5th May2009 Questions raised in the Dáil

Minister must ensure that primary care system can deal with flu threat

Sinn Féin Health spokesperson Caoimhghín Ó Caoláin has called on the Minister for Health & Children Mary Harney to act urgently to ensure that the primary care system can cope with the threat of a swine flu pandemic. Following a briefing given by the Department of Health & Children to Dáil health spokespersons this afternoon, Deputy Ó Caoláin said:

“It is clear from this afternoon’s briefing that the Department of Health & Children and the HSE are advancing their precautions and preparations for a possible swine flu pandemic. They are acting on the assumption that cases will occur here. As there is yet no vaccine for this new strain of flu and as it will take some months for one to become available the identification and isolation of cases will be vital.

“The front line in this situation is our primary care system, especially general practitioners. I would be concerned that the inadequate nature of our primary care system will be a weakness in addressing the threat. We have a relatively low GP to population ratio and primary care services are unevenly spread. High GP fees deter many people on low incomes who do not qualify for the medical card from visiting the doctor.

“Therefore I am calling on the Minister to act urgently to ensure that the primary care system can cope with this threat. This may require measures such as temporary or mobile clinics and free examinations for those with flu-like symptoms who have recently visited an affected area or have been in contact with a known case of swine flu.” ENDS
To ask the Minister for Health and Children the action she will take to provide accommodation for the 319 people with an intellectual disability currently living in psychiatric hospitals, despite stated policy that this is not appropriate; and if she will make a statement on the matter.

The discharge of clients with Intellectual Disability who are inappropriately placed in psychiatric hospitals is an important policy objective. As the Deputy's question relates to service matters I have arranged for the question to be referred to the Health Service Executive for direct reply.
Deputy Caoimhghín Ó Caoláin: I thank the Department of Health and Children officials for their briefing earlier today on the swine flu threat. A briefing such as this is always useful. However, there are grave and justifiable concerns, particularly given that primary care services will be the front line of address and we currently have a very low GP to population ratio and a poor and uneven roll-out of primary care services. Would the Taoiseach consider, given the importance of the issue and the alarm that exists-----

An Ceann Comhairle: We cannot discuss that now.

Deputy Caoimhghín Ó Caoláin: -----requesting the Minister to come to the House to deal with this?

An Ceann Comhairle: We cannot have questions on that. I allowed statements during Leaders' Questions earlier.

Deputy Caoimhghín Ó Caoláin: I ask the Government to provide time to address this issue here-----

An Ceann Comhairle: We are not going on with that. Leaders made short statements on this issue earlier and I will not go into it again.

Deputy Caoimhghín Ó Caoláin: -----in open forum in the Dáil so that we can properly inform not only ourselves but the wider public of the dangers of-----

An Ceann Comhairle: Does the Deputy understand that we cannot go into this now?

Deputy Caoimhghín Ó Caoláin: I am asking about the ordering of business.

An Ceann Comhairle: The Deputy cannot ask a question about that now because it is not in order. Standing Orders are quite specific about it.

Deputy Caoimhghín Ó Caoláin: My understanding is that it has been addressed in myriad ways.

An Ceann Comhairle: A brief statement was made by the party leaders and the Taoiseach responded-----

Deputy Caoimhghín Ó Caoláin: I was not aware that I was named under Standing Orders so that I cannot raise it but other people can.

An Ceann Comhairle: -----but the Deputy is not allowed to ask questions about this. I was going to allow the Deputy to make a brief statement like everybody else, but that was it. I cannot allow questions on it. It is just not on.

Deputy Caoimhghín Ó Caoláin: Well, there it is.

An Ceann Comhairle: The Deputy must understand my position.

Deputy Caoimhghín Ó Caoláin: I will conclude on that point and go on to my second point.

An Ceann Comhairle: Do, please.

Deputy Caoimhghín Ó Caoláin: I ask the Taoiseach to give attention to my request on this serious issue.

On the list of legislation promised by the Department of Health and Children is the nurses and midwives Bill. There is currently concern with regard to the embargo on recruitment and the potential for the further loss of some 700 nurses-----

An Ceann Comhairle: I cannot allow a speech on this now. I must move on to the next business.

