cabinet committee will oversee the development of the Government's response to the Sláintecare report. As I previously stated, the Government agrees with the broad principles of the report, which align well with current policy direction in many cases. However, as recognised by the Oireachtas committee, further work is required on the costings and practical implementation challenges. Additionally, the Government needs to consider the phasing and sequencing of the recommendations, given budgetary and capacity constraints. The Government had a dedicated discussion on health reform on 13 October at our Cabinet meeting in Cork during which the Minister for Health updated the Cabinet on the ongoing considerations of the Sláintecare report. This work will be taken forward under the auspices of the Cabinet committee.
Brendan Howlin (Wexford, Labour)
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I welcome the discussions of Sláintecare, coming as they do after the absence of any resource allocation to the implementation of or any mention of Sláintecare in the budget. With regard to Cabinet discussions, I want to raise the provision of cardiac care across the country, in particular the provision of cardiac services in the south east. On Friday, I met with a number of groups in Waterford campaigning for 24-hour cardiac care support, including a second catheterisation laboratory on a permanent basis and the provision of a 24-7 emergency facility. The report commissioned by the Government, by Dr. Niall Herity, in July 2016, stated that any elective procedures would be carried out in the south east region, putting at risk people who live more than the 90 minute critical timespace away from either the Dublin or Cork based hospitals. The Government promised to review the Herity report and the facilities to be made available in University Hospital Waterford.
More recently, the Minister for Health has announced a national review which, when it is put in place, will take 18 months to complete its work. That will be significantly resisted by people in the south east. They are working on the basis that they need facilities now. We absolutely support a national review of cardiac services but in the interim, we have to have a review of services currently available in the south east to make sure they are providing cardiac care for people who live in the south east that is on a par with the rest of the country. Will the Taoiseach give a commitment that, pending the welcome establishment and conclusion of a national cardiac review, there will be, as promised, an immediate review of cardiac services in the south east to be based at University Hospital Waterford.
Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Will the Taoiseach clarify when the Cabinet committee on health last met? I did not pick up his opening reference. Did he say December?
Leo Varadkar (Dublin West, Fine Gael)
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12 September.
Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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12 September. Pardon me - it was not clear and I was not sure. I was wondering at the gap between the last time and the next scheduled meeting later this month. I am sure the Taoiseach is aware that over the first ten months of this year, record levels of people have been left on trolleys in hospitals throughout the State. I am sure many colleagues here have particular instances reflected to them, as a very distressing case was reflected to me in the recent past. As we progress into the winter, these figures are set to continue to rise. Over the period I refer to, up to this particular point over 2017, some 82,000 patients admitted have experienced time on a trolley. Throughout the month of October, the figure reached 9,000. Any extrapolation of those figures could indicate that between this month and next, we could very well reach almost 100,000 people or more. This is a 15% increase in the October figures compared to the figure for the same month in the previous year. This is a very difficult issue not only for staff in our hospitals, but for families coping with loved ones in hospital care.
The Taoiseach is familiar with the problem, having formerly been a Minister for Health himself. At this late point, what steps are being seriously taken to address this matter? It was an issue the Taoiseach flagged up himself in the course of his own tenure in office. When he took over as leader of Fine Gael, I recall him indicating that he would take a special interest in health. What is being done to address this serious issue? When will we see a detailed, costed overall plan with a timeframe? A plan is needed to tackle this unacceptable situation across our public hospital network.
Micheál Martin (Cork South Central, Fianna Fail)
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Whereas, in principle, the Government says that it is in favour of Sláintecare, reading between the lines, I do not get a sense that the Government is totally committed to Sláintecare at all. The Taoiseach's reply confirms that to me, since he says there is further work to be done on costings and implementation which is code for me for slowing down the implementation of Sláintecare. I have not had any sense of the Government deciding to hammer out the issues, whatever the issues are that the Department and Government seem concerned about. In the absence of Sláintecare, if that work is going to continue, there does not appear to be any real strategy governing health at the moment within the Government. There has been an absence of a strategy since universal health insurance was abandoned. It took five years to abandon a false promise that was made to the people in 2011. It was repeatedly promised that there would be universal health insurance and we got nowhere near implementing it. Senator James Reilly, then Minister for Health, abolished the board of the HSE and played politics with the whole thing, and then announced the establishment of hospital groups with no boards, just a chair and executive.
