Seanad debates
Tuesday, 22 April 2008
Patient Safety: Statements (Resumed)
7:00 pm
Mary Harney (Dublin Mid West, Progressive Democrats)
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A number of issues were raised about services. I do not propose to deal with all of them. I assure Senator Prendergast that discussions are ongoing among clinicians in the south east. I was asked when the cancer control programme that is currently being implemented will be concluded. Half of it will be implemented by the end of this year and between 80% and 90% of it will be implemented by the end of next year. The programme, which is led by Professor Keane, is happening at a remarkable pace. Many clinicians were involved in the drawing up of the control programme and are now involved in the implementation of the programme. That is what delivers success. In the past, many proposals were devised by people at management or administration level who then failed to implement them. Clinical involvement, which is the key to success, is central to the new contract of employment for consultants which we have been negotiating for three years.
I know that clinicians, obstetricians and others are involved in discussions about the configuration of services between the different hospitals in the south east, which I visited recently. The Government wants to maintain the hospital infrastructure we have as long as services can be provided on the basis of patient safety. Our system has 4,000 junior doctors and 2,000 senior doctors and consultants. We intend to turn that ratio around the other way. Until we do so, it is not safe to provide some acute services in the absence of the appropriate medical expertise.
Cases such as that of the Mercy University Hospital in Cork often arise in the context of health expenditure. We have made a capital investment of more than €5 million in the hospital. An increase of 54% in staff numbers was sought as soon as we tried to open the new facility, which is not acceptable. That is why the new facility is open between 8 a.m. and 8 p.m. only. Teachers never demand a 50% increase in staff numbers when spanking new schools are provided. Such demands tend to be made in the health system, unfortunately. It is not possible to provide a 50% increase in staff to serve a fantastic state-of-the-art facility that will see an increase in patient activity of just 15%. When new facilities are opened in the health care system, they should help to improve productivity. They should not demand the huge increases in staff that are usually sought.
It has been suggested that cutbacks are being made. The HSE budget for 2008 represents an increase of €1.1 billion on last year's figure. Like any other health authority in any other country, the HSE has to live within the resources made available to it. One has to live within one's health care budget and ensure the health care priorities one has set are implemented, regardless of whether one is operating in a publicly funded system, an insurance funded system, a combination of the two or a privately funded system.
I often hear people saying how awful the HSE is. I refer to people speaking in this House, for example, or the councillors I meet at the regional forums who ask me for meetings. The HSE was established three years ago as a means of addressing the unsatisfactory nature of the health services being provided under a health board regime that had 273 members. All was not perfect then. Many of the inquiries we have had recently relate to events which occurred when the health boards were in place. That is a fact. The establishment of the new HSE organisation three years ago was an undertaking the scale of which had never been seen in Ireland before.
I remind Senator Fitzgerald that a considerable amount of work is being done by Professor Drumm and his team within the organisation's management structure. A new director of human resources will start work in the HSE shortly.
Jerry ButtimerMary Harney (Dublin Mid West, Progressive Democrats)
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No. The position in question has never been filled since the HSE was established.
Mary Harney (Dublin Mid West, Progressive Democrats)
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If Senator Buttimer thinks an organisation that employs 111,000 people can be run without a director of human resources, he should think again.
Mary Harney (Dublin Mid West, Progressive Democrats)
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No, it is not. We need appropriate management.
Mary Harney (Dublin Mid West, Progressive Democrats)
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We need good management.
Mary Harney (Dublin Mid West, Progressive Democrats)
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I do not suggest we need administration for the sake of it. We need hands-on management.
Mary Harney (Dublin Mid West, Progressive Democrats)
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When I wrote to the HSE after the Portlaoise report was published, I drew its attention to the need to learn from the governance deficiencies that were identified in the report. Regardless of where one works in the HSE, one has to be clear about what one's job is and to whom one is responsible. Some people think one can press a green button to make change happen, but it takes time. The process is under way and I have every confidence it will be completed quickly. I think the report on the ambulance service has been completed, although I have not seen it. I will get back to Senator Prendergast in relation to that.
Phil Prendergast
Terry LeydenMary Harney (Dublin Mid West, Progressive Democrats)
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The plan for Roscommon County Hospital was to merge its surgical department with that of Portiuncula Hospital. I have not seen the latest proposals. When the HSE is briefing, it is required, like all Departments, to brief Government and Opposition alike. It seems that the county council and, perhaps, the regional forum were briefed in this instance. Neither the HSE nor the various Departments can be selective when offering briefings. They have to make such services available to Government and Opposition alike. I am more than happy to ask the HSE to brief those who are interested on the Roscommon issue.
Nicky McFaddenMary Harney (Dublin Mid West, Progressive Democrats)
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The HSE recently went to tender for primary care units in 100 different places, including Athlone. I understand from Mr. Brian Gilroy, who is the HSE's head of capital planning, that many expressions of interest have been received. I cannot give specific details of the expressions of interest for Athlone. I think a major programme of primary care centres will be rolled out over the next few months.
Mary White (Fianna Fail)
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I asked about the three vacant suicide prevention officer positions.
Mary Harney (Dublin Mid West, Progressive Democrats)
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I will respond to the issues raised by Senators White and Feeney. Ten days ago, four beds were opened in Galway to cater for adolescents with psychiatric problems. A number of beds will be opened shortly on the north side of Dublin and in Cork. I understand that 15 of the 120 consultants who are being recruited at present will work in child and adolescent psychiatry. Substantial investment is being made in that area. We are catching up as far as these services are concerned.
Mary White (Fianna Fail)
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The Minister did not address the point I was making. I asked about the three vacant suicide prevention officer positions.
Mary Harney (Dublin Mid West, Progressive Democrats)
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The Minister of State, Deputy Devins, is handling that. I know he has been talking to the National Office for Suicide Prevention. I do not have the details to hand.
Liam Twomey (Fine Gael)
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Will the Minister return to the House at some stage to discuss the reduction in service throughout the country of which each individual has been made aware? I am aware of significant reductions in service in County Wexford. I am sure they must be mirrored in other parts of the country.
Pat Moylan (Fianna Fail)
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We cannot have supplementary questions.
Liam Twomey (Fine Gael)
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Perhaps the Minister will also address many people's concerns about the budget for next October.
Mary Harney (Dublin Mid West, Progressive Democrats)
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We treat 400,000 more people in our hospitals each year than we did ten years ago. Some 24,000 people with disabilities are getting day services. More than 8,000 people are in residential care. Some 4,000 people are getting respite care. Such services did not exist ten years ago. There is no question of a reduction.
Mary Harney (Dublin Mid West, Progressive Democrats)
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We are increasing services.
Frances Fitzgerald (Fine Gael)
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Is the Minister saying there are no cutbacks?
Mary Harney (Dublin Mid West, Progressive Democrats)
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There are issues that arise, to be honest. I am aware of one service where one third of the staff will go on maternity leave in May. This is an incredible statistic. We have pressure points and I will not pretend for one moment we will not have difficulties and services will have to adapt to budgetary issues. It does not make sense to keep services open if they do not run effectively and efficiently. If a procedure can be done on a day care basis as opposed to an in-hospital basis it should and people should not be called back to outpatients when it is not necessary. As Professor Keane stated, many cancer patients are called back to the consultant as outpatients when they should be going to their general practitioner. Major change is under way. I assure the House that more services will be provided this year in the community and in hospitals than was the case last year. I will be happy to return to the House.
Donie Cassidy