Deputy Caoimhghín Ó Caoláin: -----currently within the service who may not be replaced.

An Ceann Comhairle: The Taoiseach on the legislation.

Deputy Caoimhghín Ó Caoláin: Will the Taoiseach note that the nurses and midwives Bill has been on the list of promised legislation, as best I can establish, from as far back as 2002? That is a full seven years.

An Ceann Comhairle: That is it. The Taoiseach on the nurses and midwives Bill.

Deputy Caoimhghín Ó Caoláin: Does the Taoiseach not accept that there is something seriously amiss within the Department when legislation of this importance can be-----

An Ceann Comhairle: The Deputy has made his point.

Deputy Caoimhghín Ó Caoláin: -----set aside year after year?

The Taoiseach: I understand it is due next year. I agree it has had a gestation period longer than that with which midwives would normally be acquainted.

Deputy Caoimhghín Ó Caoláin: What about the issue of swine flu?


To ask the Minister for Health and Children if, regarding representations made to her on 9 April 2009 by An Bord Altranais which outlined the reason she should grant approval to the Board to manage staff numbers within an overall employment ceiling of 47, causing no added financial burden on public finances, she will approve the request; and if she will make a statement on the matter.

An Bord Altranais (The Nursing Board), which was established under the Nurses Act, 1985, is the statutory regulatory body for nurses and midwives. The Board consists of 29 members, 17 of whom are elected by nurses and 12 appointed by the Minister, 2 of whom are representatives of the Department of Health and Children.

Under the Act the Minister has a range of functions in relation to the Board one of which, Section 17 (1), relates to the officers and servants of the Board "In addition to the Chief Executive Officer, there shall be appointed such and so many persons to be officers and servants of the Board, as the Board, with the consent of the Minister, from time to time determines."

The Act also provides that the Local Government (Superannuation) Act, 1956 applies to the Board and its officers and servants as if it were a local authority.

In addition to its statutory functions, the Board also administers the Nursing Careers Centre on behalf of the Health Services. For this purpose ongoing funding is provided by the HSE and the amount of this funding in 2007 was €600,000.

While the bulk of the Board's income is generated by fees paid by nurses and midwives, it is a statutory body whose staff have access to a public service pension scheme. It is thus covered by the recent Government decision that, with effect from the 27 March 2009 to end 2010, no post in the public sector, however arising, may be filled by recruitment, promotion, or payment of an allowance for the performance of duties at a higher grade. The decision also applies to temporary appointments on a fixed-term basis and to the renewal of such contracts. Therefore, when vacancies arise each agency must reallocate or reorganise work or staff accordingly.

In the case of the health sector, any exceptions to this principle, which will arise in very limited circumstances only, require the prior sanction of the Minister for Health and Children and the Minister for Finance.

I am advised that An Bord Altranais has an overall complement of 47 staff, 11 of whom are employed on fixed term/purpose contracts. The CEO of An Bord recently wrote to the Secretary General of my Department in this regard. My Department is currently examining the submission from An Bord Altranais and a response will be issued in the near future.

To ask the Minister for Community, Rural and Gaeltacht Affairs if and the amount by which funding to the National Drugs Strategy will be increased on foot of the Government decision to incorporate alcohol into the strategy.

On 31st March last, the Government gave approval for the development of a combined National Substance Misuse Strategy to cover both alcohol and drugs.

As I’m sure the Deputies will agree, this decision is very welcome and recognises the widespread public concern in Ireland in relation to the problem use of alcohol – both as a stand-alone public health issue and in association with illicit drug use. Developing a substance misuse policy, which encompasses both drugs and alcohol, presents many challenges, therefore, given the nature and complexities of the public health and other issues involved.

Notwithstanding this, I am also very conscious that work on developing a National Drugs Strategy is well advanced at this stage and that the Steering Group, which is developing proposals in this regard, will be presenting me with their findings in the coming weeks.

