Wednesday, 31 January 2018
Ceisteanna - Questions (Resumed) - Taoiseach's Meetings and Engagements: Supplementary Questions
Cabinet Committee Meetings
I propose to take Questions Nos. 19 to 21, inclusive, together.
Cabinet committee E covers issues relating to the health service, including health system reforms. The committee last met on 23 November and will meet again on 15 February. In addition to meetings of the full Cabinet and Cabinet committees, I meet Ministers individually, as required, on particular issues. In this regard, I regularly meet the Minister for Health, Deputy Harris, to discuss the challenges facing the health service, and did so as recently as last week. While there will be a need for increased investment in the health service over the years to come, reform and productivity gains must happen in tandem or we will provide no benefits for patients and only costs for the taxpayer.
The Government has affirmed its commitment to implementing a significant programme of reform following the publication of the Sláintecare report by the Committee on the Future of Healthcare last year. Work on the report is linked to the health service capacity review which has been published, the new GP and primary care strategy and the work of the independent review group which is examining the removal of private practice from public hospitals, a specific recommendation of the Sláintecare report. A group under Donal de Buitléir has been established to do exactly that. Work will be taken forward under the auspices of the committee.
Over the past week the Taoiseach has repeatedly refused to answer direct questions on the health budget. Yesterday he tried to deflect by saying that all agencies look for more and the HSE is no different. This is not the point. The issue is the Government insisting on promising a level of services which it knows cannot be delivered for the amount of money allocated in the budget. That is the core point.
Massive overruns are not always inevitable. Over recent years the overruns have been result of a Government policy which agreed a budget and promised a higher level of service than could be delivered by that budget. That has undermined proper planning and led to escalating overruns. We know that two or three years ago we were essentially given budgets. In response, in a practice patented by the Taoiseach, the Government wrings its hands and says it is all the fault of the administrators. Information discovered by journalists through freedom of information requests, which was not made available by the Government, clearly states that the health budget is a sham. It is based on levels of savings which have no justification and service levels higher than can be delivered.
When did the Taoiseach become aware that the savings figure in the health budget were an invention with no basis in fact? That is not my presentation. It is from the HSE itself. Will he assure the House that we are being provided with all relevant information to help us assess the credibility of the health budget? This is a simple matter. I ask the Taoiseach to answer the questions.
In respect of section 39 organisations, earlier today the Taoiseach used language which suggested that the workers were caught in the middle and that there was a differential opening up. The workers in section 39 organisations are not caught in the middle. They are suffering because the Government decided not to fund their pay restoration. The Government funded pay restoration for HSE employees, but those working in disability services, hospitals and mental health services throughout the country were deliberately excluded by the Government because of a lack of transparency and honesty around the budget. I want a straight answer. The HSE said it will not be able to make the savings identified in the budget. When did the Taoiseach become aware of that?
The Euro Health Consumer Index for 2017 published this week rates waiting times for health care in the State as among the worst in Europe. We are in 24th place, which is even lower than the previous year. The authors, understandably, ask why countries with more limited means can achieve a virtual absence of waiting lists while this State fails to do so. Why can we not address this? This week has also seen record levels of patients lying on hospital trolleys. Today, 415 are languishing on hospital trolleys throughout the State. Yesterday, the figure was 644. On Monday, the figure was 543.
The publication of the report of the bed capacity review last week confirmed that, without investment and reform, this appalling situation is set to continue. There is little in the report that patients, politicians and health service workers do not know already. The report confirms that emergency department attendances will increase significantly. It also identifies a necessary increase of at least 2,600 beds in public hospitals, a projected increase of 190 adult critical care beds and 13,000 for older citizens in residential settings.
All of these beds require a planned and funded recruitment and retention strategy for nurses. The recommendations on staffing and the recruitment of nurses, doctors and other health care staff need to be addressed as a matter of urgency. This cannot be done unless the recruitment and retention crisis across all grades in the health service is addressed. That means addressing in a meaningful way working conditions, facilities, supports, training, promotion opportunities and pay.
Does the Taoiseach accept that this requires the Government to engage meaningfully with workers, representative bodies and unions, as well as establishing a commission on pay in the health service for medical professionals and health care workers, as recommended by the Dáil? What steps will the Government take to fit these recommendations into the framework on the Sláintecare report?
