Michelle Mulherin (Fine Gael) | Oireachtas source

I welcome the Minister of State. This issue is back in focus again arising from the RTE programme and the shocking revelations of children with scoliosis having to wait in an inhumane way. If I say nothing else, I will say that someone needs to be held accountable. How can it happen that children who are in pain and who need surgery in a timely way are not being facilitated? In many ways it is understandable, given that much work is done following whatever topic the media has attention or focus on at a given time.If there is a focus on trolleys, that is where the resources go. We seem to go from crisis to crisis. It is clear that there is a capacity issue. There has been an additional allocation to health this year. We have been told it is the largest allocation ever. I do not think we can get away from the issue of management accountability. This brings us back to the problem of the lengthy waiting lists being encountered by children with scoliosis who need operations. As I understand it, a person with private health insurance cannot avail of such surgery under the private health system because this service is provided through the public health system only. This means there are no options for these children and their families. While I welcome the Minister's approach to tackling this problem, which is something we all need to work towards, it is a disgrace that it has been going on for so long without being flagged as a priority.

On the capacity side, it is clear that we need more beds and more front-line staff. The issue of management arises again in this context. I suggest that in light of the current level of availability or capacity with regard to resources like theatres and beds, we need to move to from a five-day health service to a seven-day service. I question the extent to which co-operation is being received from clinicians and consultants. I am speaking generally when I say that because I know there are some very good clinicians and consultants. As we are aware, clinicians provide private health care in public hospitals. It is well cited and known that there are delays in clinicians signing off to allow the HSE to get paid for the use of its facilities for their private work. I understand there are many delays with many clinicians and consultants in doing this. Obviously, this causes funding difficulties in the public health service. In many cases, clinicians are not available on call at weekends to come in to discharge people. It has to be said that when people come to meet consultants, they often meet a registrar rather than a consultant because the consultant is somewhere else. These are serious issues. It is obvious that we have a deficit in consultants. Everybody across the board has to play ball or else it is just lip service. Given that many people with serious conditions and health problems need health care, consultants cannot just say "we are entitled to a lot more money somewhere else". It does not wash. I think there has to be a conversation about the sort of service they provide.

I would like to ask a couple of questions about HSE management and the recruitment of administrative staff, particularly Grade 8 staff and general managers. I have flagged these matters previously. I raised them in this House on 25 January last in the presence of the Minister of State, Deputy Corcoran Kennedy. I have also raised them with the Minister at the Fine Gael Parliamentary Party, but I have received no answers. How many Grade 8 officials and general managers have been appointed at Dr. Steevens' Hospital and throughout the country over the past three years? How many of them are involved in managing staff who deal with direct patient care? My understanding is that there are all sorts of new managers under the new business model. There are new types of managers in areas like business relationships, corporate business and business intelligence. I really do not understand what it means. It seems crazy that people can be recruited to manage statistics and targets when there are no people on the ground to deliver those targets and statistics.

I have called for a review of how the seven health care groups are operating. I understand the director general recently signed off on three project officers per health care group. My understanding is that these will be Grade 8 positions, at a minimum. What are the people in HSE management managing? Have they not lost the run of themselves? Where is the money for these positions coming from? Business relationship managers have been appointed to resolve disputes between operations, business and targets. I do not understand it and I think it should be explained. Even though I do not understand it, I would like to know how it can be justified in the absence of sufficient staff on the ground. How can it be justified when many people cannot get home help or home care packages and there has been a reduction in the number of physios? The inability to recruit is a problem for HSE management. How many high-grade assistants have been appointed to assist the national directors at Dr. Steevens' Hospital? There is something wrong. I asked these questions formally on 25 January last, but I have not received any answers. I know the Minister has not received any answers, which is wrong. I ask the Minister of State, Deputy Catherine Byrne, to ensure these questions are answered so that the facts can be put on the table about how the system is operating because it is not on.