Accordingly, having considered the matter, it has been decided to proceed on the following basis:

- Work on completing the National Drugs Strategy will be finalised in the coming weeks and I expect to be presenting it to Government for approval in late May/early June. The Strategy will be published as an “interim” Strategy pending the drafting and finalisation of a National Substance Misuse Strategy; and
- A new Steering Group will be established in autumn 2009 to develop proposals for an overall Substance Misuse Strategy that will incorporate the already agreed drugs policy element. The Group will be asked to report by the end of 2010.

As part of the restructuring proposed in the new Drugs Strategy, the National Drugs Strategy Team (NDST) will be discontinued from 30th April. It is intended that proposals for the establishment of a new dedicated Ministerial Drugs Office will be submitted to Government for consideration in the context of the new Drugs Strategy. In the interim, the general functions of the NDST will be absorbed appropriately within my Department.

There has been no change in the number of staff working on the new Drugs Strategy within my Department. As outlined above, this work is being overseen by a Steering Group comprising representatives of the relevant Departments, statutory agencies and the community & voluntary sectors. The Steering Group is chaired by my Department, at Assistant Secretary level, and four other officials are also engaged in the development of the Strategy, as part of their on-going Departmental work.

No decisions have yet been made on the funding of the National Substance Misuse Strategy. Considerable resources are already targeted at problem substance use in Ireland and the challenge over the coming years, given the current financial constraints facing the country, will be to maximise the overall effectiveness of that funding.
Deputy Caoimhghín Ó Caoláin: I welcome the fact that a Government backbencher brought forward a request under Standing Order 32 asking the Minister for Health and Children to come into the House and address the issue of a threatened swine vesicular disease pandemic. I have asked the Taoiseach to have this matter addressed in the House. It is very important, and now that the alert has gone to level 5, one short of a declared pandemic, there is an onus and responsibility on this House properly to address this issue. The Minister should come into the House. She is at a meeting of health Ministers today in Europe. Will she come into the House and report to us next week, and allow for an opportunity-----

An Ceann Comhairle: That is the end of that. We cannot discuss that.

Deputy Caoimhghín Ó Caoláin: With respect, I would like to finish. This is on the Order of Business. I am explaining my objection to the fact that we will not assemble here again until 2.30 p.m. next Wednesday. I would like the opportunity to explain that. We can come up with any number of issues but this is one that requires urgent address in this House. Will the Minister return to the House to deal with it? The Opposition is of one mind on this and we have evidence of it in Government benches this morning. Will the Minister for Finance agree to bring the House back early next week and have the Minister for Health and Children accountable to this House as we face a swine vesicular disease pandemic? This is a very important issue.

Deputy Brian Lenihan: Deputies Bruton and Ó Caoláin raised the long standing practice that the House does not sit until the Wednesday after a bank holiday Monday. It has always been the tradition and custom of this House. If it is wished to review that arrangement it can be discussed between the Whips.

Ó Caoláin in call for determined campaign against health cuts

Sinn Féin Dáil Leader and Health Spokesperson Caoimhghín Ó Caoláin TD, speaking at a public meeting on Health in Clondalkin, Dublin, has called for a determined campaign involving communities and trade unions across the economy against the cuts to the public health services being imposed by the Fianna Fáil/Green Party Government.

Deputy Ó Caoláin said:

“On this eve of May Day, International Workers Day, I make a call to the trade union movement, not only within the health services but across the economy, to join with communities in mounting a determined campaign against the health cuts, to save our public health services and to demand health justice.

“As we speak the Fianna Fáil/Green Party Government, through the Health Service Executive, is mounting the most serious assault on our public health services since the 1980s.

“These latest health cuts began in the autumn of 2007 but they are now being escalated. The recruitment ban, recently reinforced, means that most posts which become vacant in our public health services are not being filled.

“A memo leaked to the media last week showed that the HSE is looking to cut the number of nurses by 700.

“In addition the HSE has ordered that contracts for so-called temporary workers should not be renewed. This will mean that up to 14,000 workers will be lost to our public health services – that’s 14,000 fewer people to look after those who need care and 14,000 more people on the dole queues.

“Cuts are being made to achieve so-called savings. But they are not savings either in money terms or, more importantly, in terms of people’s health.

“An example is the disgraceful decision by Mary Harney to cancel the planned cervical cancer vaccine programme for 12-year-old girls.