The Taoiseach will be well aware of the commitment made to review cardiac services in the south east. There was grave concern and disquiet right across the region, in particular in Waterford as well as in neighbouring counties, including Wexford, Carlow, Kilkenny and Tipperary which were dependent on Waterford hospital for cardiac care. The south east did not have access on a 24-7 basis to cardiac treatment in a timely fashion, a situation which is unique. There was to be a review of Herrity and an examination of the parameters in respect of that. That has been enveloped by a new national cardiac services review.
Needless to say, because the timeline is 18 months, it has caused additional disquiet in the south east generally. In the interim, will the Government implement those elements of the Herity report it accepted on lengthening the operational hours of the existing catheterisation laboratory in Waterford city on weekdays and to include weekends? Will it ensure the first phase of the national review will involve the south east in order that we can determine the practical steps which can be made to ensure cardiac care services in the south east will measure up to those in the rest of the country?
I will do my best to answer as many direct questions as I can, but it is not always possible to answer questions directly when one does not have the answers or information in front of one or one's mind. We have this cycle most years in respect of the health service budget. The levels of activity are set out in the Health Service Executive, HSE, service plan for the numbers of outpatient attendances to be funded, the numbers of operations that will be performed, the numbers of emergency department attendances, the numbers of home care and respite care hours that will be provided and the numbers of medical cards that will be issued. Every year the Opposition states these levels of service will not be met.
I do not accept the contention that the things set out in the HSE service plan will not be delivered. I think they will be because pretty much every year the level of activity has increased. At the same time, there is almost always a financial challenge during the year which we must work out and almost always it requires a Supplementary Estimate. It is hard to do it because the financial systems are so archaic and badly managed that it is March or April before we know how much the HSE spent in the previous year. That is atypical for public bodies. This goes on throughout the year and it would not be unusual to find a dramatic change in the estimated position from week to week; €100 million or €200 million can disappear or reappear in the space of a few weeks. That presents a real problem in planning. Last year there was a projected overrun in the primary care reimbursement service, PCRS, but it never materialised. However, another overrun by several hundred million euro appeared somewhere else. I would love the funding of the health service to be transparent and to know exactly where the money goes. We used to talk about money following the patient. I would like to be able to follow the money, but, unfortunately, we cannot do so. That is a big problem, one for which the Government takes responsibility.
The Public Service Pay Commission is examining the issue of pay for health care workers. It has been asked to examine the position for health care and Defence Forces staff first. In the meantime, public service pay restoration is well under way. Recruitment in the health service is now much easier than it was a year or two ago, which is encouraging. That is due, in part, to pay increasing again, but ironically it is also as a consequence of Brexit. Fewer overseas and EU workers are moving to the United Kingdom; they seem to be more willing to come here.
The European Health Consumer Index gives a mixed picture. It is poor on access. There is no point denying this, notwithstanding the fact that the numbers waiting for operations and procedures are falling, but they are not falling for outpatients. The index does point to good outcomes in some areas, which should be recognised. It gives us a green score based on the fact that Irish patients have access to novel drugs, as well as the cost of medicines. The Deputy will be aware that in Northern Ireland patients with cystic fibrosis do not have access to medicines such as Orkambi, but here patients do.
I hope that when Michelle O'Neill is back behind her desk, that matter will be sorted out. The index ranked us very highly on matters such as smoking prevention, blood pressure, vaccinations, cancer survival rates and potential years of life lost. It is a mixed picture, but it is not surprising. It is poor on access but reasonably good on patient outcomes and experiences.
I discussed the situation in the south east with the Minister for Health earlier this week. He plans to engage in a wide review, different from the one carried out under Professor Herity, one that will hear the voice of the patient and involve groups such as the Irish Heart Foundation. That follows a motion agreed to by the House a couple of months ago. I understand the funding has been put in place to extend the operating hours, but I do not know if it has yet happened. It does require having staff who are willing to work unsocial hours, which can sometimes be difficult.
No; I cannot.
It is important to distinguish between cardiology services and 24-hour primary percutaneous coronary intervention, PCI. They are not quite the same. Primary PCI for 24 hours is a highly specialised service that can be provided only in a relatively small number of regional centres. In the entirety of Scotland which has a population of 5 million people it might be provided in only two or three centres.