Dáil debates
Wednesday, 20 June 2018
Ceisteanna - Questions (Resumed)
Cabinet Committee Meetings
1:30 pm
Joan Burton (Dublin West, Labour)
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11. To ask the Taoiseach when Cabinet committee E (Health) will next meet. [26475/18]
1:40 pm
Leo Varadkar (Dublin West, Fine Gael)
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Cabinet committee E covers issues relating to the health service including health system reforms. The next meeting of this Cabinet committee has not yet been scheduled but last week I met the Ministers for Health and Finance, Deputies Harris and Donohoe, to discuss the Sláintecare implementation report. In addition to meetings of the full Cabinet and Cabinet committees, I meet with Ministers on an individual basis as required to focus on particular issues. In this regard I meet regularly with the Minister for Health, Deputy Harris, to discuss the challenges facing the health service.
The Government is committed to enhancing the quality of the health service and has allocated significant capital funding for investment in health infrastructure of €10.9 billion over the next ten years. This will provide major investment projects and programmes, including the provision of 2,600 additional acute hospital beds to be delivered across all hospitals, along with significant reform initiatives. Investment in our health services must go hand in hand with reform.
A number of actions have been advanced on foot of the Sláintecare report including the independent working group, chaired by Donal de Buitléir, which is examining the impact of removing private practice from public hospitals. We expect that working group to report later this year. We have commenced a public consultation on the geographical alignment of hospital groups and Community Healthcare Organisations, CHOs, as recommended in the Sláintecare report. The Minister for Health has also begun discussions with general practitioner representatives on the reform of the GP contract, while reductions have been made to prescription charges, in line with the Sláintecare recommendations.
The Government’s implementation plan will be published in the coming weeks and the recruitment of a lead executive for the programme is well advanced. We are awaiting final confirmation and will then inform the House of the identity of the new lead executive. Work is also underway to strengthen the governance arrangements in the HSE. The Minister for Health has published the general scheme of the Health (Amendment) Bill to establish a HSE board and earlier this month the Public Appointments Service advertised the position of chairperson of that board. This will be a different position to that which existed in the past. It will come with remuneration so that whoever is appointed will be able to devote two days per week or more to the role.
Joan Burton (Dublin West, Labour)
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In the context of the Taoiseach's previous answer, I recall that during the last general election campaign in Dublin West the Taoiseach's slogan over the final days of the campaign was "Don't let Sinn Féin turn west Dublin into west Belfast". Having campaigned on that slogan, the Taoiseach's previous reply suggests that those who do not know history are condemned to repeat it.
The first issue I wish to raise regarding the health services is one that I have raised here previously. Where stands those who work in section 39 organisations? I am talking about the tens of thousands of workers in organisations funded through section 39 who experienced pay reductions at the beginning of the economic crisis. The Government of which the Labour Party was a member, through the then Minister for Public Expenditure and Reform, Deputy Brendan Howlin, put in place a mechanism for restoring public service pay and it was understood that section 39 organisations were to follow. These are people who work in hospices, in Rehab, in the Irish Wheelchair Association and in a wide variety of organisations vital to the health service. We know that discussions are ongoing with the Department of Health. In the summer economic statement which was published yesterday a sum of €2.6 billion has been set aside for "commitments". Does the money set aside in the summer economic statement include funding to restore pay levels for staff working in section 39 organisations or is their pay claim buried somewhere in the bowels of the Department of Health? Will those workers be left with no choice but to initiate the industrial action which they have threatened but stalled because the Taoiseach and the Minister for Finance promised them meaningful discussions?
The Taoiseach made reference to Sláintecare in his reply. Sláintecare is a product of new politics in this Dáil to which all parties and Independent Deputies genuinely contributed. However, 18 months after first talking about it, the Government has not yet appointed an executive director of the Sláintecare implementation office. We all know that without an implementation pathway, it will be almost impossible to achieve anything. What is the fate of new politics as expressed in the comprehensive agreement between all of the Members of the Oireachtas? Where stands that now? Is it sidelined and jettisoned or does the Government intend to proceed with it?