The governance of health has been in limbo for the past six years. I now learn the Government, belatedly, will reappoint an external board to the HSE. The situation has been unsatisfactory and incoherent in recent years with regard to the governance side; nobody is in a position to make up their mind, people were appointed not knowing what their mandate is and what the future held for them. Over the past year or so, hospital groups in particular have communicated to us about being in a limbo situation with regard to legislation.
I echo Deputy Howlin's comments on the south east. Prior to the Herity report, a reconfiguration report and an earlier national cardiac report recommended emergency heart care cover for the south east. I do not believe that Cork can deal with the patient cohort from the south-east area. University Hospital Waterford was left very short in respect of the reconfiguration report. Wexford and Kilkenny moved out of the south-east health area, became connected to the Dublin region and Waterford was on its own. Prior to that Waterford had been the main hospital in the south east, or was meant to be, in the South Eastern Health Board's original strategy. Now, once again, it is in a limbo situation and, as a result, is losing a lot of vital services such as the emergency cardiac care.
2:10 pm
Leo Varadkar (Dublin West, Fine Gael)
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Deputy Howlin's remark that there are no allocations for Sláintecare in the budget is incorrect. There is an allocation to establish the health reform office. One of the recommendations in the Sláintecare report was that one of the first actions to be done is the establishment of such an office to work on the implementation plan for Sláintecare. Sláintecare is a plan for a plan, it is not a plan in itself. It requires an implementation plan and it recommends that a number of reviews be done. Those reviews have to be done, one of which is the review of the public-private mix in the public hospitals and how it might be eliminated. The Minister for Health, Deputy Harris, has appointed a group to do that. This group is, I believe, led by Donal de Buitléir. The Sláintecare report also recommends that we begin, progressively over time, to reduce out-of-pocket expenses and costs for patients. There are two specific measures in the budget that do exactly that, namely, a reduction in the prescription charge for medical card holders under the age of 70 - having done it for the over-70s last year - and the reduction in the monthly charge for the drugs payment scheme, DPS, for those who do not have medical cards. That will be reduced by €10 per week-----
Micheál Martin (Cork South Central, Fianna Fail)
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That was in all our manifestos. All parties had that.
Leo Varadkar (Dublin West, Fine Gael)
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-----from January.
On the emergency cardiology issue - specifically 24-7 primary percutaneous coronary intervention, PCI, which I believe is what the Deputies mean - a report was done on that matter by Dr. Herity, a Northern Ireland-based cardiologist and expert in the field. He determined that it would not be safe or sustainable to provide 24-7 primary PCI in University Hospital Waterford. I am aware that the report has been rejected by many of the campaigners there and the clinicians working in the cardiology service there. Nonetheless, I believe all in the House would agree that decisions on where national or regional specialist units should be located must be based on scientific advice, not on politics. The Minister for Health plans a national review, which will be different to previous reviews. It will not simply be an expert review. There will be much more room in it to hear other voices such as the voices of patients and others.
On a more positive note, the second cath lab is now in place. It is a mobile cath lab at University Hospital Waterford and is working on elective cases. It seems to be having some success in reducing waiting times for people who need cardiac procedures. In the interim, we will have to give consideration to whether that second cath lab should be kept in place. While it may not be providing 24-7 primary PCI, it appears to be reducing waiting lists and waiting times for patients who need cardiac procedures on an elective basis. That has to be a positive.
Reference was made to scheduling of Cabinet sub-committee meetings. I believe I have explained this before. The Cabinet meets each week, sometimes twice per week now, and that is where most business is done. The Cabinet sub-committees meet every six weeks, not to crisis-manage but to deal with strategic planning, strategies, reviews and long-term policy thinking. I meet bilaterally with Ministers all the time, more often than I am able to keep records of.
The Government is committed to the implementation of the Sláintecare report but we do understand what it is. As I have already said, it is a plan for a plan, not an implementation plan. We are committed to the principles such as public health and the need to improve our health as a nation and as individuals. We will not deal with any of the long-term problems in health care or ever get on top of the costs if we do not deal with that. On the investment in capital and ICT, there is an increase in capital spending for health happening already and into the future. There is also a great emphasis on primary and community care, reducing out-of-pocket expenses and reviewing the public-private split in our hospitals. Those principles are very much accepted by the Government.
