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Dáil Debates & Questions
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December 08 2009 Dáil Debates Parliamentary Questions
DÁIL DEBATES Deputy Róisín Shortall (L): asked the Minister for Health and Children the progress made in the restructuring of the Health Service Executive providing regional structures and interaction between acute services and primary, community and continuing care services; Deputy Mary Harney (Minister for Health and Children): The recruitment of a new chief executive officer is a matter for the board of the HSE, as are the internal governance structures of the organisation. However, I can confirm that certain changes are being introduced in the management structures of the HSE to enable it to better manage and deliver hospital and community services in a more integrated way and to strengthen the role of clinicians in the delivery of services. In October 2009 the chief executive officer announced that four regional directors of operations were being established. They are accountable and responsible for the delivery of all health and social care services in the existing four geographical areas. In addition, the National Hospitals Office and the primary, community and continuing care directorate were being replaced by an integrated services directorate with two national directors; one responsible for reconfiguration and the other for performance and financial management. The HSE is also in the process of appointing care leaders — one each for mental health services, disability services, children and family services and services for older people. The appointees will set out operational plans and delivery targets for their areas of responsibility and will be the key link with the Department and external stakeholders. A new national director of quality and clinical care, Dr. Barry White, has been appointed. His role is to strengthen clinical leadership, improve clinical performance and ensure care is delivered in a way that maximises quality while minimising expenditure. This will involve the development and implementation of care pathways, protocols and standards for different disease programmes, particularly chronic diseases that have a high impact on the health system. In addition, support functions such as ICT, procurement and estates have been amalgamated into a single directorate. The posts which I have mentioned are being filled from within the existing complement of staff. The aim of the new management arrangements is to deliver excellent health outcomes for the population by driving the integration of hospital and community services, ensure more efficient use of resources, ensure clear lines of management accountability and support its strategy of shifting the balance of activity towards prevention and community-based care and away from hospital-based care. Deputy Jan O’Sullivan (L): On 1 January next, the HSE will have existed for five years. Everyone acknowledges that its layers of administration are top heavy. Will some posts be taken out at that level? When Professor Drumm took up his position, he brought in what has been described as a kitchen cabinet in addition to those already in the health boards. Will the Minister streamline the governance of the HSE? At the estimates meeting of the Oireachtas Joint Committee on Health and Children last week, the Minister told us she planned to reduce the numbers working in the HSE by 6,000 by removing 8,000 in some way or another and adding 2,000 for development of services. Now that the talks with the unions have broken down, does the Minister still expect to achieve that reduction and, if so, how? Will there be involuntary redundancies or has she had time to think about how she might achieve this? Deputy Mary Harney: In response to the last question, the Minister for Finance will make announcements about public service numbers in the course of his budget speech tomorrow. If the changes in the health service suggested last week, the five over seven, 8 a.m. to 8 p.m. day, redeployment and flexibility can become the norm, as most people seem prepared to accept, they will have a major impact on the capacity to make things happen speedily—— Deputy Jan O’Sullivan: It could have been achieved if the Government had reached an agreement last week. Deputy Mary Harney: -----particularly as we seek to integrate community and hospital services in a more orderly fashion than ever before. We want to move staff from providing the service in the hospital to providing it in the community and redeployment within a reasonable geographic radius provides that opportunity. One if not two of Professor Drumm’s advisers have already left the HSE. The contracts of employment of the remaining two will cease when Professor Drumm is no longer chief executive officer from next summer. The board is advertising this week or shortly for a replacement. The number at directorate or senior management level in the HSE will not change with the new arrangements. There is scope to take people out. There has been a significant interest in early retirement from the public sector, not least the health sector. We had a supplementary budget last week partly because of the increase in those numbers. A large proportion are from the management, administrative or support staff. With the moratorium, those who retire at that level will not be replaced apart from in exceptional circumstances so, for example, one replaces the CEO. Where there is scope for efficiencies, people will not be replaced in what is broadly called the front line services. Deputy James Reilly (FG): The Minister said earlier last year that she would pursue redundancies, yet when she was asked about it at the end of last year, she said it was a matter for the Minister for Finance. Today again, having told us last week that there would be redundancies, she has put it back into the lap of the Minister for Finance. Who will take responsibility for the HSE? What has changed that makes the Minister believe