There has been much debate on public radio lately around peoples' experiences of the health service. We can all agree that when one gets into the health system, the service is often very good. However, the bureaucracy and managerial confusion is heartbreaking. People go onto waiting lists which just get longer and longer. Sláintecare was meant to address that but the Government has not even addressed the implementation of same.
Pat Gallagher (Donegal, Fianna Fail)
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I will call on the other Deputies who have indicated but I remind everyone that there is another question with which we must deal before the sos.
Brendan Howlin (Wexford, Labour)
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It will come as no surprise to the Taoiseach that I raise an issue which is causing great concern in my region of the south east. There have been a number of resignations from psychiatric teams, particularly in the Child and Adolescent Mental Health Services, CAMHS in Wexford. One of the consultant psychiatrists, Dr. Kieran Moore, said that he was resigning from the Wexford team because "it's untenable and unsafe". He also said that two of his colleagues were resigning for the same reason. There is real concern about psychiatric services across the country but the most acute and immediate concerns arise in the South East and in County Wexford in particular. What will the Government do to ensure that there is no hiatus whereby there are no mental health services available to the most vulnerable of people?
Micheál Martin (Cork South Central, Fianna Fail)
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The Government's decision to delay the implementation plan for Sláintecare is deeply cynical. The Government wanted to avoid a winter crisis last year but more importantly, it wanted to avoid the Estimates and the provision that would have been necessary for the establishment of an office, the development of an implementation plan, the changes to budgets and so on. This was all referenced subsequently by the HSE's director general. We are now hearing, as confirmed by the Taoiseach, that the plans will be announced in two to three weeks' time but surely the plan should be announced to the Oireachtas Committee that was responsible for the development of Sláintecare. Will the Taoiseach or the Minister for Health commit to going before that committee to announce the plans to its members and chairperson? Otherwise, we will just see yet another Government signature launch with over the top claims, days of strategically placed articles in newspapers, active partisan briefing and so on. It is stretching credibility to a considerable degree that it would take 18 months to publish implementation plans. Perhaps this suggests that deep down and behind the scenes, despite the public announcements, the Government's heart is not in the Sláintecare plan and that it is not going to implement key elements of same.
Yesterday the Taoiseach said that costings for the global footprint strategy were not mentioned at the launch of the strategy but were included in a follow-up document. I ask the Taoiseach to give us an assurance that he will produce detailed, year to year spending and activity proposals for Sláintecare when he is announcing the implementation plans. Sláintecare represents the formal burying of the failed experiment of moving to compulsory health insurance initiated by the former Minister for Health, now Senator James Reilly, and followed up by the Taoiseach when he was Minister for Health. While off the record briefings regularly distanced the Taoiseach from this policy, the record shows a long series of measures announced by him which he said represented the steps in implementing the plan. If one looks at the massive increases in waiting lists during that period, there is a perfect correlation between the so-called reforms and increases in waiting times and delays in accident and emergency departments. Has any work been undertaken to undo the damage caused by many of these ill-fated changes?
1:50 pm
Pearse Doherty (Donegal, Sinn Fein)
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Following on from the previous discussion, it might be wise for Deputies Burton and Martin to visit Féile an Phobail this year. If they were to experience Féile an Phobail, they might be a little more informed in relation to that.
Micheál Martin (Cork South Central, Fianna Fail)
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On a point of information, my comments were not about Féile an Phobail.
Pearse Doherty (Donegal, Sinn Fein)
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I have the floor.
Micheál Martin (Cork South Central, Fianna Fail)
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My comments were about the Taoiseach's speech, which I did not get a copy of.
Pearse Doherty (Donegal, Sinn Fein)
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Some people in here would probably like to roll back the clock to a time when Sinn Féin did not have 500,000 voters on the island of Ireland, including many in west Belfast. The people have a right to choose who they want to represent them. Thankfully, more and more people have come towards Sinn Féin in each election.