There are, however, issues. Deputy Martin asked what these are. There are issues around the costings, which need to be interrogated. I had one costing looked at within recent days. I believe we would all agree that there should be a lower threshold for individuals on the DPS. It is currently assessed on a household basis and this does not properly recognise that individuals - single people - can lose out under such a system. The costings in the report suggest that the threshold could be halved and it would cost only €7 million. After interrogation, however, nobody is actually able to come up with an estimate as to what it would cost because there are no records of whether people live in single-person households. As a result, that costing is certainly wrong. That gives just one small example of how costings in the report are definitely wrong and need to be interrogated further.
The report leaves open the question as to where the money will come from for its implementation. The report does not say, for example, that the funding should come solely from general taxation. It suggests a number of different sources as to where money could come from, including co-payments and social insurance. That would need to be teased out.
The report does not deal with one of the big questions we face in health care, which is why we spend so much and not get value for money for it. I have often said that spending on health in Ireland is in the top tier per head in the western world. We do not, however, have top-tier access. Any report about reform of our health service would have to deal comprehensively with that question.
The report does not come to conclusions; it recommends a number of different reviews. It recommends that further reviews be done on certain areas such as the public-private mix, which we have started.
Micheál Martin (Cork South Central, Fianna Fail)
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So it is back to normal.
Leo Varadkar (Dublin West, Fine Gael)
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The sense I get from members of the Opposition is that they are accusing the Government of somehow paying lip-service to supporting Sláintecare, even though we are actually taking it seriously and doing some of what is recommended in it.
Micheál Martin (Cork South Central, Fianna Fail)
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But all the commentary-----
Leo Varadkar (Dublin West, Fine Gael)
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It seems to me that the Opposition parties are actually paying lip-service to it. If we look at the Opposition pre-budget plans we can see that they did not provide anywhere near enough in health-----
Brendan Howlin (Wexford, Labour)
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That is not true.
Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Yes we did.
Leo Varadkar (Dublin West, Fine Gael)
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I have not even finished the sentence. I confirmed this with the academic authors of the report. They recommend that an extra €1 billion would need to be allocated for health in year one. For next year Fianna Fáil and the Labour Party certainly did not-----
Micheál Martin (Cork South Central, Fianna Fail)
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That is wrong. We wanted to transfer to a HSE budget.
Leo Varadkar (Dublin West, Fine Gael)
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Secondary to that I have-----
Brendan Howlin (Wexford, Labour)
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This is unacceptable.
Leo Varadkar (Dublin West, Fine Gael)
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I have not heard members of any party saying that they accept the report hook, line and sinker because were they to so do, they would have to answer some of the follow-up questions, the most obvious of which being from where would all the money come. The report states it should come from a mix of measures such as co-payments and social insurance-----
Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Will the Taoiseach answer the question?
Leo Varadkar (Dublin West, Fine Gael)
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-----so a party that says it is signing up for this report hook, line and sinker should answer that question. What co-payments are wanted, how much would they be, what social insurance contributions would they agree-----
Micheál Martin (Cork South Central, Fianna Fail)
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We do not agree with-----
Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I will take one supplementary question from Deputy Howlin and then we will move on.
Brendan Howlin (Wexford, Labour)
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I will be brief. The whole idea of-----
Micheál Martin (Cork South Central, Fianna Fail)
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Everything is a negative-----
Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Deputies, please can we hear Deputy Howlin's supplementary question.
Micheál Martin (Cork South Central, Fianna Fail)
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The Taoiseach is presenting all the negatives.
2:20 pm
Brendan Howlin (Wexford, Labour)
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The impetus behind an all-party group perspective into which everyone could buy was the need to stop this bickering that is going on now with the Taoiseach accusing the Opposition.
Leo Varadkar (Dublin West, Fine Gael)
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In fairness, I have been accused as well. I am happy to stop it.