“This week the first review of vaccination policy in 40 European countries was published and it found that this State is one of the few in Europe that does not have some form of cervical cancer vaccination programme. This State and Iceland were the only countries to postpone the vaccine programme for economic reasons.

“The lives of women are being put at risk to make a so-called saving of €10 million per year. But in 2006 alone – the last year for which figures are available – the Government gave tax breaks of €10.6 million to developers of private for-profit hospitals.

“This is the second most common cancer in women aged 15 to 44 and about 73 women die from it every year in this State. Shame on the Minister and the Government for their decision.” ENDS
Deputy Caoimhghín Ó Caoláin: This is not the Health Bill we should have before us in the Dáil today. On 1 April the Minister for Health and Children, Deputy Mary Harney announced the establishment of an expert group on resource allocation and financing the health sector. It is not due to report until April 2010. I have no doubt the deliberations of the new group will be used to further delay the publication of the Eligibility for Health and Personal Social Services Bill, which has been promised for years. Why the delay? The answer is obvious. The last thing the and the Government want to discuss is the question of rights and entitlements to health services. They have presided over and reinforced a system where wealth can buy better health care and the private for-profit health business is allowed to act as a parasite on the public health system.

As the public health system reels under the cuts imposed since 2007 and braces itself for even worse to come, the Minister, Deputy Harney ploughs on with the building of private for-profit hospitals on public hospitals sites, subsidised by the hard-pressed taxpayer. The Minister, Deputy Harney and the Government imposed a so-called public service pension levy on nurses and have sanctioned the non-renewal of contracts for up to 14,000 workers in the public health service. At the same time the Minister, Deputy Harney gave a gold-plated guarantee to the hospital consultants that their €250,000 per annum contract will not be touched. This is for a 33-hour week in the public system, and they can still work up to 25% of the time in private practice. Even at that, the hours are not properly monitored, providing another lucrative let-off for whatever number - it is not everyone - is happy to abuse their privileged position.

This is what the Minister, Deputy Harney and the Department of Health and Children preside over in crumbling Hawkins House which, a view not unique to me, is the ugliest building in this city. At times it has struck me as a very appropriate symbol of this Government's health policy.

What is the role of the Legislature in all of this? We are excluded from any role, except for the rubber-stamp type of legislation we have before us today, the Health (Miscellaneous Provisions) Bill 2009. The Minister, Deputy Harney has made herself unaccountable through the establishment of the HSE, while major policy decisions with major implications for the health service are not put before the Oireachtas. For example, the Government never put one sentence of substantive legislation before us regarding its co-location proposals.

This Bill gives more functions to the HSE and the Department, something I would be reluctant to do. Earlier this month in my constituency, two prominent general practitioners resigned from the HSE GP unit, citing in an open letter to Professor Brendan Drumm the arrogance of HSE management and its complete disregard for the views of general practitioners. In February this year, 41 GPs in Cavan and Monaghan signed another open letter opposing, on patient safety grounds, the removal of acute medical services from Monaghan General Hospital.

We have no choice but to address this Bill within its limited scope and to accept in good faith the assurances we have been given that the functions of the various bodies now to be subsumed into the Department and the HSE will be properly fulfilled. However, we must also be assured, and this is the assurance I am seeking today, that the work will be properly monitored and that the Minister, Deputy Harney, and the HSE will be fully accountable for these functions.

The Bill dissolves the National Council on Ageing and Older People and transfers its employees, assets and liabilities to the Department of Health and Children. It establishes the office for older people to support the Minister of State at the Department of Health and Children with special responsibility for older people, Deputy Barry Andrews The programme for Government has a commitment to frame and publish a national positive ageing strategy and the Department has informed me that this will now be its function.

A cross-departmental group has been set up to prepare the strategy and the former Minister of State, Deputy Hoctor, has said it is intended to facilitate the participation of older people in the process of preparing the it. These include an invitation to make written submissions and the conduct of consultation meetings around the country. I urge that this work proceed without delay. I also urge that the Government reverse its recent decision and proceed with the publication of the national carers' strategy, a matter of vital concern to older people. The production and implementation of these strategies will be the real test as to whether the office of older people will work.

