Victor Boyhan (Independent) | Oireachtas source

I think this is the first time I have been in the House since the Minister for Health took up her position in health. I wish her well. I have known her for some time. She is my local TD, so I see the work she does at the coalface in our constituency. I genuinely wish her well. I think she is the right person. She has the tenacity, commitment, intelligence and political nous necessary for taking on this task.

Before I concentrate on section 1, I might put the context for those who have joined us since the previous Seanad. Our Bill seeks to “impose on the Health Service Executive certain special duties and powers in relation to the establishment of a specialised treatment service for the inpatient and outpatient treatment of children and adults [with] spinal scoliosis who are resident in the State and to confer certain duties and powers on the Minister for Health in relation to the service to be established and to provide for related matters”. It is a joint initiative by the Seanad Independent Group.

I am conscious this is Committee Stage, and I want to stay focused on section 1, which is the section we are dealing with now. However, it is important to put a few pointers here. Senator McDowell is correct that this Bill should not have been necessary.A certain turn of events precipitated this. We had a robust engagement with the Minister's predecessor, during which there were more questions than answers. The figure of €19 million was one aspect of that debate.

I am a former director of the National Treatment Purchase Fund, NTPF, having served two terms on its board. Therefore, I know the workings of the fund, albeit that things have always moved and it is an evolving situation. The problem is that we need acute waiting lists. We need exact validated data on a regular basis regarding the number of children waiting four months or more for scoliosis treatment. There is a role for the NTPF in the recording of and reporting on datasets on a range of waiting systems. I do not know whether the Minister has had time to meet representatives of the fund, but the fund has a function and role. It is slightly removed from the Department, but fully under the remit of the Minister, which I accept and acknowledge. The fund has a proven track record and expertise in maintaining data. There is a confidence in the data the fund releases. Of course, it works in collaboration with the providers of services and the Department. Central to what we propose is a legislative role for the NTPF in respect of its recording of other procedures and waiting times in the health service. There is a role for the fund in tackling this problem.

International outsourcing is an issue. We need more exact information on the ring fencing of beds. One of the problems is the lack of clarity on issues like the ring-fencing of beds, the availability of theatres and MRI capacity. Senator McDowell referred to the auditor's report which was signed off on 18 October 2024 but not published until December of that year, an interesting timeframe considering the political background and landscape at that time. I do not know why there was a delay from October to December. The report is now in our hands. It has raised a number of issues. I might add that this is a HSE internal audit report. Having had a general read of the report today, I will certainly read it again. There needs to be follow-up regarding some of the issues raised in the report.

I draw the attention of the Minister to the risk mitigation factors set out on page 57 of the report. The report refers to reputational risk to the CHI owing to the interest of the media and advocacy groups. That is a concern. The report is concerned about what the media might think. We need to consider the risk of mitigation. If I was the Minister, I would not be satisfied with the report. I think it warrants an external review. This is an internal HSE report.

The report clearly has a status in regard to each of the risks and mitigations, and I draw the attention of the Members to this very detailed report. It also raises issues in respect of MRI facilities and infrastructure in place but not put into use, as well as staff shortages. We are at a time of crisis. I do not want to spend too much time on this part of the debate going through drama, as Senator McDowell said.

We have a problem. I do not doubt the commitment of the Minister. It is great that someone fresh is coming into the Department. We need greater accountability regarding the €19 million figure the previous Minister told us about, as a result of questioning by Senators McDowell and Clonan. That money was swilling around somewhere, but no one quite knew where it was spent. I presume it was spent within the health budget envelope, but again we need reassurances on that. As the Minister who has taken on these problems, she needs reassurance.

We also need to consider the capacity of Temple Street Hospital, Crumlin Hospital, Cappagh Hospital and Blackrock Health. That relates to the core of the Bill, which is covered in section 1. The issue is the task force. The Minister was given a brief when she came into office. I have had a look at it. Buried in it is the suggestion that the task force would possibly be wound down.There would be a new mechanism in place. I am talking about the work and the task force of Mr. Mark Connaughton SC. That is what is in the Minister's brief, but again, I have only read that. Clearly, the Minister is someone I have high expectations for. I am glad she has signalled that it will not be happening, and I am greatly encouraged by her firm nod with regard to that - it is really interesting - but that was put on her desk by officials in her Department, so it raises questions about the relationship between the Department of Health and the HSE, and the then Minister. However, the Minister, Deputy Carroll MacNeill, is the new Minister, and I have high hopes for her, so we would like to hear more about it.

That briefing document in itself is fairly challenging for the Minister but this is not the day to go through that and we will have another opportunity to talk about that. We are on the issue of the availability of nurses, the availability of theatres, the resources that are required, and the validation of the waiting lists. It goes back to that central theme in our proposed legislation - the role for the National Treatment Purchase Fund. That is a good model. It works, and I want to see on a monthly and quarterly basis the figures for the National Treatment Purchase Fund. I rang the National Treatment Purchase Fund - do not forget, as I have told the Minister, that I was a director there twice - and I spoke to an official there today who said they did not really have a formal role in all of this. They described the Minister as having made arrangements in the UK, in the NewYork-Presbyterian Morgan Stanley Children's Hospital in New York, and of course Great Ormond Street Hospital for Children. I do not like informal arrangements, and I refer to 16 patients who received surgery. I understand again, from briefings I read from a number of reliable sources, that there are plans to continue that practice for the moment, and I accept that. The Minister might touch on that because, again, it is about accountability, transparency and communication. It is about engaging with the patients, the children - that is a really important part - and their parents and guardians. There is an information deficit on that.

I want to touch on two or three issues. We have problems. The task force is really important and I had hoped it would stay in place. Had I known what I know today, having read the brief the Minister was given, that there was now going to be a question by her Department about the task force, we would have been adding additional amendments to this legislation. What the Minister might say and share with us on that is going to be helpful.

We want to get on with it but it is important we are going to learn. We have to analyse the past and the mistakes that were made. We have to increase capacity. We have to address the risks and mitigation that are in the audit report that is before the Minister. I will finish by saying this. I want the Minister to look at that report. I respectfully ask her to look again at that HSE internal audit report. There are a lot of questions there, and it is a matter for the Minister but it may warrant a referral to a more specialised second look or an external look. We are here to work with the Minister; it is not about beating people up here. It is about making this arrangement and tackling these issues so we can address them for the people who are on these lists.