Brendan Howlin (Wexford, Labour)
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The Taoiseach said he wanted to embrace this. Obviously, we have to drill down and be granular. I understand the costings of health care reasonably well. However, we need to proceed on an all-party basis. Let us try and let us have momentum on this. From what the Taoiseach has said, it appears this will go the way of all other reports. We will have no overarching issue.
I asked about cardiac care. Is the Taoiseach saying it is now settled Government policy that there will not be primary PCI in the south east? The second mobile laboratory, which the Taoiseach lauded, is on a fixed contract which is about to conclude. Since the Taoiseach acknowledges its success, will a permanent laboratory be provided at Waterford University Hospital?
Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Will the Taoiseach be brief in response to those questions?
Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Can I ask a supplementary question because I received no reply from the Taoiseach?
Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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We have to move on. Will the Taoiseach reply to Deputy Ó Caoláin's question?
Leo Varadkar (Dublin West, Fine Gael)
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I will do my best. I agree completely with Deputy Howlin on this matter. Let us stop the bickering around this.
Leo Varadkar (Dublin West, Fine Gael)
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I would absolutely love to stop the bickering around health care reform. Let us not forget that the first accusation was made against me and my Government that we were not committed to Sláintecare. I explained that we were but that a lot of work needs to be done, as the report itself acknowledges, including on detailed costings, the reviews the report proposes and the unanswered questions. Let us do that. If it can be done on an all-party basis, I welcome that. It means stopping the bickering, however.
Brendan Howlin (Wexford, Labour)
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Excellent.
Leo Varadkar (Dublin West, Fine Gael)
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The leadership in that regard must be shown by the Opposition because that is where the bickering almost always starts when it comes to these issues.
Micheál Martin (Cork South Central, Fianna Fail)
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This is a Parliament, not North Korea. Come on.
Leo Varadkar (Dublin West, Fine Gael)
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Regarding the matter of 24-7 PCI in the south east, it is the settled policy of Government to decide the location of national specialist services on the basis of the best scientific advice. It is not a closed question. It depends on the best scientific advice. If that were to change, a different decision could be made. I ask the House to bear in mind that medical science changes also.
Micheál Martin (Cork South Central, Fianna Fail)
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It is amazing how consultants-----
Leo Varadkar (Dublin West, Fine Gael)
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Services exist now which did not exist ten years ago. Services that exist now may not exist in ten years time. Science changes as do population, demographics and lots of other things. One can never close the door on a decision like this. The second mobile cath lab is there on a temporary basis and the decision is that an analysis will be carried out towards the end of the contract on what has been achieved.
Brendan Howlin (Wexford, Labour)
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It is only a few months away.
Leo Varadkar (Dublin West, Fine Gael)
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A decision will be made at that point as to whether it should continue. I acknowledge the enormous distress hospital overcrowding causes to patients who are required to wait for long periods on hospital trolleys for admission to a regular ward. I acknowledge also the distress it causes for staff. Having worked in three emergency departments, I know a little about that. I also have had relatives waiting on hospital trolleys for beds and I know a little bit about that too. I understand very much the distress it causes. While we have seen the trends going in the wrong direction all of this year, the figures are down significantly for November. Compared to November 2016, the figures are down approximately 25% according to the HSE's "Trolley Gar" figures. I do not know why that is. While it might be a blip, I hope it will be a sustained trend. The Minister has already outlined some of the actions he will be taking over the next number of months, including, in particular, greater investment in home care to allow more people to get home, which is the best place for them, as quickly as possible, thereby freeing up hospital capacity.
Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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There are a number of critical things to be done.
Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I point out to the House that we have already taken eight minutes from the second and third questions. The Members can continue to discuss this if they want, but it means we will not have the time for the other questions.
Micheál Martin (Cork South Central, Fianna Fail)
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We will move on.
Brendan Howlin (Wexford, Labour)
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We will go on.
Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I want to set something out. There are four areas that dramatically impact in terms of trolley usage, the figures for which are catastrophic this year.
Micheál Martin (Cork South Central, Fianna Fail)
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This is not good enough.
Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I thank the Deputy.
Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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We need recruitment and retention of staff, the reopening of closed beds, adequate step-down facilities and proper primary and community care.
Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Deputy, please. Question No. 2 is in the name of Deputy Micheál Martin.