she can achieve redundancies? In the past she has said that the unions were not co-operating and that there was very little uptake. Will the new posts result in increased salaries or will they be the same or lower, given that everybody else is taking a cut? Deputy Mary Harney: The Minister for Finance is responsible for the public service. That is factually correct. Of course we can reduce numbers within the HSE and I have said before, including last week, that the intention is to reduce the number by 8,000 but recruit back 2,000, making a net reduction of 6,000. We want to recruit consultants, specialist nurses and health care therapists and other specialists that we require in the service. A voluntary redundancy scheme for the public service was announced in last year’s budget. We did not implement it in the health sector because it cannot be applied without redeployment. It would not be possible, for example, to have a large number leave from one hospital without being able to redeploy people from another. At present, it is not possible to redeploy from one part of a hospital to another. Any voluntary redundancy scheme must be accompanied by a redeployment scheme; otherwise, we would not achieve the savings envisaged and the voluntary redundancy scheme could be quite expensive. The people who have retired are those who were close to retirement age. That is why the number was higher this year. The Minister for Finance will enunciate pay policy in his budget speech tomorrow. Any pay reductions that apply to Ministers, politicians and public servants will apply to posts within the HSE and the wider public service. Deputy Jan O’Sullivan: Does the Minister agree it is very disappointing that the talks broke down, particularly in respect of the health service because of the likelihood of achieving agreement on redeployment, flexibility and an 8 a.m. to 8 p.m. working day? Following the breakdown of the talks, will it not be very difficult for the Minister to achieve what she wants to achieve with regard to streamlining the HSE? Is it correct to say that only 16% of those who opted for early retirement were in the administrative or management grades? Deputy Mary Harney: That would be a higher proportion. One must include support staff too. It is a great disappointment because we were discussing last week everything that had been sought for the past five years and which is central to the transformation of our health service, including a longer working day, a five over seven working week, different rostering and particularly redeployment. These are all central if we are to move from hospital-based services to community and primary care and to have the appropriate staff ratios and so on. I hope we will be able to resume that agenda very quickly. When everybody has had an opportunity to reflect and perhaps have a break because there were a lot of all night meetings over the past few weeks—— Deputy James Reilly: A change is as good as a break. Deputy Jan O’Sullivan: There is small chance of that happening. Deputy Mary Harney: I hope we can return to that agenda very early in the new year. I am delighted to have the Deputies’ support for that agenda. That applies to other aspects of the public service. Deputy Jan O’Sullivan: The Minister will find it very hard to do that. Deputy Mary Harney: I believe public servants are in favour of change and they know the kind of change that is necessary. I believe they are willing to respond. PARLIAMENTARY QUESTIONS Deputy Charles Flanagan (FG): asked the Minister for Health and Children if the development of a new central mental hospital is still a priority in view of the financial difficulties facing the State; if a decision has been made on the location of the new central mental hospital; when this decision will be announced; Minister of State at the Department of Health and Children (Deputy John Moloney): It has been ascertained that the site proposed for the development of a new Central Mental Hospital (CMH) at Thornton Hall, Co Dublin, is not large enough to accommodate an Intellectual Disability Forensic Mental Health Unit and a Child and Adolescent Forensic Mental Health, the need for which has been identified by the HSE. While the question of the relocation of the CMH to an alternative site is currently under consideration, the redevelopment of the hospital remains a priority for the Government. Deputy Joanna Tuffy (L): asked the Tánaiste and Minister for Enterprise, Trade and Employment the number of persons with disabilities who have been employed through the FÁS job initiative scheme in each of the past five years; the cost of running this scheme in each of the past five years; the cost of running this scheme in each of the past five years; Minister of State at the Department of Enterprise, Trade and Employment (Deputy Dara Calleary): The Job Initiative (JI) is a programme providing full-time employment for peoplewho, at the time of application, were 35 years of age or over, unemployed for 5 years or moreand in receipt of Unemployment Benefit, Unemployment Assistance or One Parent FamilyPayment over that period.Following changes introduced Job Initiative by the Minister for Enterprise, Trade andEmployment, in November 2004, there is currently no recruitment onto the programme sincethat date, while existing participants have their annual contracts renewed until retirement age.Analysis of the participants on JI for the last five years who were previously in receipt of adisability-linked Social Welfare payment (including current year to date figures) are set outbelow. The annual programme costs have also been included in the table:
Further details on the above programmes and supports are available on the FÁS website www.fas.ie. Deputy Bernard J. Durkan (FG): asked the Minister for Health and Children if she will put in place an enhanced degree quality and scale of support services for children with autism, Aspergers syndrome, attention deficiency disorder and ADHD or similar problems with a view to offering their parents the quality and scale of support equal to and available in the best locations throughout the European Union; if she has identified areas of particular need in this regard; if she has received communication from parents outlining such requirements; if her attention has been drawn to the fact that there appears to be an increasing number of children with autism, Aspergers syndrome, ADHD, ADD or similar conditions; the extent of research undertaken which might identify the causes; if her further attention has been drawn to the anxiety of parents regarding same; if research has been undertaken in other jurisdictions which may be beneficial here; Minister of State at the Department of Health and Children (Deputy John Moloney): The Department of Health and Children does not collect information on children identified with Autism and Aspergers on a national or international basis. Information pertaining to diagnosis is specifically excluded from the National Intellectual Disability Database as the database is not designed as a medical epidemiological tool. Accordingly the database does not record the incidence of Autism or any other disability. In 2004, the Department of Health and Children, through the Health Research Board, approved expenditure of €5 million on autism research to help improve international understanding of the genetic causes of autism. This €5 million is the Irish contribution to a new major international research initiative called the Autism Genome Project which will receive a total investment of €12 million from a variety of international organisations over three years. The other co-funders in the international consortium include Autism Speaks (US), the British Medical Research Council (MRC), Southwest Autism Research and Resource Centre (SARRC), and the Hilibrand Foundation. This unique combination of international, public and private partners funding a consortium of clinicians and scientists is a new and welcome departure in the field of autism research. The Health Research Board has informed my Department that this funding was awarded as follows:
This figure represents the largest tranche of funding to be awarded by any of the four funders within the international consortium. The Irish researchers are at the forefront in unraveling the genetic determinants of autism and related disorders. They are using novel state of the art genetic sequencing technology to analyse DNA samples taken from autistic patients to identify candidate genetic markers for autism. They will collaborate with their international colleagues to then link these genetic markers with clinical outcomes. This unique international research effort will greatly improve not only our understanding of the causes of autism, but its diagnosis and treatment. With regard to the remaining matters raised by the Deputy, these relate to the management and delivery of health and personal services, which are the responsibility of the Health Service Executive under the Health Act, 2004. Accordingly, my Department has requested the Parliamentary Affairs Division of the Executive to arrange to have these matters investigated and to have a reply issued directly to the Deputy. Deputy Ciarán Cuffe (GP): asked the Minister for Justice, Equality and Law Reform the information that has been communicated to him by the National Disability Authority regarding work it may have carried out making direct payments to persons with disabilities to ensure value for money and quality services and opportunities; Minister of State at the Department of Justice, Equality and Law Reform (Deputy John Moloney): The National Disability Authority (NDA) has not issued any advice to me on theissue of replacing direct provision with direct payments from the relevant Departments topeople with disabilities. In its strategic plan for 2010 to 2012 the NDA has outlined a programmeof work it intends to do in relation to community and independent living, and the issueof direct payments will be considered as part of that work programme. In preparation, NDAheld an informal round table on 7th July this year with key stakeholders to inform its futureprogramme of work in this area.
Deputy Joanna Tuffy (L): asked the Minister for Education and Science the number of third level students who have made an application under the fund for students with disabilities scheme over the past four years; the value of the complete fund over each of the past four years; the amount of money provided to students from County Meath in each of the past four years; the role the fund will play in the new national strategy for third level; Minister for Education and Science (Deputy Batt O’Keeffe): The Fund for Students with Disabilities provides funding to both further and higher education institutions for the provision of services and supports for full-time students with disabilities. The fund is managed by the Higher Education Authority on behalf of my Department and is funded under the National Development Plan 2007-2013, with assistance from the European Social Fund. Data on the fund as requested by the Deputy is provided in the following tables. The data includes information on overall approvals and allocations under the scheme for the previous four years. In addition, information is provided on the number of approvals and gross allocations under the fund for students from Co. Meath. The national strategy for higher education is currently being developed. Specific recommendations will become available when the strategy is finalised in 2010.
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In addition all FÁS services are open to people with disabilities. FÁS provides vocational training for the unemployed and new entrants to the labour market through specific skills training and traineeships. FÁS also provides training for those in employment through apprenticeships and in-company training. People with disabilities may be supported while in employment by FÁS through the following programmes:
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