My question relates to Cabinet committee E. The leader of Fianna Fáil has again demanded more investment in Sláintecare and all the rest. We know that cannot happen without the necessary investment. The Government and its partners in Fianna Fáil have set the limited parameters of this year's budget. The €800 million that is available is not exclusively for health. It will have to be used to deal with other areas of need, including the two-tier pay structure across the public service and social welfare. The Taoiseach has suggested that there may be tax cuts. The reality is that Sláintecare will not get off the ground unless the Government makes the necessary investment. Fianna Fáil can argue that we need this, that and the other, but it cannot happen on magic beans. We cannot open additional hospital beds or build capacity within our services on the basis of IOUs on the back of brown envelopes. The Government needs to make decisions and choices. When will we see a plan for the investment of approximately €3 billion that is being called for under Sláintecare to bring about a transformation in the issues that have been presided over by the Government with the support of Fianna Fáil every step of the way? The failure to draw up such a plan has led to the scandalous situation we have today. People are waiting two years for assessments. Scoliosis patients are waiting three years for their first appointments. Some 707,000 people are on hospital waiting lists and many more are on trolleys. The health service is facing many challenges. When can we expect the assisted human reproduction Bill to be published? Has it been considered by Cabinet committee E? In light of the number of complex issues involved in that legislation, would it be possible to deal with sections 2 and 3 of the Children and Family Relationships Act 2015 in a separate Bill as a means of resolving the issues being faced by same-sex couples? Has this been considered by Cabinet committee E? What is the Government's intention in this regard?
Pat Gallagher (Donegal, Fianna Fail)
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I should warn the House that I do not think we will get to the next group of questions.
Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I want to ask about child mental health services, which have been raised by Deputy Howlin. I think the Taoiseach needs to say something about this serious matter. Child psychiatrists are resigning because they believe child psychiatric services are "untenable and unsafe". This problem is not isolated to Wexford. I will not go into individual cases. I am aware of other areas where exactly the same thing is happening. The numbers of child psychiatrists and mental health teams are not adequate. There are not enough staff, resources and primary care services. Too many people are being referred to the psychiatrists. Essentially, they are under pressure to prescribe drugs. If they do not want to do that because their clinical judgment is that they should not do so, they get into trouble with managers who just want to tick boxes. That is what is going on. The Taoiseach needs to say that child psychiatrists and specialists in this area should act on their clinical judgment and should do what they believe is best in their clinical judgment. Managers should not be forcing them to do things they do not consider right to do. It is very important to send out that message. If we are going to ensure these services are safe, tenable and of the standard necessary to do what they are supposed to do for young and vulnerable people, we need to ensure primary care services and mental health teams are properly resourced.
Pat Gallagher (Donegal, Fianna Fail)
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The Taoiseach has six minutes in which to respond. We will not get to the next group of questions.
Leo Varadkar (Dublin West, Fine Gael)
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I would like to respond to Deputy Burton's remark about west Belfast. The phrase to which she referred was not a campaign slogan. It was a tweet.
Joan Burton (Dublin West, Labour)
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It has been part of the Taoiseach's campaign in recent days.
Leo Varadkar (Dublin West, Fine Gael)
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It was a criticism of Sinn Féin's record in government and its poor delivery for communities that vote for it in large numbers. I am happy to clarify that it was not meant to be a criticism of west Belfast as a place or as a community. If I was doing it again, I would do it differently.
Joan Burton (Dublin West, Labour)
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Is the Taoiseach apologising to west Belfast?
Leo Varadkar (Dublin West, Fine Gael)
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I am apologising to anyone who was offended by it and believed it was a reference to the people and community of west Belfast, when it was actually a reference to Sinn Féin's poor performance in government in Northern Ireland and its failure to deliver for people in west Belfast.
Pearse Doherty (Donegal, Sinn Fein)
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Sinn Féin has had five out of the six seats in west Belfast.
Micheál Martin (Cork South Central, Fianna Fail)
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I think the Taoiseach will say anything at any time when it suits.