With regard to the dissolution of the National Council on Ageing and Older People, the Women’s Health Council, the National Cancer Screening Service Board, the Drug Treatment Centre Board and the Crisis Pregnancy Agency, concern has been expressed about whether their functions will be safeguarded within the Department and the HSE. I wish to refer here to the relevant questions posed by the National Women’s Council of Ireland and I ask the Minister of State, Deputy Andrews to respond in detail. As the Bill does not provide for any review mechanism to monitor or measure this change of policy direction against outcomes how will Government and the Oireachtas know if the functions of the agencies are being carried out by the Department of Health and Children? I ask the Minister of State, Deputy Andrews, to note the specific question, as well as a number of others I wish to pose, and to ensure they will be responded to fully in his closing contribution to this Second Stage debate. What is the estimated cost of dissolving these bodies and what are the projected savings, which we are told there will be? What is being done to safeguard the knowledge or institutional memory built up by these agencies since their inception? The staff in question have much knowledge and experience which should not be lost to the public service. What commitments have been made to ensure that the Department and the HSE will continue to work in partnership with civil society and other relevant sectors?

These questions are especially relevant to the Crisis Pregnancy Agency. Its establishment in 2001 was a recognition of the need to address crisis pregnancy in a comprehensive and effective way. It has made progress and helped to improve support for women facing crisis pregnancy. Since the inception of the agency, counselling services for women in this area have expanded significantly. The agency has also played a role in helping to prevent vulnerable women from ending up in the hands of rogue pregnancy agencies. However, the need for the work of the agency is as great as ever. Crisis pregnancy is still, and will always be, a major problem. What has changed to warrant dissolving the agency? This question goes to the kernel of the Bill. Is it really about enhancing efficiency and co-ordination or is it simply a money-saving exercise? We need clarity; we need the bare facts laid before us. Whatever answers we are given, time will tell, but we also need to know what mechanisms are in place to monitor the effectiveness of the work formerly carried out by these agencies and now to be carried out by the Department and the HSE. I have made this point already and I re-emphasise it.

I welcome the amendment of the Hepatitis C compensation scheme to remove age limits for travel insurance. The National Cancer Screening Service Board is also to be dissolved and its functions subsumed within the HSE, becoming part of the HSE's cancer control programme. The Bill provides for the National Cancer Registry Board to be appointed by the Minister, yet it is also to be subsumed into the cancer control programme in 2010. Will this be an interim board pending the change in 2010? If so, what will its functions be over that period? I hope the Minister of State will address the questions I have raised during the course of this contribution.
Irish Government cut to Autism Centre disgraceful – Ó Caoláin
Sinn Féin Dáil leader and spokesperson on Health & Children Caoimhghín Ó Caoláin TD has learned that the Irish Government is cutting promised funding for the All-Ireland Centre of Excellence for Autism at Middletown, Co. Armagh. Deputy Ó Caoláin said:

“The Minister for Education and Science Batt O’Keeffe has written to the Minister for Education in the Six Counties, Caitríona Ruane, to state that the Irish government is cutting promised funding for the All-Ireland Centre of Excellence for Autism at Middletown, Co. Armagh. This is a disgraceful decision.

“Minister O’Keeffe’s Department and the Department of Health & Children will not now be providing the promised funding required to expand the Middletown Centre as had been intended this year.

“In January of this year I was a member of a cross-party Oireachtas delegation which visited Middletown and saw the excellent work being done by the Centre. I proposed that visit. The Centre itself was initiated by Martin McGuinness during his term as Education Minister in the Executive and from the beginning I have pressed for its development which finally came to fruition.

“The Centre, as acknowledged by Minister O’Keeffe, is working for the development and harmonisation of education and associated services for children and young people throughout Ireland with autistic spectrum disorder. It delivers training programmes and commissions research. The Centre is dedicated to improving and enriching the educational opportunities of children and young people with autism.

“While Minister O’Keeffe states that the Irish Government is not withdrawing all funding from Middletown, this is effectively a cut as the funding necessary for expansion is not now to be allocated. I will be urging Minister O’Keeffe not to proceed with this cut.” Críoch