Leo Varadkar (Dublin West, Fine Gael)
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Section 39 organisations are very varied. They range in size from small organisations that receive just €10,000 in State funding to major employers that receive most of their income from the HSE or the Department of Health. The staff of section 39 organisations are not employed by the State and do not receive public sector pensions. The various section 39 organisations approached and dealt with the financial crisis in different ways. Some of them cut pay and some of them did not. Some of them are compliant with public pay policy and some of them are very much not. Some of them have restored pay and some of them have not. St. Francis Hospice in my constituency has restored pay to its staff. I am aware that other section 39 hospices have not done so.
Micheál Martin (Cork South Central, Fianna Fail)
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How could they, if they do not have the money?
Leo Varadkar (Dublin West, Fine Gael)
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There is a lot going on in this space. There is now a process under way to examine this and resolve it. I am sure it will result in a cost to the taxpayer. We do not yet know what that cost will be. That is part of the work that is being done. It is difficult to allocate money until one knows the actual estimate.
Reference has been made to mental health services in the south east. Timely access to care is an essential part of good healthcare. We are committed to achieving this by increasing the funding allocated for mental health services. Indeed, the amount of money allocated for these services has increased by over €200 million each year since 2012. One CAMHS consultant in the Waterford-Wexford area is moving to Dublin. Two locums, who hold temporary posts in any case, will be resigning in August 2018. The Minister of State, Deputy Jim Daly, is meeting local representatives of the HSE CAMHS to discuss the actions that need to be taken to ensure people in the south east who need care continue to receive it. The Minister of State has scheduled a round-table meeting of all CAMHS service providers in the coming weeks. While there is no doubt that recruitment in this area is difficult, it is being dealt with. The HSE is currently operating a national and international recruitment campaign for CAMHS consultant psychiatrists. The service in the south east plans to draw on this resource to fill positions on a permanent basis, in addition to vacancies being filled on an interim or temporary basis. The recruitment of 114 assistant psychologists and 22 psychologists for primary care child psychology services has almost been completed, with 111 of the 114 assistant psychologist places and 20 of the 22 psychologist places having been filled. Of those who are being recruited, 13 will be assigned to CHO 5, which includes the south east. Improvements are being made to children's counselling services. It is intended to extend the new Jigsaw service, which is already in Cork, Limerick and Dublin, to 13 sites nationally. The HSE is in the final stages of recruiting the staff required to deliver a mental health service seven days a week in areas that do not have a seven-day service currently. The annual number of undergraduate psychiatric nursing places will increase from the current level of approximately 270 to approximately 400 by the end of the decade. It is important to point out that in April, the total number of people on the CAMHS waiting list reduced by 76 to 2,615. The number of people who have been waiting for more than a year decreased from 386 in March to 356 in April. While I appreciate that too many people are waiting for too long, it is not the case that these waiting lists are increasing.
I think Sláintecare is a good plan. Those who are proposing it have admitted that it is at best a plan for a plan. There is no implementation plan. The Government has been tasked with drawing up such a plan and that is exactly what we are doing. There is a lot to be done because the costings were off. A lot of work has had to be done in that respect. There are issues with the phasing, which proposes that we extend free GP care to an extra 500,000 people each year. Members of the committee will privately admit they do not think it is a good idea because the capacity does not exist to extend by 500,000 a year the number of people with free GP care. It is just too quick, given the capacity constraints that exist in GP surgeries and elsewhere in primary care. It would probably lead to waiting lists to see GPs, which would not be desirable.
I say that as the person who brought in free GP care for those over 70 and under six and announced the decision to extend medical cards as a right to children with serious disabilities. It is something I am very much committed to doing but I honestly believe that an extra half a million a year would be too quick, would overwhelm the services and would make them worse for everyone, not better for some.
I was asked about the transformation fund. It is there in Project Ireland 2040. There is a commitment of €10 billion to be invested over ten years in buildings. There are three hospitals now under construction. The national children's hospital was promised forever by successive health Ministers and is now very much under construction. The new National Rehabilitation Hospital in Dún Laoghaire is under construction. The new forensic mental health campus is under construction in Portrane. Some 100 primary care centres are now up and running. It will also involve the additional acute beds that are needed under the capacity review, additional equipment, and investment in ICT. If there is a game changer in health, it is going to be in ICT.